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Abstract
572
Apart from the short term smoking-related reduction in oxygen binding and delivery caused by carbon
monoxide, chronic exposure to smoking causes reduced ventilatory capacity and eventually chronic
obstructive lung disease, in addition to unfavour Adis International Limited. All rights reserved.
Erikssen
Exact assessments of physical activity in test populations using current methods (self-reports, physical activity questionnaires, structured interviews)
are difficult and these methods have not been fully
standardised. Recently, experimental use of doubly
radioactively labelled water has improved the precision in measuring energy expenditure during physical activity, as have computerised motion detectors.[5]
A high level of physical activity, necessary to
maintain high fitness, has favourable effects on serum lipids, fibrinolysis, glucose tolerance and insulin
sensitivity, platelet function, blood pressure, autonomic nervous system function, myocardial electric
stability, endothelial function and endotheliumdependent vasodilation in coronary arteries, and
the immune system.[6,7] Physical activity level also
influences aspects of mental health related to risk
of cardiovascular disease (CVD).[8]
3. Associations Between Physical
Fitness and Coronary Heart Disease
Risk Factors
In addition to physical activity level and smoking status, age-adjusted physical fitness is closely
associated with coronary heart disease (CHD) risk
factors such as systolic blood pressure, triglycerides, high and low density lipoproteins, resting heart
rate and body mass index. Such associations have
been demonstrated in both genders.[9]
Associations between physical activity level and
CHD risk factors are similar to those of physical
fitness, but generally weaker.[10] Part of this difference may be related to imprecision of measuring
activity levels, but it remains that fitness has an
important genetic component and is not a direct
mirror of activity level. However, improvements in
fitness are followed by a more favourable risk factor pattern.[6] This suggests that CHD risk factors
Sports Med 2001; 31 (8)
573
Virtually all studies of physical activity and fitness have only dealt with all-cause and CVD mortality, whereas little attention has been paid to their
association with disease development before death.
In our long term observational study of 2014 initially healthy, middle-aged men we have also had
the opportunity to study long term incidence of various diseases in relation to fitness, as reported earlier.[6] Table I shows data on the combined incidence of CVD, diabetes mellitus and cancer 8, 16
and 21 years after the baseline examinations in 1972
to 1975 among quartiles of age-adjusted physical
fitness. A virtually identical association is seen between fitness and disease as for mortality.[20] The
influence of changes in fitness and disease development is similar to that of changes in fitness and
changes in mortality (data not shown). Accordingly,
fitness appears to influence mortality and morbidity in a similar way.
5. Discussion
Reductions in mortality associated with increased
physical activity and fitness have never been demonstrated in randomised trials, and such trials are
hardly possible in free living populations. However, extensive experimental and epidemiological
research during the past 5 decades strongly indicates that this hypothesis holds true, because:
There are strong and inverse associations between physical activity/fitness and long term
cardiovascular and all-cause mortality
Physical activity has several favourable short
and long term biochemical and physiological
effects in the body
High physical fitness a state that can only be
achieved through regular physical exercise, is
favourably associated with a number of cardiovascular risk factors
Increases in fitness are associated with favourable changes in cardiovascular risk factors
Changes in physical fitness are strongly and inversely related to reductions in long term mortality.
According to common epidemiological principles,[31] it can therefore be concluded beyond reaSports Med 2001; 31 (8)
574
Erikssen
Table I. Mortality and prevalence of cardiovascular disease (CVD)a, diabetes mellitus (DM) or cancer within age-adjusted quartiles of physical
fitness (PF) determined at baseline between 1972 to 1975 among 2014 initially healthy men aged 40 to 60 years: 8, 16 and 21 years of
follow-up
Length of follow-up
(y)
Quartile of
age-adjusted PF
7.0
25.7
67.3
II
3.4
16.4
80.2
III
3.5
13.2
83.3
IV
2.3
8.6
89.1
48.8
16
21
Mortality
(%)
19.5
31.7
II
11.4
27.4
61.2
III
12.0
21.5
66.6
IV
6.2
18.2
75.6
30.3
33.3
36.4
II
24.8
31.0
44.3
III
20.6
28.6
50.8
IV
14.0
28.0
58.0
CVD includes angina pectoris, myocardial infarction, stroke, aortic aneurysm or intermittent claudication.
focus on mortality. However, favourable psychological effects of exercise and the strong associations
between fitness and nonfatal disease manifestations
should also be emphasised. Increased physical
activity is a key factor in enabling people to attain
old age without disability or becoming institutionalised the fear of which may be greater than the fear
of death.[38] This and not only prolonging life
may be the most important benefit from physical
activity in older age groups.[39]
5.4 A Public Health Perspective
In the US it was estimated in 1986 that the number of CHD deaths attributable to never or irregularly engaging in physical activity and elevated serum cholesterol were of the same magnitude, and
clearly higher than CHD deaths associated with
smoking.[40] Far from improving since 1986, the
proportion of Americans having adequate physical
activity appears to be declining,[38] as in most industrialised countries. Thus, society is becoming
increasingly successful at reducing our need to move.
In developing countries, a decline in physical activity appears to follow in the wake of economic
growth.[41]
All the studies referred to above demonstrating
inverse associations between physical fitness/physical activity and mortality have concluded that physicians and authorities should encourage people
to become more physically active. The question
remains whether such messages will have the desired effects. Experience from various anti-smoking
campaigns is discouraging in this regard. In many
countries, authorities are now enforcing laws and
regulations to prevent people from smoking. Application of similar measures to force people to become
more physically active which might be equally important in a public health perspective, is difficult
to conceive. Convenience and necessity are the main
determinants of our everyday actions, and the development of, for example, electronic communication media does not support any drive towards exercising. Encouragement of physical movement,
therefore, is an increasingly challenging task.
Adis International Limited. All rights reserved.
575
Disregarding these rather pessimistic considerations, the fact still remains that each individual
regardless of any genetic component has a decisive influence on their own fitness. Scientific evidence strongly indicates that improvements in fitness particularly among those who are least fit,
are associated with substantial health gains. Even
in this rather unusual context, Darwins idea of the
survival of the fittest[42] may not be far from the
truth.
6. Conclusion
Extensive research during the past 50 years
strongly indicates that physical fitness and changes
in fitness are causally related to long term health.
The apparently inevitable decline in physical activity
followed by industrialisation will undoubtedly
have grave impact on global health unless countermeasures are taken. Creation of drives towards exercising in the community is an increasingly important and difficult task.
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