The goals of Healthy People 2020 include engaging adults in 30 minutes of moderate physical activity on most days of the week, and ensuring that health care professionals assess patients' physical activity and ways to make progress toward meeting physical activity guidelines. Further, the US Department of Health and Human Services' health promotion and disease prevention initiative, Healthy People 2020, has made the topic of physical activity a public health priority. First Lady Michelle Obama took aim at the epidemic of childhood obesity with the Let's Move! campaign. US Congress established the National Prevention, Health Promotion, and Public Health Council chaired by the Surgeon General and tasked with developing a national prevention strategy. 15 In 2010, the spotlight was on health promotion with two first-of-their-kind national initiatives.
In 2000 in the United States, national costs associated with physical inactvity topped $76 billion it is estimated that if 10% of adults began a regular walking program, a $5.6 billion cost savings would be realized. 14 In addition to the health benefits, the fiscal benefits are clear. Also, increased physical activity favorably impacts a range of cardiometabolic indices, including weight, blood pressure, glycemic parameters, blood lipids, inflammation, and psychoscial factors. 12,13 The effect of exercise on health outcomes appears to be dose-dependant. 11 Even modest incremental increases in physical actvity and exercise yields a measurable reduction in mortality. 6-10 Diminished levels of fitness as measured by exercise testing correlated with increased risk of mortality. Lack of regular exercise and excess sedentary behavior are clearly associated with cardiovascular risk and mortality in both men and women. Physical activity is one of the key lifestyle risk factors that warrants attention. Observational studies suggest that four out of in five myocardial infarctions may be prevented by adopting low-risk, health-related behaviors. However, although it is particularly challenging to get patients to change lifestyle behaviors, this action may be the most powerful and underutilized prescription. 4 Such identified cardiometabolic metrics are highly correlated and typically modifiable. 3 In the landmark INTERHEART (Effect of Potentially Modifiable Risk Factors Associated With Myocardial Infarction in 52 Countries) study that spanned 52 countries, nine risk factors (smoking, lipids, hypertension, diabetes, obesity, diet, alcohol consumption, physical activity, and psychosocial factors) accounted for >90% of risk for acute myocardial infarction in men and 94% of the risk in women. The American Heart Association, as part of its strategic goals for 2020 and beyond, has identified seven ideal health metrics: not smoking, a normal body mass index (BMI), physical activity, a healthy diet, normal cholesterol, normal blood pressure, and a normal fasting glucose level.
2 Given modern society's various challenges that limit the ease of adopting such behaviors, organized efforts infrastructurally and individually are required to reduce cardiovascular risk through such non-pharmacologic means. We continue to recognize that promoting beneficial health-related behaviors reduces cardiovascular risk. William Heberden cited an example of exercise being beneficial for cardiovascular disease without knowing the nature of the disease: "I knew one who set himself the task of sawing wood for half an hour each day and was nearly cured." 1 The importance of lifestyle factors and health behaviors to maintaining health has been recognized for centuries.