A pile of evidence currently exists that regular physical activity has significant and far-reaching health benefits. Reduced risk of chronic diseases like heart disease, type 2 diabetes, and some cancers, as well as enhanced function and longevity, are just a few of the advantages. As a senior citizen, I am encouraged by the expanding amount of research indicating physical activity slows cognitive decline and is helpful to both the brain and the rest of the body.
Physical inactivity is one of the most important public health crises of the twenty-first century, if not the most serious, according to the data. This is not to argue that other health issues aren't essential; they certainly are.
In addition, cutting-edge, evidence-based preventive medical care is available. My biggest concern is that many people working in public health and clinical care underestimate the importance of physical activity. Figure 1 depicts the data that led to my conclusions about the importance of inactivity. As most of you are aware, the attributable fraction is an estimate of the proportion of deaths in a population that might have been avoided if a particular risk factor had not occurred. That scenario assumes that all smokers quit smoking and that all sedentary persons walked for 30 minutes five days a week. The results of a large group of women who were followed up on are shown in
## Figure 1. With the except for hypertension in males, low cardiorespiratory fitness accounted for around 16 percent of all deaths in both women and men in this cohort, which is much higher than the other risk factors. Consider how often each of these risk factors is evaluated in a standard medical exam, and how often each risk factor is addressed if it is elevated. I don't have any numbers, but I'm betting that an average doctor will check cholesterol, blood pressure, and BMI 10–50 times more often than fitness. Fitness was measured in the ACLs, with a maximal exercise test on a treadmill, therefore this exposure is based on an objective, laboratory measurement. Obviously, such a test is required.
## Figure 1: Attributable fractions (percentages) for all-cause deaths among the 40 842 (3333 deaths) males and 12 943 (491 deaths) women in the Aerobics Center Longitudinal Study.
## Figure 2 provides yet another example of the importance of fitness. In our study, we followed, 2316 men with type 2 diabetes for an average of 15.9 years, and 179 of them died of cardiovascular disease (CVD). The results in figure 2 clearly show a significant inverse gradient for CVD death across fitness categories within each BMI category. Obese men who were moderately/highly fit had a death risk that was less than half that of unfit normal-weight men. Thousands of people with type 2 diabetes visit a doctor every day for a checkup. How many of these patients had their height, weight, and BMI measured before being assigned to one of two groups?
This is the wrong message to convey. Regular physical activity will, of course, promote weight loss, but it will also benefit the patient's health regardless of weight loss.
As you can see, I am a big believer in the importance of regular physical activity for both personal and public health, and I feel we need to pay much more attention to this issue. As a result, I was overjoyed when Professor Khan invited me to help arrange a special issue of the British Journal of Sports Medicine on the subject. He and I have spent the last few months putting together an incredible team of scientists and doctors to produce special papers on a variety of topics.
## Figure 2: Mortality risk from cardiovascular disease by cardiorespiratory fitness and BMI categories, 2316 men with type 2 diabetes at baseline, 179 deaths When computing risk ratios, age and examination year are taken into account. Low cardiorespiratory fitness is indicated by black bars, moderate cardiorespiratory fitness is indicated by white bars (in the obese category, the white bar includes both moderate and high cardiorespiratory fitness,
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