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Abstract

This quote from Steve Blair describes the importance of food physical fitness and regular moderate physical activity in disease prevention. The article that follows provides more details. “It is clear that moderate levels of fitness offer significant health benefits. The key is moving from the unfit category--some 30 to 40 million people in this country--to the moderately fit category. By beginning in programs of moderate regular exercise--half an hour each day, three times a week--anyone can join this group, and markedly lower their death rates from all-cause mortality, cancer, and cardiovascular disease." Dr. Steven Blair.
Th e He alth Ben efit s of Phy sica l
Ac tivi ty
Ch arle s B. Cor bin
Ro be rt P. Pang ra zi
ARI ZONA STA TE UNI VER S ITY
ORIGINALLY PUBLISHED AS SERIES 1, NUMBER 1, OF THE PCPFS RESEARCH DIGEST.
HI GHLI GHT
“I t is cl ear th at mo dera te le vels of fi tnes s of fer co nsid erab le
he alth be nefi ts. Th e ke y is mo ving fr om th e un fit ca tego ry—
so me 30 to 40 m i llio n pe ople in th is co untr y—to th e
m o d era tely fi t ca t ego ry. By be gin n in g p r ogra m s of m o dera te,
re gula r ex erci se—h alf an ho ur ea ch da y, th ree ti m es a we ek—
an yone ca n jo in th is gr oup, an d ma rked ly lo wer th eir de ath
ra tes fr om al l-ca use mo rtal ity, ca ncer , an d ca rdio vasc ular
di seas e.
Dr . St even Bla ir, The Coop er I nsti tute for Aer obic s Re sear ch
In 1990, Healthy People 2000 was released by Dr. Louis Sullivan, Secretary, Department of
Health and Human Services. The document elaborated national health promotion and disease
prevention goals for the year 2000. A central goal of the document is to increase the span of
healthy life for Americans. While improved treatment of disease to prevent premature death is
an important concern, Healthy People 2000 emphasizes the importance of prevention of
illness/disease, especially lifestyle or chronic illnesses that have become the leading sources of
death in our society. But perhaps most important of all, the goals focus on efforts to promote
a quality of life and a sense of well-being associated with good health. Dr. Michael McGinnis,
Director of the Office of Disease Prevention and Health Promotion, made the following
statement.
...it is not through happenstance that the physical activity category is the first priority area of the
Healthy People 2000 effort. Physical activity is related to the health of all Americans. It has the
ability to reduce directly the risk of several major chronic diseases as well as to catalyze positive
changes with respect to other risk factors of these diseases. Dr. William Foege, former Director of
the Centers for Disease Control, suggests that physical activity may provide the shortcut we in
public health have been seeking for the control of chronic diseases, much like immunization has
facilitated progress against infectious diseases (McGinnis, 1992, p. S196).
The inclusion of physical activity as an important lifestyle for promoting good health is
now clear. But for those interested in the health benefits of physical activity, it is not easy to
find a single source that summarizes these benefits. For this reason, we have attempted to
provide a simple sum-mary of the benefits in three sections: disease prevention and treatment;
health promotion; and physical fitness development. Six principal sources are used for this
summary. Readers are encouraged to consult these references and their sources for more
complete details.
DI SEAS E PR EVEN TION AN D TRE ATME N T
Prior to 1940, the leading killers in the United States were infectious diseases. Improvement in
public health practices, implementation of personal and public health education, and vaccines
have greatly reduced the incidence of these diseases. As indicated in the early statement by
Dr. Foege, “chronic diseases” are now our major health concerns. These chronic diseases are
often referred to as “lifestyle diseases” because changes in lifestyle, including increased
activity and fitness, can reduce the threat of early death and the incidence of disease. Figure
6.1 lists several of the diseases for which regular physical activity can reduce risk, either of
getting the disease or of dying from it. Also illustrated in Figure 6.1 are some of the possible
reasons why exercise reduces risk of these diseases.
FI GURE 6 .1
Ph ysic al ac tivi ty an d ma jor li fest yle di seas es.
