Even greater risk reductions for all-cause mortality and chronic disease (e.g., 50%) are often observed when objective measures of fitness are taken (see Table 1). Health benefits of routine physical activityĪctive adults have a 20% to 35% reduced risk of premature mortality and various other chronic medical conditions. This paradox can be better understood by examining the dose-response relationship between physical activity and health, by reviewing the risks associated with exercise, and by considering how physical activity guidelines might better reflect evidence-based best practice. Exercise appears to increase the short-term risk of CVD and SCD while simultaneously reducing the long-term risk for adverse events. In evaluating the literature, a risk-benefit paradox is revealed when the effects of physical activity on health are considered. However, there is also evidence of sudden cardiac death (SCD) and advanced CVD occurring in athletes and former athletes, and risks are associated with both vigorous physical activity and prolonged strenuous activity. Moreover, various studies of former athletes have demonstrated reduced mortality rates and prevalence of chronic disease, including diabetes, cancer, and hypertension. Today irrefutable evidence indicates that habitual physical activity reduces premature mortality and is an effective primary and secondary prevention measure for more than 25 chronic medical conditions, including cardiovascular disease (CVD). The health benefits of physical activity have been documented since ancient times, beginning more than 2000 years ago when Hippocrates highlighted the importance of active living. Despite the risk-benefit paradox, it is clear that the health benefits of physical activity far outweigh the risks, and virtually everyone can benefit from becoming more physically active. There is strong evidence to support the need for individualized exercise prescriptions for patients, including varied recommendations for improving health-related physical fitness and functional status. Current physical activity guidelines have been widely criticized because they do not include varied types and amounts of activities to address the diverse needs of society. Inactive individuals may be discouraged by recommendations for an amount of activity that seems unachievable and is greater than what is required for clinically relevant health benefits, while endurance athletes often exercise at levels and intensities well beyond what is needed to achieve health benefits. The optimum and minimum amounts of physical activity/exercise needed to achieve health benefits are disputed. Prolonged strenuous exercise training or events have been associated with various risks, including sudden cardiac death, atrial and ventricular arrhythmias, and pathological remodeling of the myocardium. There may, however, be an attenuation of benefit at the extreme end of the exercise continuum (e.g., for ultra-endurance events). An exercise dose-response relationship exists with the greatest benefits seen when previously inactive individuals become more active. Active individuals often exhibit risk reductions of 50% or more for mortality and morbidity. Vigorous exercise can transiently increase the short-term risk for an adverse event (such as a myocardial infarction or sudden cardiac death) however, participation in routine exercise can also markedly reduce the long-term risk for premature mortality and is an effective primary and secondary preventive measure for more than 25 chronic medical conditions. ABSTRACT: A risk-benefit paradox applies when considering how much exercise is needed for good health.
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