Stressing harms of physical inactivity to promote exercise.

See Online/Articles http://dx.doi.org/10.1016/ S0140-6736(12)61031-9 Exercise has been called a miracle drug that can benefi t every part of the body and substantially extend lifespan. Yet it receives little respect from doctors or society. Socially, being inactive is perceived as normal, and in fact doctors order patients to remain on bed rest far more often than they encourage exercise. This passive attitude towards inactivity, where exercise is viewed as a personal choice, is anachronistic, and is reminiscent of the battles still being fought over smoking. Physical inactivity burdens society through the hidden and growing cost of medical care and loss of productivity. Getting the public to exercise is a public health priority because inactive people are contributing to a mortality burden as large as tobacco smoking. To individuals, the failure to spend 15–30 min a day in brisk walking increases the risk of cancer, heart disease, stroke, and diabetes by 20–30%, and shortens lifespan by 3–5 years. Although the benefi ts of exercise and the harms of inactivity might seem like two sides of a coin, the benefi ts message emphasised so far has not worked well for most of the population. In tobacco control, doctors did not emphasise the benefi ts of non-smoking, but the harms of smoking. Similarly, armed with credible global and national data, we should emphasise the harms of inactivity and not merely the benefi ts of exercise. Smoking and physical inactivity are the two major risk factors for non-communicable diseases around the globe. Of the 36 million deaths each year from noncommunicable diseases, physical inactivity and smoking each contribute about 5 million. Physical inactivity and smoking have similar population attrib utable risks, although their relative risks and prevalence are somewhat diff erent (fi gure). For smoking, intensive and coordinated tobacco control eff orts have been organised through WHO’s Framework Convention on Tobacco Control (FCTC), a treaty already ratifi ed by 175 countries. By contrast, we have few organised eff orts to combat physical inactivity. Governmental programmes to move people from sedentary living to meeting recommended levels of exercise are very limited, in both developed and developing countries. Where available, these programmes are viewed as useful but not as essential as, say, antismoking programmes, partly owing to a failure to emphasise the colossal harms of inactivity. Furthermore, treatment of physical inactivity is not a reimbursable item under most health insurance programmes, and few fi nancial incentives exist for health-care providers to spend time discussing exercise during medical visits. Estimates of the eff ect of inactivity on noncommunicable diseases, such as a 6–10% contribution, are very conservative as reported by one of the papers in this Series. First, the minimally active population might not be separated from those who are completely inactive, with a 3-year gap in life expectancy reported between the two groups. The largest health gain occurs for the fi rst 15–29 min per day of exercise by inactive people. Second, the prevalence of inactivity could be underestimated substantially, particularly in Asian countries where up to 80% national prevalence for inactivity has been reported. Third, if the life expectancy gap between active and inactive people were to be derived from summary risk estimates, under estimation would occur if adjusted rather than unadjusted relative risks were used, or if mortality risks were not constant across age groups. Finally, the small increase in the estimated life expectancy gap should be read with caution as it is relevant to the population as a whole, and is not limited to inactive people. There is much to learn from tobacco control strategies to reduce the harms of inactivity. WHO introduced the MPOWER measures to assist in reducing smoking harms at the country level. MPOWER includes monitoring behaviour, protecting people from smoke, off ering treatment, warning of harms, enforcing the law, and raising the price. Applying MPOWER to