Until recently, many health professionals have advised that obesity and smoking are the most important risk factors for ill health and early death.

Things may be about to start changing, however. Recent newspaper articles have reported new research suggesting that physical inactivity causes twice as many deaths as obesity.

I thought I’d ask our Health and Wellbeing Director whether these newspaper reports were accurate – and what implications this may have for the advice provided by health professionals in the future.

Nick: So is it true that physical activity is far more important for long term health than anything else?

James: Yes, absolutely – in fact data suggests that it’s more important than obesity.

Nick: So, why has so much attention been given to obesity for so long?

James: That is a really good question, Nick… in fact the evidence for lack of fitness as being a major cause of a premature death is not new! Information from the Cooper Center Longitudinal Study, (CCLS) which has been in existence for 27 years, has already provided overwhelming scientific evidence that physical inactivity is well ahead of obesity as a cause of a premature death.

The accumulated evidence from the study shows that, if you are moderately fit, you can be overweight and still have a normal health profile in terms of, blood pressure, cholesterol levels and glucose tolerance.

Nick: So is the evidence saying that if you are “fat but fit” you can have a normal, healthy life and an average life expectancy?

James: Absolutely Nick – there is good evidence to show that people who are overweight and fit can out-live people who are slim, but unfit.

Nick: That’s great news – in fact I’m feeling a bit better already!

James: That is good Nick, but don’t get me wrong – there are still many health risks associated with being obese – particularly if you are morbidly obese. Having said that, I think people are too hung up and worried about being overweight – a bit of a stigma has developed here.

You can no longer assume that if someone you see or know is overweight that they are unfit and will develop diabetes or some other chronic disease – this is simply not true.

Nick: OK – so can we slow down and go back a bit?

James: Sorry Nick – of course we can – I tend to get a bit enthused about this topic.

Nick: Thanks – just now you mentioned that physical inactivity is well ahead of obesity as a cause of a premature death. This implies that there are other causes of a premature death….if physical activity is top of the league table, what are the other causes I should be aware of?

James: Yes, your assumption is correct and your analogy of a league table is a good one. The CCLS research included following 4000 people to their death.

The league table results for men may surprise you. In first place, as I mentioned, was low fitness caused by inactivity. Second was high blood pressure, followed by smoking, then high cholesterol, diabetes with obesity in sixth place.

The table positions were slightly different for women. Physical inactivity was still in first place, but smoking was second, followed in order by: high blood pressure, obesity, then diabetes, with high cholesterol in sixth place.

This data was published in the British Journal of Sorts Medicine in 2009; so, as I implied earlier, we have known about physical activity being a major cause of a premature death for some time. It just seems to be getting publicity, now which is good.

Nick: The premature death league tables are indeed surprising. You mentioned something else earlier – glucose tolerance – what is that?

James: People who have impaired glucose tolerance (IGT) have a higher than normal level of glucose in their blood, but not so high that you have diabetes. The good news is that, by achieving a moderate level of fitness, people can substantially reduce their risk of going on to developing full blown diabetes.

Nick: How much exercise do we have to do to significantly reduce our chances of becoming diabetic?

James: Recent articles in many national newspapers, including the Daily Mail and the Independent mention twenty minutes of moderate intensity exercise per day.

The evidence from the CCLS suggests that 30 minutes on five or more days of the week is the base line which will benefit you with a 50 percent reduction in the risk of an early death.

The 30 minutes can be split up – for example into 3 ten minute sessions – providing the sessions are at the right level or intensity.

Twenty minutes of exercise will still gain significant health benefits and is a good place to start.

Nick: Thanks, could I just ask you about the intensity and perhaps type of exercise we should be doing?

James: There are many forms of exercise that people can take part in. For those who have been inactive, a good place to start is with walking at a brisk pace.

The simple way of knowing if you are exercising at the right intensity is the “talk test”. If you are walking and are mildly breathless, but can still talk with little effort, then you’re probably doing moderate-intensity exercise. That is where you should aim to be.

If, however, you are walking or running and gasping for breath, and you feel your heart thumping and you can talk only with difficulty, then you are in the vigorous activity range.
People who are not used to exercise must avoid vigorous activity levels and gradually build up to moderate exercise levels. If you are not used to it, exercising at vigorous levels can be dangerous for you.

In any case, achieving a moderate level of fitness will achieve substantial health benefits. This only requires a moderate-intensity level of exercise on a regular basis.

Nick: As a specialist in this field, what is your take home message advice?

James: I think those providing advice in the public health arena should stop banging on about obesity. I am not convinced that it is working, or indeed will ever work.

We need to focus instead on becoming more active as a nation and as individuals. We certainly have to eat more vegetables and fruits, more whole grain breads and reduce our alcohol and fat intake.

The most important thing each of us can do, however, that will have a major impact on our health and longevity is to carry out 30 minutes of brisk walking at least five days per week.

Nick: Thanks, that’s really clear and informative advice. Where can I find more information?

James: The COPE web site!