The "weekend warrior" and risk of mortality

Physical activity improves health, and current recommendations encourage daily exercise. However, little is known about any health benefits associated with infrequent bouts of exercise (e.g., 1-2 episodes/week) that generate the recommended energy expenditure. The authors conducted a prospective cohort study among 8,421 men (mean age, 66 years) in the Harvard Alumni Health Study, without major chronic diseases, who provided details about physical activity on mailed questionnaires in 1988 and 1993. Men were classified as "sedentary" (expending <500 kcal/week), "insufficiently active" (500-999 kcal/week), "weekend warriors" (>/=1,000 kcal/week from sports/recreation 1-2 times/week), or "regularly active" (all others expending >/=1,000 kcal/week). Between 1988 and 1997, 1,234 men died. The multivariate relative risks for mortality among the sedentary, insufficiently active, weekend warriors, and regularly active men were 1.00 (referent), 0.75 (95% confidence interval (CI): 0.62, 0.91), 0.85 (95% CI: 0.65, 1.11), and 0.64 (95% CI: 0.55, 0.73), respectively. In stratified analysis, among men without major risk factors, weekend warriors had a lower risk of dying, compared with sedentary men (relative risk = 0.41, 95% CI: 0.21, 0.81). This was not seen among men with at least one major risk factor (corresponding relative risk = 1.02, 95% CI: 0.75, 1.38). These results suggest that regular physical activity generating 1,000 kcal/week or more should be recommended for lowering mortality rates. However, among those with no major risk factors, even 1-2 episodes/week generating 1,000 kcal/week or more can postpone mortality.     

Environmental perceptions and walking in English adults

STUDY OBJECTIVE: To examine the relation between adults' perceptions of the social and physical environment and their self reported walking behaviour. DESIGN: Cross sectional survey. SETTING: England. PARTICIPANTS: A national sample of 4265 adults aged 16-74 years. MAIN OUTCOME MEASURES: Self reported walking behaviour was categorised into two dichotomous variables: (a) any reported walking in past four weeks, (b) reported walking > or =150 minutes per week in the past four weeks. Perceptions of the social environment covered safety of walking alone and social support for walking. Perceptions of the physical environment covered attractiveness of local area for walking, access to shops, leisure centres, parks, cycle paths, and traffic density. MAIN RESULTS: In women, perceived safety of walking during the day (OR = 0.53; 95% CI: 0.31 to 0.88), and no shop within walking distance (OR = 0.72; 95% CI: 0.52 to 0.99) were associated with any reported walking occasions. Perceptions of the environment were not related to women walking > or =150 min/week. In men, having a park within walking distance was associated with walking > or =150 min/week (OR = 2.22; 95% CI: 1.18 to 4.35). No other significant associations were found. CONCLUSIONS: Women seem to be more concerned about walking for utility and in safety. Men are more likely to walk > or =150 min/week if they have access to a local park but their walking is not influenced by concerns about safety. Future research should focus on the relation between objective measures rather than perceptions of the environment and physical activity.     

Impact of walking upon medical care expenditure in Japan: the Ohsaki Cohort Study

BACKGROUND: Physical activity is expected to reduce medical costs by lowering the risk for a variety of chronic diseases. However, little is known about the actual magnitude of medical cost saved by physical activity. We attempted to quantify the association between time spent walking and medical care costs, based on a 4-year prospective observation of National Health Insurance (NHI) beneficiaries in rural Japan. METHODS: In 27 431 Japanese men and women, aged 40-79 years, who had no functional limitation or conditions interfering with physical activity at the baseline survey in 1994, we ascertained all hospitalizations, outpatient visits, and the costs through computerized linkage with NHI claims history files between January 1995 and December 1998. RESULTS: Medical costs significantly reduced with longer time spent walking. Per capita medical cost was pound 111.80 per month (95% CI: 109.3, 114.2) in those who walked for < or =30 minutes/day, pound 108.10 (95% CI: 105.7, 110.5) in those who walked for 30 minutes-1 hour, and pound 97.30 (95% CI: 95.5, 99.0) in those who walked for > or =1 hour, after multivariate adjustment of potential confounders. CONCLUSIONS: This prospective study in Japan indicated that time spent walking was significantly associated with lower medical costs.     

