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Preventable chronic disease has proven to be a stubborn problem, responsible for 60% of deaths worldwide, and its associated morbidity and mortality has not changed in 40 years. The real issue in disease prevention is the lack of progress and the seeming absence of innovation.1
Beedie et al's2 recent editorial reminds us of the importance of phase IV trials to study effectiveness, not just efficacy, of exercise, arguing that what matters to those who make funding decisions are health outcomes, not proxy measures. We argue that these are also the outcomes that matter to the people whom these interventions are supposed to help: patients and members of the public. It is well past time to include them in solving this long-standing problem.
Disease prevention is not a problem for which the core issue is a lack of scientific evidence for and against exercise, regardless of the phase of research. Restricting our perspective to what can be accomplished by continuing to accumulate scientific evidence in the fight against chronic disease relegates us to the fringes of a complex problem when …
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