It has been estimated that as many as 250,000 deaths per year in the United States are attributable to lack of regular physical activity.
18 Ongoing longitudinal studies have provided consistent evidence of varying strength documenting the protective effects of activity for a number of chronic diseases, including CHD,
4,
5,
8,
9,
10,
12,
19,
20 type 2 diabetes,
20,
21,
22,
23,
24 hypertension,
25 osteoporosis,
26 and site-specific cancers.
27 In contrast, low levels of physical fitness or activity are consistently associated with higher cardiovascular and all-cause mortality rates.
2,
4,
5,
19,
20,
28 Mid-life increases in physical activity, through change in occupation or recreational activities, are associated with a decrease in mortality rates.
29
The landmark epidemiologic work of the late Ralph Paffenbarger and associates among Harvard alumni
6,
29,
30,
31,
32,
33 has been particularly persuasive in support of physical activity and therefore the development of the CDC, AHA, IOM, and ACSM guidelines.
Table 37-1 illustrates the rates and relative risks of death over a 9-year period among 11,864 Harvard alumni by patterns of physical activity. Several findings in
Table 37-1 are particularly noteworthy. The largest benefits in terms of mortality appear to occur by engaging in moderate activity levels;
moderate is generally defined as activity performed at an intensity of 3 to 6 metabolic equivalents (METs) (a multiple of the resting metabolic rate), approximately equivalent to brisk walking for most adults.
34 Note also that regular moderate walking or sports participation is associated with 30% to 40% reductions in mortality compared with more sedentary individuals (relative risk of death 0.60 to 0.70). Likewise, the physical activity index, expressed as kilocalories per week (the sum of walking, stair climbing, and sports participation) suggests that a 40% reduction in mortality occurs by engaging in modest levels of activity (1,000 to 2,000 kcal/week, equivalent to three to five 1-hour sessions of activity), whereas only minimal additional benefits are achieved by engaging in greater-intensity activity. These findings agree closely with earlier results among 16,936 Harvard alumni assessed in the early 1960s and followed for all-cause mortality for nearly 20 years.
30 Similar results have been reported from large studies that have followed subjects for CHD morbidity and mortality in the range of 10 to 20 years among British civil servants,
35,
36 U.S. railroad workers,
37 San Francisco longshoremen,
33 nurses,
38,
39,
40 physicians,
41 U.S. Veterans,
42 and other cohorts (for review, see Kohl
19 or Pedersen and Saltin
43). Clearly, the evidence linking a physically active lifestyle and cardiovascular health is substantial.