Benefits of leisure-time physical activity on the cardiovascular risk profile at older age.

BACKGROUND: Intensity, frequency and duration of physical activity may contribute in different ways to the maintenance of cardiovascular health. Their relative importance may also change at different stages in life and this should be taken into account for activity recommendations. METHODS: The relationship of frequency and duration of leisure-time physical activities with cardiovascular risk factors was studied in 4942 male and 5885 female participants aged 50-69, of the German Cardiovascular Prevention Study (1984-1991). RESULTS: After adjustment for several possible confounders, women with modest levels (2-12 times per month, 0.5-2 h per week) of moderate-to-vigorous activity (> or =5 kcal/kg/h) had significantly lower systolic blood pressure (-1.8%), resting heart rate (-3.1%) and body mass index (-3.2%) values than sedentary women. Beneficial differences increased with frequency and duration of activity. Light activities (3-4.5 kcal/kg/h), conducted > or =5 times a week, were significantly associated with favourable lower diastolic blood pressure (-1.4%), resting heart rate (-2.3%) among women, and body mass index (women -2.9%, men -2.2%) among both genders. Recommended activity levels (> or =5 times, > or =3.5 h weekly) were associated with a lower prevalence of multiple risk factors (odds ratio [OR] = 0.55, 95% CI: 0.41-0.75 for men and OR = 0.44 95% CI: 0.31-0.63 for women). CONCLUSIONS: For sedentary elderly, even less physical activity than currently recommended, is likely to improve the cardiovascular risk profile.     

Physical activity and cardiovascular risk: a cross-sectional study of middle-aged premenopausal women

The relationship between self-reported physical activity and cardiovascular risk factors was evaluated in a population-based sample. The sample included 541 premenopausal women recruited for a study of the natural history of risk factor change associated with change in sex hormone status. Physical activity was assessed using the Paffenbarger Activity Questionnaire. Women were classified according to quartile of weekly energy expenditure into groups of 0-500, 501-999, 1,000-1,999, and 2,000 kcal or greater. Results showed that the more active the women, the lower their blood pressure and heart rate. More active women had lower cholesterol and triglycerides, and higher high-density lipoprotein (HDL) cholesterol. Tricep and suprailiac skinfolds, fasting insulin, and insulin/glucose levels were also lower among the more active women. When the analysis was repeated controlling for the effect of education and body mass index, the statistical test for linear trend remained significant except for the trend for heart rate, total cholesterol, and triglycerides. Women reporting activity of 1,000 kcal/week had higher high-density lipoprotein cholesterol and lower diastolic blood pressure, body mass index, skinfolds, fasting insulin, and fasting insulin/glucose ratios compared with women reporting lower levels of activity. Only those women who reported 2,000 kcal/week had significantly lower total cholesterol, triglycerides, and low-density lipoprotein cholesterol, and higher HDL2 cholesterol; women reporting less activity did not differ with regard to these lipids and lipoproteins. The study suggests that physical activity is associated with improved cardiovascular risk profiles among middle-aged women and that the beneficial effects of activity are seen at different levels for specific risk factors.     

