The negative impact of smoking, obesity and diabetes on health has long been known and a lot of time, money and effort goes into trying to identify and treat these problems. What is perhaps not so well understood is that being physically inactive actually has a bigger impact on your health than the combination of all three of these problems. In simpler terms, it is better for you to have ‘Smokadiabesity’ (to smoke, be diabetic and obese) and be physically active than be an inactive, non-smoker, non-diabetic with a normal BMI. A related study has shown that it was better to be ‘fit and fat’ than ‘skinny and sedentary’. In this study, patients with an elevated BMI and had a good level of fitness had similar mortality rates to those with a normal BMI. Unfit individuals, however, had twice the risk of mortality regardless of their BMI. It is, however, important to notice that obesity does have other negative impacts on health - including a substantially increased rate of osteoarthritis.

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What constitutes physical activity is also not well understood. Most patients believe that they need to go to a gym or to go for a run to be active. This is simply not true. What we should be aiming for is between 150-300 minutes of activity each week. Any activity that makes you feel slightly puffed (for example walking upstairs, doing the vacuuming or walking briskly to work) is sufficient to meet these goals. The other good news is that the activity can be accumulated in small chunks throughout the day. Even small changes, like taking the first carpark you see rather than circling and looking for the closest one, have been demonstrated to have a tangible impact on health.

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Exercise and physical activity have overwhelmingly positive effects on health. Clinicians need to give careful thought about how they can get their patients to be more active and to think beyond ’go to the gym’. In terms of measuring and recording patients activity levels, we recently wrote an article about the Exercise Vital Sign (EVS) here which can serve as a useful measure of physical activity.

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If there was a pill that conveyed all of the health benefits associated with exercise we would all be taking it. Unlike most medications, it has very few sides effects (sweating would be the most common), does not require a formal prescription and can be safely used during pregnancy.