Not Working Out Could be Worse Than Smoking

by Jodi Helmer
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Not Working Out Could be Worse Than Smoking

You know smoking has serious side effects, including increased risk of heart attack and stroke, lung cancer and chronic bronchitis. However, the side effects of low levels of physical activity haven’t been investigated as fully until now. New research published in JAMA Network Open found the health consequences of skipping exercise could be just as serious.


Researcher Dr. Kyle Mandsager, cardiologist at the Cleveland Clinic, tracked stress test data from 122,000 patients over almost two decades. While he wasn’t surprised that greater aerobic fitness was associated with a lower risk of death during the study period, a second finding was more startling: Those with the lowest levels of physical fitness had an increased risk of death comparable to or greater than more traditional risk factors like smoking.

“While it may be a bit shocking to compare the risk of poor fitness with smoking, based on not just our study, but many years of scientific investigation, it really shouldn’t be,” Mandsager says. “Exercise has an incredibly positive impact on our health … It lowers blood pressure, improves cholesterol profiles, improves glucose metabolism and helps maintain a healthy weight [leading] to reductions in our risk of heart disease, stroke, diabetes, obesity, even cancer. What we have come to recognize is that the converse — being sedentary — has a profoundly negative impact on our health, likely involving the same complex pathways.”

Although the number of U.S. adults who smoke declined to 15.5% in 2016, more than 80% of adults do not meet the recommended guidelines for aerobic fitness and strength training.

Dr. Mary Ann Bauman, spokesperson for the American Heart Association, believes smoking and a lack of exercise have similar impacts on the heart: Both cause hardening of the arteries.


Researchers followed 8,425 middle-aged men between 1998–2007 and found the regular exercisers were less apt to have calcification (plaques) in their arteries; each increase in fitness level (from inactive to super active) was associated with an 11% decrease in the risk of heart events. The research was published in the journal Circulation. Additional research showed that up to 62% of smokers had coronary artery calcification.

“A sedentary lifestyle has been called the new smoking,” Bauman says.

While the American Heart Association encourages a minimum of 150 minutes of moderate intensity exercise weekly, or 75 minutes per week of vigorous exercise, Mandsager believes any amount of exercise is beneficial, but adds, “Achieving greater benefits will require more intense and more frequent activity.”

In light of recent studies that found associations between extreme exercise and cardiovascular events, the JAMA Network Open study looked at a group of athletes who fell into the top 2.5 percentile for physical activity in their age and gender to determine the impact of high levels of physical fitness.

Despite 2017 research showing that 68% of men with the highest activity levels had abnormal calcification scores (compared to 43% of men with the lowest activity levels), Mandsager found that extremely fit patients lived the longest, even after accounting for differences in baseline risk factors. In other words, the more fit patients were, the lower their risk of death.


Based on the findings, Mandsager believes the advice is simple: Get moving.

“Find an activity that you enjoy and maintain it,” he says. “Challenge yourself physically — it doesn’t have to be running a marathon; if that’s getting out and walking around the neighborhood on a regular basis, then do that. But if you enjoy pushing your body to its limits, do it.”

About the Author

Jodi Helmer

Jodi Helmer writes about health and wellness for publications like WebMD, AARP, Shape, Woman’s Day, Arthritis Today and Costco Connection among others. She often comes up with the best story ideas while hiking with her rescue dogs. You can read Jodi’s work or follow her on Twitter @helmerjodi.


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