Walking trends among U.S. adults: the Behavioral Risk Factor Surveillance System, 1987-2000

OBJECTIVE: To examine trends in walking among adults in 31 states. METHODS: Trends by sociodemographic strata were analyzed from respondents who participated in the Behavioral Risk Factor Surveillance System (BRFSS). RESULTS: The prevalence of walking among men increased 3.8% (95% confidence interval [CI]=2.4-5.2), from 26.2% (95% CI=25.1-25.3) in 1987 to 30.1% (95% CI=29.4-30.8) in 2000. In women, walking increased 6.6% (95% CI=5.4-7.8), from 40.4% (95% CI=-39.4-41.1) to 46.9% (95% CI=46.2-47.6) during the same time period. However, the prevalence of walking three times a week for 30 minutes duration remained constant across all years. The largest increases occurred in minority subpopulations: 8.7% (95% CI=3.2-14.2) in Hispanic women, 8.5% (95% CI=4.4-12.6) non-Hispanic black women, and 7.0% (95% CI=2.3-11.7) in non-Hispanic black men. Walking was the most frequently reported activity among adults who met the national recommendations for regular physical activity (defined as five or more times a week for > or =30 minutes per session). CONCLUSIONS: Given the acceptability of walking across all sociodemographic subgroups, efforts to increase the frequency of walking could markedly increase the percentage of U.S. adults who engage in regular physical activity, a national priority identified in the Healthy People 2010 objectives for the nation.     

Walking decreased risk of cardiovascular disease mortality in older adults with diabetes

OBJECTIVE: This study examines the association of walking with mortality in persons with type 2 diabetes compared to those with normal glucose tolerance. STUDY DESIGN AND SETTING: This prospective study included community-dwelling adults from the Rancho Bernardo Study aged 50-90 years in 1984-86 who had type 2 diabetes (n=347) or normal glucose tolerance (n=1,317). During the 10-year follow up, Cox proportional hazards modeling was used to model time until death from all causes (n=538), coronary heart disease (CHD, n=143), other cardiovascular disease (non-CHD CVD, n=138), and other causes (n=257) while adjusting for multiple potential confounders. RESULTS: After adjusting for sex, age, smoking, body mass index, alcohol, exercise, history of CHD, and other covariates, adults with diabetes who walked > or =1 mile per day were half as likely to die from all causes combined (hazard ratio [HR]=0.54; 95% confidence interval [CI]: 0.33, 0.88), and less than one-fifth as likely to die from non-CHD CVD (HR=0.19; 95% CI: 0.04, 0.86) compared to adults with diabetes who did not walk. Walking was also protective among adults with normal glucose tolerance (HR=0.55; 95% CI: 0.32, 0.96). CONCLUSION: Results suggest walking > or =1 mile per day may provide strong protection from all-cause and non-CHD CVD mortality in older adults with diabetes.     

Fruit and vegetable intakes and risk of colorectal cancer in the NIH-AARP diet and health study

The authors examined the associations between fruit and vegetable intakes and risk of colorectal cancer in the NIH-AARP Diet and Health Study. Diet was assessed with a food frequency questionnaire at baseline. Relative risks and 95% confidence intervals were estimated by using the Cox proportional hazards model. During 5-year follow-up of 488,043 men and women aged 50-71 years, 2,972 incident colorectal cancer cases were identified. The respective 10th and 90th percentiles of total fruit and vegetable intake (servings/1,000 kcal per day) were 1.4 and 5.2 for men and 1.8 and 6.5 for women. Compared with that for the lowest quintile of vegetable intake, the multivariate relative risk for the highest quintile was 0.82 (95% confidence interval: 0.71, 0.94) for men and 1.12 (95% confidence interval: 0.90, 1.38) for women. Increased risk of colorectal cancer was observed for very low intake of total fruits and vegetables by men (multivariate relative risk for <1 vs. > or =2.0 servings/1,000 kcal per day = 1.26, 95% confidence interval: 1.03, 1.54). Among subgroups of vegetables, green leafy vegetables were associated with a lower risk of colorectal cancer for men (multivariate relative risk for the highest quintile vs. the lowest = 0.86, 95% confidence interval: 0.74, 0.99). Intake of fruits was not related to risk of colorectal cancer in men or women.     

