Changes in physical activity, mortality, and incidence of coronary heart disease in older men

Physical activity and health: evidence from a study of deprived communities in England

This study aims to explore the relationship between physical activity levels and the self-reported health status of residents living in deprived communities in England. A cross-sectional interview survey was conducted in communities in receipt of funding from the New Deal for Communities (NDC) regeneration programme. A sample of 848 addresses was selected by random sampling from within each of the 39 NDC areas, and one adult from each household was selected for interview. A total of 19 574 residents were interviewed between July and October 2002. The main outcome measures were physical activity level and health status assessed using four self-reported health measures: health in the last 12 months, health change in the last 12 months, long-standing illness or disability and a mental health-related quality-of-life score. There are large regional and demographic variations in respect of NDC residents' physical activity levels. The areas with the lowest levels of physical activity are mainly located in northern industrial towns. Residents who did little or no physical activity were more than twice as likely to feel that their health was not good (adjusted OR 2.54, 95% CI 2.35-2.75).

Low Alanine Aminotransferase Activity in Older People Is Associated with Greater Long-Term Mortality

OBJECTIVES

To find possible association between liver enzymes and mortality in older people.

DESIGN

A prospective cohort study.

SETTING

Jerusalem.

PARTICIPANTS

A systematically selected representative sample of 455 70-year-old ambulatory individuals was prospectively followed for 12 years.

MEASUREMENTS

An extensive social and medical profile was developed at age 70 using a detailed interview and physical and ancillary examination. Information on mortality was obtained annually. Differences in survival between subjects stratified according to liver enzyme levels were assessed using the Kaplan-Meier method. Multivariable survival analyses using a Cox proportional hazards model were performed to determine the association between liver enzyme levels at age 70 and mortality over 12 years.

RESULTS

Median alanine aminotransferase (ALT) activity of the study population was 11.00 U/L for women and 13.00 U/L for men. Twelve-year survival rates for women with ALT below and above the median levels were similar (78%). For men, these rates were 54% and 65%, respectively (P < .001). Proportional hazards models demonstrated that this greater mortality risk was independent of numerous common risk factors for mortality (hazard ratio (HR) = 1.5, 95% confidence interval (CI) = 1.08-2.19). Adding an interaction between sex and low ALT to the model demonstrated a higher risk of mortality for men with low ALT levels (HR = 2.42, 95% CI = 1.15-5.08). No such risk was demonstrated for the other liver enzymes.

CONCLUSION

ALT activity represents a strong and independent surrogate marker for mortality in community-dwelling elderly men.

Long-term physical activity in leisure time and mortality from coronary heart disease, stroke, respiratory diseases, and cancer. The Copenhagen City Heart Study

BACKGROUND

The purpose of this study was to describe the associations between different levels of long-term physical activity in leisure time and subsequent causes of deaths.

DESIGN

The Copenhagen City Heart Study is a prospective cardiovascular population study of 19 329 men and women aged 20-93 in 1976. Physical activity in leisure time was estimated at the examinations in 1976-78 and 1981-83. This analysis consists of 2136 healthy men and 2758 women aged 20-79 years, with unchanged physical activity at the two examinations, and with all covariates included in the multivariate analyses: smoking, total-cholesterol, high-density lipoprotein-cholesterol, systolic blood pressure, diabetes mellitus, alcohol consumption, body mass index, education, income, and forced expiratory volume in 10.78 (% predicted).

RESULTS

Adjusted relative risks (95% confidence interval) for coronary heart disease were, for moderate physical activity 0.71 (0.51, 0.99) and for high 0.56 (0.38, 0.82). For cancer, moderate activity 0.77 (0.61, 0.97) and high activity 0.73 (0.56, 0.95) and for all-cause mortality, moderate 0.78 (0.68, 0.89) and high 0.75 (0.64, 0.87) for both sexes combined. Using Kaplan-Meier plots we calculated gained years of expected lifetime from age 50. Men with high physical activity survived 6.8 years longer, and men with moderate physical activity 4.9 years longer than sedentary men. For women the figures were 6.4 and 5.5 years, respectively.

CONCLUSION

Long-term moderate or high physical activity was in both sexes associated with significantly lower mortality from coronary heart disease, cancer and all-causes. The same tendency was found for stroke and respiratory diseases, but the associations did not reach statistical significance.

Physical activity and medicine use: evidence from a population-based study

Background

Few studies have investigated the association between physical activity practice and medicine use; data from these studies are inconsistent. The aim of this study was to evaluate the association between level of physical activity and medicine use in adults aged 20 years or more.

Methods

A population-based cross-sectional study was carried out in the first semester of 2002 in the urban area of Pelotas; a medium-sized Southern Brazilian city. Physical activity was assessed with the short version of the International Physical Activity Questionnaire. A physical activity score was created as the weekly time spent in moderate-intensity activities plus twice the weekly time spent in vigorous-intensity activities. Medicine use in the 15 days prior to the interview was also assessed. Adjusted analyses taking into account the sampling design was carried out using Poisson regression. Wald tests for heterogeneity and linear trend were used to calculate significance.

Results

Out of the 3,182 individuals interviewed, 41% were not sufficiently active according to current physical activity guidelines. Only 34% of the subjects did not use medicines in the previous 15 days, and 18% used three or more drugs in the same period. Level of physical activity was inversely associated with the number of medicines used both in the crude and in the adjusted analyses.

Conclusion

There are well-documented benefits of physical activity for several chronic diseases in the literature. Data from the present study suggest that medicine use is also positively affected by physical activity behavior.