Di seas e Ph ysic al Ac tivi ty Be nefi t
He art Di seas e He alth y h e art mu scle
lo wer res t in g hear t ra te
mo re b lood pum ped with eac h be at
re duce d bl o od p res sure i n s ubm axim al w ork
He al t hy a rter i es
less atherosclerosis (deposits in arteries)
hi g her HDL (“g ood” cho l est erol )
be tter blo od f at p rofi le ( fewe r “b ad” fats )
de crea sed plat el et and les s fi bri n (re lat e d to ath eros cl er os is )
be tter blo od f low
Be tter wor ki ng cap aci t y
fe wer dema nds duri ng w ork
greater ability to meet work demands
Stroke Healthy arteries (see above)
lo wer bloo d pr essu re
Pe riph eral Im prov ed wo rki n g ca paci t y
Va scul ar Di seas e Hi gher HD L
Be tter blo od f at p rofi le
Hi gh Bl ood Re duct ion in bl ood pr essur e am ong
Pr essu re th ose wi th hi gh le vels
Re duct ion in b ody fatn ess (ass ocia ted with hig h bl ood pres sure )
Di abet es Re duce d bo dy fa tnes s (m ay re l iev e
(n on -i nsul in )sy mpt o ms o f ad ul t on se t di abet es )
Be tter car bohy drat e me tabo lism (im prov ed i nsul in s ensi tivi ty)
Ca ncer Le ss ri sk o f co l on ca ncer (b ette r tr ans i t ti me o f fo o d?)
Ob esit y In crea ses l e an bo dy ma ss
De crea ses b ody fat p er cen t age
Le ss c entr al f at d istr ibut ion
De pres s ion Re lief fr om so me s y mpto ms
Back Pain Increased muscle strength and endurance
Im prov ed f lexi bili ty
Im prov ed p os tu re
Os teop oros is Gr eate r bo ne de nsit y as a re sult of st ress ing lo ng bo nes
In spite of the fact that deaths from heart disease have decreased in recent years, it is still
the leading cause of death. Studies by Paffenbarger and colleagues (1989) as well as others
have clearly shown that those who do regular physical activity are at less risk of dying from
this major killer. Physically inactive people have almost twice the risk of developing heart
disease as active people (Powell et al., 1987). In fact, the American Heart Association
(Fletcher et al., 1992) has recently classified inactivity (sedentary living) as a primary risk
factor for heart disease comparable to high blood pressure, high blood cholesterol, and
cigarette smoking. Both stroke (lack of blood flow and oxygen to the brain) and peripheral
vascular disease (lack of blood flow and oxygen to the limbs) have been shown (Haskell et al.,
1992) to be associated with sedentary living for many of the same reasons why inactivity is
related to heart disease (see Figure 6.1). High blood pressure or hypertension is a condition
that predisposes people to other health risks such as heart disease and diabetes. Regular
exercise has been shown to reduce blood pressure among those who have high levels though,
by itself, exercise cannot normalize high blood pressure for most people (Haskell et al.,
1992).
In the introduction of the Physical Activity and Fitness section of Healthy People 2000
(Public Health Service, p. 94), it is noted that physical activity can help to prevent and manage
non-insulin-dependent diabetes and osteoporosis. Recent evidence also has shown that
inactive people have a higher incidence of colon and breast cancer than active people. While
the evidence is less than complete, one researcher reached the following conclusion based on
a review of recent research.
Given the consistency in the direction and magnitude of the findings regarding colon cancer...the
evidence supports the conclusion that activity is protective against colon cancer. Although that
protective effect may be small, the attributable risk of colon cancer associated with inactivity may
be quite high given the prevalence of inactivity in Western societies. (Sternfeld, 1992, p. 1195)
It is generally conceded that regular muscle fitness and flexibility exercise can aid in
improving posture. Together, exercise and good posture can have a positive effect on back
problems as evidenced by less risk of back pain. In a recent review, Plowman (1992) noted
that while we do not yet know the exact amounts of muscle strength, muscle endurance, and
flexibility necessary to reduce the risk of back pain, there is support for the notion that poor
scores on these fitness measures are predictive of low back pain.
