A Word to the Wide: Work Out or Conk Out
The price of doing nothing is high. The first study to tally the health care costs that result from inactivity estimates the national bill conservatively at $24.3 billion.
And all of those costs could be avoided if people who are inactive now did the minimum recommended by the federal government--30 minutes of moderate activity on most days of the week, said researcher Graham A. Colditz of Harvard-affiliated Brigham & Women’s Hospital in Boston.
“This group is the 28% of the population who report no leisure-time physical activity,” Colditz said. “They are presumably driving their car to the supermarket and back to their garage and maybe getting the groceries into the house--and presumably that’s the most exercise they get.”
Other studies have found that lack of exercise raises the risks of such conditions as high blood pressure, heart disease, stroke, diabetes, hip fractures resulting from osteoporosis, and cancers of the breast and colon.
Colditz searched the Medline online database for research that estimated the preventable costs of those diseases. He then computed the costs related to only a sedentary lifestyle.
The damage done by lack of exercise was huge. Inactivity accounted for 22% each of coronary heart disease, colon cancer and osteoporotic fractures, as well as 12% of diabetes, the study said.
“Approximately 2.4% of all health care costs in 1995 are due to or the result of lack of physical activity,” said the study in the American College of Sports Medicine journal, Medicine and Science in Sports and Exercise.
The analysis was based on health care costs in 1995, the year in which the federal Centers for Disease Control and Prevention estimated 28% of Americans do no exercise. The estimate is based on the CDC’s Behavioral Risk Factor Surveillance System survey.
And it could be higher, for a number of reasons.
State-level reports have indicated up to 48% of people do some activity, but not enough to get the health benefits, Colditz’ study said. If the state-level estimates of inactivity are used, “we estimate the costs of inactivity as $37.2 billion (3.7% of direct health care costs),” it said.
Also, other medical conditions that the study did not analyze could affect total cost, Colditz said. He said he wouldn’t be surprised if the real cost is twice the approximately $24 billion he best can substantiate.
But, if Americans took the exercise message to heart, and did even more than the federal minimums, the cost savings would be greater than $24 billion, Colditz said.
“The challenge I think we face is to find ways to get people to incorporate some exercise back into their daily lives,” Colditz said. “We have succeeded in designing a society that has removed the need for energy expenditure.”
On the other hand, society has made it a lot easier to consume energy: food is everywhere. Colditz’s earlier work examined the health care costs of obesity. That research prompted the American College of Sports Medicine to ask him to do a similar study on exercise, he said.
When he did the exercise project, he also updated his figures on obesity. Based on estimates that about 23% of Americans are obese, the health care costs of obesity are approximately $70 billion, or 7% of 1995 total health care costs, the study said. “The public health burden of inactivity and obesity is substantial,” it said.
Colditz, however, focuses on being more active as the best way to attack the problem. Activity burns calories, so people who exercise more also can lose weight. But people who only diet can’t get the independent health benefits of exercise, he said.
Colditz’s figures look right--and may be, as Colditz said, on the low side, said researcher Guijing Wang, who has been working on a similar project but with more recent numbers at CDC.
And the emphasize-activity approach may be the most effective, Wang said. CDC is encouraging programs to make communities more walking-friendly by such measures. It would like to see more sidewalks built, and it promotes having children walk to school instead of being driven.
Actually, the cost of prevention may be higher than the cost of care. Americans already spend a lot on exercise-related items. And, although the bills are scattered over a wide area, they could easily exceed $24 billion.
For instance, health clubs amount to a $10-billion industry, said John McCarthy, executive director of the International Health, Racquet & Sportsclub Assn. in Boston.
To that must be added the costs of shoes, clothing and equipment. A cursory look through the nation’s 1998 expenses for exercise-related items, from swimsuits to home exercise equipment, totaled $14 billion, according to the National Sporting Goods Assn. in Mt. Prospect, Ill.
However, even if the bill for prevention is higher than the cost of treatment, association spokesman Larry Weindruch considered it a good deal. “It’s a dollar better spent doing the activity to make my life healthier and more enjoyable than to fix something that’s broken,” he said.