Midlife physical activity and mobility in older age: The InCHIANTI study

BACKGROUND

Among older adults, loss of mobility represents a critical stage in the disablement process, whereby the risk for disability is significantly increased. Physical activity is a modifiable risk factor that is associated with reduced risk of losing mobility in older adulthood; however, few studies have examined physical activity performed earlier in life in relation to mobility later in life.

METHODS

Data from a population-based study of 1155 adults aged 65 years and older living in the Chianti region of Italy in 1998-2000 were analyzed in 2005 and 2006. Participants retrospectively recalled their physical activity levels in midlife and underwent mobility testing and medical examination. Two objective mobility outcomes were examined as a function of past physical activity: the Short Physical Performance Battery (SPPB) and the ability to walk 400 meters.

RESULTS

Older Italian adults (mean age 74.8, standard deviation 7.3) who engaged in higher levels of physical activity in midlife were significantly more likely to perform better on the SPPB than individuals who were less physically active in midlife. In addition, failure to complete the 400-meter walk test was significantly less likely among physically active men (Level II) (odds ratio [OR] = 0.37, 95% confidence interval [CI] = 0.15-0.93) and very active men (Level III) (OR = 0.23, 95% CI = 0.09-0.63) when compared to men who were less active (Level I) in the past (p for trend, 0.008). These associations remained after adjustment for demographic factors, medical conditions, and physiologic impairments.

CONCLUSIONS

Older adults who reported higher levels of physical activity in midlife had better mobility in old age than less physically active ones.

Exercise training affects age-induced changes in SOD and heat shock protein expression in rat heart

The aim of this study was to test the effects of age and chronic exercise training on antioxidant and heat shock protein (Hsp) expression by comparing the hearts of young (Y), sedentary old (SO) and trained old (TO) rats. In SO rats, there were: (a) changes in myocardial structure and function; (b) increased malondialdehyde levels; (c) no changes in superoxide-dismutase (SOD) enzymes; (d) reduced Hsp70 expression; and (e) increased Hsp27 expression. In TO rats, SOD enzymes and Hsp70 expression were increased and Hsp27 was further increased. Malondialdehyde level did not differ between TO and SO rats, which shows that chronic exercise did not affect the peroxidation index. In summary, by increasing Hsp27 and Hs70 levels, prolonged exercise partially counterbalanced the heart age-related effects in the antioxidant system without altering peroxidation levels. These findings suggest that the beneficial effects on aged-related cardiovascular changes could be connected to the "anti-oxidant" effects of prolonged exercise training.

Exercise really is good for you

When it comes to reducing the risk of coronary heart disease, it may never to be too late to start exercising and benefit from the effects of moderate physical activity.

Relationship between components of leisure physical activity and mortality in Taiwanese older adults

BACKGROUND

Whether the major components of leisure physical activity (number of types, intensity, frequency, and duration) have independent contribution to mortality reduction and there is a minimum amount of activity beneficial for the elderly remain unclear.

METHODS

The prospective follow-up study aimed at examining the relationship between exercise components and total mortality in general elderly population. A total of 2113 persons aged 65 and older participating in 2001 Taiwan National Health Interview Survey were studied. Information regarding leisure physical activity, its energy parameters, other factors at baseline, and vital status at the end of 2003 was analyzed with Cox model.

RESULTS

A total of 197 deaths occurred during a 2-year follow-up. Regular exercisers reduced 35% risk of death compared with sedentary individuals after adjustment for covariates. Moreover, exercisers with a weekly amount of energy exceeding 1000 kcal had significant benefit of risk reduction when energy expenditure is considered. There was a significant dose-response relationship between number of activity and the reduction in total mortality. The benefit on mortality reduction among the three components of total energy amount was only observed in intensity.

CONCLUSIONS

For the amount of energy dedicated to leisure physical activity, older persons are recommended to expend at least 1000 kcal per week through regular exercise for mortality reduction. In addition to energy amount, protection of exercise against death also increases with the number of activities. Among the three components of total amount of energy, only intensity is significantly associated with mortality reduction.

Endurance training reduces circulating inflammatory markers in persons at risk of coronary events: Impact on plaque stabilization?

Inflammatory pathways are involved in destabilization of atherosclerotic plaques. We assessed the hypothesis that endurance training decreases circulating concentrations of inflammatory markers in persons with coronary artery disease (CAD) and cardiovascular risk factors (CVRFs). Thirty-two subjects with CAD and/or CVRFs joined a 12-week supervised endurance training. We found a significant decrease of the chemokines interleukin (IL)-8 (pre: 3.9+/-0.6, change: -1.2+/-0.4 pg/ml, -21%, p=0.002) and monocyte chemoattractant protein-1 (pre: 213+/-9, change: -20.4+/-8.2 pg/ml, -5%, p=0.03). Diabetes mellitus (DM) significantly influenced changes of IL-8 (p=0.002). IL-8 substantially dropped by 39% in diabetics. Moreover, matrix metalloproteinase-9 (MMP-9) highly significantly decreased in response to training (pre: 750+/-98, change: -278+/-77 ng/ml, -18%, p=0.005). Exercise-induced changes of MMP-9 were influenced by concomitant use of statins (p=0.038). We observed a particularly strong MMP-9 reduction of 44% in patients treated with statins. Acute phase reactants IL-6 (pre: 1.7+/-0.3, change: +0.25+/-0.7 pg/ml, +4%, p=0.58) and high sensitivity C-reactive protein (pre: 2.1+/-0.5, change: -0.25+/-0.4 mg/l, -9%, p=0.54) did not change in response to training. In conclusion, endurance training decreased circulating chemokines and MMP-9, which may in part explain its beneficial effect on coronary risk. Patients with DM or treated with statins because of hypercholesterolemia may particularly take advantage.

