Relationship of Leisure-Time Physical Activity and Mortality
01 Jan 2017-
TL;DR: Leisure-time physical activity is associated with reduced mortality, even after genetic and other familial factors are taken into account.
Abstract: Urho M. Kujala, MD; Jaakko Kaprio, MD; Seppo Sarna, PhD; Markku Koskenvuo, MDContext.— Physical activity and fitness are believed to reduce premature mor-tality, but whether genetic factors modify this effect is not known.Objective.— To investigate leisure physical activity and mortality with respect tofamilial aggregation of health habits during childhood and factors that may enablesome individuals to achieve higher levels of fitness.Design.— Prospective twin cohort study.Setting.— Finland.Subjects.— In 1975, at baseline, 7925 healthy men and 7977 healthy women ofthe Finnish Twin Cohort aged 25 to 64 years who responded to a questionnaire onphysical activity habits and known predictors of mortality. Those who reported ex-ercising at least 6 times per month with an intensity corresponding to at least vig-orous walking for a mean duration of 30 minutes were classified as conditioningexercisers, those who reported no leisure physical activity were classified as sed-entary, and other subjects were classified as occasional exercisers.Main Outcome Measures.— All-cause mortality and discordant deaths amongsame-sex twin pairs from 1977 through 1994.Results.— Among the entire cohort, 1253 subjects died. The hazard ratio fordeath adjusted for age and sex was 0.71 (95% confidence interval [CI], 0.62-0.81)in occasional exercisers and 0.57 (95% CI, 0.45-0.74) in conditioning exercisers,comparedwiththosewhoweresedentary(Pfortrend ,.001).Amongthetwinpairswho were healthy at baseline and discordant for death (n=434), the odds ratio fordeath was 0.66 (95% CI, 0.46-0.94) in occasional exercisers and 0.44 (95% CI,0.23-0.83) in conditioning exercisers compared with those who were sedentary (Pfor trend, .005). The beneficial effect of physical activity remained after controllingfor other predictors of mortality.Conclusion.— Leisure-time physical activity is associated with reduced mortal-ity, even after genetic and other familial factors are taken into account.
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TL;DR: Well controlled studies are needed to clarify the mental health benefits of exercise among various populations and to address directly processes underlying the benefits of Exercise on mental health.
Abstract: Physical activity may play an important role in the management of mild-to-moderate mental health diseases, especially depression and anxiety. Although people with depression tend to be less physically active than non-depressed individuals, increased aerobic exercise or strength training has been shown to reduce depressive symptoms significantly. However, habitual physical activity has not been shown to prevent the onset of depression. Anxiety symptoms and panic disorder also improve with regular exercise, and beneficial effects appear to equal meditation or relaxation. In general, acute anxiety responds better to exercise than chronic anxiety. Studies of older adults and adolescents with depression or anxiety have been limited, but physical activity appears beneficial to these populations as well. Excessive physical activity may lead to overtraining and generate psychological symptoms that mimic depression. Several differing psychological and physiological mechanisms have been proposed to explain the effect of physical activity on mental health disorders. Well controlled studies are needed to clarify the mental health benefits of exercise among various populations and to address directly processes underlying the benefits of exercise on mental health.
1,652 citations
TL;DR: There is good consensus across studies with most showing an inverse dose-response gradient across both activity and fitness categories for morbidity from coronary heart disease, stroke, cardiovascular disease, or cancer; and for CVD, cancer, or all-cause mortality.
Abstract: BLAIR, S. N., Y. CHENG, and J. S. HOLDER. Is physical activity or physical fitness more important in defining health benefits? Med. Sci. Sports Exerc., Vol. 33, No. 6, Suppl., 2001, pp. S379 ‐S399. Purpose: We addressed three questions: 1) Is there a dose-response relation between physical activity and health? 2) Is there a dose-response relation between cardiorespiratory fitness and health? 3) If both activity and fitness have a dose-response relation to health, is it possible to determine which exposure is more important? Methods: We identified articles by PubMed search (restricted from 1/1/90 to 8/25/00) using keywords related to physical activity, physical fitness, and health. An author scanned titles and abstracts of 9831 identified articles. We included for thorough review articles that included three or more categories of activity or fitness and a health outcome and excluded articles on clinical trials, review papers, comments, letters, case reports, and nonhuman studies. We used an evidence-based approach to evaluate the quality of the published data. Results: We summarized results from 67 articles meeting final selection criteria. There is good consensus across studies with most showing an inverse dose-response gradient across both activity and fitness categories for morbidity from coronary heart disease (CHD), stroke, cardiovascular disease (CVD), or cancer; and for CVD, cancer, or all-cause mortality. Conclusions: All studies reviewed were prospective observational investigations; thus, conclusions are based on Evidence Category C. 1) There is a consistent gradient across activity groups indicating greater longevity and reduced risk of CHD, CVD, stroke, and colon cancer in more active individuals. 2) Studies are compelling in the consistency and steepness of the gradient across fitness groups. Most show a curvilinear gradient, with a steep slope at low levels of fitness and an asymptote in the upper part of the fitness distribution. 3) It is not possible to conclude whether activity or fitness is more important for health. Future studies should define more precisely the shape of the dose-response gradient across activity or fitness groups, evaluate the role of musculoskeletal fitness, and investigate additional health outcomes. Key Words: EPIDEMIOLOGY, MORTALITY, CARDIOVASCULAR DISEASE, CANCER, DIABETES, LONGITUDINAL STUDY
1,126 citations
TL;DR: In this article, the authors quantify the dose-response association between leisure time physical activity and mortality and define the upper limit of benefit or harm associated with increased levels of physical activity.