The potential benefits of regular physical activity in reducing obesity are well
documented. Regular exercise expends calories that can result in reduced fat storage in the
body’s fat cells. At the same time, exercise designed to build muscle fitness increases lean
body tissue (muscle), which can result in a lesser relative percentage of fat in the body and a
higher resting metabolism. Getting obese Americans to adopt regular exercise that would help
them achieve normal levels of body fatness is not as successful as we might hope.
Nevertheless, physical activity has great potential for reducing the incidence of obesity in our
society (Epstein et al., 1990).
Depression is a major medical problem that causes much pain and suffering. The number
of bed days and disabilities associated with depression is greater than that for the eight major
chronic health conditions (Public Health Service, 1990). A recent position statement of the
International Society of Sport Psychology (1992) states that studies on depressed patients
reveal that aerobic exercises are as effective as different forms of psychotherapy. In addition,
the Society summarizes by saying: “Exercise can have beneficial emotional effects across all
ages and for both sexes.”
HE ALTH PRO MOTI ON
The previous section dealt primarily with disease. Of course, disease treatment and prevention
are critical to good health in our society. Nevertheless, it is widely acknowledged that optimal
health is much more than freedom from disease. The challenge of Healthy People 2000
(Public Health Service, 1990) illustrates this point.
The health of people is measured by more than death rates. Good health comes from reducing
unnecessary suffering, illness, and disability. It comes as well from an improved quality of life.
Health is thus best measured by citizens’ sense of well-being. (p. 6)
Prevention of disease is a high priority and regular physical activity has been shown to
help prevent the conditions discussed in the preceding sections. But what of high-quality
living and a sense of well-being? Many of these are quite subjective. Corbin and Lindsey
(1990) summarize some of the perceived benefits of exercise based on subjective feelings of
people responding to national surveys. Some of the reported benefits are supported by
scientific evidence, including a reduction in stress levels and in symptoms of depression
(International Society of Sport Psychology, 1992), improved appearance, and increased
working capacity. Other benefits such as improved sleep habits, greater ability to enjoy
leisure, improved general sense of well-being, and improved self-esteem are less easy to
document. Nevertheless, what people think is true influences their quality of life and the
results of national opinion polls show that many Americans have positive feelings about the
benefits they receive from regular exercise (Corbin and Lindsey, 1990). Among older adults,
regular physical activity has been shown to increase independent functioning, increase the
ability to drive a car, and improve social interactions (Corbin and Lindsey, 1990). There is
similar evidence to show that physical activity can positively influence other health-related
behaviors (Blair, 1985). One survey, for example, showed that regular exercisers were 50%
more likely to quit smoking; 40% more likely to eat less red meat; 30% more likely to cut
down on caffeine; 250% more likely to eat low calorie foods and drinks; 200% more likely to
lose weight, and 25% more likely to cut down on salt and sugar than non-exercisers (Harris &
Gurin, 1985).
Physical activity’s contribution to quality of life and a personal sense of well-being is
more difficult to document than its contribution to prevention and treatment of disease. In the
long run, however, it may be equally important if the national goal of lengthening healthy life
is to be achieved. It is doubtful that most Americans would favor an extended life if “quality
of life” was lacking. The evidence suggests that humans were designed to be physically active
and that physical activity has great potential for enhancing quality of life and sense of well-
being. Additional research is necessary to determine the full extent of activity’s contribution
to these important variables.
PH YSIC AL F ITNE SS
There is no doubt that regular physical activity builds physical fitness. What has become
increasingly clear in recent years is that physical activity and physical fitness, as evidenced by
performance on fitness tests, are independent but related phenomena. Likewise, physical
fitness is associated with good health. For example, Blair et al. (1989) have shown that those
with “good” levels of fitness have less heart disease risk than those with “low” levels of
fitness. The previously cited review by Plowman (1992) suggests that muscle fitness is
necessary to prevent back pain. Others have pointed out the importance of fitness to injury
prevention (McGinnis, 1992). Body fatness, often considered a health-related component of
physical fitness, is associated with medical problems of various kinds.