Physical Activity and Television Watching in Relation to Risk of Type 2 Diabetes: The Black Women's Health Study

Few modifiable risk factors for type 2 diabetes have been documentedin the high-risk population of US black women. The authors useddata from 45,668 black women aged 21–69 years, followedbiennially from 1995 to 2005 in the Black Women's Health Study,to estimate incidence rate ratios for type 2 diabetes comparingvarious levels of physical activity and television watching.Cox proportional hazards models were used to control confoundingfactors. During 10 years of follow-up, 2,928 incident casesof type 2 diabetes were identified. Vigorous activity was inverselyassociated with type 2 diabetes risk (P_trend < 0.0001); theincidence rate ratio for 7 hours per week was 0.43 (95% confidenceinterval (CI): 0.31, 0.59) relative to no activity. Brisk walkingfor 5 hours per week was associated with reduced type 2 diabetesrisk (incidence rate ratio = 0.67, 95% CI: 0.49, 0.92) relativeto no walking. Television watching was associated with an increasedtype 2 diabetes risk: The incidence rate ratio was 1.86 (95%CI: 1.54, 2.24) for 5 hours relative to <1 hour of televisionper day, independent of physical activity. These observationaldata suggest that black women might reduce their risk of developingtype 2 diabetes by increasing their time spent walking or engagedin vigorous physical activity and by limiting television watching. African continental ancestry group; diabetes mellitus, type 2; exercise; incidence; motor activity; television; walking; women's health     

Physical activity and risk of prostatic cancer among college alumni.

Clinical observations and laboratory experiments have suggested a role for testosterone in the development of prostatic cancer. Since physical training may act to lower testosterone levels, men who are very active may have a reduced risk of this cancer. To test this hypothesis, the authors prospectively followed 17,719 Harvard alumni (aged 30-79 years) from 1965 or 1969 to 1977, and 1980 to 1988 for the occurrence of prostatic cancer (n = 419). Physical activity was assessed in either 1962 or 1966, and again in 1977, based on self-reported stair climbing, walking, and sports played. Alumni who expended greater than 4,000 kcal/week at both assessments were at reduced risk of developing prostatic cancer (age-adjusted rate ratio, 0.12; 95% confidence interval 0.02-0.89) compared with their inactive counterparts who expended less than 1,000 kcal/week at both assessments. These results should be interpreted cautiously, since only one case of prostatic cancer was identified among alumni highly active at both assessments, who contributed 4% of total person-years to the analysis. Among alumni aged 70 years and older, those who extended greater than 4,000 kcal/week at either assessment had about half the risk of those who expended less than 1,000 kcal/week at either assessment (age-adjusted rate ratio, 0.53; 95% confidence interval 0.29-0.95). The authors attribute these findings to the increased precision with which physical activity could be measured when combining two activity assessments. Alternatively, long-term maintenance of a high level of physical activity may be necessary for further reduction of risk. There was no evidence of a dose-response relation.     

Case-control study of lifetime physical activity and breast cancer risk

A population-based case-control study of 1,233 incident breast cancer cases and 1,237 controls was conducted in Alberta, Canada, in 1995-1997 to examine the effect of lifetime physical activity patterns on breast cancer risk. No associations between physical activity and breast cancer were found for premenopausal women. For postmenopausal women in the highest quartile (> or =161 metabolic equivalent (MET)-hours/week per year) versus the lowest quartile (<104.8 MET-hours/week per year) of lifetime total physical activity, the adjusted odds ratio was 0.70 (95% confidence interval (CI): 0.52, 0.94). When the risks associated with each type of activity were examined for postmenopausal women, household and occupational activity conferred the largest risk reductions (odds ratio (OR) = 0.57, 95% CI: 0.41, 0.79 and OR = 0.59, 95% CI: 0.44, 0.81, respectively, for highest vs. lowest quartiles of activity), while recreational activity was not associated with any risk reductions. For postmenopausal women, the authors found stronger risk reductions for those who were also nonsmokers (OR = 0.64, 95% CI: 0.46, 0.88), non-alcohol-drinkers (OR = 0.39, 95% CI: 0.11, 0.77), or nulliparous (OR = 0.22, 95% CI: 0.07, 0.70) when they compared the highest with the lowest quartile of lifetime total physical activity. This study provides evidence that lifetime total activity reduces risk of postmenopausal breast cancer.     

