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Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy.
Lancet. 2012 Jul 21; 380(9838):219-29
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12 Sep 2012
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DOI: 10.3410/f.717954078.793459853
By estimating that 9% of premature mortality worldwide, amounting to more than 5.3 million deaths per year, is attributable to physical inactivity, Lee et al. starkly illustrate the global burden of this unhealthy behavior.
Nearly 60 years' worth of epidemiological studies has established that physical...Continue reading
Nearly 60 years' worth of epidemiological studies has established that physical...Continue reading
By estimating that 9% of premature mortality worldwide, amounting to more than 5.3 million deaths per year, is attributable to physical inactivity, Lee et al. starkly illustrate the global burden of this unhealthy behavior.
Nearly 60 years' worth of epidemiological studies has established that physical inactivity increases the risk of chronic disease. Nevertheless, much of the world’s population remains physically inactive, and physical inactivity seemingly receives less public attention than smoking and obesity as a cause of death and disability. In this study, Lee et al. show that the global health effects of physical inactivity are similar to those of tobacco smoking and obesity; all three factors cause approximately 5 million deaths per year and shorten life expectancy by roughly 0.7 to 2 years. Thus, in a commentary on Lee et al., Wen and Wu {1} argue that national and international programs to reduce physical inactivity, along with health insurance reimbursements and financial incentives for health-care providers to promote physical activity, are needed to escalate the battle against physical inactivity to the scale of the existing campaigns against tobacco smoking and obesity.
Using published data on the prevalence of physical inactivity in large cohorts and chronic disease cases, along with pooled relative risks for the association between physical inactivity and coronary heart disease, breast and colon cancers, and type 2 diabetes, Lee et al. estimated the population attributable fraction for each outcome and total mortality due to physical inactivity within countries and across international regions. They also used life-table analysis to estimate gains in life expectancy that could be expected if physical inactivity were eliminated or, more realistically, reduced by 10% or 25%. The results were striking, with 3.2% to 7.8% of the worldwide burden of coronary heart disease, 5.6% to 14.1% of breast cancer, 5.7% to 13.8% of colon cancer, 3.9% to 9.6% of type 2 diabetes, and 5.1% to 12.5% of premature mortality, along with a 0.68-year global decrease in life expectancy, being attributable to physical inactivity.
Limitations of this study include its reliance on self-reported physical activity levels in epidemiological cohorts, the use of a single relative risk (derived primarily from North American and European study populations) to estimate population attributable fractions for each outcome in all populations, the lack of consideration of different levels of physical inactivity, the use of an adjustment factor to estimate the prevalence of physical inactivity in cases, and the omission of many health outcomes related to physical inactivity. These limitations are counterbalanced by the sweeping international scope of the study, its estimation of effect measures that are of direct public health importance (i.e. absolute risks instead of relative risks), and its use of country-specific data on the prevalence of physical inactivity and age-specific mortality rates to produce findings that are relevant to all populations.
Of course, quantifying the global health impact of physical inactivity is only the first small step toward ameliorating its effects. Even if articles such as this are effective in informing health-care providers, policy makers, and individual citizens about the health burden due to physical inactivity, further research is clearly needed to develop effective ways to implement changes in behaviors, attitudes, and built environments to facilitate and promote physical activity. By shining a spotlight on physical inactivity as being equally as harmful to health as tobacco smoking and obesity, Lee et al. and the rest of the Lancet Physical Activity Series Working Group (which published a series of related articles in the same issue) are helping to make physical activity a worldwide public health priority.
Nearly 60 years' worth of epidemiological studies has established that physical inactivity increases the risk of chronic disease. Nevertheless, much of the world’s population remains physically inactive, and physical inactivity seemingly receives less public attention than smoking and obesity as a cause of death and disability. In this study, Lee et al. show that the global health effects of physical inactivity are similar to those of tobacco smoking and obesity; all three factors cause approximately 5 million deaths per year and shorten life expectancy by roughly 0.7 to 2 years. Thus, in a commentary on Lee et al., Wen and Wu {1} argue that national and international programs to reduce physical inactivity, along with health insurance reimbursements and financial incentives for health-care providers to promote physical activity, are needed to escalate the battle against physical inactivity to the scale of the existing campaigns against tobacco smoking and obesity.