Abstract: Importance The 2008 Physical Activity Guidelines for Americans recommended a minimum of 75 vigorous-intensity or 150 moderate-intensity minutes per week (7.5 metabolic-equivalent hours per week) of aerobic activity for substantial health benefit and suggested additional benefits by doing more than double this amount. However, the upper limit of longevity benefit or possible harm with more physical activity is unclear. Objective To quantify the dose-response association between leisure time physical activity and mortality and define the upper limit of benefit or harm associated with increased levels of physical activity. Design, Setting, and Participants We pooled data from 6 studies in the National Cancer Institute Cohort Consortium (baseline 1992-2003). Population-based prospective cohorts in the United States and Europe with self-reported physical activity were analyzed in 2014. A total of 661 137 men and women (median age, 62 years; range, 21-98 years) and 116 686 deaths were included. We used Cox proportional hazards regression with cohort stratification to generate multivariable-adjusted hazard ratios (HRs) and 95% CIs. Median follow-up time was 14.2 years. Exposures Leisure time moderate- to vigorous-intensity physical activity. Main Outcomes and Measures The upper limit of mortality benefit from high levels of leisure time physical activity. Results Compared with individuals reporting no leisure time physical activity, we observed a 20% lower mortality risk among those performing less than the recommended minimum of 7.5 metabolic-equivalent hours per week (HR, 0.80 [95% CI, 0.78-0.82]), a 31% lower risk at 1 to 2 times the recommended minimum (HR, 0.69 [95% CI, 0.67-0.70]), and a 37% lower risk at 2 to 3 times the minimum (HR, 0.63 [95% CI, 0.62-0.65]). An upper threshold for mortality benefit occurred at 3 to 5 times the physical activity recommendation (HR, 0.61 [95% CI, 0.59-0.62]); however, compared with the recommended minimum, the additional benefit was modest (31% vs 39%). There was no evidence of harm at 10 or more times the recommended minimum (HR, 0.69 [95% CI, 0.59-0.78]). A similar dose-response relationship was observed for mortality due to cardiovascular disease and to cancer. Conclusions and Relevance Meeting the 2008 Physical Activity Guidelines for Americans minimum by either moderate- or vigorous-intensity activities was associated with nearly the maximum longevity benefit. We observed a benefit threshold at approximately 3 to 5 times the recommended leisure time physical activity minimum and no excess risk at 10 or more times the minimum. In regard to mortality, health care professionals should encourage inactive adults to perform leisure time physical activity and do not need to discourage adults who already participate in high-activity levels.
1,086 citations
Cites background from "Relationship of Leisure-Time Physic..."
...To fill the gap in scientific knowledge of the doseresponse relationship between LTPA and mortality, we aimed to quantify (1) the upper threshold for longevity benefit from LTPA and (2) mortality risks associated with very high levels of exercise....
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...Our findings on the shape of the physical activity–mortality doseresponse curve offer 3 unique and important contributions to inform health care professionals and future guidelines: (1) the currently recommended amounts of LTPA provide most of the longevity benefits, (2) the longevity benefit threshold appears to be approximately 3 to 5 times the recommended physical activity minimum, and (3) there does not appear to be an elevated mortality risk with LTPA levels as high as 10 or more times the recommended minimum....
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TL;DR: These prospective data indicate that brisk walking and vigorous exercise are associated with substantial and similar reductions in the incidence of coronary events among women.
Abstract: Background The role of walking, as compared with vigorous exercise, in the prevention of coronary heart disease remains controversial, and data for women on this topic are sparse. Methods We prospectively examined the associations between the score for total physical activity, walking, and vigorous exercise and the incidence of coronary events among 72,488 female nurses who were 40 to 65 years old in 1986. Participants were free of diagnosed cardiovascular disease or cancer at the time of entry and completed serial detailed questionnaires about physical activity. During eight years of follow-up, we documented 645 incident coronary events (nonfatal myocardial infarction or death from coronary disease). Results There was a strong, graded inverse association between physical activity and the risk of coronary events. As compared with women in the lowest quintile group for energy expenditure (expressed as the metabolic-equivalent [MET] score), women in increasing quintile groups had age-adjusted relative risks of 0.77, 0.65, 0.54, and 0.46 for coronary events (P for trend or =6 MET) was associated with similar risk reductions (30 to 40 percent). Sedentary women who became active in middle adulthood or later had a lower risk of coronary events than their counterparts who remained sedentary. Conclusions These prospective data indicate that brisk walking and vigorous exercise are associated with substantial and similar reductions in the incidence of coronary events among women.