Associations of changes in exercise level with subsequent disability among seniors: a 16-year longitudinal study

BACKGROUND

The effect of changes in physical exercise on progression of musculoskeletal disability in seniors has rarely been studied.

METHODS

We studied a prospective cohort annually from 1984 to 2000 using the Health Assessment Questionnaire Disability Index (HAQ-DI). The cohort included 549 participants, 73% men, with average end-of-study age of 74 years. At baseline and at the end of the study, participants were classified as "High" or "Low" vigorous exercisers using a cut-point of 60 min/wk. Four groups were formed: "Sedentary" (Low-->Low; N = 71), "Exercise Increasers" (Low-->High; N = 27), "Exercise Decreasers" (High-->Low; N = 73), and "Exercisers" (High-->High; N = 378). The primary dependent variable was change in HAQ-DI score (scored 0-3) from 1984 to 2000. Multivariate statistical adjustments using analysis of covariance included age, gender, and changes in three risk factors, body mass index, smoking status, and number of comorbid conditions. Participants also prospectively provided reasons for exercise changes.

RESULTS

At baseline, Sedentary and Increasers averaged little exercise (16 and 22 exercise min/wk), whereas Exercisers and Decreasers averaged over 10 times more (285 and 212 exercise min/wk; p <.001). All groups had low initial HAQ-DI scores, ranging from 0.03 to 0.08. Increasers and Exercisers achieved the smallest increments in HAQ-DI score (0.17 and 0.11) over 16 years, whereas Decreasers and Sedentary fared more poorly (increments 0.27 and 0.37). Changes in HAQ-DI score for Increasers compared to Sedentary were significantly more favorable (p <.05) even after multivariate statistical adjustment.

CONCLUSIONS

Inactive participants who increased exercise achieved excellent end-of-study values with increments in disability similar to those participants who were more active throughout. These results suggest a beneficial effect of exercise, even when begun later in life, on postponement of disability.

Health benefits of physical activity: the evidence

The primary purpose of this narrative review was to evaluate the current literature and to provide further insight into the role physical inactivity plays in the development of chronic disease and premature death. We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death. We also reveal that the current Health Canada physical activity guidelines are sufficient to elicit health benefits, especially in previously sedentary people. There appears to be a linear relation between physical activity and health status, such that a further increase in physical activity and fitness will lead to additional improvements in health status.

Prescribing exercise as preventive therapy

Energy expenditure of about 1000 kcal (4200 kJ) per week (equivalent to walking 1 hour 5 days a week) is associated with significant health benefits. Health benefits can be achieved through structured or nonstructured physical activity, accumulated throughout the day (even through short 10-minute bouts) on most days of the week. In this article we outline the means of evaluating cardiovascular and musculoskeletal fitness, the methods of evaluating physical activity levels, the current recommendations for exercise (including intensity, type, time and frequency) and the resources available for patients and physicians interested in learning more about the evaluation of physical activity and fitness levels and the prescription of exercise.

Effort/reward imbalance and sedentary lifestyle: an observational study in a large occupational cohort

OBJECTIVES

To investigate the association between effort/reward imbalance (ERI) at work and sedentary lifestyle.

METHODS

Cross sectional data from the ongoing Finnish Public Sector Study related to 30,433 women and 7718 men aged 17-64 were used (n = 35,918 after exclusion of participants with missing values in covariates). From the responses to a questionnaire, an aggregated mean score for ERI in a work unit was assigned to each participant. The outcome was sedentary lifestyle defined as <2.00 metabolic equivalent task (MET) hours/day. Logistic regression with generalised estimating equations was used as an analysis method to include both individual and work unit level predictors in the models. Adjustments were made for age, marital status, occupational status, job contract, smoking, and heavy drinking.

RESULTS

Twenty five per cent of women and 27% of men had a sedentary lifestyle. High individual level ERI was associated with a higher likelihood of sedentary lifestyle both among women (odds ratio (OR) = 1.08, 95% CI 1.01 to 1.16) and men (OR = 1.17, 95% CI 1.02 to 1.33). These associations were not explained by relevant confounders and they were also independent of work unit level job strain measured as a ratio of job demands and control.

CONCLUSIONS

A mismatch between high occupational effort spent and low reward received in turn seems to be associated with an increased risk of sedentary lifestyle, although this association is relatively weak.

An implementation intentions intervention, the use of a planning strategy, and physical activity after myocardial infarction

The paper investigates the relations between involvement in an implementation intention intervention programme, frequency of the use of a self-regulatory physical activity planning strategy, and moderate physical activity among patients who had suffered myocardial infarction (MI). It examines whether effects of the implementation intention intervention on behavior change was mediated by change in the use of a planning strategy. A total of 114 patients from central and northern Poland took part in the study after their first uncomplicated MI. Data were collected individually at approximately 1 week after MI (Time 1), 2 weeks after short-term rehabilitation (about 8 weeks after MI: Time 2), and 8 months after MI (Time 3). After data collection at Time 2, patients were randomly assigned to the control group or the intervention group. Patients who participated in the implementation intention intervention maintained the same number of sessions of moderate physical activity at 8 months after MI (Time 3) as at 2 weeks after rehabilitation (Time 2). By contrast, patients from the control group performed significantly fewer sessions of moderate physical activity at Time 3, compared to Time 2. The intervention resulted in the more frequent use of a planning strategy at 8 months after MI. Change in the frequency of the use of a planning strategy completely mediated effects of the intervention on change in physical activity. Only patients who participated in the implementation intention intervention and increased their use of a planning strategy adhered to the recommended three or more sessions of moderate physical activity per week.

