REVIEW ARTICLE

Physical Exercise and Health: A Review

B. Adamu FWACP, M. U. Sani FWACP, A. Abdu MWACP

Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria.

ABSTRACT
Background: Physical activity results in increased health in developed countries, most of the population in
exercise capacity and physical fitness, which may lead developing countries has not benefited equally leading
to many health benefits. Individuals who are more to a disparate burden of illness, disability, and
physically active appear to have lower rates of all-cause premature death2. Regrettably, these countries are ill
mortality, probably due to a decrease in chronic equipped to handle these diseases and their
diseases including coronary artery disease (CAD). This complications. Control of these diseases at the
may result from an improvement in cardiovascular risk community level through encouraging physical activity
factors in addition to enhanced fibrinolysis, improved can be a highly cost effective public health intervention3.
endothelial function, decreased sympathetic tone, and Physical exercise is a form of planned physical
other yet undetermined factors. activity with the goal of achieving or preserving physical
Methods: We reviewed the literature on physical fitness. Exercise training may be a more accurate term,
activity and health with particular reference to the since similar activity may be viewed as exercise by one
benefits derivable by engaging in regular physical 4
person and not by others . Physical exercise has been
activity. The MEDLINE/PUBMED and bibliographic recognized as having health benefits since the time of
searches for English language studies were used. Hippocrates 5. Conversely, few studies have shown that
Results: Physical inactivity is now considered a risk physical inactivity doubles health risks and adds a
factor for Cardiovascular diseases (CVD). Regular disease burden to society comparable with smoking6, as
exercise results in an increase in exercise capacity and well as obesity and hypertension7. This article reviews
lower myocardial oxygen demand leading to existing literature on the health benefits of physical
cardiovascular benefits, including lower mortality rates. exercise, and highlights some of its hazards.
Physically active individuals suffer from fewer ailments
than do less-active individuals. Physical activity The Concept of Physical Activity and Exercise.
reduces cardiovascular risk through lowering of blood The world health organization (WHO) defined
pressure, improved glucose tolerance, reduced obesity, physical activity in 1997 as “movements in everyday life,
improvement in lipid profile, enhanced fibrinolysis, including work, recreation, exercise, and sporting
improved endothelial function and enhanced activities" 8. Physical activity therefore includes ordinary
parasympathetic autonomic tone. daily activities, physical exercise, as well as sports.
Conclusion: Physical exercise has many health Physical exercise has been defined as an activity
benefits and the evidence for this continues to for the express purpose of improving fitness or health .
9

accumulate. Health care professionals should Physical exercise may be classified based on
incorporate counselling to patients for physical exercise mechanical and metabolic aspects of contraction.
in their daily clinical practice, while health policy makers Mechanical properties relate to whether limb movement
and community physicians should see to occurs and includes isometric contraction (muscle
implementation of this at the community level. tension without limb movement) and isotonic
contraction (limb movement without change in muscle
KEYWORDS: Physical exercise; Health; Benefits. tension). Metabolic properties of physical activity are
divided into two: Aerobic and anaerobic. In aerobic
Paper accepted for publication 24th February 2006. exercise, large groups of muscles are used
continuously with increased tissue demand for oxygen,
INTRODUCTION which is met through aerobic metabolism with increased
Non-communicable diseases are currently the cardiac output. This type of exercise (e.g. brisk walking,
leading causes of death worldwide accounting for about jogging swimming, etc) can be maintained for a long
60% of all deaths annually (66% of these in developing time. Anaerobic exercise on the other hand can only be
countries) and expected to rise to 73% by 20201. maintained for a few minutes (e.g. weight lifting,
Despite the advances in medicine over the past several sprinting), because it is heavy work utilizing few groups
decades, which have dramatically improved the public of muscle and metabolism is anaerobic10.
Correspondence to: Dr. B. Adamu
E-mail:[email protected]
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 Physical Exercise and Health: A Review - B. Adamu, M.U. Sani, A. Abdu

