Medicolegal neglect? the case for physical activity promotion and Exercise Medicine

Abstract

Medical science has shown that low cardiorespiratory fitness (resulting from sedentary behaviour) is one of, if not, the most important risk factors for all-cause mortality, 13 yet clinical practice, medical education and public health strategy continue to focus on all other risk factors except sedentary behaviour. Physical activity promotion is embedded within a large number of ever-increasing clinical guidelines with strong supporting evidence, both medical and cost-effective, delivering positive clinical messages and medicolegal responsibility to healthcare practitioners. Is it possible that there may be a time when a lawyer cross examines a doctor in the witness stand, asking why they did not address their sick or dead patients' physical inactivity, citing clinical guidelines, because it is known to be one of the highest modifiable risk factors for morbidity and mortality? Physical activity promotion is one of the first treatment recommendations in numerous clinical guidelines with a good reason and should no longer be medically neglected. Physical activity failings are institutionally embedded within our environment, medical practice, education and culture. The public are being let down on physical activity promotion, treatment choices (eg, Exercise Medicine), preventive medicine, the sedentary environment, corporate influences, a lack of physically active medical role models and failed by a lack of funding for physical activity and inactivity research. All resulting in between approximately 27-59 million 14 people in the UK alone, when measured subjectively and objectively, respectively, 15 literally sitting in a pre-disease or disease state caused by physical inactivity - probably the biggest silent killer of our times.