Does occupational social class predict coronary heart disease after retirement? A 12-year follow-up study in Sweden

AIMS

To examine whether socioeconomic status and coronary heart disease (CHD) risk factors remain significant predictors of CHD among people aged >or=65 years. Previous studies in this age group are few and inconsistent.

METHODS

Follow-up study of a simple random sample of Swedish women and men aged >or=65 years interviewed in a national survey 1988-89 and followed up until 31 December 2000, for CHD incidence rates. Cox regression was used to study the association between socioeconomic status (occupation) and CHD, after adjustment for age, sex, physical activity, smoking, BMI, diabetes, and hypertension. Participants with CHD hospitalization two years before the start of the study and those who rated their general health as poor were excluded.

RESULTS

Among manual workers and lower-level employees the risk of CHD was significantly higher than among middle-level employees and professionals (49% and 50%, respectively), after adjustment for age and sex. The association between low socioeconomic status and increased CHD risk disappeared after adjustment for the CHD risk factors, which were more prevalent among those with low socioeconomic status. All the CHD risk factors (with the exception of BMI) were associated with increased CHD incidence rates.

CONCLUSIONS

Low socioeconomic status remains a significant predictor of CHD among people aged >or=65 years. Healthcare policies among elderly patients should encourage physical activity and smoking cessation in all socioeconomic groups.

Lifestyle and Prevention of Cardiovascular Disease in the Elderly: An Italian Perspective

The life span of human beings is partially influenced by genetic factors, but outcomes of aging are profoundly influenced by lifestyle and other environmental factors. Age-related modifications of the cardiovascular system are preserved by antiaging lifestyle interventions such as physical activity and caloric restriction. Accordingly, physical activity and low body mass index reduce mortality in older men with cardiovascular diseases. Several mechanisms have been proposed to explain the protective effect of lifestyle interventions against cardiovascular diseases in the elderly, including a reduction of vulnerability (i.e., the age-related reduction of endogenous mechanisms protective against pathologic insults). The age-related reduction of ischemic preconditioning, the most powerful endogenous protective mechanism against myocardial ischemia, is restored by both physical activity and caloric restriction. Thus, older persons can implement lifestyle practices that minimize their risk of death from cardiovascular diseases.

From a postal questionnaire of older men, healthy lifestyle factors reduced the onset of and may have increased recovery from mobility limitation

BACKGROUND AND OBJECTIVE

We have examined predictors of the onset of and recovery from mobility limitation and the association between lifestyle changes in later life and mobility status.

STUDY DESIGN AND SETTING

From a cohort of 7,735 men recruited at ages 40-59 years (1978-1980), 5,075 men completed follow-up postal questionnaires in 1992 (Q92), then aged 52-73 years, and again in 1996 (Q96). Mobility limitation was defined as reported difficulty in any one or more of the following: getting outdoors, walking 400 yards, or climbing stairs.

RESULTS

Lifestyle factors (smoking, obesity, physical inactivity, and heavy drinking) and manual worker social class were significantly and independently associated with onset of mobility limitation and with the exception of physical activity remained significant after further adjustment for chronic diseases. Smoking cessation and taking up physical activity in later life are associated with reduced onset of mobility limitation. Among men with mobility limitation at Q92 (n=645), light or moderate levels of physical activity were associated with significantly increased odds of recovery at Q96 (light activity, OR=2.43, 95% CI 1.48, 4.00; moderate activity, OR=2.57, 95% CI 1.31, 5.02).

CONCLUSION

Maintaining and adopting a healthy lifestyle in later life reduces the onset of mobility limitation in old age. Maintaining physical activity may improve recovery.

Job strain and leisure-time physical activity in female and male public sector employees

BACKGROUND

High work stress could decrease physical activity but the evidence of the relationship has remained equivocal. The present study examined the association between job strain and leisure-time physical activity in a large sample of employees.

METHODS

Cross-sectional data related to a cohort of 46,573 Finnish public sector employees aged 17-64 years. Job strain was measured by questions derived from Karasek's Demand/Control model. Leisure-time physical activity was defined using activity metabolic equivalent task (MET) index. Analysis of variance was used to compare means of MET-hours/week by job strain categories and by tertiles of job control and job demands.

RESULTS

Women and men with high strain (low control and high demands), passive jobs (low control and low demands), and low job control had 2.6 to 5.2 MET-hours/week less than their counterparts with low strain and high control, respectively, even after the effects of age, marital status, socioeconomic status, job contract, smoking, heavy drinking, and trait anxiety were taken into account. Active jobs (high control and high demands) were additionally associated with lower mean of MET-hours in men and in older workers.

CONCLUSIONS

Our findings suggest an independent, albeit substantially weak, association between higher work stress and lower leisure-time physical activity.

The associations of physical activity and adiposity with alanine aminotransferase and gamma-glutamyltransferase

The mechanisms linking obesity and inactivity to diabetes mellitus are unclear. Recent studies have shown associations of alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) with diabetes. In a random sample of 3,789 British women aged 60-79 years, the authors examined the associations of obesity and physical activity with ALT and GGT (1999-2001). Both body mass index and waist:hip ratio were independently (of each other, physical activity, alcohol consumption, smoking, and childhood and adulthood social class) positively and linearly associated with ALT and GGT. In adjusted models, a one-standard-deviation increase in body mass index was associated with a 0.46-units/liter (95% confidence interval (CI): 0.16, 0.75) increase in ALT and a 2.14-units/liter (95% CI: 0.99, 3.30) increase in GGT. Similar results for a one-standard-deviation increase in waist:hip ratio were 13.96 (95% CI: 10.44, 17.48) for ALT and 39.44 (95% CI: 25.89, 52.98) for GGT. Frequency of physical activity was inversely and linearly associated with GGT in fully adjusted models, but the inverse association with ALT was attenuated towards the null after adjustment for body mass index and waist:hip ratio. Adjustment for ALT and GGT resulted in some attenuation of the strong linear associations of body mass index and waist:hip ratio with diabetes. These findings provide some support for the suggestion that the relation between obesity and diabetes is, at least in part, mediated by liver pathology.