Health Benefits of Physical Exercise kilocalories per week. In the Nurses' Health Study18
Evidence supporting the health benefits of physical 73,029 women (aged 40 to 65 years) were followed for 4
exercise continues to accumulate at an accelerated years. Physical activity in women was inversely related
rate. In recognition of this, the World Health to the risk for stroke and CAD.
Organization dedicated the world health day 2002, to Physical exercise has benefits both in the
promoting physical exercise11. prevention and treatment of cardiovascular diseases.
All forms of physical activity are beneficial to health, Exercise improves lipid profile, glucose tolerance,
but for maximal health benefits, a minimum duration and obesity, insulin resistance and elevated blood pressure.
intensity is usually prescribed. The American College of However, modification of atherosclerotic risk factors
Sports Medicine (ACSM) and the Centre for Disease does not fully explain the benefits that have been
Control (CDC) and Prevention recommends that all observed. Other possible mechanisms including effects
adults should accumulate 30 minutes or more of on thrombosis, endothelial function, and autonomic
moderate-intensity physical activity on most, preferably tone may play an important role. Physical activity
12
all, days of the week . Table I summarises the current reduces the risk of developing coronary heart disease
19, 20
recognized health benefits of physical exercise but the and hypertension by half . Physical activity also
list is likely to continue growing. reduces the risk of stroke and is beneficial in
21
rehabilitation after stroke .
Better Quality of Life
Physical exercise has been shown to be associated Hypertension
with better quality of life generally. In a large study Studies have shown that regular physical exercise
involving 175,850 adults, regular exercise of > 90 prevents the development of hypertension. In the
minutes/ day was associated with better health related Harvard alumni study22 there was a 35% increased risk
quality of life than physical exercise of less than 20 for the development of hypertension in sedentary
minutes per day. This demonstrates a positive versus active individuals. This risk was more
13 23
relationship as well as dose related response . pronounced in obese subjects. Blair and colleagues in
another study found that compared with physically-fit
Improvement of Bodily Functions patients, those who were less fit had a relative risk of 1.5
Exercise has been shown to increase the duration for the development of hypertension. As a result of these
of slow-wave sleep and total sleep time, to decrease studies, the US Preventive Services Task Force
sleep onset latency and rapid eye movement (REM) believes that there is evidence to recommend regular
sleep in healthy individuals14. Physical exercise physical activity for the prevention of hypertension24.
enhances some aspects and suppresses other aspects In addition to preventing hypertension, regular
of immunity, but the biological significance of these exercise has also been found to lower blood pressure.
alterations in the immune system is still a subject of In mildly hypertensive men, short-term physical activity
15
investigation . Physical activity has also been shown to decreases blood pressure for 8 to 12 hours after
have positive effect on sexual function. In a study by exercise, and average blood pressure is lower on
Dahn et al, after controlling for age, medical co- exercise than on no exercise days25. In severely
morbidity, fatigue and urinary/bowel functioning, greater hypertensive black men, moderate physical activity
levels of physical activity were associated with better performed for 16 to 32 weeks results in a decrease in
sexual functioning among men treated for localized diastolic blood pressure, which is sustained even after
16
prostate cancer . reduction in antihypertensive medications. In addition, a
significant decrease in left ventricular hypertrophy
Cardiovascular disease (LVH) has been reported as early as 16 weeks after the
Many studies have demonstrated that regular initiation of exercise26. Physical exercise reduces
exercise and physical activity prevent primary and established hypertension (average 4.3 mmHg) and aids
secondary cardiac events. In one of the most well- in the rehabilitation of patients after myocardial
known studies, male Harvard alumni without a history of infarction19.
17
CVD were followed for 16 years . There was a 39%
reduction in cardiovascular morbidity and a 24% Diabetes mellitus
reduction in cardiovascular mortality in subjects with Physical activity has beneficial effects on both
exercise energy-expenditures of more than 2000 glucose metabolism and insulin sensitivity. These

