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These are extracts from an edit­or­ial com­ment in the lead­ing med­ical journal “The Lancet”, July 2012.

Stressing harms of phys­ical inactiv­ity to pro­mote exer­cise

Exercise has been called a mir­acle drug that can bene­fit every part of the body and sub­stan­tially extend lifespan. Yet it receives little respect from doc­tors or soci­ety. Socially, being inact­ive is per­ceived as nor­mal, and in fact doc­tors order patients to remain on bed rest far more often than they encour­age exer­cise. This pass­ive atti­tude towards inactiv­ity, where exer­cise is viewed as a per­sonal choice, is ana­chron­istic, and is remin­is­cent of the battles still being fought over smoking.

Physical inactiv­ity bur­dens soci­ety through the hid­den and grow­ing cost of med­ical care and loss of pro­ductiv­ity. Getting the pub­lic to exer­cise is a pub­lic health pri­or­ity because inact­ive people are con­trib­ut­ing to a mor­tal­ity bur­den as large as tobacco smoking. To indi­vidu­als, the fail­ure to spend 15—30 min a day in brisk walk­ing increases the risk of can­cer, heart dis­ease, stroke, and dia­betes by 20—30%, and shortens lifespan by 3—5 years. Although the bene­fits of exer­cise and the harms of inactiv­ity might seem like two sides of a coin, the bene­fits mes­sage emphas­ised so far has not worked well for most of the pop­u­la­tion. In tobacco con­trol, doc­tors did not emphas­ise the bene­fits of non-​smoking, but the harms of smoking. Similarly, armed with cred­ible global and national data, we should emphas­ise the harms of inactiv­ity and not merely the bene­fits of exer­cise.

Smoking and phys­ical inactiv­ity are the two major risk factors for non-​communicable dis­eases around the globe. Of the 36 mil­lion deaths each year from non-​communicable dis­eases, phys­ical inactiv­ity and smoking each con­trib­ute about 5 mil­lion. …

Governmental pro­grammes to move people from sedent­ary liv­ing to meet­ing recom­men­ded levels of exer­cise are very lim­ited, in both developed and devel­op­ing coun­tries. Where avail­able, these pro­grammes are viewed as use­ful but not as essen­tial as, say, anti-​smoking pro­grammes, partly owing to a fail­ure to emphas­ise the colossal harms of inactiv­ity. Furthermore, treat­ment of phys­ical inactiv­ity is not a reim­burs­able item under most health insur­ance pro­grammes, and few fin­an­cial incent­ives exist for health-​care pro­viders to spend time dis­cuss­ing exer­cise dur­ing med­ical vis­its.

There is much to learn from tobacco con­trol strategies to reduce the harms of inactiv­ity. WHO intro­duced the MPOWER meas­ures to assist in redu­cing smoking harms at the coun­try level. MPOWER includes mon­it­or­ing beha­viour, pro­tect­ing people from smoke, offer­ing treat­ment, warn­ing of harms, enfor­cing the law, and rais­ing the price. Applying MPOWER to phys­ical inactiv­ity, we will need to mon­itor inactiv­ity pre­val­ence and factors behind it; pro­tect the safety of the exer­cisers and their built envir­on­ment; offer ser­vices to the inact­ive to gain skills for sus­tain­able and enjoy­able exer­cise; warn the pub­lic of the haz­ards of inactiv­ity through repeated cam­paigns; ensure that the med­ical com­munity ful­fils its respons­ib­il­ity to reduce inactiv­ity; and, finally, raise money or provide fund­ing to encour­age phys­ical activ­ity and dis­cour­age inactiv­ity…

Read the full edit­or­ial from the Lancet 18 July 2012

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