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The Importance of Physical Activity

Every second year, the Australian Physiotherapy Association has a conference that highlights the latest research in every area of physiotherapy. In 2015, this conference was held on the Gold Coast and was called CONNECT 2015.


I read a wonderful summary of the opening speech, which I’ve copied here for you:

(InMotion magazine, December 2015, page 29)


Food for Thought

Connect 2015 officially commenced with a thought-provoking address from University of South Carolina’s Professor Steven Blair, who elaborated on the core focus of his 40-year research career – energy balance.

‘Many people often ask me: ‘what’s the best exercise?’ I have the perfect answer to that: it’s the one you will do. Or it’s the one that you can get your patients to do.’ 

Providing the opening keynote presentation at CONNECT 2015, Professor Steven Blair was quick to underline the preponderant role than an individual’s physical activity level has on their overall health.

‘Inactivity causes more deaths than smoking. That’s how big it is. And, in my opinion, a lot of the published data on the topic is an underestimate,’ he said. ‘It is a bigger health problem than diet is, that’s for sure. 

Expanding on this statement, Steven asserted that while he doesn’t ifnore an unhealthy diet as a risk factor, the health benefits gained from a quality physical lifestyle far outweigh those derived from a healthy diet.

‘It has been said by a number of US scientists that if you drink a bottle of coke, you have to walk three miles to burn off that energy. Well how far do you have to walk to burn off a banana? Or an apple? Or anything you eat?

‘It always astonishes me how many professors and researches overlook such a simple thing when they look at how much a person has to walk to burn off 150 calories. It does depend a little bit on your body size; body size is a big determinant of resting metabolic rate.’

Supporting his viewpoint by running delegates through some of the findings from his comprehensive research history, it was evident that Steven’s investigative focus on energy balance, intake and expenditure has heralded cardiorespiratory fitness as being the key physical characteristic encompassing health 

Drawing on his objective laboratory data, which includes large-scale studies focusing on cardiorespiratory fitness and mortality in both men and women, Steven focused on the low impact that an individual’s healthy eating index has on their health and mortality.

‘An unhealthy eating index doesn’t predict mortality risk on those who are considered ‘high fit’. Additionally, if you are ‘low fit’, a healthy eating index doesn’t appear to have a whole lot of advantage,’ he said.

In contrast, Steven was adamant that the benefits derived from a healthy physical lifestyle were tenfold.

‘If one can get out of the bottom 20 per cent – that is, the definition we have been using in our studies for ‘low fit’ – and get into the next 40 per cent of the distribution, there are just so many benefits.’



I looked into some of Professor Blair’s work and the results really are compelling. These are all very large studies with long-term follow up so their findings are quite powerful. Here are some snippets:


“… study published by Blair et al. (34), the mortality rate over a 5-year period was inversely related to the fitness level. In this study, subjects were stratified into five levels of fitness according to the maximal exercise test results. The greatest decline in the mortality rate was observed when individuals with very low fitness (level 1) were compared with those who exhibited modest levels of physical fitness (level 2). With such a modest increase in fitness, the risk ratio for death declined from 3.44 to 1.37 in men, and from 4.65 to 2.42 in women.” [i]


“Normal body mass index (BMI) is associated with lower mortality and may be achieved by physical activity (PA), healthy eating (HE), or both. We examined the association of PA and HE with mortality and incidence of heart failure (HF) among 2040 community-dwelling older adults aged ≥ 65 years with baseline BMI 18.5 to 24.99kg/m2 during 13 years of follow-up in the Cardiovascular Health Study.

Among community dwelling-older adults with normal BMI, physical activity regardless of healthy eating was associated with a lower risk of mortality and incident HF, but healthy eating had no similar protective association in this cohort.” [ii]


“We assessed the effects of the four newly defined American Heart Association (AHA) lifestyle factors on mortality by examining the association population attributable fractions (PAFs) of these factors.

Assuming a causal relationship between smoking, low fitness and mortality, avoidance of both would have prevented 13% of the deaths in the current population. Preventive interventions to increase physical activity and stop smoking would most likely promote longevity.” [iii]

Note that ‘population attributable fractions’ is the percentage of outcomes (i.e. death) that can be directly related to a specific risk factor (in this study they were smoking, low physical fitness, poor diet and high BMI)


“We studied physical fitness and risk of all-cause and cause-specific mortality in [men and women] who were given a preventive medical examination. Physical fitness was measured by a maximal treadmill exercise test. Average follow up was more than 8 years … Age-adjusted all cause mortality rates declined across physical fitness quintiles … Attributable risk estimates for all-cause mortality indicated that low physical fitness was an important risk factor in both men and women. Higher levels of physical fitness appear to delay all-cause mortality primarily due to lowered rates of cardiovascular disease and cancer.

The results presented herein show a strong and graded association between physical fitness and mortality due to all causes, cardiovascular disease, and cancer. The findings are consistent for men and women, and hold after adjustment for age, serum cholesterol level, blood pressure, smoking habit, fasting blood glucose level, family history of [chronic heart disease], and length of follow-up. Strengths of the study are a maximal exercise test, participants free of known chronic disease at baseline, wide range of physical fitness, objective end points (mortality), a large sample (13,344 men and women) with extensive follow-up experience … and a large enough sample of women to permit meaningful analyses. We believe that this is the only study of physical fitness and health that meets all these criteria.”[iv]


You can see that Professor Blair’s life’s work has been about researching the impact of physical fitness versus the impact of healthy eating on important outcomes like mortality, and there are consistent results in the very large groups that were studied making the evidence quite convincing.


[i] Hainer, Toplak & Stitch. 2009. Fat or Fit: What is more important? Diabetes Care. 32 (Suppl 2), S392-@397

[ii] Abdelmawgoud, Brown, Sui, Fonarow, Kokkinos, Bittner, Aronow, Kheirbek, Fletcher, Blair & Ahmed. 2015. Relationship of physical activity and health eating with mortality and incident heart failure among community-dwelling older adults with normal body mass index. ESC Heart Failure. 2 (1) p20-24

[iii] Sui, Li, Zhang, Chen, Zhu & Blair. 2013. Percentage of Deaths Attributable to Poor Cardiovascular Health Lifestyle Factors: Findings from the Aerobics Center Longitudinal Study. Epidemiology Research International. 2013 DOI: http://dx.doi.org/10.1155/2013/437465

[iv] Blair, Kohl, Paffenbarger, Clark, Cooper & Gibbons. 1989. Physical Fitness and All-Cause Mortality: A Prospective Study of Healthy Men and Women. JAMA. 262 (17), p2395-2401