Treating low back pain: Alexander technique and exercise, antibiotics (!) and Paul Hodges on dynamic stability.

I am delighted that major luminaries including Professors Frank Booth and Paul Hodges have agreed to share their wisdom in this issue of BJSM. Professor Booth’s millennium review, ‘‘Waging war on modern chronic diseases’’, is compulsory reading. It clearly trumps Machiavelli’s The Prince for top spot among the Great Literature; Macca never made it onto PubMed nor did he get cited 187 times for 1 paper in 8 short years. In his magnum opus, Professor Booth provides incontrovertible evidence that physical inactivity causes medical costs of $US 1 trillion (yes, trillion, that’s a thousand billion) annually in the USA alone. Don’t just skip over that number—it happens to equal the estimate for the projected deficit of the USA in 2009. So with just a 12.5% reduction in the cost of physical inactivity, President Obama could have it all paid off by the time he leaves the White House in 2016. Not bad. My point? If you are having trouble justifying the importance of physical activity to a patient, government representative, Dean or President/Vice Chancellor, just slap Professor Booth’s paper on the desk and remind the person that a trillion is 16 times the current population of the planet. Emphasise the annual. And this is in the USA alone. Time to commit to physical activity—the cure. For BJSM readers, Professor Booth examines the likely connection between physical activity as a fundamental environmental factor and the body’s necessary gene expression to improve metabolic health (see page 950). You can’t live without it – the body must receive aerobic exercise stimulus and muscle contraction stimulus to function normally. Professor Booth’s recent work shows that inactivity causes almost immediate (ie, within 24 hours) increases in key metabolic markers of disease such as insulin resistance. Activity is not an optional extra. He argues that national research agencies should support the search for the causal link between physical activity and the triple association of survival, athletic performance and prevention of most chronic diseases. Don’t watch TV, don’t check your email. Please read this article and also consider Witkowski and Spangenburg’s thoughtful take on it (see page 952). Share this piece around along with ‘‘Waging war...’’.