Fitness, as measured by fitness tests, is NOT solely related to regular physical activity. As
noted in Figure 6.2, there are many other factors that contribute to physical fitness. Among
children, fitness scores are influenced by chronological age and maturation (physiological
age). In some cases, children and adolescents who are inactive have higher fitness scores than
younger or more active peers (Pangrazi & Corbin, 1990; Pate, Dowda, & Ross, 1990).
Bouchard and colleagues (1992) have demonstrated that heredity plays a significant role in a
person’s ability to improve fitness as a result of exercise. Some people respond to training
more favorably than others, so it is possible that regular exercisers could sometimes have
lower fitness performance levels than those who are sedentary. Of course, other factors such
as nutrition, learned skills, and environment also play a role in fitness performances.
There is little doubt that good physical fitness is associated with reduced risk of disease.
Further, it can be stated that good fitness helps people function effectively, look better, and
have the ability to enjoy their free time. But evidence exists to support other important
statements about physical fitness.
Physical fitness, as measured by fitness tests, is not as meaningful to good health as
physical fitness that results from regular physical activity as part of the normal lifestyle.
Physical fitness, as measured by fitness tests, will ultimately improve as the result of
regular exercise to the extent that hereditary predispositions allow. The amount and rate
of change in fitness will take longer for some to achieve than for others.
Physical fitness is associated with good health but is not the same as good health. Regular
physical activity has positive benefits for both good health and adequate physical fitness.
For good health benefits to result, it is important NOT to be in a low fit category. On the
other hand, high levels of fitness test performance do NOT seem to be necessary for
attaining health benefits. All people with regular physical activity have the potential to
achieve adequate levels of fitness that are associated with good health.
FI GURE 6 .2
Fa ctor s af fect in g ph ysic al fi tn es s pe r for manc es.
Ot her Fact ors (Nut rit i on, Stre ss, etc. )
He redi ty Fi tn es s Ma tura ti on
Ph ysic al A ctiv ity
S UM MA R Y
In recent years, much has been learned about regular physical activity and physical fitness.
Many of the health benefits of exercise and physical fitness are now well documented. Other
potential benefits require much more research. In the meantime, the following quotes seem to
best summarize our knowledge. From leading researchers Paffenbarger and Hyde (1980):
Evidence mounts that the relationship between exercise and good health is more than circumstantial.
If some questions are not yet answered, they are far less important than those that have been.
From Edward Cooper during a news conference for the American Heart Association, July
1, 1992:
Now I’d like to say to those who are not engaged in “exercise training” that any physical activity is
better than none. According to our panel, housework, gardening, shuffleboard—anything that causes
us to move—is beneficial. Maybe you don’t have time or ability to attain “cardiovascular fitness,”
that is, to enable your heart to function at its most efficient level...maybe you don’t have the money
to join a health club or buy a bicycle...still there are activities you can perform as a part of your
daily life that will benefit your heart. I encourage you to make activity a part of your routine every
day—just as much a part of your day as brushing your teeth or enjoying breakfast.
From John Dryden, spoken several hundred years ago, as cited by Paffenbarger and Hyde
(1980):
Better to hunt in fields, for health unbought, than fee the doctor for nauseous draught; the wise, for
cure, on exercise depend; God never made his work for man to mend.
R EF ER EN CE S
Blair, S.N. (1985). Relationship between exercise or physical activity and other health behaviors. Public Health
Reports, 100, 172–180.
Blair, S.N., Kohl, H.W., Paffenbarger, R.S., Clarke, D.G., Cooper, K.H., & Gibbons, L.W. (1989). Journal of the
American Medical Association, 262, 2395–2401.
Bouchard, C., Dionne, F.T., Simoneau, J., & Boulay, M.R. (1992). Genetics of aerobic performances. In J.O.
Holloszy (Ed.), Exercise and sport sciences reviews: Vol. 20 (pp. 27–58). Baltimore: Williams and Wilkins.
Corbin, C.B., & Lindsey, R. (1990). Concepts of physical fitness. (7th ed.). Dubuque, IA: Wm. C. Brown Co.