Lifestyle and cardiovascular disease in middle-aged British men: the effect of adjusting for within-person variation

AIMS

To examine the effect that within-person variation has on the estimated risk associations between cigarette smoking, physical inactivity, and increased body mass index (BMI) and the development of cardiovascular disease (CVD) in middle-aged British men.

METHODS AND RESULTS

In total, 6452 men aged 40-59 with no prior evidence of CVD were followed for major CVD events (fatal/non-fatal myocardial infarction or stroke) and all-cause mortality over 20 years; lifestyle characteristics were ascertained at regular points throughout the study. A major CVD event within the first 20 years was observed in 1194 men (18.5%). Use of baseline assessments of cigarette smoking and physical activity in analyses resulted in underestimation of the associations between average cumulative exposure to these factors and major CVD risk. After correction for within-person variation, major CVD rates were over four times higher for heavy smokers (> or =40 cigarettes/day) compared with never smokers and three times higher for physically inactive men compared with moderately active men. Major CVD risk increased by 6% for each 1 kg/m(2) increase in usual BMI. If all men had experienced the risk levels of the men who had never regularly smoked cigarettes, were moderately active, and had a BMI of < or =25 kg/m(2) (6% of the population), 66% of the observed major CVD events would have been prevented or postponed (63% before adjustment for within-person variation). Adjustment for a range of other risk factors had little effect on the results. Similar results were obtained for all-cause mortality.

CONCLUSION

Failure to take account of within-person variation can lead to underestimation of the importance of lifestyle characteristics in determining CVD risk. Primary prevention through lifestyle modification has a great preventive potential.

Estágios de mudança de comportamento relacionados à atividade física em adolescentes

Estudos relacionados ao comportamento quanto à prática de atividades físicas vêm despertando interesse cada vez maior nos pesquisadores. Porém, especialmente em adolescentes ainda percebe-se grande carência de investigações com esse enfoque. O objetivo desta pesquisa do tipo descritivo analítico foi classificar a prática de atividade física segundo a teoria dos estágios de mudança de comportamento (EMC) de acordo com o sexo, série e nível socioeconômico. Os sujeitos foram adolescentes do ensino médio, da cidade do Recife-PE, com média de idade de 16,2 ± 1,1 (14 a 19 anos), selecionados por amostragem por conglomerados, totalizando 2.271 estudantes (1.022 rapazes e 1.249 moças), de 29 escolas de ensino privado. Características sociodemográficas e EMC foram levantados mediante aplicação de um questionário de auto-relato. As análises dos dados foram feitas usando a estatística descritiva, o teste do qui-quadrado, a correlação de Spearman e o teste U de Mann-Whitney (p < 0,05). Os estudantes apresentaram as seguintes características: 66,3% pertenciam à classe econômica A1 e A2, o que evidenciou o alto poder aquisitivo da amostra. No grupo estudado, 61,6% dos adolescentes foram classificados como inativos ou irregularmente ativos, e 26,2%, como sedentários (pré-contemplativos e contemplativos); na análise por sexo, os rapazes eram mais ativos fisicamente que as moças segundo os EMC agrupados. Verificou-se ainda declínio na prática de atividades físicas com o avanço na série escolar. Sugere-se a criação de intervenções nas escolas da região, com o intuito de incentivar a prática de atividades físicas, principalmente nas moças, que contemplem opções escolhidas pelos jovens, reformas estruturais para adequar horários/atividades, como formas eficazes de mudança de comportamento em relação às atividades físicas.

The Effects of Moderate, Strenuous, and Overtraining on Oxidative Stress Markers and DNA Repair in Rat Liver

Physical exercise above a certain load has been suggested as being a cause of oxidative stress. We have tested whether training with moderate (MT), strenuous (ST), or over (OT) load can cause alterations in the activities of antioxidant enzymes, lipid peroxidation, protein oxidation, DNA damage, or activity of 8-oxoG-DNA glycosylase (OGG1) in rat liver. The levels of corticosterone decreased in all exercising groups but the differences were not significant. Adrenocorticotrophin hormone (ACTH) levels decreased, not significantly, in MT and OT compared to C. Activity levels of antioxidant enzymes did not change significantly in the liver. The levels of reactive carbonyl derivative (RCD) content decreased in the liver of exercising animals, and the differences reached significance between control and moderately trained groups. The changes in the levels of lipid peroxidation (LIPOX) were not significant, but were lower in the exercised groups. The 8-hydroxydeoxyguanosine (8-OHdG) levels increased in the OT group, and the activity of OGG1 measured from crude cell extracts tended to increase in MT and ST. The findings of this study imply that overtraining induces oxidative damage to nuclear DNA, but not to liver lipids and proteins. Key words: exercise, oxidative damage, adaptation, OGG1

Exercise and hormesis: oxidative stress-related adaptation for successful aging

The hormesis theory purports that biological systems respond with a bell-shaped curve to exposure to chemicals, toxins, and radiation. Here we extend the hormesis theory to include reactive oxygen species (ROS). We further suggest that the beneficial effects of regular exercise are partly based on the ROS generating capability of exercise, which is in the stimulation range of ROS production. Therefore, we suggest that exercise-induced ROS production plays a role in the induction of antioxidants, DNA repair and protein degrading enzymes, resulting in decreases in the incidence of oxidative stress-related diseases and retardation of the aging process.