Relationships between walking hours, sleeping hours, meaningfulness of life (ikigai) and mortality in the elderly: prospective cohort study

The purpose of this study was to determine lifestyle factors in the elderly that affected longevity, using a population-based prospective study. The participants were 440 men and 625 women aged 60 to 74 living in a rural Japanese community. The baseline data such as age, sex, present illness, walking hours per day, sleeping hours per day, alcohol consumption, a history of smoking, and "ikigai" (meaningfulness of life) were collected in July 1990. During 90 months of follow-up from July 1990 to December 31 1997, there were 123 deaths. By Cox's multivariate hazard model adjusted age, sex, and medical histories, walking > or = 1 hour/day (HR = 0.63, 95% CI 0.44-0.91) and an "ikigai" (HR = 0.66, 95% CI 0.44-0.99) lowered the risk for all-cause mortality independently. In regard to hours of sleep, the cumulative survival curve showed that 7 hours/day was the border and sleeping > or = 7 hours/day lowered the risk (HR = 0.49 95% CI 0.33-0.74). Based on the findings in this study, walking > or = 1 hour/day, sleeping > or = 7 hours/day, and "ikigai" are important factors for longevity in the elderly.     

Coffee consumption and risk of myocardial infarction among older Swedish women

Numerous studies have examined the association between coffee consumption and risk of myocardial infarction (MI), but results have been inconsistent. Case-control studies generally suggest a harmful effect of coffee drinking, whereas cohort studies have mostly shown no association. Recent studies found that coffee may lower the risk of diabetes, a major coronary risk factor. The authors prospectively examined the effect of coffee consumption on MI risk in 32,650 older Swedish women, aged 40-74 years, participating in the Swedish Mammography Cohort; 459 cases of MI developed during 165,896 person-years of follow-up from 1997 to 2002. After adjustment for age, coronary heart disease risk factors, and dietary variables, the relative risk of MI associated with drinking >/=5 cups/week versus 0-4 cups/week was 0.68 (95% confidence interval (CI): 0.43, 1.07). The authors observed a nonsignificant trend toward lower risk with higher consumption levels. Compared with that for 0-4 cups/week, the relative risks of MI were 0.84 (95% CI: 0.51, 1.38) for 5-7 cups/week, 0.65 (95% CI: 0.41, 1.03) for 2-3 cups/day, 0.64 (95% CI: 0.39, 1.04) for 4-5 cups/day, and 0.65 (95% CI: 0.37, 1.12) for >/=6 cups/day (p-trend = 0.07). Contrary to previous case-control studies, the authors concluded that coffee consumption does not increase MI risk. Coffee consumption of >/=5 cups/week was nonsignificantly inversely associated with MI risk among older Swedish women.     

Physical sports activity in a representative sample of the population of Región de Murcia,Spain

OBJECTIVE: To estimate the prevalence of intense physical activity according to age and sex in the region of Murcia, Spain, and to analyze its association with major demographic and socioeconomic determinants and other cardiovascular risk factors. METHODS: Survey of a representative sample of the population aged between 18 and 65 years from Murcia was performed using multistage random sampling with definition of the sample quotas. A total of 3091 individuals were surveyed. The frequency and duration of intense physical sports activity during the two weeks prior to the survey was obtained using a validated questionnaire. Information was also collected on socioeconomic variables, smoking, blood pressure, weight and height and a blood test was performed to determine plasma lipids. Intense or vigorous physical activity (> or = 6 Metabolic Equivalents [MET]) was measured in kcal/day and reduced to hours/week to give three categories: no vigorous physical activity, less than 2 hours/week, and 2 hours/week or more. RESULTS: Overall, 17.8% (95% CI: 16.6-19.0) of the adult population of the region of Murcia performed intense physical activity for > or = 2 hours/week. The figures were twice as high in men (23.1%; 95% CI: 21.0-25.2) than in women (12.5%; 95% CI: 10.9-14.1). In the logistic regression analysis, a higher frequency of intense physical activity was associated with age, level of education and employment situation. In men it was also associated with occupation and residence in urban areas. CONCLUSIONS: During the study period, one in five adults in the region of Murcia took intense physical sports activity with a frequency and duration that were compatible with the prevention of episodes of coronary ischemia.     

