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Dynamic Chiropractic – August 26, 2008, Vol. 26, Issue 18

The High Cost of Inactivity

By Meridel I. Gatterman, MA, DC, MEd

The economic consequences of inactivity are substantial. There is a growing body of research quantifying physical inactivity as a serious and expensive public-health problem. The costs associated with physical inactivity are borne by taxpayers, employers and individuals.1 Chiropractors have an important role to play in the reduction of such cost by encouraging active lifestyles when counseling patients on health promotion and wellness.

Overall fitness, as well as reduced back pain, depends on regular exercise.

In the long run, physical inactivity threatens to reverse the decades of progress that followed President John F. Kennedy's call to improve the fitness of all Americans. This progress reduced morbidity and mortality associated with many chronic conditions including cardiovascular disease. A physically inactive population puts our society at risk both medically and financially. Medically, many chronic diseases can occur including heart disease, stroke, colon cancer, diabetes, obesity, osteoporosis and depression. Financially, the astronomical cost to society in terms of lost productivity and ever-increasing health care costs can be mitigated by decreasing sedentary lifestyles.2

One of the greatest economic drains on society can be impacted if chiropractic patients are encouraged to exercise regularly. Health care costs for preventive, diagnostic and treatment services related to chronic conditions can be dramatically reduced by a more physically active population. These costs include expenditures for physician visits, pharmaceuticals, ambulance services, rehabilitation services and hospital and nursing-home care.2 The economic cost from work loss and decreased productivity from disability also can decrease with a reduction in chronic diseases. There are other costs associated with the value of future earnings lost by premature death.2 The high cost of health care and the economic impact of lost productivity run into billions of dollars annually. Adoption of a population-wide physical activity strategy can produce cost savings among most adults.3

Reducing Health Care Costs and Increasing Productivity

Since regular physical activity helps prevent disease and promote health, it's reasonable to expect it will decrease health care costs. A 1996 study conducted by the Centers for Disease Control and Prevention found that physically active people had, on average, lower annual direct medical costs than inactive people. The study estimated that increasing regular, moderate physical activity among the more than 88 million inactive Americans over the age of 15 could reduce annual direct medical costs by as much as $76.6 billion in 2000.4

Workplace Costs of Physical Inactivity

It has been estimated that workplace physical activity programs can reduce short-term sick leave by 6-32 percent, reduce health care costs by 20-55 percent and increase productivity by 2-52 percent .4 Indirect costs include: training replacement workers, longer rehabilitation times and the cost of drug reactions. Indirect costs are estimated to be three times that of direct costs.5 Both employees and employers can benefit from wellness programs that include physical fitness, stress management, smoking cessation, prenatal care and nutrition.

Reducing the Cost of Medicare and Medicaid Programs

Reducing the cost of the Medicare and Medicaid programs alone can account for more than $84 billion annually for five major chronic conditions. This could be significantly decreased by increasing levels of physical fitness, specifically for heart disease, depression, cancer, arthritis and diabetes.2 Medicare spent $10.4 billion alone on diabetes in the year 2000. Medicare spending on heart disease grew from $21.1 billion in 1992 to $34.9 billion in 2000, with spending on depression growing from $1.3 billion to $2.5 billion during the same period. Annual costs for cancer more than doubled from 1992 to 2004. These estimates include only Medicare program payments for direct costs, not indirect costs that might be significant including copayments and deductibles.5

Diseases Impacted by Inactivity

Studies have shown virtually all individuals can benefit from regular physical activity, whether they participate in vigorous exercise or some type of moderate health-enhancing physical activity.6 Regular physical activity has been shown to reduce the morbidity and mortality from many chronic diseases. Millions of people suffer from chronic illnesses that can be prevented or improved through regular physical activity.

Inactivity Is a Major Risk Factor

Physical inactivity is a major risk factor for a number of diseases, including cardiovascular disease. It's estimated that more than 12.6 million people have coronary heart disease, with 1.1 million people suffering from heart attacks in a given year. It can be expected this number will dramatically reduce with physical activity.7

An epidemic of diabetes affected an estimated 20.8 million people in 2005, which represents 7 percent of the population.8 This is up from an estimated 17 million cases in 2002.8 Type 2 diabetes, associated with obesity and physical inactivity, makes up 90 to 95 percent of those with diabetes.8 In addition, approximately 16 million people in the U.S. are estimated to be pre-diabetic with impaired glucose tolerance. Moderate physical activity, such as walking 2.5 hours each week can significantly reduce the effects of diabetes.