Prevention of Cardiovascular Events in Elderly People

BACKGROUND AND OBJECTIVE

Cardiovascular disease has been identified as the leading cause of morbidity and mortality in developed countries. Given the increase in life expectancy and the development of cardiovascular preventive measures, it has become increasingly important to detect and prevent cardiovascular diseases in the elderly. We reviewed the scientific literature concerning cardiovascular prevention to assess the importance of cardiovascular preventive measures in old (> or =65 years of age) individuals.

METHODS

We undertook a systematic search for references relating to prevention of cardiovascular disease in the elderly, mainly ischaemic stroke, coronary artery disease and heart failure, on the MEDLINE database 1962-2005. For cardiovascular prevention by drugs or surgery, emphasis was placed on randomised controlled trials, review articles and meta-analyses. For cardiovascular prevention by lifestyle modification, major cohort studies were also considered.

RESULTS

Stroke, coronary heart disease and heart failure were found to be the main targets for cardiovascular prevention in published studies. Antihypertensive treatment has proven its efficacy in primary prevention of fatal or nonfatal stroke in hypertensive and high-risk patients >60 years of age, particularly through treatment of systolic hypertension. Systolic blood pressure reduction is equally important in the secondary prevention of stroke. Similarly, in nonvalvular atrial fibrillation, an adjusted dose of warfarin with a target International Normalized Ratio (INR) of between 2 to 3 prevents ischaemic stroke in elderly patients with an acceptable haemorrhagic risk but is still under prescribed. Antiplatelet agents are indicated in elderly patients with nonembolic strokes. Few large-scale studies have investigated the effect of HMG-CoA reductase inhibitors (statins) on stroke prevention in old individuals. To date, the largest trials suggest a beneficial effect for stroke prevention with use of statins in high-risk elderly subjects < or =82 years of age. Carotid endarterectomy is indicated in carotid artery stenosis >70% and outcomes are even better in elderly than in younger patients. However, medical treatment is still the first-line treatment in asymptomatic elderly patients with <70% stenosis. In ischaemic heart disease, different trials in elderly individuals have shown that use of statins, antithrombotic agents, beta-adrenoceptor antagonists and ACE inhibitors plays an important role either in primary or in secondary cardiovascular prevention. Hormone replacement therapy has been used to treat climacteric symptoms and postmenopausal osteoporosis and was thought to confer a cardiovascular protection. However, controlled trials in elderly individuals changed this false belief when it was found that there was no benefit and even a harmful cardiovascular effect during the first year of treatment. Smoking cessation, regular physical activity and healthy diet are, as in younger individuals, appropriate and effective measures for preventing cardiovascular events in the elderly. Finally, antihypertensive treatment and influenza vaccination are useful for heart failure prevention in elderly individuals.

CONCLUSIONS

Cardiovascular prevention should be more widely implemented in the elderly, including individuals aged > or =75 years, and this might contribute to improved healthy status and quality of life in this growing population.

Physical activity, obesity and cardiovascular diseases

Sedentary lifestyle and overweight are major public health, clinical, and economical problems in modern societies. The worldwide epidemic of excess weight is due to imbalance between physical activity and dietary energy intake. Sedentary lifestyle, unhealthy diet, and consequent overweight and obesity markedly increase the risk of cardiovascular diseases. Regular physical activity 45-60 min per day prevents unhealthy weight gain and obesity, whereas sedentary behaviors such as watching television promote them. Regular exercise can markedly reduce body weight and fat mass without dietary caloric restriction in overweight individuals. An increase in total energy expenditure appears to be the most important determinant of successful exercise-induced weight loss. The best long-term results may be achieved when physical activity produces an energy expenditure of at least 2,500 kcal/week. Yet, the optimal approach in weight reduction programs appears to be a combination of regular physical activity and caloric restriction. A minimum of 60 min, but most likely 80-90 min of moderate-intensity physical activity per day may be needed to avoid or limit weight regain in formerly overweight or obese individuals. Regular moderate intensity physical activity, a healthy diet, and avoiding unhealthy weight gain are effective and safe ways to prevent and treat cardiovascular diseases and to reduce premature mortality in all population groups. Although the efforts to promote cardiovascular health concern the whole population, particular attention should be paid to individuals who are physically inactive, have unhealthy diets or are prone to weight gain. They have the highest risk for worsening of the cardiovascular risk factor profile and for cardiovascular disease. To combat the epidemic of overweight and to improve cardiovascular health at a population level, it is important to develop strategies to increase habitual physical activity and to prevent overweight and obesity in collaboration with communities, families, schools, work sites, health care professionals, media and policymakers.

Physical activity and mortality in frail, community-living elderly patients

BACKGROUND

The authors describe the prevalence of moderate-intensity physical activity in a population of older persons living in the community. In addition, they explore the relationship between physical activity and mortality.

METHODS

In this longitudinal observational study, the authors analyzed data from patients admitted to home care programs collected as part of the Italian Silver Network Home Care project. Twelve home health agencies participated in the project, which evaluated the implementation of the Minimum Data Set for Home Care (MDS-HC) instrument. A total of 2757 patients were enrolled in the current study. The primary outcome measures were the prevalence of 2 or more hours per week of physical activity and survival.

