Abstract
Individuals who choose to be inactive accept the same increased risk of heart disease as individuals who smoke a pack of cigarettes a day! Unfortunately, between 11%-15% of the adult population still smoke a pack of cigarettes a day, whereas, 60%-80% of adults are either not adequately active or completely inactive. Thus, inactivity carries the same risk as smoking a pack of cigarettes per day and is between 4-5 times more prevalent!
“We are pleased to publish 5 well-conducted studies on physical activity from a variety of distinguished organizations and universities.”
There is no longer any serious double that regular physical activity is a key to healthy living. This concept is supported by literally thousands of studies.
We know that inactive individuals increase their risk of cardiovascular disease by 150%-240%. A landmark study performed a number of years ago by the Centers for Disease Control compared individuals who met the CDC standards of physical activity (150 minutes of moderate intensity physical activity per week) with inactive individuals. By the criteria used in this study, 80% of individuals in the United States do not meet these CDC standards and 60% are “very inactive.” When the risk of heart disease in active people was compared to that of very inactive people, the inactive segment of the population carried twice the risk of CHD (coronary heart disease) compared to the active people.
We have the mandate and an enormous opportunity to encourage the American public to become more physically active and thereby combat the adverse health effects of the epidemic of inactivity which is currently present in the United States. This is a particular challenge and central opportunity for all of us who practice lifestyle medicine!
Despite overwhelming evidence of the multiple health benefits of regular physical activity, and the widespread recognition in general terms of the benefits of physical activity amongst physicians, studies have shown that only 40% of physicians actually counsel their patients on physical activity. This is an unfortunate missed opportunity since over 70% of adults in the United States see their primary care physician on at least an annual basis. In a sense, the lack of counseling about physical activity amongst physicians is not surprising given that only 9% of medical schools in the United States have designated classes in physical activity! This is another area where lifestyle medicine physicians must seize the leadership position.
I have been personally committed to regular physical activity for many years not only as a cardiologist, but also in my personal life. In fact, I can count on one hand the number of days each year when I did not get at least 30-60 minutes of physical activity. Professionally, my first academic position as a cardiologist, in addition to performing cardiac catheterizations and attending in the Coronary Care Unit, also involved running a cardiac rehabilitation program. In fact, my initial research laboratory was called the “Exercise Physiology Laboratory.” In this context, my research team published numerous articles and books on walking and, in fact, coined the term “fitness walking.”1-4 We also developed the first fitness test utilizing brisk walking. 5
As our work progressed, it quickly became apparent that there were broader issues we needed to study beyond just physical activity. We changed the name of our organization to “Rippe Lifestyle Institute” and started conducting research in the combination of physical activity, nutrition, weight management and stress reduction. This provided the roots for my first academic textbook in this area entitled “Lifestyle Medicine.” 6
With all of this as background, and in keeping with my position as Editor of the American Journal of Lifestyle Medicine, it is particularly gratifying for me to publish an ever-increasing number of well-conducted research studies demonstrating the multiple benefits of regular physical activity as a key component of health and specifically link these benefits to the overall practice of lifestyle medicine.
In the current issue of AJLM, we are pleased to publish 5 well-conducted studies on physical activity from a variety of distinguished organizations and universities. The article by Piercy et al from the Office of Disease Prevention and Health Promotion at the Centers for Disease Control specifically focuses on the evidence of supporting multiple benefits of physical activity for older adults. 7 The article by Brown et al from the Moffitt Cancer Center provides the good news message that even brief bouts of physical activity (often called “exercise snacks”), increase adherence to overall physical activity. 8 The article by Onyeaka et al from Harvard Medical School, provides the important point that awareness of physical activity among individuals who are diagnosed as having anxiety or depression improve the likelihood of engaging in physical activity. 9 The article by Hall et al from the School of Public Health at the University of Alabama reviews the links between physical activity and self-compassion (defined as self-kindness, mindfulness and common humanity). 10 As the authors note, this connection is likely to play an important role in initiating and sustaining the healthy behavior change of regular physical activity. Patel et al from South Pacific College in Auckland, New Zealand showed multiple benefits of physical activity of both the physical and psychological health of prostate cancer survivors. 11
We are entering an era where the information of the multiple health benefits of physical activity is now readily accessible. In addition to the CDC interim report summarized in the current issue of AJLM, we also have abundant evidence from the Physical Activity Guidelines for Americans 2018 (PAGA 2018) of the multiple benefits of regular physical activity. 12 The Executive Summary from PAGA 2018 should be in the tool kit of every lifestyle medicine practitioner.
For individuals who are looking for a shorter summary of the multiple benefits of physical activity, I would recommend my book “Increasing Physical Activity: A Practical Guide” (CRC Press 2021) 13 which is drawn extensively from the more detailed evidence found in PAGA 2018. The Exercise is Medicine® movement from the American College of Sports Medicine, provides a user-friendly way of initiating conversations on physical activity. 14 The American College of Lifestyle Medicine (ACLM) has also been active in urging its members to include physical activity counseling as a component of the “6 Pillars of Lifestyle Medicine.” 15
I hope the wide variety of resources and information available not only in this issue of AJLM, but other places, as already indicated in this Editorial, will rekindle and validate the enthusiasm of all practitioners of lifestyle medicine to emphasize the profound value of physical activity for a lifetime of good health.
Let’s all commit to not just “talking the talk” but also to “walking the walk”!
James M. Rippe, MD Editor in Chief, AJLM
Professor of Medicine, UMass Chan Medical School, Worcester, MA
Founder and Director, Rippe Lifestyle Medicine, Shrewsbury, MA