And What About Exercise? Fitness and Risk of Death in “Low-Risk” Adults

Leafing through this morning’s Sunday paper, I could not help but feel a sense of unease about our current state of preventive medicine. A lead article in the opinion section argued that most of the elements of the “annual physical exam” are “in many ways pointless or (worse) dangerous.”1 Routine electrocardiograms are of “no use.” Another essay attacked the government’s guidelines for dietary salt reduction, noting that the “eat-less-salt argument has been surprisingly controversial . . . Not because the food industry opposes it, but because the evidence to support it has always been so weak.”2 Yet another writer praised the mayor of New York City for his efforts to institute a ban on sugary beverages, a proposed ban that has run into much opposition.3 So controversy continues about salt, sugar, and the annual physical. And what about exercise? Just a few days before, a front-page news story had described a study finding that some people could be “harmed” by exercise.4 Among 1687 patients who were enrolled in 6 separate studies of rigorous exercise, approximately 10% saw worsening of measures traditionally thought to improve with exercise; these measures included blood pressure, high-density lipoprotein cholesterol, triglycerides, and fasting insulin levels.5 The news story included questions about current guidelines that call for at least 150 minutes of moderate-level exercise per week. The guidelines are based on “a weak form of evidence . . . that compared the health of people who exercised with that of people who did not.”4