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Developing healthcare systems to support exercise: exercise as the fifth vital sign
  1. Robert Sallis
  1. Correspondence to Dr Robert Sallis, Department of Family Medicine, Kaiser Permanente Medical Center, 9961 Sierra Avenue, Fontana, CA, 92336, USA; robert.e.sallis{at}

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The importance of physical activity to health and wellness has been established incontrovertibly. There is a linear relationship between physical activity and health—those who maintain an active and fit way of life live longer, healthier lives.1 Those who are unfit and sedentary very predictably develop chronic diseases prematurely and die at a younger age.1 This association between activity level and health status exists in various major subgroups of the population. It doesn't matter whether you study men or women, various ethnic groups, diverse nations, children or the aged, the results are always the same: people who are active and fit live longer, healthier lives. This is no longer news.

Assessing physical activity levels at every clinical consult

Exercise, therefore, is medicine that every patient needs to take. Its tremendous and proven clinical benefits should not be denied any patient. Especially in patients who have chronic diseases like diabetes, heart disease and hypertension to list just three. Likewise, anyone who is at risk for these chronic diseases should consider exercise an essential vaccine to greatly lower risk of illness and almost certainly extend life. The ready availability of this powerful therapy means that a patient's exercise habits should be assessed at every clinical visit and used by the clinician in the management of every patient.2

Unfortunately, the medical community has resisted attempts to utilise exercise as a medication, believing that doctors prescribing exercise has no effect on our patient's behaviour. That just does not make sense! On a daily basis, we physicians convince our patients to undertake therapy that is …

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  • Competing interests None.

  • Provenance and peer review Commissioned; not externally peer reviewed.