Sperling Prostate Center

Are You Out of Shape? It’s as Dangerous as Being a Smoker

UPDATE: 9/5/2023
Originally published 12/5/2018

How do you define a healthy lifestyle? At this moment, do you believe you are living a healthy life?

Experts recognize four key ingredients for wellbeing and longevity: healthy diet, healthy weight, exercise, and not smoking. The last two, being a couch potato and smoking, are roughly equivalent as far damage to your health, yet they differ in one respect.

The Heart Foundation says, “The difference between sitting and smoking is that society has outcast one of them, and completely expanded upon the other.”

Obviously, smoking is the outcast; between 2005 and 2021, rates dropped from 20 smokers per 100 people to 11 smokers per 100.

At the same time, lifestyles seem to be increasingly sedentary. If you sit in a chair all day for work, then come home and relax with TV or a book, it can harm you as much as if you’re a smoker.

After the news-making study described in the original blog below, a British population study of over 6400 people found that while neither smoking nor lack of activity is bad for you, the combination is especially dire: “Both smoking and low levels of physical activity were associated with increased risk of incident health problems over the 12-year follow-up period.

Current smokers with low levels of physical activity had especially high risks of developing fair/poor self-rated health, CHD, stroke, cancer and chronic lung disease compared with highly active never smokers.”

This is no fable, but it definitely has a moral. Quit smoking and get moving!


We all know that fitness is important. Why? A new study shows that people who are in shape live longer than those who are not. In fact, even if you never smoked in your life, if you are a couch potato you have about the same risk of early death as if you are a smoker!

A team of Cleveland Clinic researchers and physicians designed a study to verify the common-sense notion that people who are physically in good shape live longer than those who are not.[i] By “in good shape” they are referring to cardiorespiratory (heart-lung) fitness—meaning whatever aerobic activity you do, you are building the ability of your body to burn energy efficiently and last longer while doing it. The results show how aerobically fit a person is.

The researchers wanted an objective way to evaluate if cardiorespiratory fitness is indeed linked with longevity (living longer). They also wanted to know if it’s possible to be “too fit”—to exercise to the point of overusing your body and wrecking your health.

It’s interesting to note that this study did not focus on any particular type of exercise or aerobic routine. Instead, fitness was defined by performance on a treadmill stress test. (If you’ve never had one, it’s jogging on a treadmill that gradually increases the speed and incline, all the while being hooked up to a device that records what’s going on with your heart.)

The research team had stress test records for 122,007 consecutive patients, and access to their health/death records for up to 10 years after they completed the test (median follow-up 8.4 years). Based on their test results, the researchers divided them into fitness categories:

  • low (<25th percentile)
  • below average (25th-49th percentile)
  • above average (50th-74th percentile)
  • high (75th-97.6th percentile)
  • elite (?97.7th percentile or top 2%).

Death occurred in 13,637 persons. Not surprisingly, those who were in the lower fitness categories had higher rates of premature death, while those in the upper categories had longer lifespans. In fact, “The 2 percent of the people with elite fitness lived longer than those with high fitness and were about 80 percent less likely to die prematurely than the men and women with the lowest endurance.”[ii] These elite fitness buffs had the lowest risk-adjusted all-cause mortality compared with all other categories.

If there is any surprise to their findings, it’s this: “The increase in all-cause mortality associated with reduced cardiorespiratory fitness … was comparable to or greater than traditional clinical risk factors” including coronary artery disease, smoking, and diabetes.[iii] Let me put this another way: If you are a fitness slouch, you have about the same chance as a smoker of dying early—even if you never took a puff in your life. Therefore, according to one reporter who wrote an article on the study, “Being in shape may be as important to a long life as not smoking…”[iv]

Of course, there are many factors that influence longevity that this study did not consider. A person’s genetic makeup, their socioeconomic status, their access to healthcare, and an interest in being healthy were not included in the records.

One of the authors, Dr. Wael Jaber, sums up the value of the evidence for all of us. “We know from other research that you can increase fitness with exercise,” he says. “So I think we can say, based on this study and others, that it is a very good idea to exercise if you hope for a long and healthy life.”[v]

All of us at the Sperling Prostate Center encourage you (and all our patients and readers) to commit to vigorous aerobic exercise three times per week. Remember that what’s healthy for your heart is healthy for your prostate, too.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Mandsager K, Harb S, Cremer P et al. JAMA Netw Open. 2018;1(6):e183605.

[ii] Gretchen Reynolds. “Being Fit may be as Good for You as Not Smoking.” NY Times, Oct. 31, 2018. https://www.nytimes.com/2018/10/31/well/move/being-fit-may-be-as-good-for-you-as-not-smoking.html

[iii] Mandsager et al., ibid.

[iv] Reynolds, ibid.

[v] Ibid.

About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.

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