The quantity and quality of physical activity among those trying to lose weight

BACKGROUND: Regular exercise to elicit caloric expenditure is an important component for achieving weight loss. The Healthy People 2000 objectives recommend regular sustained physical activity lasting 30 minutes, five days per week (Objective 1.3) particularly for weight loss. Moreover, this recommendation has been restated for weight loss and overall health benefits in the Centers for Disease Control and Prevention / American College of Sports Medicine (CDC/ACSM) statement and Surgeon General's Report (SGR) on Physical ActivitY and Health. Thus, we sought to identify the relative quality, and quantity of physical activity among people trying to lose weight. DESIGN: Cross-sectional self-reported data from the West Virginia Behavioral Risk Factor Surveillance System (BRFSS) were used. The BRFSS is a state-based telephone survey of adults that uses a multistage cluster design based on the Waksberg method of random-digit dialing. Data froM 2769 men and 4490 women were obtained from the 1992, 1994, and 1996 surveys. RESULTS: Half (49.6%) of individuals trying to lose weight did not engage in any physical activity. Further, only 15% of respondents trying to lose weight reported exercising regularly. Nevertheless, those trying to lose weight were more likely (OR [odds ratio] = 1.3; 95% CI [confidence interval], 1.14, 1.51, p < 0.001) to exercise regularly than those not trying to lose weight. In particular, women trying to lose weight were significantly more likely (OR = 1.45; 95% CI, 1.22,1.74, p < 0.001) to exercise regularly than women not trying to lose weight. Conversely, men trying to lose weight were no more likely to exercise regularly (p = .23) than men not trying to lose weight. Among respondents who were using exercise for weight loss, only 14.7% were expending > or =1000 kcal/week and 18.2% were expending > or =500 kcal/week. Weekly expenditure rates of > or =1000 kcal/week were more likely to occur among men (17%) than women (13.8%), in younger age groups, and among those with higher educational attainment. CONCLUSION: These data suggest that while certain individuals trying to lose weight are more likely to engage in regular physical activity, most persons trying to lose weight have not adopted regular physical activity as part of their weight loss practice. These results suggest that public health efforts to effectively integrate physical activity into weight control practices of West Virginians have been minimally successful.     

Alcohol intake and incidence of coronary disease in Australian aborigines

AIMS: To examine risk for coronary heart disease (CHD) and cardiovascular disease (CVD) in relation to alcohol in a cohort of Australian Aborigines. METHODS: In 1988-1989, alcohol intake, drinking pattern, and beverage preference were elicited by interviewer-administered questionnaire in Western Australian Aborigines (258 men and 256 women) and cardiovascular outcomes ascertained through linkage to mortality and hospital admission records to 2002. RESULTS: In proportional hazards models, risk for CHD, relative to lifetime abstainers, was significantly increased in ex-drinkers [Hazard ratio (HR), 2.29; 95% confidence intervals (CI), 1.23-4.27], those drinking 41-60 g/day in men or 21-40 g/day in women (HR 2.80; 95% CI, 1.04-7.53) and those drinking >150 g/day for men or >100 g/day for women (HR, 2.25; 95% CI, 1.03-4.90) with a J-shaped relationship. Low-to-moderate drinkers had lower waist girth, exercised more and had a lower prevalence of overweight and smoking than at-risk drinkers. A preference for wine was associated with lower HR (0.28; 95% CI, 0.10-0.95). With CVD, only ex-drinkers showed significantly increased risk (HR, 1.87; 95% CI, 1.20-2.91). CONCLUSIONS: More favourable health-related behaviours in low-to-moderate drinkers suggest that lower risk could be mediated by lifestyle, as proposed in other populations.     