RESULTS

Fewer than 20% of patients had regular physical activity. During a median follow-up period of 10 months from the initial MDS-HC assessment, 442 (16%) patients died. After adjusting for sex, physical and cognitive disability, and all potential risk factors for death, active patients were less likely to die compared with those with no or very low-intensity physical activity (relative risk ratio [RR], 0.51; 95% confidence interval [CI], 0.35-0.73). This inverse relationship was also significant in patients aged 80 years and older (RR 0.55; 95% CI, 0.32-0.95).

CONCLUSIONS

Physical activity is associated with a significantly lower risk of all-cause mortality. The current findings support the possibility that moderate-intensity physical activity has an independent effect on survival even among frail and old persons.

Risk factors for heart failure

Despite remarkable therapeutic advances in the management of patients with heart failure (HF), the mortality due to this syndrome remains high. Identifying free-living individuals who are at high risk for developing HF may allow implementing strategies that can prevent HF. Prospective epidemiologic studies have identified several risk factors and risk markers for HF. This article reviews current knowledge regarding conventional and newer risk markers for HF, outlines possible underlying mechanisms for the increased HF risk, and provides a framework for clinical multivariate risk prediction using HF risk factors.

Short-term aerobic exercise improves arterial stiffness in type 2 diabetes

OBJECTIVE

To investigate whether: (1) aerobic exercise decreases arterial stiffness and (2) reduction in arterial stiffness is associated with improvement in insulin resistance in type 2 diabetes.

METHODS

Common carotid and femoral arterial stiffness was ultrasonographically evaluated using stiffness index beta in 23 type 2 diabetic subjects before and after a 3-week exercise protocol including ergometer and walking. Insulin sensitivity (Clamp-IR) was assessed using euglycemic-hyperinsulinemic clamp before and after the protocol. Arterial stiffness was also examined in steady hyperinsulinemic state during clamp.

RESULTS

Anthropometrical factors did not change following exercise. Clamp-IR tended to increase after exercise protocol (P = 0.061). Stiffness index beta decreased following exercise in both common carotid and femoral arteries (P = 0.020 and P < 0.001, respectively). DeltaClamp-IR was significantly correlated with the changes in stiffness index beta of both common carotid (P = 0.040) and femoral artery (P = 0.016). Divided into tertiles according to DeltaClamp-IR, decreases in stiffness index beta for both common carotid (P = 0.009) and femoral (P = 0.037) arteries was greater in tertile group with a higher DeltaClamp-IR. Hyperinsulinemia during clamp decreased stiffness index beta in both common carotid (P = 0.031) and femoral (P = 0.025) arteries before exercise, but these effects disappeared after the exercise protocol.

CONCLUSIONS

Short-term aerobic exercise significantly decreased arterial stiffness in both common carotid and femoral arteries, and the reduction of stiffness was associated with improvement of insulin resistance in type 2 diabetes.

Relative risk of mortality in the physically inactive is underestimated because of real changes in exposure level during follow-up

Relative risk among exposure groups in prospective cohort studies is based on the assumption that all subjects are exposed at the level recorded at baseline throughout the study. Changes in risk behavior during follow-up will dilute the relative risk. This prospective cohort study in Copenhagen, Denmark, between 1964 and 1994 included 30,640 men and women; 19,149 were examined twice, with an interval of 6.7 (standard deviation, 3.4) years. Relative risks calculated from baseline measurements for moderately active and sedentary groups compared with the highly active group were 1.11 (95% confidence interval: 1.05, 1.18) and 1.64 (95% confidence interval: 1.53, 1.75), respectively. The relative risk between the highly active group and the sedentary group decreased with increasing follow-up time. When intraindividual changes in physical activity level during follow-up were taken into account, the relative risk of physical inactivity was 24-59% higher compared with the relative risk estimated from baseline measurements. The risk of a sedentary lifestyle is underestimated when it is calculated from one baseline measurement in prospective studies, because subjects change behavior during follow-up.

An active and socially integrated lifestyle in late life might protect against dementia

The recent availability of longitudinal data on the possible association of different lifestyles with dementia and Alzheimer's disease (AD) allow some preliminary conclusions on this topic. This review systematically analyses the published longitudinal studies exploring the effect of social network, physical leisure, and non-physical activity on cognition and dementia and then summarises the current evidence taking into account the limitations of the studies and the biological plausibility. For all three lifestyle components (social, mental, and physical), a beneficial effect on cognition and a protective effect against dementia are suggested. The three components seem to have common pathways, rather than specific mechanisms, which might converge within three major aetiological hypotheses for dementia and AD: the cognitive reserve hypothesis, the vascular hypothesis, and the stress hypothesis. Taking into account the accumulated evidence and the biological plausibility of these hypotheses, we conclude that an active and socially integrated lifestyle in late life protects against dementia and AD. Further research is necessary to better define the mechanisms of these associations and better delineate preventive and therapeutic strategies.

A life course approach to diet, nutrition and the prevention of chronic diseases

OBJECTIVE

To briefly review the current understanding of the aetiology and prevention of chronic diseases using a life course approach, demonstrating the life-long influences on the development of disease.

DESIGN

A computer search of the relevant literature was done using Medline-'life cycle' and 'nutrition' and reviewing the articles for relevance in addressing the above objective. Articles from references dated before 1990 were followed up separately. A subsequent search using Clio updated the search and extended it by using 'life cycle', 'nutrition' and 'noncommunicable disease' (NCD), and 'life course'. Several published and unpublished WHO reports were key in developing the background and arguments.

