For almost 200 years, people have associated high fitness levels with health, longevity, and beauty. Eugene Sandow, the father of bodybuilding, began proselytizing fitness in the second half of the Nineteenth Century. As part of the physical culture movement emanating from Germany in the mid-Nineteenth Century, he embraced exercise as a means to greater health and because it sought to emulate the Greek standard of beauty in the figures of Olympian gods. This tradition lived on in Arlene Pieper and Jack Lalanne one hundred years later in the United States, with an emphasis more on health than physical beauty emphasis. Arlene and Jack advocated for fitness as a way of life and a way to better mental performance. In the 1960s, Dr. Kenneth Cooper, MD, noticed cardiac rehabilitation patients at his clinic recovered more rapidly if they were active. Dr. Cooper became the father of aerobics, and exercise, rather than bed rest, was adopted as a standard part of the rehabilitation of cardiac patients. Research floodgates opened: the London Transport Workers Study, the Framingham Heart Study, and dozens, if not hundreds of cross-sectional, longitudinal, systematic reviews, and even randomized controlled trial studies have the same result: the more a person exercises, the more likely that person is to have a longer life free of morbidity. Exercise and its resulting fitness are associated with reduced rates of sarcopenia, osteoporosis, coronary heart disease, cancer, diabetes, depression, dementia, and some mental illnesses. And, yes, you look better, and your self-image improves.

Current research is investigating not if but how exercise increases longevity and lowers morbidity. But the mechanisms are as varied as the conditions attenuated. Strength training causes greater muscular strength and bone density in all age groups. This leads to many improvements in the functional health of people of all ages. Cardiovascular training significantly improves VO2Max, an important vital sign. Beyond this, multiple areas of metabolism are improved by regular, vigorous exercise. Telomeres regrow. Chromosomes replicate more accurately. Gut health improves—muscle mitochondrial density increases. Metabolic and hormonal function improve. Seemingly every possible physical and mental function is rejuvenated by vigorous exercise.

In this context, two recent research papers caught my eye. The first, published in iScience, is a large survey study of the relationship between weight loss, all-cause mortality, and various physical fitness modalities. It takes the unusual position of advocating for weight-neutral management of the health effects of obesity. Global obesity has continued unabated for almost three-quarters of a century despite efforts by both governments and individuals to stem it.  Instead, the article suggests focusing on the health outcomes of overweight and obese individuals. The article reviews a dozen peer-reviewed primary research on the effects of cardiovascular and strength training on all-cause mortality and cardiovascular (CVD) disease in lean, overweight, and obese individuals. The results show sharply reduced mortality rates and incidence of CVD in fit individuals largely independent of adipose tissue.


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The two figures to the left are published in Obesity treatment: Weight loss versus increasing fitness and physical activity for reducing health risks.

Figure 1 shows the impact of all-cause mortality of cardiorespiratory fitness (CRF) on normal-weight, overweight, and obese persons. Note that the association between obesity and all-cause mortality is weak, and the observed increases are well within statistical margins of error margins. However, fitness reduces all-cause mortality by over 50% across all weight groups. The data suggest that overweight and obese individuals can achieve much greater reductions in mortality by becoming fit.

 Figure 2 suggests that the risk of cardiovascular disease (CVD) in unfit individuals of normal weight is slightly more than 100% higher than in fit, normal individuals. The risk in unfit, obese individuals is greater than 300% in fit individuals of normal weight. This figure underscores two points. In unfit individuals, obesity possibly contributes to increased CVD mortality, though, once again, the increases are smaller than the margins of error. But the greatest reduction in CVD risk occurs when comparing fit and unfit individuals at any weight range. 

The study concludes that if the goal is to improve health outcomes of sedentary obese individuals, emphasizing fitness rather than trying to lose weight has the potential for greater success.

Unlike Big Tabacco, governments have essentially lost in their efforts to muzzle Big Food. The result is that we are flooded from cradle to grave with a continuous stream of marketing designed to both lie to us about the health effects of their products (1, 2) and to create addictions to those products (3). Consumers are confused by the cacophonous messaging about food, lifestyle, and exercise in an era when any individual or special interests can broadcast deception and lies over social media for no cost and no consequence. Thus, global obesity continues to grow and is unlikely to be checked.


All-cause mortality. Mortality rates (no. of deaths/100 person-years) for all-cause mortality in relation to activity level and blood pressure (BP) level. In the table below: No. of observations, and in parenthesis, no. of events is given.


Cardiovascular events. Event rates (no. of events/100 person-years) for cardiovascular events in relation to activity level and blood pressure (BP) level. Cardiovascular events are defined as admissions due to acute myocardial infarction, heart failure, stroke, or death of one of the causes. In the table below: No. of observations, and in parenthesis, no. of events is given.
The second study is primary research titled Dose-Response Association Between Level of Physical Activity and Mortality in Normal, Elevated, and High Blood Pressure