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Rapid response to:


Recommended physical activity and all cause and cause specific mortality in US adults: prospective cohort study

BMJ 2020; 370 doi: (Published 01 July 2020) Cite this as: BMJ 2020;370:m2031

Rapid Response:

Exercise; a persistently underused intervention.

We congratulate Zhao et al on their timely study, that very much falls into category of research labelled “the road less travelled”. Positive results promoting a free intervention (exercise); with the potential to prevent disease, reduce mortality and reduce the healthcare costs of Long-Term Conditions (LTC) in patients. The authors comment that only 4 studies have previously reported results on the association between patients meeting physical activity guidelines and all cause mortality. If this is the state of our evidence base, it is no wonder why exercise is so often forgotten and perhaps the most underused intervention available to clinicians today.

If exercise was a pharmaceutical product, with commercial potential it most certainly would be undergoing a re-branding. We propose a three-pronged strategy. Firstly, exercise should not be a binary target, some is better than none and more is better than less. Increases in physical activity even below the recommended guideline amounts is associated with a reduction in all-cause mortality (1,2). Secondly, we need to lead by example, and that includes seamlessly integrating exercise into referral and treatment pathways to prevent and treat LTC’s. Thirdly and finally we can’t do this alone, not without social policies that promote active lifestyle in work and leisure time and that provide funding for research on exercise interventions.

1. Ekelund Ulf, Tarp Jakob, Steene-JohannessenJostein, Hansen Bjørge H, Jefferis Barbara, Fagerland Morten W et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis BMJ 2019; 366 :l4570
2. Leitzmann MF, Park Y, Blair A, et al. Physical Activity Recommendations and Decreased Risk of Mortality. Arch Intern Med. 2007;167(22):2453–2460. doi:10.1001/archinte.167.22.2453

Competing interests: No competing interests

07 July 2020
Irfan Ahmed
GP / Sport & Exercise Medicine Registrar
Barts Health NHS trust
Barts Health NHS trust