Brisk walking can reduce mortality in people who have been sedentary for decades

Nearly 70% of Spaniards who go to the doctor for health checkups don’t achieve the minimum recommended levels of physical activity – 150 minutes a week. They could easily go above and beyond that with just 25 minutes of vigorous exercise like brisk walking, dancing, playing tennis or doing aerobics. The mortality rate for active people is 30%-60% lower than for people who lead a sedentary lifestyle and exercise can often help to reduce the incidence of almost every disease. The benefits are obvious, and the accumulated evidence is enormous, but life sometimes gets in the way of doing the right thing for our health.

To accurately measure the benefits of prescribing exercise instead of medication, and to determine how much exercise is needed for an observable benefit, a team led by the Basque Health Service’s Biscay Primary Care Research Unit followed 3,357 sedentary patients from 11 Spanish primary care centers for 15 years. The results of their study, recently published in the British Journal of General Practice, show that the mortality of those who maintained the minimum recommended 150 minutes of weekly moderate activity (or 75 minutes of vigorous activity) was almost 50% lower than in sedentary people. In addition, 20% of the deaths in the study group would not have occurred if all sedentary patients had met the minimum recommended activity levels.

Even more significant was the study’s discovery that people who have been sedentary for 40 years can still benefit from physical activity. While the benefits are greatest when the recommended minimum activity levels are exceeded, even very small changes can be helpful. Just 50 minutes a week of moderate activity produced a 31% reduction in mortality.

“Our research followed the types of patients that a primary care physician encounters on a daily basis,” said Gonzalo Grandes, head of the Biscay Primary Care Research Unit and leader of the study. “Health professionals who see people with decades of inactivity, very poor physical fitness, obesity and chronic diseases like diabetes and osteoarthritis often question whether recommending a physical activity program is worthwhile, and whether patients can be motivated to actually undertake the program. The study shows that even patients with little time to exercise or who may doubt their own ability to make a change, can see positive results with very little additional activity.”

The next step for Grandes and his research team is to develop strategies for healthcare professionals to include physical activity as a component of their medical interventions. “We want to implement physical activity as standard therapy for people with chronic pathologies such as cardiovascular disease, cancer or diabetes,” said Grandes. “But making changes to clinical practices is slow and difficult. Some professionals don’t have the training to develop physical activity plans for patients, and community-level public health programs would have to be redesigned.”

Montserrat Romaguera is a family doctor who also specializes in sports medicine. She also recently published a book, Mi médico me manda a paseo (or, My doctor sends me on a walk), that stresses the importance of exercise for good health and wellbeing. Romaguera agrees that physician training is needed so they prioritize physical activity and are able to recommend appropriate levels of exercise. “Like drugs, not all patients should be given the same treatment dose for the same duration,” said Romaguera. She also believes that societal attitudes and circumstances influence a population’s physical activity levels.

“Children and adults are hooked on screens, and many people live in places where exercising is difficult,” said Romaguera. “In many European countries, people cycle to work. But in some places with heavy traffic, cycling on the streets can mean risking your life.” After Malta, Spain has the highest levels of childhood obesity in Europe. “The change must start in the schools. Right now, physical education is more oriented to sports than to educating children on the importance of lifelong exercise. We must also make it easier for young people to get outside and exercise, which means opening school playgrounds on weekends and creating more cycle lanes. We have to transform cities by considering our physical exercise needs, which is an investment in mental and physical health, as this study demonstrates.”

Isabel Egoecheaga, a member of the Spanish Society of General and Family Physicians, says studies like this one show that doctors need to stress the importance of exercise to patients. “We know that when health care professionals do something as simple as recommending a patient stop smoking, it can have a significant impact. The results of this study show that we should begin recommending more frequent exercise, even if it’s just a little and doesn’t meet the minimum recommended activity levels.” While primary care physicians have many time constraints, Egoecheaga says that unlike hospital doctors, they “see patients more often and can monitor and make an impact on their behavior.” They can also rely on nurses and other healthcare providers to help with patient education. “Exercise,” says Egoecheaga, “should be prescribed like medication, and personalized to each individual. A patient can benefit even if we only succeed in decreasing sedentary behavior a little.”