Physical activity and the incidence of coronary heart disease

Our review focuses on all articles in the English language that provide sufficient data to calculate a relative risk or odds ratio for CHD at different levels of physical activity. The inverse association between physical activity and incidence of CHD is consistently observed, especially in the better designed studies; this association is appropriately sequenced, biologically graded, plausible, and coherent with existing knowledge. Therefore, the observations reported in the literature support the inference that physical activity is inversely and causally related to the incidence of CHD. The two most important observations in this review are, first, better studies have been more likely than poorer studies to report an inverse association between physical activity and the incidence of CHD and, second, the relative risk of inactivity appears to be similar in magnitude to that of hypertension, hypercholesterolemia, and smoking. These observations suggest that in CHD prevention programs, regular physical activity should be promoted as vigorously as blood pressure control, dietary modification to lower serum cholesterol, and smoking cessation. Given the large proportion of sedentary persons in the United States (91), the incidence of CHD attributable to insufficient physical activity is likely to be surprisingly large. Therefore, public policy that encourages regular physical activity should be pursued.