We have all heard that exercise if good for you. But a new study in JAMA goes one step further, finding that a sedentary lifestyle is worse for your health than smoking, diabetes and heart disease.

This was a retrospective cohort study that looked at patients at a tertiary care academic medical center from January 1, 1991, to December 31, 2014. The study population was 122,007 patients (mean age, 53.4 years; 59.2% male). Death occurred in 13 637 patients during 1.1 million person-years of observation.

Dr. Wael Jaber, a cardiologist at the Cleveland Clinic and senior author of the study, called the results "extremely surprising. Being unfit on a treadmill or in an exercise stress test has a worse prognosis, as far as death, than being hypertensive, being diabetic or being a current smoker. We've never seen something as pronounced as this and as objective as this."

• Being unfit should be considered as strong of a risk factor as hypertension, diabetes and smoking - if not stronger than all of them

• Being unfit should be treated as a disease

• The prescription for this disease is called exercise

• Comparing those with a sedentary lifestyle to the top exercise performers, the increase in risk associated with death is 500% higher

When compared with the lowest performers, elite performance was associated with an 80% reduction in mortality risk. In addition, the adjusted mortality risk of reduced performance was comparable to, if not significantly greater than, traditional clinical risk factors, such as CAD, diabetes, and smoking.

See article in JAMA, Oct 19, 2018