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DOI:10.1016/S0140-

6736(11)61029-5

findings from a very large observational study, showing

that a small amount of leisure-time physical activity

reduces total mortality, mortality from cardiovascular

disease, and mortality from cancer. Although the ability

of physical activity in moderate amounts to reduce

the public-health recommendation in most countries

is to do the equivalent of at least 30 min per day of

Wen and colleagues’ study shows that half this amount

of physical activity (15 min per day for 6 days a week)

reduces all-cause mortality by 14%, cancer mortality by

10%, and mortality from cardiovascular disease by 20%.

To our knowledge, this is the first observational study of

this size to report important and global health benefits at

such a low volume of leisure-time physical activity with

this degree of precision. The benefits of physical activity

follow a dose-response curve (figure), which clearly shows

that although a little amount of physical activity is good,

more is better. In an ideal world, people would benefit

greatly from 300 min of moderate-intensity physical

activity per week, but data from most countries show

that this amount of physical activity is achieved by only

this reality is multifactorial and complex, and individual,

Repeated, simple advice from a physician—as Wen and

colleagues suggest—is one of many interventions that

We agree that this advice is very simple and probably

easily achievable.

Because of its observational nature, Wen and

colleagues’ study cannot establish causality, but their

results are entirely consistent with the findings of

prospective randomised trials in secondary cardiovascular

prevention that show a clear mortality benefit from

exercise are irrefutable. Exercise can reduce cardiovascular

mortality and, in particular, coronary mortality by many

mechanisms, including improvements in endothelial

function, autonomic tone, inflammation, and risk-factor

control. The final common pathways of cardiovascular

risk reduction presumably operate through both

improved endothelial function and improved autonomic

endothelial function leads to the prevention and

stabilisation of coronary atherosclerosis, thereby

Sedentary

Health benefits

100 200 300

Weekly physical activity (min)

400 500 600