Combined effect of blood pressure and physical activity on cardiovascular mortality

BACKGROUND: High blood pressure increases cardiovascular mortality, but whether the effect is counteracted by physical activity is not clear. METHODS: The combined association of blood pressure and physical activity on cardiovascular mortality was assessed in a cohort of 30 597 women and 30 508 men, using standardized blood pressure measurements and information on usual frequency, duration, and intensity of physical exercise. RESULTS: During 16 years of follow-up, 1942 women and 2824 men with no history of cardiovascular disease or diabetes, who had never used blood pressure medication, died from cardiovascular causes. Cardiovascular mortality increased continuously with increasing blood pressure, and, at each blood pressure level, risk was higher in men and women with no physical activity compared with those who reported high physical activity. High activity combined with increasing pressure, however, yielded higher risk than high activity combined with normotensive pressure. Compared with the reference (systolic pressure 120-129 mmHg and high activity), the relative risk of cardiovascular death for systolic pressure of 140-159 mmHg combined with high activity was 1.21 (95% confidence interval, 0.97-1.52), compared with a relative risk of 1.73 (95% confidence interval, 1.37-2.19) in men with no activity. For women, the corresponding relative risks were 1.47 (95% confidence interval, 1.04-2.09) in the high activity group and 1.93 (95% confidence interval, 1.39-2.69) for no activity. The combined results for diastolic pressure and physical activity displayed similar patterns. CONCLUSIONS: The results support the hypothesis that cardiovascular health of individuals with moderate hypertension will benefit from regular physical exercise.     

Mobility difficulties and physical activity as predictors of mortality and loss of independence in the community-living older population

OBJECTIVE: In older people, mobility impairments and physical inactivity are risk factors for further disability and death. We studied the interaction of physical activity and mobility impairment as a predictor of dependence and mortality. DESIGN: A population-based, prospective study. The data were collected in structured interviews in the year 1988 and 8 years later in the year 1996 as part of the Evergreen Project. PARTICIPANTS: Subjects were 1109 independently living, at baseline 65- to 84-year-old people in the city of Jyvaskyla, in central Finland. METHODS: Participants were ranked into four groups: (1) Intact mobility and physically active (Mobile-Active), (2) Intact mobility and sedentary (Mobile-Sedentary), (3) Impaired mobility and physically active (Impaired-Active), and (4) Impaired mobility and sedentary (Impaired-Sedentary). The confounders adjusted for in the models included age, marital status, education, chronic conditions, smoking, and physical exercise earlier in life. RESULTS: In men and women, the relative risk of death was two times greater in Impaired-Active and three times greater in Impaired-Sedentary groups than the risk of death in Mobile-Active groups. However, the risk of death did not differ between Mobile-Active and Mobile-Sedentary groups. The odds ratio for dependency (95% confidence interval) in Impaired-Sedentary men was 5.21 (1.44-18.70) and in Impaired-Sedentary women was 2.92 (1.52-5.60) compared to Mobile-Active groups. The risk of dependence did not differ significantly between Mobile-Active, Mobile-Sedentary, and Impaired-Active groups. CONCLUSIONS: Mobility impairments predicted mortality and dependence. However, among people with impaired mobility, physical activity was associated with lower risks, whereas the risk did not differ according to activity level among those with intact mobility. Despite of their overall greater risk, mobility-impaired people may be able to prevent further disability and mortality by physical exercise.     