988 citations
TL;DR: Results suggest that stimulating activity, either mentally or socially oriented, may protect against dementia, indicating that both social interaction and intellectual stimulation may be relevant to preserving mental functioning in the elderly.
Abstract: Recent findings suggest that a rich social network may decrease the risk of developing dementia. The authors hypothesized that such a protective effect may be due to social interaction and intellectual stimulation. To test this hypothesis, data from the 1987-1996 Kungsholmen Project, a longitudinal population-based study carried out in a central area of Stockholm, Sweden, were used to examine whether engagement in different activities 6.4 years before dementia diagnosis was related to a decreased incidence of dementia. Dementia cases were diagnosed by specialists according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria. After adjustment for age, sex, education, cognitive functioning, comorbidity, depressive symptoms, and physical functioning at the first examination, frequent (daily-weekly) engagement in mental, social, or productive activities was inversely related to dementia incidence. Adjusted relative risks for mental, social, and productive activities were 0.54 (95% confidence interval (CI): 0.34, 0.87), 0.58 (95% CI: 0.37, 0.91), and 0.58 (95% CI: 0.38, 0.91), respectively. Similar results were found when these three factors were analyzed together in the same model. Results suggest that stimulating activity, either mentally or socially oriented, may protect against dementia, indicating that both social interaction and intellectual stimulation may be relevant to preserving mental functioning in the elderly.
906 citations
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9,803 citations
TL;DR: Higher levels of physical fitness appear to delay all-cause mortality primarily due to lowered rates of cardiovascular disease and cancer, and lower mortality rates in higher fitness categories also were seen for cardiovascular Disease and cancer of combined sites.
Abstract: We studied physical fitness and risk of all-cause and cause-specific mortality in 10 224 men and 3120 women who were given a preventive medical examination. Physical fitness was measured by a maximal treadmill exercise test. Average follow-up was slightly more than 8 years, for a total of 110 482 person-years of observation. There were 240 deaths in men and 43 deaths in women. Age-adjusted all-cause mortality rates declined across physical fitness quintiles from 64.0 per 10 000 person-years in the least-fit men to 18.6 per 10 000 person-years in the most-fit men (slope, —4.5). Corresponding values for women were 39.5 per 10 000 person-years to 8.5 per 10 000 person-years (slope, —5.5). These trends remained after statistical adjustment for age, smoking habit, cholesterol level, systolic blood pressure, fasting blood glucose level, parental history of coronary heart disease, and follow-up interval. Lower mortality rates in higher fitness categories also were seen for cardiovascular disease and cancer of combined sites. Attributable risk estimates for all-cause mortality indicated that low physical fitness was an important risk factor in both men and women. Higher levels of physical fitness appear to delay all-cause mortality primarily due to lowered rates of cardiovascular disease and cancer. ( JAMA . 1989;262:2395-2401)
3,957 citations
TL;DR: The combination of frequency, intensity, and duration of exercise is found to be the most important factor in determining the intensity and quality of exercise a person receives.
Abstract: SUMMARYACSM Position Stand on The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Adults. Med. Sci. Sports Exerc., Vol. 30, No. 6, pp. 975-991, 1998. The combination of frequency, intensity, and duration of chr
3,095 citations
Journal Article•
TL;DR: Cardiovascular survey methods, Card cardiovascular survey methods , مرکز فناوری اطلاعات و اصاع رسانی, کδاوρزی
Abstract: Cardiovascular survey methods , Cardiovascular survey methods , مرکز فناوری اطلاعات و اطلاع رسانی کشاورزی
2,637 citations
TL;DR: Starting moderately vigorous sports activity, quitting cigarette smoking, maintaining normal blood pressure, and avoiding obesity were separately associated with lower rates of death from all causes and from coronary heart disease among middle-aged and older men.
Abstract: Background Recent trends toward increasing physical exercise, stopping cigarette smoking, and avoiding obesity may increase longevity. We analyzed changes in the lifestyles of Harvard College alumni and the associations of these changes with mortality. Methods Men who were 45 to 84 years of age in 1977 and who had reported no life-threatening disease on questionnaires completed in 1962 or 1966 and again in 1977 were classified according to changes in lifestyle characteristics between the first and second questionnaires. We analyzed changes in their level of physical activity, cigarette smoking, blood pressure, and body weight, and the relation of these factors to mortality between 1977 and 1985. Results Of the 10,269 men, 476 died during this period (which totaled 90,650 man-years of observation). Beginning moderately vigorous sports activity (at an intensity of 4.5 or more metabolic equivalents) was associated with a 23 percent lower risk of death (95 percent confidence interval, 4 to 42 percent; P = 0.0...
2,011 citations