Using published data on the prevalence of physical inactivity in large cohorts and chronic disease cases, along with pooled relative risks for the association between physical inactivity and coronary heart disease, breast and colon cancers, and type 2 diabetes, Lee et al. estimated the population attributable fraction for each outcome and total mortality due to physical inactivity within countries and across international regions. They also used life-table analysis to estimate gains in life expectancy that could be expected if physical inactivity were eliminated or, more realistically, reduced by 10% or 25%. The results were striking, with 3.2% to 7.8% of the worldwide burden of coronary heart disease, 5.6% to 14.1% of breast cancer, 5.7% to 13.8% of colon cancer, 3.9% to 9.6% of type 2 diabetes, and 5.1% to 12.5% of premature mortality, along with a 0.68-year global decrease in life expectancy, being attributable to physical inactivity.
Limitations of this study include its reliance on self-reported physical activity levels in epidemiological cohorts, the use of a single relative risk (derived primarily from North American and European study populations) to estimate population attributable fractions for each outcome in all populations, the lack of consideration of different levels of physical inactivity, the use of an adjustment factor to estimate the prevalence of physical inactivity in cases, and the omission of many health outcomes related to physical inactivity. These limitations are counterbalanced by the sweeping international scope of the study, its estimation of effect measures that are of direct public health importance (i.e. absolute risks instead of relative risks), and its use of country-specific data on the prevalence of physical inactivity and age-specific mortality rates to produce findings that are relevant to all populations.
Of course, quantifying the global health impact of physical inactivity is only the first small step toward ameliorating its effects. Even if articles such as this are effective in informing health-care providers, policy makers, and individual citizens about the health burden due to physical inactivity, further research is clearly needed to develop effective ways to implement changes in behaviors, attitudes, and built environments to facilitate and promote physical activity. By shining a spotlight on physical inactivity as being equally as harmful to health as tobacco smoking and obesity, Lee et al. and the rest of the Lancet Physical Activity Series Working Group (which published a series of related articles in the same issue) are helping to make physical activity a worldwide public health priority.
References
1.
Stressing harms of physical inactivity to promote exercise.
Lancet 2012 Jul 21; 380(9838):192-3
PMID: 22818933
DOI: 10.1016/S0140-6736(12)60954-4
Disclosures
None declared
Add Comment
Chang E: F1000Prime Recommendation of [Lee IM et al., Lancet 2012, 380(9838):219-29]. In F1000Prime, 12 Sep 2012; DOI: 10.3410/f.717954078.793459853. F1000Prime.com/717954078#eval793459853
F1000Prime Recommendations, Dissents and Comments for [Lee IM et al., Lancet 2012, 380(9838):219-29]. In F1000Prime, 25 May 2013; F1000Prime.com/717954078
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BACKGROUND: Strong evidence shows that physical inactivity increases the risk of many adverse health conditions, including major non-communicable diseases such as coronary heart disease, type 2 diabetes, and breast and colon cancers, and shortens life expectancy. Because much of the world's population is inactive, this link presents a major public health issue. We aimed to quantify the eff ect of physical inactivity on these major non-communicable diseases by estimating how much disease could be averted if inactive people were to become active and to estimate gain in life expectancy at the population level.
METHODS: For our analysis of burden of disease, we calculated population attributable fractions (PAFs) associated with physical inactivity using conservative assumptions for each of the major non-communicable diseases, by country, to estimate how much disease could be averted if physical inactivity were eliminated. We used life-table analysis to estimate gains in life expectancy of the population.
FINDINGS: Worldwide, we estimate that physical inactivity causes 6% (ranging from 3·2% in southeast Asia to 7·8% in the eastern Mediterranean region) of the burden of disease from coronary heart disease, 7% (3·9-9·6) of type 2 diabetes, 10% (5·6-14·1) of breast cancer, and 10% (5·7-13·8) of colon cancer. Inactivity causes 9% (range 5·1-12·5) of premature mortality, or more than 5·3 million of the 57 million deaths that occurred worldwide in 2008. If inactivity were not eliminated, but decreased instead by 10% or 25%, more than 533 000 and more than 1·3 million deaths, respectively, could be averted every year. We estimated that elimination of physical inactivity would increase the life expectancy of the world's population by 0·68 (range 0·41-0·95) years.
INTERPRETATION: Physical inactivity has a major health eff ect worldwide. Decrease in or removal of this unhealthy behaviour could improve health substantially.
FUNDING: None.
DOI: 10.1016/S0140-6736(12)61031-9
PMID: 22818936
