Summary Background Strong evidence shows that physical inactivity increases the risk of many adverse health conditions, including the world’s major non-communicable diseases (NCDs) of coronary heart disease (CHD), type 2 diabetes, and breast and colon cancers, and shortens life expectancy. Because much of the world’s population is inactive, this presents a major public health problem. We aimed to quantify the impact of physical inactivity on these major NCDs by estimating how much disease could be averted if those inactive were to become active and to estimate gain in life expectancy, at the population level. Methods Using conservative assumptions, we calculated population attributable fractions (PAF) associated with physical inactivity for each of the major NCDs, by country, to estimate how much disease could be averted if physical inactivity were eliminated, and used life table analysis to estimate gains in life expectancy of the population. Findings Worldwide, we estimate that physical inactivity is responsible for 6% of the burden of disease from CHD (range: 3.2% in South-east Asia to 7.8% in the Eastern Mediterranean region); 7% of type 2 diabetes (3.9% to 9.6%), 10% of breast cancer (5.6% to 14.1%), and 10% of colon cancer (5.7% to 13.8%). Inactivity is responsible for 9% of premature mortality (5.1% to 12.5%), or >5.3 of the 57 million deaths that occurred worldwide in 2008. If inactivity were not eliminated, but decreased instead by 10% or 25%, >533,000 and >1.3 million deaths, respectively, may be averted each year. By eliminating physical inactivity, life expectancy of the world’s population is estimated to increase by 0.68 (0.41 to 0.95) years. Interpretation Physical inactivity has a major health impact on the world. Elimination of physical inactivity would remove between 6% and 10% of the major NCDs of CHD, type 2 diabetes, and breast and colon cancers, and increase life expectancy.

Studies that did not directly measure sedentary behavior often have been used to draw conclusions about the health effects of sedentariness. Future claims about the effects of sedentary, light, and moderate-to-vigorous activities on health outcomes should be supported by data from studies in which all levels of physical activity are differentiated clearly and measured independently.

Objective To examine prospectively the association between muscular strength and mortality from all causes, cardiovascular disease, and cancer in men. Design Prospective cohort study. Setting Aerobics centre longitudinal study. Participants 8762 men aged 20-80.

Doctors are well positioned to provide physical activity (PA) counselling to patients. They are a respected source of health-related information and can provide continuing preventive counselling feedback and follow-up; they may have ethical obligations to prescribe PA. Several barriers to PA counselling exist, including insufficient training and motivation of doctors and improvable, personal PA habits. Rates of exercise counselling by doctors remain low; only 34% of US adults report exercise counselling at their last medical visit. In view of this gap, one of the US health objectives for 2010 is increasing the proportion of patients appropriately counselled about health behaviours, including exercise/PA. Research shows that clinical providers who themselves act on the advice they give provide better counselling and motivation of their patients to adopt such health advice. In summary, there is compelling evidence that the health of doctors matters and that doctors' own PA practices influence their clinical attitudes towards PA. Medical schools need to increase the proportion of students adopting and maintaining regular PA habits to increase the rates and quality of future PA counselling delivered by doctors.

Background:To describe the lessons learned after 10 years of use of the International Physical Activity Questionnaire (IPAQ) in Brazil and Colombia, with special emphasis on recommendations for future research in Latin America using this instrument.Methods:We present an analytical commentary, based on data from a review of the Latin American literature, as well as expert consultation and the authors' experience in administering IPAQ to over 43,000 individuals in Brazil and Colombia between 1998 and 2008.Results:Validation studies in Latin America suggest that the IPAQ has high reliability and moderate criteria validity in comparison with accelerometers. Cognitive interviews suggested that the occupational and housework sections of the long IPAQ lead to confusion among respondents, and there is evidence that these sections generate overestimated scores of physical activity. Because the short IPAQ considers the 4 physical activity domains altogether, people tend to provide inaccurate answers to it as well.Conclusions:Use of the leisure-time and transport sections of the long IPAQ is recommended for surveillance and studies aimed at documenting physical activity levels in Latin America. Use of the short IPAQ should be avoided, except for maintaining consistency in surveillance when it has already been used at baseline.

Physical inactivity is one of the most prevalent major health risk factors, with 8 in 10 US adults not meeting aerobic and muscle-strengthening guidelines, and is associated with a high burden of cardiovascular disease. Improving and maintaining recommended levels of physical activity leads to reductions in metabolic, hemodynamic, functional, body composition, and epigenetic risk factors for noncommunicable chronic diseases. Physical activity also has a significant role, in many cases comparable or superior to drug interventions, in the prevention and management of >40 conditions such as diabetes mellitus, cancer, cardiovascular disease, obesity, depression, Alzheimer disease, and arthritis. Whereas most of the modifiable cardiovascular disease risk factors included in the American Heart Association's My Life Check - Life's Simple 7 are evaluated routinely in clinical practice (glucose and lipid profiles, blood pressure, obesity, and smoking), physical activity is typically not assessed. The purpose of this statement is to provide a comprehensive review of the evidence on the feasibility, validity, and effectiveness of assessing and promoting physical activity in healthcare settings for adult patients. It also adds concrete recommendations for healthcare systems, clinical and community care providers, fitness professionals, the technology industry, and other stakeholders in order to catalyze increased adoption of physical activity assessment and promotion in healthcare settings and to contribute to meeting the American Heart Association's 2020 Impact Goals.

Associations between serum uric acid (UA) levels and metabolic syndrome (MetS) have been reported in cross-sectional studies. Limited information, however, is available concerning the prospective association of UA and risk of developing MetS. The authors evaluated UA as a risk factor for incident MetS in a prospective study of 8,429 men and 1,260 women (ages 20-82 years) who were free of MetS and for whom measures of waist girth, resting blood pressure, fasting lipids and glucose were taken during baseline and follow-up examinations between 1977 and 2003. Hyperuricemia was defined as >7.0 mg/dL in men and >6.0 mg/dL in women. MetS was defined with NCEP ATP III criteria. The overall prevalence of hyperuricemia was 17%. During a mean follow-up of 5.7 years, 1120 men and 44 women developed MetS. Men with serum UA concentrations ≥6.5 mg/dL (upper third) had a 1.60-fold increase in risk of MetS (95% confidence interval [CI]: 1.34-1.91), as compared with those who had concentrations <5.5 mg/dL (lowest third). Among women, the risk of MetS was at least 2-fold higher for serum UA concentrations ≥4.6 mg/ dL (p for trend=0.02). Higher serum UA is a strong and independent predictor of incident MetS in men and women.

Broad implementation of PA counselling and referral systems, as clinical practice standard of care, has the potential to improve PA at the population level by complementing and leveraging other efforts and to contribute to achieving global targets for the reduction of inactivity and related morbidity and mortality.