Epstein, L.H., McCurley, M., Wing, R.R., Valoski, A. (1990). Five-year follow-up of family-based behavioral
treatments for childhood obesity. Journal of Consulting Clinical Psychology, 58, 661–664.
Fletcher, G.F., Blair, S.N., Blumenthal, J., Caspersen, C., Chaitman, B., Epstein, S., Falls, H., Froelicher, E.,
Froelicher, V., & Pina, I. (1992). Statement on exercise: Benefits and recommendations for physical activity
for all Americans. Circulation, 86, 2726–2730.
Harris, T.G., & Gurin, J. (1985). Look who’s getting it all together. American Health, 4 (2), 42–47.
Haskell, W.L., Leon, A.S., Caspersen, C., Froelicher, V.F., Hagberg, J.M., Harlan, W., Holloszy, J.O.,
Regensteiner, J.G., Thompson, P.D., Washburn, R.A., & Wilson, P. W.F. (1 992) . Ca rdio vasc ular be nefi ts
an d as sess ment of ph ysic al ac tivi ty an d ph ysic al fi tnes s in ad ults . Me dici ne an d Sc ienc e in Sp orts an d
Ex erci se, 24 , S2 01–S 220.
International Society of Sport Psychology. (1992). Physical activity and psychological benefits. Physician and
Sportsmedicine, 20, 179–184.
McGinnis, J.M. (1992). The public health burden of a sedentary lifestyle. Medicine and
Science in Sports and Exercise, 24, S196–S200.
Paffenbarger, R.S., & Hyde, R.T. (1980). Exercise as protection against heart attack. New England Journal of
Medicine, 302, 1026–1027.
Paffenbarger, R.S., Hyde, R.T., Wing, A.L., & Hsieh, C. (1986). Physical activity, all-cause mortality, and
longevity of college alumni. New England Journal of Medicine, 314, 605–614.
Pangrazi, R.P., & Corbin, C. B. (1990). Age as a factor relating to physical fitness test performance. Research
Quarterly for Exercise and Sport, 61, 410–414.
Pate, R.R., Dowda, M., & Ross, J.G. (1990). Association between physical activity and physical fitness of
children. American Journal of Diseases in Children, 144, 1123–1129.
Powell, K.E., Thompson, K.D., Caspersen, C.J., & Kendrick, J.S. (1987). Physical activity and the incidence of
coronary heart disease. Annual Review of Public Health, 8, 253–287.
Public Health Service. (1990). Healthy People 2000. Washington, DC: U.S. Government Printing Office.
Sternfeld, B. (1992). Cancer and the protective effect of physical activity: The
epidemiological evidence. Medicine and Science in Sports and Exercise, 24, 1195–
1209.
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Systematic surveillance of injuries and illnesses is the foundation for developing preventive measures in sport. To analyse the injuries and illnesses that occurred during the XXII Olympic Winter Games, held in Sochi in 2014. We recorded the daily occurrence (or non-occurrence) of injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the Sochi 2014 medical staff. NOC and Sochi 2014 medical staff reported 391 injuries and 249 illnesses among 2780 athletes from 88 NOCs, equalling incidences of 14 injuries and 8.9 illnesses per 100 athletes over an 18-day period of time. Altogether, 12% and 8% of the athletes incurred at least one injury or illness, respectively. The percentage of athletes injured was highest in aerial skiing, snowboard slopestyle, snowboard cross, slopestyle skiing, halfpipe skiing, moguls skiing, alpine skiing, and snowboard halfpipe. Thirty-nine per cent of the injuries were expected to prevent the athlete from participating in competition or training. Women suffered 50% more illnesses than men. The rate of illness was highest in skeleton, short track, curling, cross-country skiing, figure skating, bobsleigh and aerial skiing. A total of 159 illnesses (64%) affected the respiratory system, and the most common cause of illness was infection (n=145, 58%). Overall, 12% of the athletes incurred at least one injury during the games, and 8% an illness, which is similar to prior Olympic Games. The incidence of injuries and illnesses varied substantially between sports. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Type: JOURNAL ARTICLEType: REVIEWType: REVIEW, TUTORIALLanguage: Eng
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