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Length of life and quality of health depend on a complex mix of factors of individual variable weighting. Genotype, lifestyle variables, country of residence and luck all have a role to play (1,2). An individual has little control over some of these factors. Others such as the lifestyle variables – obesity, diet, physical activity levels and smoking – have at least an element of personal choice and control (1–4). The aim of this perspective was to discuss one of these variables – physical activity – in relation to the health of men. Although the focus of this study is on men the messages on physical activity are relevant to both sexes across all ages.

Although for thousands of years it has been suggested that physical activity is beneficial to health, serious scientific research into the topic has only occurred over the last 60 years (5). During this period strong evidence has accumulated to verify that physical activity is indeed good for health. Regular physical activity reduces the risks of many diseases, improves longevity and improves function and quality of life (5,6). Indeed, Church and Blair (7) claim that the beneficial effects are so great that if it could be taken in pill form it would radically alter the world as we know it. It is with certainty that all health care professionals can recommend some form of physical activity to their patients.

Why should I exercise?

  1. Top of page
  2. Why should I exercise?
  3. How much physical activity should I do?
  4. What should I do?
  5. Is it too late?/Am I too old to start?
  6. What is the point I’ve never been able to lose weight or give up smoking?
  7. I’m too busy/I don’t have time
  8. Summary
  9. Disclosures
  10. References

Living a sedentary lifestyle is a risk factor for many chronic diseases and increases an individual’s chance of premature mortality (8–10). The link between increased physical activity and reduced risk of cardiovascular disease (CVD) is well established (5,6). Regular moderate to intense physical activity is associated with decreased risk of coronary heart disease, ischaemic and haemorrhagic stroke (11,12). The benefits of regular physical activity also extend to secondary prevention in patients with established CVD (6). In addition, a growing body of evidence suggests that increasing physical activity can also reduce risk of certain types of cancers, osteoporosis, type 2 diabetes, depression, obesity and hypertension (5,9,13). Rhodes et al. (14) note that regular physical exercise is presently considered to be beneficial in the primary and secondary prevention of about 25 conditions. Regular exercise and physical activity can also reduce or slow the deterioration associated with age related changes in many of the body’s systems (15).

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Evidence of the beneficial effects of physical activity in the primary prevention and management of cancer is growing (6,16). Cancer mortality has been found to be inversely related to physical activity levels (17,18). In addition to decreased mortality Orsini et al. (19) found that walking or cycling for at least an hour a day was associated with a 16% reduction in overall cancer incidence. For specific cancer sites the evidence is mixed. For colon cancer in both sexes, there is a strong relationship between increased physical activity and decreased incidence (20,21). Other cancers in men have yet to demonstrate such a clear relationship. Prostate cancer incidence seems to be less for those who are active at work, defined as not sitting for most of the day (22,23). The link with leisure time physical activity is less clear. The European Prospective Investigation into Cancer and Nutrition did not find a link between prostate cancer and leisure time physical activity (23). Orsini et al. (22), however, did find that walking or cycling for more than 30 mins a day was associated with decreased incidence. Also of note is that post diagnosis, physical activity can aid recovery and improve outcomes (16).

As men age, the risk of erectile dysfunction increases. There are many potential factors that can contribute to the problem. Amongst these a number of modifiable lifestyle variables have been identified. Physical inactivity and obesity are associated with increased risk of erectile dysfunction (24). Conversely being physically active is associated with decreased risk.

How much physical activity should I do?

  1. Top of page
  2. Why should I exercise?
  3. How much physical activity should I do?
  4. What should I do?
  5. Is it too late?/Am I too old to start?
  6. What is the point I’ve never been able to lose weight or give up smoking?
  7. I’m too busy/I don’t have time
  8. Summary
  9. Disclosures
  10. References

The American College of Sports Medicine and the American Heart Association have put out physical activity recommendations for healthy adults aged between 18 and 65 (25). The core recommendations are that individuals should aim for a minimum of 30 min on 5 days each week of moderate intensity aerobic exercise (brisk walking is an example). This can be substituted by vigorous intensity exercise for a minimum of 20 min 3 days each week (jogging is an example). A combination of moderate and vigorous exercise can be used to meet the guidelines. In addition, strength training 2 days a week using the major muscle groups with a load that allows 8–12 repetitions to volitional fatigue is also recommended. For healthy older adults the recommendations are essentially the same but the addition of balance and flexibility training should also be considered.

Frequently in the research literature when advising/assessing level of physical activity, 150 min/week of moderate intensity physical activity is used as a level to aim for. For both clinical and research purposes this is a useful guide as it is clear and easily remembered.

Although these guidelines give a benchmark, there is a strong dose response rate and doing more is associated with increased benefits (25). The Cancer Research Fund/American Institute for Cancer Research recommends at least 60 min a day of physical activity. Research findings indicate that the benefits of decreased risk of cancer are more evident at higher levels of physical activity (12,19).

It must be noted, however, that physical activity that does not reach the level of the guidelines is still beneficial (14,15). Bouts of appropriately intense activity of 10 min or more can also count towards daily quota (25). Although episodic accumulation has been shown to improve fitness to the same degree as a continuous session, it has not been firmly established whether equivalent health benefits are also gained (26).

What should I do?

