EDITORIAL

Warm up

Exercise

P McCrory

You would think by now that the message should be getting through. The evidence of the relationship between physical inactivity and premature mortality is irresistible. It really is a no brainer. Want to live longer? Do some exercise. Want to prevent disease? Walk.

The good news is that it is not as bad as it sounds—even modest levels of exercise helps. The Copenhagen City Heart Study followed over 7000 subjects who were initially free of coronary heart disease over a 25 year period.¹ Men and women who engaged in moderate (light activity 2–4 hours per week) or high (>4 hours per week) exercise had significantly lower risks of death than those who reported low (<2 hours per week) activity. Those people who increased their activity from low to moderate also reduced their risk of death and, interestingly, this effect was most pronounced in men aged 65–79 years old.

Now for the bad news. For those of you who don’t like the idea of sweaty bodies and hoped that liposuction may offer a short cut to fitness as well as a more svelte shape, the news isn’t so good. While being hooked up to the fat vacuum is a safe way of removing large quantities of fat, it does not seem to confer any useful health benefit. Normally losing weight helps lower blood pressure, lipid levels, and the risk of diabetes; however, a recent American study shows that even removing 20% of the total fat mass of the subjects did not alter any measurable metabolic parameter.²

So exercise works—and it works at all ages. Big surprise. Two hours of activity per week is hardly taxing even with a busy lifestyle. So why then don’t we have hospital departments devoted to exercise? Why doesn’t the Government move from the interminably slow process of accrediting sports medicine as a specialty in its own right and jump right to drafting sports physicians into a military strategy to increase the activity at a population level? Obesity and inactivity is an epidemic, not simply a media story.

To paraphrase former US President—John F Kennedy—who noted in an address to the National Football Foundation in 1961, that if Thomas Jefferson—the man who wrote the Declaration of Independence and was US Secretary of State and twice President—could give two hours of exercise per day then the nation’s children could spare 10 to 15 minutes.

As the evidence of benefit accumulates and our girths proportionally expand, his simple advice seems to have been ignored.

1. Schnohr l P, Scharling H, Jensen J. Changes in leisure time physical activity and risk of death; an observational study of 7,000 men and women. Am J Epidemiol 2003;158:639–44.[Abstract/Free Full Text]
2. Klein S , Fontana L, Young V, et al. Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med 2004;350:2549–57.[Abstract/Free Full Text]

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