Health benefits of physical activity: the evidence

Abstract

P hysical inactivity is a modifiable risk factor for cardiovascular disease and a widening variety of other chronic diseases, including diabetes mellitus, cancer (colon and breast), obesity, hypertension, bone and joint diseases (osteoporosis and osteoarthritis), and depression.1-14 The prevalence of physical inactivity (among 51% of adult Canadians) is higher than that of all other modifiable risk factors. 15 In this article we review the current evidence relating to physical activity in the primary and secondary prevention of premature death from any cause, cardiovascular disease, diabetes, some cancers and osteoporosis. We also discuss the evidence relating to physical fitness and musculoskeletal fitness and briefly describe the independent effects of frequency and intensity of physical activity. (A glossary of terms related to the topic appears in Appendix 1). In a companion paper, to be published in the Mar. 28 issue, we will review how to evaluate the healthrelated physical fitness and activity levels of patients and will provide exercise recommendations for health.Several authors have attempted to summarize the evidence in systematic reviews and meta-analyses. These evaluations are often overlapping (reviewing the same evidence). Some of the most commonly cited cohorts have been described in different studies over time as more data accumulate (see Appendix 2, available online at www.cmaj.ca/cgi/content/full/174/6 /801/DC1). In this review, we searched the literature using the key words "physical activity," "health," "health status," "fitness," "exercise," "chronic disease," "mortality" and diseasespecific terms (e.g., "cardiovascular disease," "cancer," "diabetes" and "osteoporosis"). Using our best judgment, we selected individual studies that were frequently included in systematic reviews, consensus statements and meta-analyses and considered them as examples of the best evidence available. We also have included important new findings regarding the relation between physical activity and fitness and allcause and cardiovascular-related mortality. All-cause and cardiovascular-related death Primary preventionSince the seminal work of Morris and colleagues in the 1950s16,17 and the early work of Paffenbarger and colleagues in the 1970s, 18,19 there have been numerous long-term prospective follow-up studies (mainly involving men but more recently women also) that have assessed the relative risk of death from any cause and from specific diseases (e.g., carciovascular disease) associated with physical inactivity. 6,20-26Both men and women who reported increased levels of physical activity and fitness were found to have reductions in relative risk (by about 20%-35% 27,28) of death (see Appendix 2, available at www.cmaj.ca/cgi/content/full/174/6/801/DC1). For example, in a study involving healthy middle-aged men and women followed up for 8 years, the lowest quintiles of physical fitness, as measured on an exercise treadmill, were associated with an increased risk of death from any cause compared with the top quin...

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