ArticlesEffect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy
Introduction
Ancient physicians—including those from China in 2600 BC and Hippocrates around 400 BC—believed in the value of physical activity for health. By the 20th century, however, a diametrically opposite view—that exercise was dangerous—prevailed instead.1 During the early 20th century, complete bed rest was prescribed for patients with acute myocardial infarction. And, at the time of the 100th boat race between the Universities of Oxford and Cambridge, UK, in 1954, the senior health officer of Cambridge University undertook a study to investigate the alleged dangers of exercise by comparing university sportsmen with intellectuals.1
One of the pioneers whose work helped to change that tide of popular opinion was Jerry Morris, who undertook the first rigorous, epidemiological studies investigating physical inactivity and chronic disease risk, published in 1953.2 Since then, much evidence has clearly documented the many health benefits of physical activity (panel 1).3, 4, 5 Despite this knowledge, a large proportion of the world's population remains physically inactive. To quantify the effect of physical inactivity on the world's major non-communicable diseases, we estimated how much of these diseases could be averted in the population if inactive people were to become active, as well as how much gain in life expectancy could occur at the population level. We focus on the major non-communicable diseases emphasised by the UN as threats to global health:6 coronary heart disease; cancer, specifically breast and colon cancers, which are convincingly related to physical inactivity; and type 2 diabetes.
Section snippets
Population attributable fraction
The population attributable fraction (PAF) is a measure used by epidemiologists to estimate the effect of a risk factor on disease incidence in a population.7, 8 It estimates the proportion of new cases that would not occur, absent a particular risk factor. Thus, it provides policy makers with useful quantitative estimates of the potential effect of interventions to reduce or eradicate the risk factor.
PAF is related to prevalence of the risk factor and its associated relative risk (RR). At
Results
We estimated the prevalence of physical inactivity in cases of the outcomes studied, by country, using adjustment factors of 1·20 (SE 0·03) for coronary heart disease, 1·23 (0·05) for type 2 diabetes, 1·05 (0·09) for breast cancer, 1·22 (0·08) for colon cancer, and 1·22 (0·07) for all-cause mortality. The highest prevalence was noted in people who went on to develop type 2 diabetes, followed by those who died and those who developed colon cancer, coronary heart disease, and breast cancer (table
Discussion
Worldwide, we estimated that physical inactivity causes 6–10% of the major non-communicable diseases of coronary heart disease, type 2 diabetes, and breast and colon cancers. Furthermore, this unhealthy behaviour causes 9% of premature mortality, or more than 5·3 of the 57 million deaths in 2008.18 With elimination of physical inactivity, life expectancy of the world's population might be expected to increase by 0·68 years. These findings make inactivity similar to the established risk factors
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