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 Physical Exercise and Health: A Review - B. Adamu, M.U. Sani, A. Abdu

include increased sensitivity to insulin, decreased lipoproteincholesterol (HDL-C), and 5% increase in

production of glucose by the liver, larger numbers of HDL-C. The greatest changes in lipids were noted in
muscle cells that utilize more glucose than adipose those patients who also lost weight during their exercise
27
tissue, and reduced obesity . In addition physical program (total cholesterol decreased by 13.2 mg/dl,
exercise reduces the risk of development of type 2 LDL-C decreased by 11.1 mg/dl). When body weight
diabetes, and in those with the disease, has beneficial increased, lipid levels worsened. The mechanisms by
effects on the various components of the metabolic which exercise may improve the lipid profile remain
syndrome, such as obesity, hypertension, disturbance uncertain. Exercise-induced lipolytic enzyme activity
of lipid and glucose metabolism, and insulin resistance. that promotes the degradation of triglyceride-rich
28 35, 36
Lynch et al. found that men who participated in lipoproteins appears to be a factor .
moderate physical activity for at least 40 minutes a week Although the above studies suggest an
were at lower risk for developing NIDDM. This risk improvement in lipid profile with exercise training, the
reduction was even more pronounced in men at high effects are quite modest. These improvements may
risk for developing diabetes. Increased physical activity have a favourable effect on cardiovascular risk.
also reduces the risk of atherosclerosis16.
Glycaemic control can also be improved in type 1 Thrombosis
diabetics with regular, well-timed physical activity that Emerging evidence suggests that exercise training
has been adjusted according to insulin and nutritional favourably affects the fibrinolytic system. This may help
intake of patients. In addition, it has a beneficial effect on to explain the reduction in cardiac events observed in
the risk factors of coronary heart disease and on life those who are more physically active. Strenuous
expectancy. Care should however be taken to avoid endurance exercise for 6 months in healthy older
hypo or hyperglycaemia16. patients (aged 60 to 82 years) resulted in a significant
improvement in haemostatic parameters, with a
Obesity reduction in plasma fibrinogen levels of 13%, an
Obesity is now a global pandemic and poses increase in mean tissue-plasminogen activator (t-PA) of
multiple health risks29. Physical exercise has been 39%, an increase in active t-PA of 141%, and a reduction
shown to prevent weight gain in the general population, of plasminogenactivator inhibitor-1 (PAI-1) of 58%37. In
and is beneficial for weight loss in those with obesity. contrast, younger patients (aged 24 to 30 years), whose
However, more than the recommended 30 minutes per baseline fibrinolytic variables were lower than the older
day is required to achieve this (at least 60 minutes/day group, had no significant change in fibrinogen, t-PA, or
required) 30. PAI-1 activity. However, other studies have shown
Body composition and fat distribution are linked to favourable effects of fibrinolytic enzymes after exercise
cardiovascular mortality31and are favourably affected by training in younger subjects38 and in patients after MI39.
exercise. On average, exercise-training programs There is also evidence that acute and chronic
reduce body fat by approximately 1.6%32. Physically exercise affects platelet activation. Platelet activation is
active men and women have a more favourable waist- important in the pathophysiologic mechanisms of
hip ratio (WHR) (<0.9) than do sedentary individuals. unstable coronary syndromes and acute MI. Kestin et
These changes, although significant, are rather small (- 40
al. studied the effects of treadmill exercise on platelet
0.04) even after 1 year of both diet and exercise33. activation in sedentary and physically fit individuals.
After acute strenuous exercise of similar duration and
Lipid Profile intensity, platelet activation and hyperreactivity were
There is much variability in the results of increased in sedentary subjects but remained
exercise/lipid lowering studies, at least in part due to the unchanged in physically fit subjects. Rauramaa et al.
41

heterogeneity of the study methods, populations,

demonstrated that regular, moderate-intensity physical
exercise interventions, and the use of adjunctive
activity in middle-aged, overweight, mildly hypertensive
interventions such as diet or pharmacological lipid-
lowering agents. A meta-analysis of 95 studies34, most of men results in decreased platelet aggregation. After the
which were not randomized controlled trials, concluded 12-week exercise program, the study subjects
that exercise leads to a reduction of 6.3% in total demonstrated a 52% reduction in secondary platelet
cholesterol, 10.1% in low density lipoproteincholesterol aggregation compared with a 17% decrease for the
(LDL-C) and 13.4% in cholesterol/high-density control group. Thus, it appears that although acute

