Despite conferring favorable long-term effects on well-being
and survival, exercise can acutely be associated with risk of adverse events, and the complex individual cardiovascular demands and adaptations
imposed by exercise pose distinct challenges to the physician asked
to evaluate athletes.
Physical inactivity furthermore is estimated as being the principal cause for
approximately 21–25% of breast and colon cancer burden, 27% of diabetes and
approximately 30% of ischaemic heart disease burden in addition, NCDs
now account for nearly half of the overall global burden of disease. Exercise
therefore is one of the most important modifiable risk factors for chronic
Exercise produces roughly similar benefits to drugs in the secondary
prevention of coronary heart disease, rehabilitation after stroke, treatment
of heart failure, and prevention of diabetes. In addition, exercise has recently
been shown to reduce the risk of dementia and improve mental health.
Furthermore, exercise was mentioned to only a sixth of patients with
diabetes or hypertension, despite these being conditions for which exercise
There is nothing miraculous about exercise. What is extraordinary is how
long it is taking mainstream medicine to accept the importance of physical
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