Anthropometric variables and physical activity as predictors of cardiac cachexia

BACKGROUND: This study explored the frequency of cardiac cachexia in Mexican patients, the role of anthropometric variables as predictors of its development and its association with food intake and physical activity. METHODS: Seventy three patients with systolic heart failure were included in the study. Cardiac cachexia was defined as weight loss of >6.0% in 6 months. Anthropometric data, physical activity and dietary intake were evaluated by a 3-day questionnaire at the beginning of the study and 6 months later. RESULTS: After 6 months of follow up, 14 (19%) patients developed cachexia with a mean weight loss of 12.1+/-3.4%. Significant decrease in the anthropometric variables were observed in patients which developed cachexia except in the waist to hip ratio, which increased in these patients due to bigger diminish of hip circumference than in the waist one. The subjects which developed cachexia had significant less physical activity after 6 months (-6.9%) in comparison with the non cachexic group. Reported energy intake did no differ among groups. Patients with cardiac cachexia showed greater prevalence of obesity and overweight, a high body fat percentage and a low arm circumference. CONCLUSIONS: Cardiac cachexia development was not related with low energy intake or increase in the total energy expenditure (explained by the physical activity). The only variable related to cachexia development was lower physical activity.     

Low physical activity as a predictor for total and cardiovascular disease mortality in middle-aged men and women in Finland.

AIMS: To investigate separately for men and women whether moderate or high leisure time physical activity, occupational physical activity, and commuting activity are associated with a reduced cardiovascular disease (CVD) and all-cause mortality, independent of CVD risk factors and other forms of physical activity. METHODS AND RESULTS: Prospective follow-up of 15,853 men and 16,824 women aged 30-59 years living in eastern and south-western Finland (median follow-up time 20 years). CVD and all-cause mortality were lower (9-21%) in men and women (2-17%) who were moderately or highly physically active during leisure time. Moderate and high levels of occupational physical activity decreased CVD and all-cause mortality by 21-27% in both sexes. Women spending daily 15 min or more in walking or cycling to and from work had a reduced CVD and all-cause mortality before adjustment for occupational and leisure time physical activity. Commuting activity was not associated with CVD or all-cause mortality in men. CONCLUSION: Moderate and high levels of leisure time and occupational physical activity are associated with a reduced CVD and all-cause mortality among both sexes. Promoting already moderate levels of leisure time and occupational physical activity are essential to prevent premature CVD and all-cause mortality.     

Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis.

BACKGROUND: Over the past several decades, numerous large cohort studies have attempted to quantify the protective effect of physical activity on cardiovascular and all-cause mortality. The aim of the authors' review was to provide an up-to-date overview of the study results. METHODS: In a systematic MEDLINE search conducted in May 2007, the authors included cohort studies that assessed the primary preventive impact of physical activity on all-cause and cardiovascular mortality. The authors reported risk reductions on the basis of comparison between the least active and the most active population subgroups, with the least active population subgroup as the reference group. Random-effect models were used for meta-analysis. RESULTS: A total of 33 studies with 883,372 participants were included. Follow-up ranged from 4 years to over 20 years. The majority of studies reported significant risk reductions for physically active participants. Concerning cardiovascular mortality, physical activity was associated with a risk reduction of 35% (95% confidence interval, 30-40%). All-cause mortality was reduced by 33% (95% confidence interval, 28-37%). Studies that used patient questionnaires to assess physical activity reported lower risk reductions than studies that used more objective measures of fitness. CONCLUSIONS: Physical activity is associated with a marked decrease in cardiovascular and all-cause mortality in both men and women, even after adjusting for other relevant risk factors.     

Glomerular filtration rate and N-terminal pro-brain natriuretic peptide as predictors of cardiovascular mortality in vascular patients.

