The relationship between physical activity and all-cause mortality, or death, is a striking one. Admittedly, I'm biased as a physical therapist in terms of pushing to get individuals more active. Typically I'm doing so to assist in relief of a painful or limiting condition and to improve the overall health of the individual. However, in review of the current evidence, it appears that increasing both intensity and duration of physical activity can also improve longevity and dodge death from a variety of causes.
There are a couple of ways that I think about this:
There is a relationship between the health conditions that are more likely to cause death and inactivity such that a more sedentary individual is many times more likely to have these conditions.
Despite the first point, it appears that increasing physical activity even after the diagnosis of these conditions leads to a mitigation in the risk of death as well as negative impact of the condition itself.
To illustrate this point, below is a graph of the causes of death in the year 2020 in the United States:
In previous posts, we have detailed the link between many of the listed causes of death and how exercise can prevent their existence. For example, in the case of cardiovascular diseases (heart disease and stroke), physical activity has been shown to lower blood pressure and improve cholesterol and triglyceride levels. In the case of type II diabetes, physical activity has been shown to improve glucose regulation and insulin sensitivity.
Even in the case of COVID-19, I believe this issue is relevant. As a virus, contracting the illness has more to do with exposure and the immune response than with long term unhealthy lifestyle. Obviously, having a greater level of health likely means you have a stronger immune system and are better equipped to fight off the virus without serious complications.
COVID-19 is an ongoing and increasingly political topic that has obviously negatively impacted daily life and society in a number of ways. There are also plenty of documented cases where COVID-19 unfortunately takes the life of an individual who was previously and otherwise in fantastic health. However, in the majority of cases where COVID-19 results in mortality we see other comorbid (meaning occuring alongside) conditions that ARE caused by a sedentary lifestyle.
Main takeaway? If we consider COVID-19 a pandemic, I believe we also may have a pandemic of heart disease and diabetes caused by a lack of exercise and healthy lifestyle.
Mok A, Khaw KT, Luben R, Wareham N, Brage S. Physical activity trajectories and mortality: population based cohort study. BMJ. 2019;365:l2323. Published 2019 Jun 26. doi:10.1136/bmj.l2323
Min, C., Yoo, D.M., Wee, J.H. et al. Mortality and cause of death in physical activity and insufficient physical activity participants: a longitudinal follow-up study using a national health screening cohort. BMC Public Health 20, 1469 (2020). https://doi.org/10.1186/s12889-020-09564-x
Sanchez-Lastra MA, Ding D, Dalene KE, Ekelund U, Tarp J. Physical Activity and Mortality Across Levels of Adiposity: A Prospective Cohort Study From the UK Biobank. Mayo Clin Proc. 2021;96(1):105-119. doi:10.1016/j.mayocp.2020.06.049
Wang Y, Nie J, Ferrari G, Rey-Lopez JP, Rezende LFM. Association of Physical Activity Intensity With Mortality: A National Cohort Study of 403 681 US Adults. JAMA Intern Med. 2021;181(2):203-211. doi:10.1001/jamainternmed.2020.6331
Millard LAC, Tilling K, Gaunt TR, Carslake D, Lawlor DA. Association of physical activity intensity and bout length with mortality: An observational study of 79,503 UK Biobank participants. PLoS Med. 2021;18(9):e1003757. Published 2021 Sep 15. doi:10.1371/journal.pmed.1003757
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