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Exercise interventions for health: time to focus on dimensions, delivery, and dollars
  1. H A McKay,
  2. H Macdonald,
  3. K E Reed,
  4. K M Khan
  1. School of Human Kinetics, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
  1. Correspondence to:
 Dr McKay, School of Human Kinetics, University of British Columbia, 6081 University Boulevard, Vancouver, BC V6T 1Z1, Canada; 

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The importance of physical activity is proven, and methods of implementing exercise programmes should be urgently researched

“It is tragically ironic that major legislative actions have been implemented to protect society against all other forms of preventable deaths except those resulting from physical inactivity.” Booth, 2000

It is very likely that the reader of the British Journal of Sports Medicine will agree that “exercise has preventive and therapeutic health benefits”. Yet the vast majority of people in the developed world choose to remain inactive. The prevalence of chronic diseases contributed to by physical inactivity is escalating so rapidly that their costs will exceed $1 trillion in the United States in the next decade!1 More alarming, there are 250 000 deaths annually in the United States directly attributable to physical inactivity.1 Despite these distressing data, most physicians and health providers miss many opportunities to prescribe exercise when treating chronic diseases such as obesity, diabetes, and cardiovascular disease. What lies behind this striking paradox, this dissonance between knowledge and practice? How do we create, implement, and sustain programmes of physical activity in a culture that actively encourages overeating and sedentary behaviour?2 This leader suggests strategies for bringing practice (physically active behaviour) into line with the evidence that treatment of physical inactivity provides enormous health benefits.1


The reasons behind an inactive, rather than an active, lifestyle, have been discussed at length elsewhere3–5 and will not be iterated here. We emphasise that millions, if not billions, of dollars have been spent to encourage increased “voluntary” physical activity. Although many of these studies have reported short term benefits in surrogate measures of health, such as reduced blood pressure, we do not know of any that have been powered to show benefits in end stage outcome measures—for example, stroke, myocardial …

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