OBJECTIVES: The purpose of this work was to assess the prognostic role of glomerular filtration rate (GFR) and NT-terminal pro-B-type natriuretic peptide (NT-proBNP) for mortality end points in the vascular population. BACKGROUND: The GFR and NT-proBNP have been shown to predict mortality end points in free-living and limited vascular populations, independent of traditional risk factors. However, their prognostic power in an unrestricted vascular population is poorly understood. METHODS: A total of 412 subjects from a vascular cohort with a history of either peripheral arterial disease (PAD) and/or other cardiovascular disease (CVD) were included in this prospective cohort analysis and followed for an average of 6.7 years. Outcome variables were all-cause mortality, ischemic heart disease (IHD) mortality, and any cardiovascular mortality. The prognostic roles of GFR and NT-proBNP levels were determined using multivariate survival analysis. RESULTS: Higher GFR (per 10 ml/min/1.73 m2) was significantly protective for all-cause mortality (hazard ratio [HR] 0.81, p < 0.001), IHD mortality (HR 0.82, p = 0.008), and CVD mortality (HR 0.84, p = 0.005). Conversely, NT-proBNP was not a significant predictor of any mortality end point. The GFR showed the strongest association in subjects with a history of other CVD. Although NT-proBNP did not demonstrate a significant prognostic role in any of the subgroups, the data were suggestive for patients with PAD alone. CONCLUSIONS: Glomerular filtration rate was a robust predictor of all-cause, IHD, and cardiovascular mortality in the vascular population, particularly in those with a history of other CVD, while NT-proBNP showed a suggestive association limited to the group with PAD only. These findings suggest that these markers must be selectively applied in the vascular population for greatest clinical utility.     

Everyday physical activity as a predictor of late-life mortality

PURPOSE: The present study hypothesized that simple, everyday physical activity (EPA) would decline with advancing age; that women would have a more favorable EPA profile than would men; and that EPA would have a survival benefit. DESIGN AND METHODS: Community-dwelling participants (aged 80-98 years, n = 198) wore mechanical actigraphs in order for EPA to be assessed. Individuals were classified as active, inactive, and sedentary based on their level of EPA exhibited over a substantial part of the day. Survival status was available at approximately 2 years. RESULTS: Mean EPA scores decreased with advancing age and, in contrast to men, women in their early eighties appeared to be protected from declining EPA. This partially supported the hypothesis that women would have a more favorable EPA profile. What is most important is that mean EPA scores predicted mortality. Moreover, when compared with their less sedentary counterparts, sedentary adults were more than three times as likely to be deceased 2 years later. IMPLICATIONS: Researchers need to conduct new trials to determine whether or how physical activity is associated with mortality.     

Adiposity,physical fitness and incident diabetes: the physical activity longitudinal study

Aims/hypothesis The purpose of this study was to investigate the relationships among adiposity, physical activity, physical fitness and the development of diabetes in a diverse sample of Canadians. Methods The sample included 1,543 adults (709 men and 834 women) from the Canadian Physical Activity Longitudinal Study who were free of diabetes at baseline (1988). Several indicators of adiposity (BMI, waist circumference, WHR, sum of skinfold thicknesses), musculoskeletal fitness (sit-ups, push-ups, grip strength, trunk flexibility), cardiorespiratory fitness (maximal metabolic equivalents [METs]) and leisure-time physical activity levels were measured at baseline. Participants were followed until 2002–2004 for the ascertainment of new cases of diabetes. Results The 15.5-year cumulative incidence of diabetes was 5.0% (5.2% in men, 4.9% in women). Adiposity and physical fitness, but not physical activity, were significant predictors of diabetes after adjustment for age, sex and several covariates. For each standard deviation of the indicators of adiposity, the risk of diabetes was 99–194% higher. Conversely, the risk was 70 and 61% lower for each standard deviation of maximal METs and composite musculoskeletal fitness score, respectively. Receiver operating characteristic curve analyses confirmed that neither adiposity nor physical fitness provided a superior prediction of incident diabetes. Conclusions/interpretation Adiposity and physical fitness were both important predictors of the development of diabetes in this cohort of Canadians.     

