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Is physical inactivity a risk factor for heart disease?

Yes. High blood pressure is important only to the degree to which it predisposes people to strokes, heart attacks, and other forms of cardiovascular disease. Several of the benefits of exercise relate to the prevention of heart disease rather than to the reduction of blood pressure. A good example of this comes from a study known as the Lipid Research Clinics Mortality Follow-up Study, which was designed to evaluate the role of cholesterol in causing heart disease, but also collected information about physical fitness, which was measured by having the subjects perform an exercise test.

Four thousand, two hundred and seventy six men were tested and were divided into four groups according to their level of fitness. The men in the fittest group tended to have lower blood pressures and lower cholesterol levels. Over the next eight and a half years the rate of death from cardiovascular disease was eight times higher in the least fit group than in the most fit.

There are also numerous studies which show that people who exercise regularly are at lower risk of developing coronary heart disease than those who do not.

A survey of 18,000 British civil servants who all had sedentary jobs found that those people who reported that they indulged in some form of physical exercise during the previous weekend had half the risk of having a heart attack over the next eight years in comparison with those who said that they had not exercised. Similar findings were reported in a study of Harvard alumni: those who exercised regularly were at lower risk than those who were sedentary. It's also clear that the exercise doesn't have to be leisure time activity. San Francisco longshoremen who had physically active jobs had half the risk of heart disease as compared to their colleagues whose jobs were sedentary.

The explanation for the beneficial effect of exercise is most probably its impact on the traditional risk factors for heart disease: it reduces obesity, hypertension, diabetes and blood cholesterol.