Nigerian Journal of Medicine, Vol. 15, No. 3, July - September 2006 192
 Physical Exercise and Health: A Review - B. Adamu, M.U. Sani, A. Abdu

exercise can lead to increased platelet activity

especially in sedentary individuals, regular exercise
may abolish or improve this response.

Other diseases
Evidence continues to accumulate on the beneficial
effects of physical exercise on many other diseases
such as malignancies (e.g. colon and breast cancer),
osteoporosis, osteoarthritis, asthma, chronic
obstructive airway disease, back pain, 16 mental
diseases and possibly many others to come. In general,
exercise is associated with decreased anxiety and
42
depression and increased sense of well-being .
Psychological benefits have also been found in cardiac
patients who are more physically active43.

Reduction of overall mortality

The observation that physically active individuals
suffer from fewer ailments than do less-active
4
individuals dates as far back as the 1500s, when Cogan
noted that compared with active individuals, sedentary
students were more likely to become ill. Data
accumulated over the past 50 years have confirmed the
health benefits of exercise. Epidemiologic studies have
shown that active individuals are at lower risk for
developing many chronic diseases12. In addition, all-
cause mortality rates are higher in less-active people
17, 44
than in those who are more active . Approximately
12% of deaths per year in the United States are
associated with inactivity45. The risk for all-cause
mortality decreases in inactive individuals who become
46
more physically active . Overall, physical exercise is
associated with a more than 40% reduction in age
47
adjusted all cause mortality . In a college alumni study
spanning 25 years, Paffenbarger et al demonstrated
that regular exercise during leisure time protects people Exercise Prescription
6
against death from any cause .
46 The CDC and ACSM have recommended that
Despite these teeming benefits of physical exercise every adult exercise for 30 minutes at moderate
to health, majority of people don't exercise. In 1995, the intensity levels on most, if not all, days to achieve a
51
U.S. Surgeon General reported that only 15% of weekly energy expenditure of 1400 calories. The AHA
Americans older than 18 years of age engaged in recommends a total exercise energy-expenditure of
regular vigorous activity, while 60% reported no regular 700 to 2000 calories per week. These statements stem
or sustained leisure time activity, and 27% reported no from evidence that regular moderate physical activity
leisure time activity at all 48. Adedeji reported lack of provides many health benefits. In addition, these
physical activity in 69% of Nigerians studied49. Doctors recommendations stress that physical activity can be
also share the blame, as physician counselling of accomplished in multiple short intervals, which may be
patients on exercise is low even in developed more feasible for many individuals, rather than
countries50. continuous 30-minute exercise sessions. Lower
intensity exercise should be performed more frequently

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 Physical Exercise and Health: A Review - B. Adamu, M.U. Sani, A. Abdu

and for longer durations. causes which conspire to render the life of man short
Previous recommendations emphasized the and miserable, none have greater influence than the
3
performance of moderate-to-high intensity endurance- wantof proper exercise” .
exercise (60% to 90% of maximum heart rate) for 20 to In conclusion, physical exercise has many health
60 minutes three or more times a week6. These benefits and the evidence for this continues to
endorsements were based on studies that revealed accumulate. Health care professionals should
dose-response improvements in functional capacity incorporate counseling to patients for physical exercise
with higher levels of training. The newer in their daily clinical practice, while health policy makers
recommendations are meant to complement and not and community physicians should see to
replace these previous statements, since it appears that implementation of this at the community level.
moderate intensity physical-activity can also provide
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