Osteoporosis, the leading cause of more than 300,000 hip fractures annually, is partially linked to a sedentary lifestyle. Postmenopausal females are more susceptible, but one-third of osteoporotic hip fractures occur in men.9

Obesity also has reached epidemic proportions. Nearly 50 million adults (between the ages of 20 and 74), or 27 percent of the adult population, are obese. Overall more than 108 million adults, or 61 percent of the adult population, are either obese or overweight.2 Associated with obesity and inactivity is hypertension, with approximately 50 million people suffering from high blood pressure.7

Colon cancer also is linked to inactivity, with 107,000 Americans newly diagnosed with this condition each year.10 Mental illness affects approximately 20 percent of the U.S. population during a given year.11 Regular physical activity enhances psychological well-being and appears to reduce symptoms of depression and anxiety and improve mood.11

Regular physical activity:

  • reduces the risk of death from heart disease and other conditions;
  • reduces the risk of developing high blood pressure and reduces blood pressure in people with hypertension;
  • reduces the risk of developing colon and breast cancer;
  • helps maintain a healthy weight;
  • helps build and maintain healthy bones, muscles and joints;
  • helps older adults become stronger and more stable; and
  • promotes psychological well-being.

Despite these well-known benefits of physical activity, many adults and children lead relatively sedentary lifestyles, defined as engaging in no leisure-time physical activity (exercise, sports or physically active hobbies) in a two-week period.12

Call to Action

On average, people who are physically active outlive those who are sedentary.11 It's important that chiropractors increase the awareness of their patients to the health risks associated with inactivity. It's paramount all patients be encouraged to participate in moderate activity on a regular basis. Adults (18 years of age or older) should be engaged in a minimum moderate level of physical activity for 30 minutes five or more days per week.11

Physical activity is crucial to reducing health care costs. It's estimated that in Michigan alone, if one in 20 sedentary adults become physically active, it could result in a cost avoidance of approximately $575 million per year.5 Physical activity need not be strenuous, such as 30 minutes of walking five or more times a week. In addition, physical activity does not need to be sustained for long periods of time in order to provide health benefits. Repeated shorter bursts of moderately intense activity also yield health benefits, such as walking two 15-minute segments or three 10-minute segments regularly. Perhaps the most important factor in increasing physical activity is determining the right type of activity for each individual. The only good activity is one performed on a regular basis. Unless an activity is enjoyed for its intrinsic value, it will not be practiced on a regular basis.

Clearly, the goal of a more active population is a challenge, requiring a commitment to change on the part of individuals, families, workplaces and communities. To decrease ever-spiraling health care costs, both the public and private sectors need to band together to promote more healthy habits for those of all ages.13

As chiropractors, we can collaborate with organizations that promote healthy lifestyles. Some communities have an existing infrastructure that support physical activity, such as sidewalks, bicycle trails, and workplaces, schools and shopping areas in close proximity to residential areas. However, in many other areas, such community amenities need to be developed to foster exercise as a regular part of daily activity.

Work sites provide opportunities to reinforce the adoption and maintenance of healthy lifestyle behaviors. County and state public health departments can be a resource for chiropractors looking for programs to get patients moving. In order to help reduce health care costs, chiropractors need to commit to equipping their patients with the knowledge and skills to enjoy healthy, vigorous lifestyles.


  1. Garrett NA, Brazure M, Schnitz RH, et al. Inactivity: direct cost to a health plan. Am J Prev Med, 2004;27(4):314-9.
  2. U.S. Dept of Health and Human Services Public Health Service. Rockville, Md.: Office of the Surgeon General, 2001.
  3. Pratt M, Macera C, Wang G. Higher direct medical costs associated with physical inactivity. Phys Sports Med, 2000;28:63-70.
  4. U.S. Dept of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta: National Center for Chronic Disease Prevention and Health Promotion, 1996.
  5. DeJong G, Shepherd L, Lieber M, Chenoweth D. Executive Summary: The Economic Cost of Inactivity in Michigan. Michigan Fitness Foundation, 2003.
  6. Butler RN, Davis R, Lewis DB, et al. Physical fitness: benefits of exercise for the older patient. Geriatrics, 1998;53:46-62.
  7. American Heart Association 2002 Heart and Stroke Statistical Update, 2001.
  8. Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2005. General information and national estimates on diabetes in the United States, 2002.
  9. Meier C, Kraenzlin ME. Gonadal hormones and their influence in men. J Mens Health, 2007;4:181-91.
  10. American Cancer Society. Cancer Facts and Figures.
  11. Healthy People 2010: Understanding and Improving Health, November 2000.
  12. U.S. Dept of Health and Human Services, Dec. 14, 2007.
  13. U.S. Dept of Health and Human Services. The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. Rockville, Md.: Office of the Surgeon General, 2001.

Click here for previous articles by Meridel I. Gatterman, MA, DC, MEd.

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