Human Limits

Exploring performance and health with Michael J. Joyner, M.D.

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Should Physical Inactivity Be Medicalized?

The Olympics showed us all the amazing things humans can do as a result of intense training on top of talent.  While performances in the Olympics and other sporting events get better and better the sad reality is that the world as a whole is getting less fit and less active.  Here is a link to a statistics filled analysis of the inactivity pandemic that appeared in the Lancet medical journal just before the Olympics.

This paper was part of a series of articles on physical inactivity and what to do about it.  The article points out that “inactive people would gain 1.3–3.7 years (of life expectancy) from age 50 years by becoming active” and that “with elimination of smoking, life expectancy at age 50 years was estimated to increase by 2.3–2.5 years in the US population”.

These data are consistent with the idea physical inactivity now rivals smoking as a cause of premature death.  Inactivity is also perhaps the major cause of non-communicable diseases worldwide.   In fact regular exercise or even just building more activity into your daily routine can be used to either prevent or treat all sorts of things including:

  • Diabetes
  • Hypertension
  • Coronary artery disease and other forms of atherosclerosis
  • Aging associated frailty
  • Obesity
  • Depression
  • Fibromyalgia, Chronic Fatigue Syndrome and POTS.

The figure below shows just how protective physical activity is.  The data are from about 4,000 middle aged men in Great Britain, but all sorts of studies in all sorts of populations have essentially generated curves that look just like this.  The important thing to note is that most of the protective effects of physical activity occur when people go from inactive to moderately active.










The question now is what to do about all of this inactivity?  In a recent editorial on a form of orthostatic intolerance (light headedness and fainting when standing up) I pointed out that, like so many other medical conditions, exercise training appears to make this condition better.   I then argued that inactivity should become an official medical diagnosis.   This would raise awareness of the problem, improve physician training related to exercise, and perhaps stimulate organizations that pay for medical care to do more.  It might also lead to more widespread support of supervised progressive training or “reconditioning” programs and related public health measures.

These ideas are not new, and in fact Dr. Frank Booth, a truly visionary scientist, has been making similar arguments for many years.

Finally forget mortality and the cold hard statistics mentioned above, and ask yourself how many people are leading limited lives because they are unfit, frail, or suffer from preventable chronic diseases?  How many older people can’t chase their grandchildren around the yard?  How many people can’t go for a hike on beautiful but challenging mountain trail or body surf at the beach?   It is a big world and being fit makes it possible to engage fully in the many interesting things that are out there and waiting for us.



4 Responses to “Should Physical Inactivity Be Medicalized?”

  1. August 15th, 2012 at 11:21 am

    Dennis Depenbusch says:

    An inactivity diagnosis would be a great first step, along with health insurance adjustments (or rewards?) for people of different inactivity levels. Get the diagnosis and I am sure the market would decide how to motivate/penalize the decisions made by people, just like tobacco.

    Great article!

  2. August 15th, 2012 at 3:26 pm

    George Brose says:

    Under the much maligned Canadian national health care plan, if a person needs a heart transplant and is a smoker, they will be triaged to the bottom of the list of potential recipients. Same for a liver transplant if one is a heavy drinker. One’s lifestyle is important up there. Cigarette packs have rather gruesome pictures of cancerous lungs and throats and tongues to remind people of what they might face. Ok , now I’m really going to step off the edge of the cliff. I agree that people have a right to own and carry a gun, but with that privilege they should also have an obligation to pay for a user’s permit (not a tax) that would cover the costs of the potential injuries that could be inflicted by their gun, much like motorcycle insurance, and insurance for young drivers which comes at a high rate.

  3. August 16th, 2012 at 11:12 am

    Eric Snyder says:

    I have been quite impressed here at the University of Minnesota with their wellness plan. If you earn 300 points you have most of your insurance premiums paid for the year. You can get points by biking to work (they have a DeroZap system that logs your rides throughout campus with an RFid on your bike), hitting the gym 8 times per month, etc. It is bizarre that more institutions do not have programs in place like this! Good article.

  4. August 17th, 2012 at 6:05 am

    Physical Activity: Are We Getting Enough? | Human Limits: Michael J. Joyner, M.D. says:

    […] a bit better over the last 10 years, but 25% of people are completely inactive and as we saw in the chart from a couple days ago, the biggest improvements in health occur when people go from being completely inactive to doing […]

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