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Ode to Joy: call to action for doctors to play their role in curing the global pandemic of physical inactivity: drilling into one of the ‘7 investments’—simple solutions for the pandemic
  1. Karim M Khan
  1. Department of Family Practice and School of Kinesiology, Centre for Hip Health & Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Karim M Khan, Department of Family Practice and School of Kinesiology, Centre for Hip Health & Mobility, The University of British Columbia, 769-2635 Laurel Street, Vancouver, BC, Canada V5Z 1M9; karim.khan{at}

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AMSSM's Dr Elizabeth Joy and three additional giants of physical activity research and advocacy provide a very clear blueprint for the role of sports and exercise medicine physicians in addressing the global public health pandemic of physical inactivity.1 As a BJSM reader, you will know that health professionals provide one of the seven ‘best investments’2 for solving the physical inactivity crisis. If you are not familiar with the ‘7 investments’ please read it now (open access) and listen to Fiona Bull's podcast about ‘7 investments’ ( Whenever we advocate for one of the 7 investments, I respectfully recommend we immediately remind our listener that there is a cohesive, comprehensive solution; my fear if we outline one element of the physical inactivity solution at a time our blinkered listener will think our suggestion is insufficient for the complex problem of physical inactivity. “One man says the answer is targeting schools, one man says it's health professionals, another one says it is urban design….one of them must be wrong” (with apologies to Mark Knopfler, ‘Industrial Disease’

Is physical activity really that effective?

Joy's data indicate that the physical activity antidote (also called ‘Exertol’, 10 min taken 3 times daily) is much more effective than other prescription drugs. Self-reporting taking ‘Exertol’ (physical activity) confers a 24% reduction in mortality compared with self-reporting not taking it. Imagine media frenzy if personalised pharmacological treatment provided such a cure. There would be massive lineups outside pharmacies. Remarkably, when the physical inactivity antidote has actually been taken the results are even more striking. Moderate fitness (which can be gained by walking for 22 min a day) confers a 44% reduction in mortality. Remind your local politician that low fitness kills more Americans annually than do smoking, diabetes and obesity combined (smokadiabesity).3 Then say—‘Why don't we address physical inactivity?’ Then hand over the 7 investments postcard, look her in the eye and smile. Later, tweet that this lawmaker rocks (positive reinforcement) and provide your Twitter followers a link to Joy's article1 in BJSM.

Governments would fund Exertol if it really were a drug. Voters must lobby for a contribution to funding exercise prescription so that the irrational distinction between less effective pharmacotherapy (eg, statins4) and this effective ‘biological’ (‘Exertol, physical activity) is eliminated. However, if we are to push lawmakers in this way we must have a specific ask—drug companies ask for their drug to be funded—they do not ask for ‘pharmacotherapy’ to be funded broadly. I suggest the Australian government plan of funding 4 referral visits to an exercise physiologist is a fine ‘success story’ (; About $400 for 44% reduction in mortality. It is a bargain even for those staring over a fiscal cliff.

Addressing physical inactivity will provide health benefits because the bar has fallen off its supports

Since physical inactivity is such a pandemic, even a mediocre effort—anything other than walking away and ignoring the problem altogether will save thousands of lives. A 1% reduction in physical inactivity, year over year for the next 9 years, will save 533 000 deaths a year at that point.5 Smoking has ceased at a slower rate than that—about 0.75% per year. Yet we watch Mad Men and think that the smoking levels are from another planet. In a few years, a tiny percentage change year over year. This pandemic is a walk over—unless we just ignore it! Unless we get distracted by the talk about obesity.6 Let's stay focused on the task which is to reduce physical inactivity. If you forget how to do that check out the ‘7 investments’.2 Along with the paper,2 there is a website ( where you can download the four pages in each of seven languages and also a postcard (

A three-part call to action in the primary care sector

The Heath Brothers have convinced me that we need ‘clear messages’7 and Joy's team provides a lovely three-part call to action. (1) Help doctors. (2) Educational resources. (3) Role models from medical students up through the ages. Simple and inexpensive. Within part 1—doctors—the authors focus on the exercise vital sign, linking the patient to community resources (referral) and they are optimistic about incentives for both doctors and patients. Simple. Part 2—educational resources—the authors have comprehensively spelled out how physical activity prescription can be integrated into students’ learning. Part 3 highlights ‘walk the talk’ and ‘lead the way’. This establishes social norms.8

Echoing the authors, “Clinical sports medicine should evolve into ‘sports and exercise medicine’, and must not only talk the talk, but also walk the walk, and lead the way.”


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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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