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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:

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

Dear Editor,

Further to the article on physical activity, all cause mortality and specific mortality, the research is timely in its conclusion that the largest survival rates in the population surveyed were those who engaged in both aerobic and muscle strengthening activities. (1)

In clinical practice, it is often difficult to go through the specifics of exercise prescription, due to time and comprehension constraints. A simple message often works best. Particularly if this message incorporates the state of the art science which has been provided by this and other informative papers, which recommend 150 minutes or more of moderate intensity exercise a week

The game of golf provides this very prescription. There are different ways to play golf. Walk carrying a bag, pulling a bag, using an electric caddy car or driving in a golf buggy. Each have different energy expenditures and physiology affects. There are known physiological numbers for a variety of activities, called Metabolic Equivalent Units (METs) ( 2 ), which a numerical score of the energy spend of an activity. METs are also used to score an individuals aerobic fitness level or functional capacity. METs are useful when prescribing exercise in different populations.

The average 50-year-old male has an aerobic capacity of 9.2 METs and a female 8.2 MET. (3). Playing golf carrying a golf bag gives you a MET spend of 5.5 METS, pulling a caddy car a metabolic spend of 5METS, whereas an electric caddy car will only utilise 3.5 METs. Assuming average fitness levels, playing golf while carrying a bag or pushing a caddy car will put the 50 year old exerciser into the moderate intensity bracket of 60-85% of functional capacity. This fits neatly into the optimal exercise as described in the paper.

Therefore, playing 9 or 18 holes regularly carrying your golf clubs on your back or pushing a caddy car will give you the required exercise prescription, significantly enhance your wellbeing and survival potential. More physical activity than the minimal recommendation of 150 minutes of moderate intensity activity a week is reported as providing greater health benefits. Thus, extra rounds of golf will have an added wellness enhancement.

In 1948 Mark Twain stated that golf was a good walk spoilt. This research questions Twain`s words Golf is better described as a good walk enhanced, as it add the element of resistance activity with episodes of anaerobic activity, in the golf swing, to the aerobic walk.

Unlike so many things in medicine this is a positive message to give a patient. So often a doctor has to deliver unpleasant news to the patient about their life style and remove something pleasurable from their compendium of life activities. This message is different. Play golf. A few days a week if you can and carry your bag or push the bag if you are able. Simple messaging such as this should yield dividends for the health and wellbeing and survival rates of the population. It could be paraphrased as: “A round a day keeps the doctor away”

1. Zhao, M., et al., Recommended physical activity and all cause and cause specific mortality in US adults: prospective cohort study. BMJ 2020;370:m2031
2 Arena , Myers ,Williams et al Assessment of Functional Capacity in Clinical and Research Settings. A Scientific Statement From the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation 2007;116:329–343
3 Riebe; Ehrman; Liguori et al . American College of Sports Medicine, guidelines for exercise testing and prescription 10TH Ed, Philadelphia : Wolters Kluwer, [2018]

Competing interests: No competing interests

08 July 2020
Consultant Physician
Sports Surgery Clinic Santry Dublin
Suite 26 Blackrock Clinic