In a meta-analysis we investigated the effect of physical activity with different intensity categories on all-cause mortality. Many studies have reported positive effects of regular physical activity on primary prevention. This recent meta-analysis analyzed all-cause mortality with special reference to intensity categories. A computerized systematic literature search was performed in EMBASE, PUBMED, and MEDLINE data bases (1990–2006) for prospective cohort studies on physical leisure activity. Thirty-eight studies were identified and evaluated. The presentation refers to studies with 3 or 4 different intensities of regular physical activity according to a standard questionnaire. There was a significant association of lower all-cause mortality for active individuals compared with sedentary persons. For studies with three activity categories (mildly, moderately, and highly active) and multivariate-adjusted models, highly active men had a 22% lower risk of all-cause mortality (RR=0.78; 95% CI: 0.72 to 0.84) compared to mildly active men. For women, the relative risk was 0.69 (95% CI: 0.53 to 0.90). We observed similar results in moderately active persons compared to mildly active individuals (RR=0.81 for men and RR=0.76 for women). This association of activity to all-cause mortality was similar and significant in older subjects. Regular physical activity over longer time is strongly associated with a reduction in all-cause mortality in active subjects compared to sedentary persons. There is a dose-response curve especially from sedentary subjects to those with mild and moderate exercise with only a minor additional reduction with further increase in activity level.

Zahlreiche Studien haben negative Folgen von Bewegungsmangel und sitzender Tätigkeit auf Morbidität und Mortalität ergeben. Regelmäßige körperliche Aktivität hat dagegen eindeutig positive Auswirkungen. Inzwischen hat körperliches Training Eingang in die klinische Medizin gefunden und wird heute in vielen Disziplinen als Therapie und Therapieergänzung eingesetzt. Der vorliegende Beitrag basiert auf einer Literaturrecherche, Meta-Analysen und aktuellen Übersichtsarbeiten. Beschrieben wird die Bedeutung und Evidenz des körperlichen Trainings bei Herz-, Gefäß- und Lungenerkrankungen, bei Diabetes mellitus, Nierenkrankheiten und Tumorleiden. Körperliche Aktivität spielt für die Primärprävention und Therapie eine bedeutende Rolle. Die Evidenz wird in den meisten klinische Fächern und Krankheiten als hochgradig eingestuft. Körperliches Training wird in der Therapie, im Verlauf und in der Rehabilitation verschiedener Krankheiten mittlerweile wie ein hochwirksames Medikament eingesetzt. Es besteht eine nicht-lineare Dosis-Wirkungsbeziehung, psychologische Aspekte spielen eine Rolle, Nebenwirkungen sind zu beachten. Für das körperliche Training bieten sich detaillierte, allgemeine und krankheitsbezogene Trainingsempfehlungen an. Diese beinhalten die Trainingsart, -dauer, -häufigkeit, -intensität und -steigerung. A sedentary lifestyle has been shown to have negative effects on morbidity and mortality. In contrast, a large number of prospective cohort studies on the effects of regular physical activity demonstrated positive effects. Therefore, physical training is today an essential part of prevention and therapy in internal medicine. This review is based on literature research in meta-analysis and review papers. Regular physical exercise or training is a significant and evidence-based part of prevention and therapy of diseases such as heart, cardiovascular and lung diseases, diabetes mellitus, renal disease and cancer. Evidence of training effects is mostly high grade. Physical activity or exercise training is indicated in many diseases as medicine – similar as a drug. It is applied after acute treatment as a component of the standard drug therapy. There is a non-linear dose-response effect, psychological aspects and some side-effects need to be considered. In conclusion, physical exercise acts as a highly efficient drug, and should be used in many diseases. Training recommendations refer to the kind, the duration, the intensity, the frequency and the increase of training.

The aim of this overview was to recommend individual training plans using exercise prescriptions for adults and older adults during home-based rehabilitation. Over the last decade, many regular physical activity studies with large prospective cohorts have been conducted. Taken together, more than a million subjects have been included in these exercise studies. The risk of morbidity and mortality has been reduced by 30% to 40% as a result of exercise. These risk reductions hold true for many diseases, as well as for prevention and rehabilitation. Physical activity has also been in the treatment of many diseases, such as cardiopulmonary, metabolic or neurologic/psychiatric diseases, all with positive results. Based on these results, the prescription of exercise was developed and is now known as the exercise prescription for health in many European countries. Details have been published by the European Federation of Sports Medicine Associations (EFSMA). The exercise prescription is strongly recommended for inpatients, discharged patients and outpatients who have recovered from severe diseases. Rehabilitation improves general health, physical fitness, quality of life and may increase longevity of life.

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