Calcium, dairy foods, and risk of incident and fatal prostate cancer: the NIH-AARP Diet and Health Study

Calcium and dairy foods in relation to prostate cancer were examined in the National Institutes of Health (NIH)-AARP (formerly known as the American Association of Retired Persons) Diet and Health Study (1995/1996-2001). Diet was assessed with a food frequency questionnaire at baseline. Multivariate relative risks and 95% confidence intervals were estimated by Cox regression. During up to 6 years of follow-up (n = 293,888), the authors identified 10,180 total prostate cancer cases (8,754 nonadvanced, 1,426 advanced, and 178 fatal cases). Total and supplemental calcium were unrelated to total and nonadvanced prostate cancer. However, a statistically nonsignificant positive association with total calcium was observed for advanced (> or = 2,000 vs. 500-<750 mg/day: relative risk (RR) = 1.25, 95% confidence interval (CI): 0.91, 1.71; p(trend) = 0.06) and fatal (> or = 1,000 vs. 500-<750 mg/day: RR = 1.39, 95% CI: 0.92, 2.09; p(trend) = 0.10) prostate cancer. Skim milk, but not other dairy foods, was associated with increased risk of advanced prostate cancer (> or = 2 vs. zero servings/day: RR = 1.23, 95% CI: 0.99, 1.54; p(trend) = 0.01). In contrast, calcium from nondairy foods was associated with lower risk of nonadvanced prostate cancer (> or = 600 vs. < 250 mg/day: RR = 0.82, 95% CI: 0.68, 0.99; p(trend) = 0.04). Although the authors cannot definitively rule out a weak association for aggressive prostate cancer, their findings do not provide strong support for the hypothesis that calcium and dairy foods increase prostate cancer risk.     

Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy

Physical activity has been associated with a reduced risk of gestational diabetes mellitus, but inferences have been hampered by recall and selection bias. The authors examined the relation between recreational physical activity before and during pregnancy and risk of gestational diabetes mellitus in a prospective cohort study. In 1996-2000, 909 normotensive, nondiabetic women in Seattle and Tacoma, Washington, were questioned during early gestation about physical activity performed during the year before and 7 days prior to the interview during pregnancy. Compared with inactive women, women who participated in any physical activity during the year before experienced a 56% risk reduction (relative risk (RR) = 0.44, 95% confidence interval (CI): 0.21, 0.91). Women spending >/=4.2 hours/week engaged in physical activity experienced a 76% reduction in gestational diabetes mellitus risk (RR = 0.24, 95% CI: 0.10, 0.64), and those expending >/=21.1 metabolic equivalent-hours/week experienced a 74% reduction (RR = 0.26, 95% CI: 0.10, 0.65) compared with inactive women. Physical activity during pregnancy was also associated with reductions in gestational diabetes mellitus risk. Women who engaged in physical activity during both time periods experienced a 69% reduced risk (RR = 0.31, 95% CI: 0.12, 0.79). Findings suggest that efforts to increase maternal physical activity may contribute to substantial reductions in gestational diabetes mellitus risk.     