Relation of physical activity to cardiovascular disease mortality and the influence of cardiometabolic risk factors

Physical activity can improve several metabolic risk factors associated with cardiovascular disease (CVD) and is associated with a lower risk of CVD mortality. We sought to evaluate the extent to which metabolic risk factors mediate the association between physical activity and CVD mortality and whether physical activity provides protective effects against CVD mortality in healthy adults and those with metabolic risk factors. A sample of 10,261 adults from the Third National Health and Nutrition Examination Survey with public-access mortality data linkage (follow-up 13.4 ± 3.9 years) was used. Physical activity was assessed by questionnaire and classified into inactive, light, and moderate/vigorous activity categories. Metabolic risk factors (dyslipidemia, type 2 diabetes mellitus, obesity, hypertension, inflammation, and insulin resistance) were categorized using clinical thresholds. After adjusting for basic confounders, engaging in light or moderate/vigorous physical activity was associated with a lower risk of CVD mortality (p < 0.05). Adjustment for each risk-factor set only slightly attenuated this relation. When all risk-factor sets were added to the model simultaneously, light (hazard ratio 0.72, 0.62 to 0.84) and moderate/vigorous (hazard ratio 0.72, 0.62 to 0.85) activity remained at lower risk of CVD mortality. In addition, physical activity provided protective effects for CVD mortality in healthy subjects and those with metabolic risk factors in isolation or in clusters. In conclusion, physical activity was associated with a lower risk of CVD mortality independent of traditional and inflammatory risk factors. Taken together these results suggest that physical activity may protect against CVD mortality regardless of the presence of metabolic risk factors.     

Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes

BACKGROUND: Questions remain as to whether higher levels of cardiorespiratory fitness, a measure of regular physical activity, are associated with lower risk of cardiovascular disease (CVD) mortality in overweight and obese individuals with diabetes. Our objective was to quantify the independent and joint relations of cardiorespiratory fitness (hereafter, fitness) and body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) with CVD mortality in men with diabetes. METHODS: This study was conducted using prospective observational data from the Aerobics Center Longitudinal Study. Study participants comprised 2316 men with no history of stroke or myocardial infarction and who were diagnosed as having diabetes (mean [SD] age, 50 [10] years); had a medical examination, including a maximal exercise test during 1970 to 1997 with mortality surveillance to December 31, 1998; and had a BMI of 18.5 or greater and less than 35.0. The main outcome measure was CVD mortality across levels of fitness with stratification by BMI. RESULTS: We identified 179 CVD deaths during a mean (SD) follow-up of 15.9 (7.9) years and 36,710 man-years of exposure. In a model containing age, examination year, fasting glucose level, systolic blood pressure, parental history of premature CVD, total cholesterol level, cigarette smoking, abnormal resting, and exercise electrocardiograms, a significantly higher adjusted risk of mortality was observed in men with a low fitness level who were normal weight (hazard ratio, 2.7 [95% confidence interval, 1.3-5.7]), overweight (hazard ratio, 2.7 [95% confidence interval, 1.4-5.1]), and class 1 obese (hazard ratio, 2.8 [95% confidence interval, 1.4-5.1]) compared with normal weight men with a high fitness level. CONCLUSION: In this cohort of men with diabetes, low fitness level was associated with increased risk of CVD mortality within normal weight, overweight, and class 1 obese weight categories.     

Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with type 2 diabetes

BACKGROUND: Although physical activity is recommended as a basic treatment for patients with diabetes, its long-term association with mortality in these patients is unknown. OBJECTIVE: To evaluate the association of low cardiorespiratory fitness and physical inactivity with mortality in men with type 2 diabetes. DESIGN: Prospective cohort study. SETTING: Preventive medicine clinic. PATIENTS: 1263 men (50+/-10 years of age) with type 2 diabetes who received a thorough medical examination between 1970 and 1993 and were followed for mortality up to 31 December 1994. MEASUREMENTS: Cardiorespiratory fitness measured by a maximal exercise test, self-reported physical inactivity at baseline, and subsequent death determined by using the National Death Index. RESULTS: During an average follow-up of 12 years, 180 patients died. After adjustment for age, baseline cardiovascular disease, fasting plasma glucose level, high cholesterol level, overweight, current smoking, high blood pressure, and parental history of cardiovascular disease, men in the low-fitness group had an adjusted risk for all-cause mortality of 2.1 (95% CI, 1.5 to 2.9) compared with fit men. Men who reported being physically inactive had an adjusted risk for mortality that was 1.7-fold (CI, 1.2-fold to 2.3-fold) higher than that in men who reported being physically active. CONCLUSIONS: Low cardiorespiratory fitness and physical inactivity are independent predictors of all-cause mortality in men with type 2 diabetes. Physicians should encourage patients with type 2 diabetes to participate in regular physical activity and improve cardiorespiratory fitness.     

