Physical activity: From epidemiological evidence to individualized patient management

Background: Physical activity (PA), physical fitness (PF), and even a few sedentary behaviors (SB) are strongly and independently linked to improved survival rate. However, key questions remain: what are the physiological interrelationships between SB, PA, and PF? How should we differently emphasize promoting PA, increasing PF with exercise, and decreasing SB among other prevention measures? What are the interrelationships of both PA and SB levels with drug treatment efficacy? Methods: To address these questions we developed an integrated patient-centric model combining physiology with epidemiological evidence to characterize the individual risk attached to PA level, PF, and SB. Epidemiological data were collected by extensive literature review. Results: Nine meta-analyses, 198 cohort studies (3.8 million people), and 13 controlled trials were reviewed. 1. A high level of SB induces chronic stress and increases the risk of both chronic disease and mortality. 2. Vigorous PA increases PF and physiological reserve, thereby improving survival rate. This effect is not mediated by improved traditional risk factors. The risk for most individuals is a mix of high SB, low to mild PA, and low to mild PF. This model can improve the individualized prescription of PA modalities. Furthermore, the benefit of treatments such as statins or beta-blockers can be cancelled out if a decrease in PA or an increase in SB is induced by drug related side effects. Conclusions: To improve patient management both types of therapeutic interventions and dose should be carefully chosen for each individual in order to maintain/increase PA level while decreasing SB. (C) 2013 Elsevier Ireland Ltd. All rights reserved.