Primary prevention of disease and physical activity

The World Health Organization shows that the leading causes of morbidity and mortality are high blood pressure (13% of total deaths), tobacco use (9%), high blood glucose (6%), physical inactivity (6%) and obesity (5%). 1 Physical inactivity is not only an independent risk factor but influences most of the other causes. Indeed, physical inactivity has been described as the greatest public health threat in today’s society. 2 The Chief Medical Officer’s 2011 report Start Active, Stay Active outlines a recommendation for adults to undertake 150 minutes of moderate intensity physical activity per week and reinforces that regular physical activity people live healthier, longer lives.

Disease Risk Reduction Strength of Evidence
Death 20-35% Strong
CHD & Stroke 20-35% Strong
Type2 Diabetes 35-50% Strong
Colon Cancer 30-50% Strong
Breast Cancer 20% Strong
Hip Fracture 36-68% Moderate
Depression 20-30% Strong
Alzheimer’s Disease 30% Moderate
Table 1: Chronic diseases prevented by physical activity. 3

Simply helping people move from inactivity to low or moderate activity will provide the greatest benefit. The curvilinear dose-response curve below illustrates the higher the level of physical activity, the lower the risk of coronary heart disease and type 2 diabetes. 4

risk

Source: Department of Health (2004) at least Five a Week: evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer

Compelling data from the Aerobic Center of Longitudinal study, which follows up 52,000 men and women, reinforces that physical inactivity is possibly the greatest public health threat in today’s society. 5 In the figure below, the attributable risk/fraction estimates the number of deaths in a population that would have been avoided if a specific risk factor had been absent (e.g. if all smokers were non-smokers). Low cardio-respiratory fitness (CRF) accounts for about 16% of all deaths in both women and men in this population. This is substantially more, with the exception of hypertension in men, than any of the other risk factors.

attributable factors

Figure. Attributable Fractions (%) for All-Cause Mortality 6

In the 2012 Lancet series on physical activity, the population Attributable fraction of mortality due to inactivity was calculated for every country for CHD, Type 2 diabetes, breast cancer, colon cancer and all-cause mortality. They found that physical inactivity in the UK contributes more to mortality than almost every other large country in the world even when compared to the USA which is generally considered to have worse obesity problems than the UK 7

References:

  1. World Health Organisation (2009). Global Health risks: mortality and burden of disease attributable to selected major risks. http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf
  2. Blair SN. Physical inactivity: the biggest public health problem of the 21stcentury. Br J Sports Med 2009;43:1-2
  3. Start active; Stay active for health from the four home countries’ CMO, Department of Health, 2011. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_128210.pdf
  4. Start active; Stay active for health from the four home countries’ CMO, Department of Health, 2011. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_128210.pdf
  5. Blair SN. Physical inactivity: the biggest public health problem of the 21st century. Br J Sports Med 2009;43:1-2
  6. Blair SN. Physical inactivity: the biggest public health problem of the 21st century. Br J Sports Med 2009;43:1-2
  7. Lee I-M et al. Effects of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy. The Lancet 2012 published online July 18

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