The primary purpose of this narrative review was to evaluate the current literature and to provide further insight into the role physical inactivity plays in the development of chronic disease and premature death. We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death. We also reveal that the current Health Canada physical activity guidelines are sufficient to elicit health benefits, especially in previously sedentary people. There appears to be a linear relation between physical activity and health status, such that a further increase in physical activity and fitness will lead to additional improvements in health status.

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Health benefits of physical activity: the evidence

Purpose of reviewThis review highlights recent work evaluating the relationship between exercise, physical activity and physical and mental health. Both cross-sectional and longitudinal studies, as well as randomized clinical trials, are included. Special attention is given to physical conditions, i

Exercise and well-being: a review of mental and physical health benefits associated with physical activity.

This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise.

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Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases

Objective. —To evaluate the relationship between changes in physical fitness and risk of mortality in men. Design. —Prospective study, with two clinical examinations (mean interval between examinations, 4.9 years) to assess change or lack of change in physical fitness as associated with risk of mortality during follow-up after the subsequent examination (mean follow-up from subsequent examination, 5.1 years). Setting. —Preventive medicine clinic. Study Participants. —Participants were 9777 men given two preventive medical examinations, each of which included assessment of physical fitness by maximal exercise tests and evaluation of health status. Main Outcome Measures. —All-cause (n=223) and cardiovascular disease (n=87) mortality. Results. —The highest age-adjusted all-cause death rate was observed in men who were unfit at both examinations (122.0/10 000 man-years); the lowest death rate was in men who were physically fit at both examinations (39.6/10000 man-years). Men who improved from unfit to fit between the first and subsequent examinations had an age-adjusted death rate of 67.7/10 000 man-years. This is a reduction in mortality risk of 44% (95% confidence interval, 25% to 59%) relative to men who remained unfit at both examinations. Improvement in fitness was associated with lower death rates after adjusting for age, health status, and other risk factors of premature mortality. For each minute increase in maximal treadmill time between examinations, there was a corresponding 7.9% (P=.001) decrease in risk of mortality. Similar results were seen when the group was stratified by health status, and for cardiovascular disease mortality. Conclusions. —Men who maintained or improved adequate physical fitness were less likely to die from all causes and from cardiovascular disease during follow-up than persistently unfit men. Physicians should encourage unfit men to improve their fitness by starting a physical activity program. (JAMA. 1995;273:1093-1098)

Changes in Physical Fitness and All-Cause Mortality: A Prospective Study of Healthy and Unhealthy Men

(2000). Assessment of Physical Activity by Self-Report: Status, Limitations, and Future Directions. Research Quarterly for Exercise and Sport: Vol. 71, No. sup2, pp. 1-14.

Assessment of physical activity by self-report: status, limitations, and future directions.

Physical activity and fitness: evolutionary perspective and trends for the future, Per-Olof Astrand heredity, activity level, fitness and health, Claude Bouchard and Louis Perusse costs and benefits of an active versus an inactive society, Robert L. Kaman and Robert W. Patton laboratory and field tests for assessing health-related fitness, James S. Skinner and Pekka Oja measurement of health status and well-being, Carl J. Caspersen et al demography of health-related fitness levels within and between populations, Roy J. Shephard physical activity and nutrition in the context of fitness and health, Gail E. Butterfield and Angelo Tremblay physical activity and the microcirculation in cardiac and skeletal muscle, M. Harold Laughlin et al response and adaptation of skeletal muscle to changes in physical activity, John A. Faulkner et al physical activity and carbohydrate metabolism, George A. Brooks physical activity and ageing - sensory and perceptual processing, George E. Stelmach physical activity and psychosocial outcomes, Edward McAuley, physical activity, fitness and atherosclerosis, Sean Moore physical activity, fitness and osteoarthritis, Richard S. Panush physical activity, fitness and depression, William P. Morgan physical activity - relationship to growth, maturation and physical fitness, Robert M. Malina exercise training and the male reproductive system, David C. Cumming and Garry D. Wheeler risks of exercising - musculoskeletal injuries, Russell A. Pate and Caroline A. Macera dose-response issues from a biological perspective, William L. Haskell.

Thomas Stephens

Papers

Physical activity, fitness, and health consensus statement