[Physical activity for decreasing cardiovascular mortality and total mortality. A public health perspective].

Forty years of epidemiological research have shown that physical activity as well as physical fitness are inversely related to cardiovascular and all-cause mortality in men and women. This association is likely to be causal. The moderate and most active or fit individuals experience mortality rates that are approximately one-third to one half lower than the rates among those least active or fit. Furthermore, moderate or high levels of physical activity or cardiorespiratory fitness seem to protect against the influence of other potential predictors on mortality. There appears to be a dose-response curve. The greatest benefit is registered when the least active become moderately active or fit. In western societies the prevalence of physical inactivity has been found to be as high as 40%. Exercise guidelines, as traditionally prescribed for disease prevention and improvement of aerobic capacity, unfortunately have failed to enhance the level of physical activity. Currently, exercise training is being extended to include broader physical activity. This new paradigm emphasizes the potential effectiveness of moderately intense activities of daily life (lifestyle activity) for achieving health benefit, and aims at improving levels of general energy expenditure throughout the day. This paper analyses the actual epidemiological evidence for these new recommendations and discusses approaches at different levels of physical activity intervention including individual, community, organisational, environmental and policy-level strategies to increase the activity levels of inactive population groups as well as across the population as a whole.