Quality-of-Life measures as predictors of mortality and morbidity

Poor quality of life assessed singly, using an instrument designed to assess quality of life, or variously, using assessments of job stress, depression, anxiety, hostility, anger, or life events, seems to be predictive of poor cardiovascular health and attendant morbidity and mortality. Since risk factors appear to cluster together, new studies may benefit from concentrating on assessing quality of life and health in multivariate domains, including both psychological and behavioral aspects of life, and validating instruments for use as predictive tools in the future. However, single questions on energy also appear useful as predictors.     

Abnormal cardiovascular reflex tests are predictors of mortality in Type 2 diabetes mellitus.

AIMS: To determine whether diabetic autonomic neuropathy is an important factor contributing to mortality in Type 2 diabetes mellitus. METHODS: Between 1989 and 1993, 431 men and 181 women with Type 2 diabetes were given diabetic autonomic neuropathy cardiovascular reflex (CVR) tests. These subjects were followed for the subsequent 5--9 years to assess mortality rates. RESULTS: The prevalence rate of abnormal CVR tests was 46.1% in patients with the history of diabetes less than 5 years and up to 69.4% when the history of diabetes exceeded 20 years. During the follow-up period from 1 January 1989 to 31 December 1997 (mean 7.7 years), a total of 135 participants died. The 8-year survival rate for patients with abnormal CVR tests was 63.6% in males and 76.4% in females, compared with 80.9 and 93.3% for patients with normal CVR tests. The results were grouped as: group 1, normal CVR tests without postural hypotension (PHT); group 2, normal CVR tests with PHT; group 3, abnormal CVR tests without PHT; and group 4, abnormal CVR tests with PHT. The 8-year survival rate was 85.4% in group 1, 80.9% in group 2, 74.5% in group 3 and 61.1% in group 4. CONCLUSION: Type 2 diabetic patients with abnormal CVR tests may have increased mortality, and those combined with postural hypotension have higher mortality than those without. Abnormal CVR tests may be important predictors of mortality in Type 2 diabetes mellitus.     

The effect of physical activity on haematological predictors of cardiovascular risk - evidence of a dose response

Cardiovascular disease is a major cause of morbidity and mortality in the developed world. Large epidemiological studies have reported a strong association between increases in haematological factors and increased cardiovascular risk. Haematological risk factors predicted cardiovascular disease at least as strongly as traditional risk factors such as blood lipid concentrations. Lifestyle factors such as physical activity level could significantly reduce risk. The aim of this study was to determine the effect of physical activity level on haematological predictors of cardiovascular risk. Healthy subjects (156) were recruited. Physical activity in subjects was assessed by IPAQ physical activity questionnaire. Blood was collected and blood cell counts were determined by automated cell counter; neutrophil elastase was determined by ELISA. Increased levels of physical activity were associated with reduced red cell (p = 0.001), white cell (p = 0.002) and platelet counts (p = 0.001) and with reduced plasma neutrophil elastase concentration (p = 0.001). There was a continuous linear relationship between increase in physical activity and decrease in haematological risk factors. Hence, the authors conclude that increased levels of physical activity improve the flow properties of blood and thus reduce the risk of developing cardiovascular disease. Even small increases in activity result in some reduction in cardiovascular risk.