Lifestyle factors,cardiovascular disease and all-cause mortality in middle-aged and elderly women: a systematic review and meta-analysis

Cardiovascular disease (CVD) risk factors, incidence and death increases from around the time of menopause comparing to women in reproductive age. A healthy lifestyle can prevent CVD, but it is unclear which lifestyle factors may help maintain and improve cardiovascular health for women after menopausal transition. We conducted a systematic review and meta-analysis of prospective cohort studies to evaluate the association between modifiable lifestyle factors (specifically smoking, physical activity, alcohol intake, and obesity), with CVD and mortality in middle-aged and elderly women. Pubmed, Embase, among other databases and reference lists were searched until February 29th, 2016. Study specific relative risks (RR) were meta-analyzed using random effect models. We included 59 studies involving 5,358,902 women. Comparing current versus never smokers, pooled RR were 3.12 (95% CI 2.15–4.52) for CHD incidence, 2.09 (95% CI 1.51–2.89) for stroke incidence, 2.76 (95% CI 1.62–4.71) for CVD mortality and 2.22 (95% CI 1.92–2.57) for all-cause mortality. Physical activity was associated with a decreased risk of 0.74 (95% CI 0.67–0.80) for overall CVD, 0.71 (95% CI 0.67–0.75) for CHD, 0.77 (95% CI 0.70–0.85) for stroke, 0.70 (95% CI 0.58–0.84) for CVD mortality and 0.71 (95% CI 0.65–0.78) for all-cause mortality. Comparing moderate drinkers versus non-drinkers, the RR was 0.72 (95% CI 0.56–0.91) for CHD, 0.63 (95% CI 0.57–0.71) for CVD mortality and 0.80 (95% CI 0.76–0.84) for all-cause mortality. For women with BMI 30–35 kg/m² the risk was 1.67 (95% CI 1.24–2.25) for CHD and 2.3 (95% CI 1.56–3.40) for CVD mortality, compared to normal weight. Each 5 kg/m² increase in BMI was associated with 24% (95% CI 16–33%) higher risk for all-cause mortality. This meta-analysis suggests that physical activity and moderate alcohol intake were associated with a reduced risk for CVD and mortality. Smoking and higher BMI were associated with an increased risk of these endpoints. Adherence to a healthy lifestyle may substantially lower the burden of CVD and reduce the risk of mortality among middle-aged and elderly women. However, this review highlights important gaps, as lack of standardized methods in assessing lifestyle factors and lack of accurate information on menopause status, which should be addressed by future studies in order to understand the role of menopause on the association between lifestyle factors and cardiovascular events.     

Chin-Shan Community Cardiovascular Cohort in Taiwan-baseline data and five-year follow-up morbidity and mortality

A cohort consisting of 3602 residents (82.8% of the target population) aged 35 years and older was established in 1990 in the Chin-Shan Community, a suburb 20 miles outside of metropolitan Taipei, Taiwan. The long-term objective was to investigate the prospective impact on cardiovascular health in a society undergoing transition from a developing to a developed nation. This article presents the study design, selected baseline risk factors of cardiovascular diseases (CVD), and CVD events at the 5-year follow-up evaluation with an emphasis on sociodemographic differences. The multivariate logistic regression analyses revealed that white-collar individuals were more likely than blue-collar workers to have dyslipidemia including high-density lipoprotein cholesterol (HDL-C) levels <35 mg/dl [odds ratio (OR) = 1.7, 95% confidence interval (CI) = 1.2-2.4] and low-density lipoprotein cholesterol (LDL-C) levels >/=160 mg/dl (OR = 1.3, 95% CI = 1.0-1.7). However, they were at slightly lower risk for stroke and CVD/sudden death, and at moderately higher risk for coronary artery disease and diabetes, although both these trends were not significant. Men were more likely than women to have HDL-C levels <35 mg/dl (OR = 1.8, 95% CI = 1.4-2.2), but they were less likely to have LDL-C levels >/=160 mg/dl (OR = 0.7, 95% CI = 0.6-0.8). The risk of CVD/sudden death was higher for men than for women during the follow-up period (OR = 1.9, 95% CI = 1.3-2.9). This could be due to risk factors such as a much higher prevalence of tobacco (61.9% vs. 4.5%) and alcohol (43.7% vs. 6.4%) use in men. In conclusion, individuals of higher socioeconomic status have a higher prevalence of dyslipidemia but slightly lower 5-year incidence of CVD events.