  1. Top of page
  2. Why should I exercise?
  3. How much physical activity should I do?
  4. What should I do?
  5. Is it too late?/Am I too old to start?
  6. What is the point I’ve never been able to lose weight or give up smoking?
  7. I’m too busy/I don’t have time
  8. Summary
  9. Disclosures
  10. References

Walking, cycling, running, aerobic sports, land/water based aerobics classes, dancing, swimming, stair climbing, gym, gardening/yard work and other similar activities performed at an appropriate intensity all count towards physical activity. Which is most appropriate depends on an individual’s lifestyle, what is enjoyable to the individual and presence of other pathologies. An example of a pathology that might influence the type of advised physical activity could be OA. For a patient with severe knee OA, it may be better to recommend cycling/pool based exercise rather than jogging or high impact running sports (27). Other factors such as osteopenia should also be taken into account. Weight bearing impact exercise such as running based sports, high impact aerobics or walking with a weighted back pack are better for maintenance of bone density than swimming or cycling (28,29). If sarcopenia is a concern, the addition of a strengthening programme may be appropriate. Exercise prescription may also vary with age, an example being the addition of balance training exercises in older adults (7,12). Recommending increased physical activity is the first step, but for motivated individuals tailored programmes can be designed to best match individual needs (7). The current evidence base suggests that even in those with health problems, there should be some performance of exercise/physical activity (16,30).

Is it too late?/Am I too old to start?

  1. Top of page
  2. Why should I exercise?
  3. How much physical activity should I do?
  4. What should I do?
  5. Is it too late?/Am I too old to start?
  6. What is the point I’ve never been able to lose weight or give up smoking?
  7. I’m too busy/I don’t have time
  8. Summary
  9. Disclosures
  10. References

The scientific evidence suggests that those who are middle aged or elderly and physically active should continue to be so. Those who are not should increase their physical activity levels (12). Stessman et al. (31) found that continuing and indeed commencing physical activity once very old was associated with better survival and function. King et al. (32) found those in middle age who adopted a healthy lifestyle (five fruit and vegetables, exercise, healthy weight and no smoking) had statistically significant reduction in CVD and all cause mortality. Similarly, Yates et al. (1) found that smoking abstinence, weight management, blood pressure control and regular exercise were associated with extended lifespan, good health and improved function during older age. Byberg et al. (33) found that a cohort of 50-year-old men who increased their physical activity levels achieved a similar reduction in mortality to that of men who had always been physically active. It took 10 years, however, for the groups to reach parity. In addition to the benefits previously mentioned, there is growing evidence that physical activity helps to maintain cognitive performance and decreases the risk of dementia in the elderly (12).

What is the point I’ve never been able to lose weight or give up smoking?

  1. Top of page
  2. Why should I exercise?
  3. How much physical activity should I do?
  4. What should I do?
  5. Is it too late?/Am I too old to start?
  6. What is the point I’ve never been able to lose weight or give up smoking?
  7. I’m too busy/I don’t have time
  8. Summary
  9. Disclosures
  10. References

Ideally, to gain maximal health benefits, men should exercise, not smoke, eat a healthy diet and have a body mass index (BMI) of < 25 (3). The more of these healthy traits an individual has the less likely they are to develop a range of chronic disorders. It is obviously desirable for an individual to give up smoking and maintain a healthy weight range, but if they can not, they will still gain health benefits from increasing their physical activity (3,34–36). It is important to explain the health benefits of losing weight or giving up smoking, but if a patient can not, they should still be encouraged to be more physically active.

I’m too busy/I don’t have time

  1. Top of page
  2. Why should I exercise?
  3. How much physical activity should I do?
  4. What should I do?
  5. Is it too late?/Am I too old to start?
  6. What is the point I’ve never been able to lose weight or give up smoking?
  7. I’m too busy/I don’t have time
  8. Summary
  9. Disclosures
  10. References

Many people have very busy lives but given the health benefits, time should be found for regular physical activity. Ideally time should be set aside each day for exercise. If this is not possible then increased physical activity can be incorporated into other activities. More data are emerging on the impact of active commuting (walking/cycling). Current evidence from epidemiological studies indicate that active commuting is associated with decreased cardiovascular risk factors (37,38). Hamer and Chida (39) in their meta-analytical review found that active commuting decreased the risk of CVD but the effect was more robust amongst women than men. Given that blood pressure, BMI, insulin and triglyceride levels are all positively influenced, active commuting should be encouraged as a strategy for increasing physical activity (38).

Multiple small bursts of physical activity can also be useful. Parking further from destination and walking some of the way, taking stairs instead of the lift and doing more energetic housework/gardening are all ways that individuals can increase their physical activity levels in bursts without having to find lots of extra time. Although studies show that from a fitness perspective accumulated short bouts of physical activity have a similar effect as the same amount of time of continuous activity, the research has not been conducted to confirm that the health benefits are the same (26).

Summary

  1. Top of page
  2. Why should I exercise?
  3. How much physical activity should I do?
  4. What should I do?
  5. Is it too late?/Am I too old to start?
  6. What is the point I’ve never been able to lose weight or give up smoking?
  7. I’m too busy/I don’t have time
  8. Summary
  9. Disclosures
  10. References

Apart from not smoking, being physically active is the most powerful lifestyle choice an individual can make for improved health outcomes (7). Booth and Laye (40) note that long-term exercise and physical activity result in positive adaptations to almost every cell type, tissue and system in the body. The same authors make the point that this could also be viewed as, physical inactivity results in widespread pathophysiological changes (40). Perhaps our bodies have evolved to function optimally on a certain level of physical activity that many people just do not achieve in our modern day society? The results are witnessed by a broad range of health care professionals, across many different specialties and in many health care settings. Men and women of all ages who do not meet the minimal physical activity guidelines should be encouraged to be more physically active.

References

  1. Top of page
  2. Why should I exercise?
  3. How much physical activity should I do?
  4. What should I do?
  5. Is it too late?/Am I too old to start?
  6. What is the point I’ve never been able to lose weight or give up smoking?
  7. I’m too busy/I don’t have time
  8. Summary
  9. Disclosures
  10. References