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Section Diabetes Prevention sub Heading Section Exercise is Medicine—The Importance of Physical Activity, Exercise Training, Cardiorespiratory Fitness, and Obesity in the Prevention and Treatment of Type 2 Diabetes Carl J Lavie, MD, 1 Neil Johannsen, PhD, 2 Damon Swift, PhD, 3 Martin Sénéchal, PhD, 4 Conrad Earnest, PhD, 5 Timothy Church, MD, MPH, PhD, 6 Adrian Hutber, PhD, 7 Robert Sallis, MD, PhD 8 and Steven N Blair, PED 1. Professor of Medicine, Medical Director, Cardiac Rehabilitation and Prevention Director, Stress Testing Laboratory, Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, and Department of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana, US; 2. Assistant Professor, School of Kinesiology, Louisiana State University and Department of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana, US; 3. Postdoctoral Researcher, Department of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana, US; 4. Postdoctoral Researcher, Manitoba Institute of Child Health, Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; 5. Professor, Department for Health, University of Bath, UK and Pennington Biomedical Research Center, Baton Rouge, Louisiana, US; 6. Pennington Biomedical Research Center, Baton Rouge, Louisiana, US; 7. Vice President, Exercise is Medicine, American College of Sports Medicine, Indianapolis, Indiana, US; 8. Department of Family Medicine, Fontana Medical Center, Kaiser Permanente, Southern California, California, US; 9. Professor, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, US Abstract Type 2 diabetes has reached epidemic proportions worldwide and is associated with increased risk for cardiovascular diseases and premature mortality. Diet and physical activity (PA)-based lifestyle interventions have been shown to prevent progression to type 2 diabetes in patients at high risk. Regular PA substantially reduces the risk for type 2 diabetes and a high level of PA is associated with a substantial reduction in type 2 diabetes risk. In addition, there is strong evidence suggesting a steep inverse relationship between both PA and cardiorespiratory fitness (CRF) and mortality in patients with type 2 diabetes. Of particular concern is the dramatic, steep increase in mortality among patients with low CRF. An important point is that obese individuals who are at least moderately fit have a lower mortality risk than those who are normal weight but unfit. A large body of evidence demonstrates that exercise improves glycemic control in type 2 diabetes; the greatest improvements are achieved with combined aerobic and resistance training. A primary goal ‘Find of and Replace’ strategies + is Shift promote PA and spaces with single out spaces least fit, high-risk cohort by increasing PA among the least active. Any plan to public health (Apple to + H) double move patients of the throughout Word global epidemic Convert 2 diabetes doc must to give text major attention to low PA and how this can be reversed in the general population. deal with the document. of type Word file before importing. n Keywords Fitness, mortality, physical activity, exercise, type 2 diabetes Disclosure: The authors have no conflicts of interest to declare. Received: March 21, 2013 Accepted: April 26, 2013 Citation: US Endocrinology, 2013;9(2):95–100 Correspondence: Carl J Lavie, MD, John Ochsner Heart and Vascular Institute, Ochsner Clinical School–The University of Queensland School of Medicine, 1514 Jefferson Hwy, New Orleans, LA 70121, US. E: clavie@ochsner.org Support: The publication of this article was supported by The Coca-Cola Company. The views and opinions expressed are those of the authors. Globally, type 2 diabetes has reached epidemic proportions and is associated with an increased risk for cardiovascular disease (CVD) and premature mortality. The total number of people with diabetes worldwide is projected to rise from 366 million in 2012 to 552 million in 2030. 1 In 2012, type 2 diabetes imposed direct and indirect costs of an estimated $245 billion in the US. 2 It is estimated that low levels of physical activity (PA) causes 7 % of the global burden of disease from type 2 diabetes, and that inactivity causes more deaths than smoking. 3 In addition to type 2 diabetes, low PA has been demonstrated to contribute to obesity, coronary heart disease (CHD)/myocardial infarction (MI), stroke, hypertension (HTN), dyslipidemia, osteoporosis, and cancer (colon, breast, and bowel). 4,5 As a result, sedentary lifestyles are one of the most significant public health problems of the 21st century. Low PA was directly © TO U CH MEDICAL MED IA 2013 responsible for 3  % of disability adjusted life–years in the UK in 2002. 6 Furthermore, it has been estimated that low cardiorespiratory fitness (CRF) was the cause of approximately 16  % of deaths in the Aerobics Center Longitudinal Study, which was more than the combined number of deaths due to smoking, obesity, and diabetes in this population. 7 Despite the known risks of low PA, there have been substantial declines in PA over the past decades. Over the last 50 years in the US, it has been estimated that daily occupation-related PA has decreased by more than 100 calories, 8 and household management PA has fallen by well over this amount. 9 In addition to the effects of PA on morbidity and mortality, there are clear economic reasons to improve PA: a US cohort study (8,000 health plan members and national population percentage estimates derived from the National Health Interview Survey) found that low PA, overweight, and obesity were associated with 23 % of health plan healthcare charges and 27 % of national healthcare charges. 10 95