Cardiorespiratory fitness is an important risk factor

Our research has shown that schizophrenia is associated with a 25 year reduction in life expectancy.1 The top four mortality risk factors were low fitness, hypertension, smoking, and diabetes. The World Health Organization identified these same top four risk factors in the general population.2 Blair reported that physical inactivity with low cardiorespiratory fitness was the major public health risk for all cause mortality in Western society.3 Moreover, he highlighted a failure of primary care to assess this risk factor, with its focus on traditional risk factors (hypertension, cholesterol, diabetes, and body mass index). Meta-analysis confirms cardiorespiratory fitness as a valuable indicator of cardiac and all cause mortality risk, equivalent at least to traditional risk factors.4 Muscular strength is an independent positive factor.

Hingorani and Hemmingway reviewed the debate about balancing the individual and population benefits of statins for preventing cardiovascular disease,5 and a Cochrane review suggests they have few benefits in primary prevention.

In public health the debate about lowering cardiac risk in the general population in those at low and high risk should include assessment of cardiorespiratory fitness. A public health campaign to improve fitness would have many benefits, including improvement in cardiac and all cause mortality risk factors. In an ageing population, improved fitness would help to maintain elderly people’s independence without the well documented side effects of statins. Prescription of exercise and strength regimens should be routine and may cost little or nothing at all.