SETTING

International and national public health and nutrition policy development in light of the global epidemic in chronic diseases, and the continuing nutrition, demographic and epidemiological transitions happening in an increasingly globalized world. RESULTS OF REVIEW: There is a global epidemic of increasing obesity, diabetes and other chronic NCDs, especially in developing and transitional economies, and in the less affluent within these, and in the developed countries. At the same time, there has been an increase in communities and households that have coincident under- and over-nutrition.

CONCLUSIONS

The epidemic will continue to increase and is due to a lifetime of exposures and influences. Genetic predisposition plays an unspecified role, and with programming during fetal life for adult disease contributing to an unknown degree. A global rise in obesity levels is contributing to a particular epidemic of type 2 diabetes as well as other NCDs. Prevention will be the most cost-effective and feasible approach for many countries and should involve three mutually reinforcing strategies throughout life, starting in the antenatal period.

Why Older Australians Participate in Exercise and Sport

Research on variables that encourage older adults to exercise is limited. This study was carried out to identify the participation motives of older Australians involved in regular exercise and sport. The 815 participants (399 men, 416 women) ranged in age from 55 to 93 years (M= 63.6,SD= 7.8) and were participating in their activities of choice at least once per week. All participants completed the Participation Motivation Questionnaire for Older Adults. The most common exercise/sport activities that participants were involved in were walking, golf, lawn bowls, tennis, and swimming. The most highly reported motives for participation were to keep healthy, liking the activity, to improve fitness, and to maintain joint mobility. Principal-components analysis of the questionnaire revealed 6 factors: social, fitness, recognition, challenge/benefits, medical, and involvement. Analyses of variance showed significant differences in reasons for participation in exercise and sport based on gender, age, education level, and occupation.

Changes in neighborhood walking are related to changes in perceptions of environmental attributes

BACKGROUND

Several studies have found significant cross-sectional associations of perceived environmental attributes with physical activity behaviors. Prospective relations with environmental factors have been examined for vigorous activity, but not for the moderate-intensity activities that environmental and policy initiatives are being designed to influence.

PURPOSE

To examine prospective associations of changes in perceptions of local environmental attributes with changes in neighborhood walking.

METHODS

Baseline and 10-week follow-up telephone interviews with 512 adults (49% men).

RESULTS

Men who reported positive changes in aesthetics and convenience were twice as likely to increase their walking. Women who reported positive changes in convenience were more than twice as likely to have increased their walking. There were contrasting findings for men and women who reported traffic as less of a problem: Men were 61% less likely to have increased walking; however, women were 76% more likely to have done so.

CONCLUSIONS

Further studies are needed to determine the possibly causal nature of such environment-behavior relations and to elucidate relevant gender differences. Such evidence will provide underpinnings for public health initiatives to increase participation in physical activity.

The Economic Costs Associated With Physical Inactivity and Obesity in Canada: An Update

The purpose of this analytical review was to estimate the direct and indirect economic costs of physical inactivity and obesity in Canada in 2001. The relative risks of diseases associated with physical inactivity and obesity were determined from a meta-analysis of existing prospective studies and applied to the health care costs of these diseases in Canada. Estimates were derived for both the direct health care expenditures and the indirect costs, which included the value of economic output lost because of illness, injury-related work disability, or premature death. The economic burden of physical inactivity was $5.3 billion ($1.6 billion in direct costs and $3.7 billion in indirect costs) while the cost associated with obesity was $4.3 billion ($1.6 billion of direct costs and $2.7 billion of indirect costs). The total economic costs of physical inactivity and obesity represented 2.6% and 2.2%, respectively, of the total health care costs in Canada. The results underscore the importance of public health efforts aimed at combating the current epidemics of physical inactivity and obesity in Canada. Key words: overweight, lifestyle, meta analysis, population attributable risk, cost-of-illness

Physical inactivity, excess adiposity and premature mortality

The purpose of this report is to review the evidence that physical inactivity and excess adiposity are related to an increased risk of all-cause mortality, and to better identify the independent contributions of each to all-cause mortality rates. A variance-based method of meta-analysis was used to summarize the relationships from available studies. The summary relative risk of all-cause mortality for physical activity from the 55 analyses (31 studies) that included an index of adiposity as a covariate was 0.80 [95% confidence interval (CI) 0.78-0.821, whereas it was 0.82 [95% CI 0.80-0.84] for the 44 analyses (26 studies) that did not include an index of adiposity. Thus, physically active individuals have a lower risk of mortality by comparison to physically inactive peers, independent of level of adiposity. The summary relative risk of all-cause mortality for an elevated body mass index (BMI) from the 25 analyses (13 studies) that included physical activity as a covariate was 1.23 [95% CI 1.18-1.29], and it was 1.24 [95% CI 1.21-1.28] for the 81 analyses (36 studies) that did not include physical activity as a covariate. Studies that used a measure of adiposity other than the BMI show similar relationships with mortality, and stratified analyses indicate that both physical inactivity and adiposity are important determinants of mortality risk.

Influência de programas não-formais de exercícios (doméstico e comunitário) sobre a aptidão física, pressão arterial e variáveis bioquímicas em pacientes hipertensos

Fundamentos e objetivo: O exercício físico é aceito como estratégia complementar no tratamento da hipertensão arterial. Contudo, são poucos os estudos que analisaram o efeito potencial de programas cujo controle do volume de treinamento é menos estrito, principalmente os não-supervisionados. Assim, o estudo investigou os efeitos de dois programas não-formais de exercício sobre a pressão arterial, aptidão física e perfil bioquímico sanguíneo de adultos hipertensos. Métodos: Foram acompanhados por 18 meses participantes um programa de exercícios não-supervisionado (extramuros) (n = 29; idade = 53 ± 11 anos) e outro de tipo comunitário (ginástica) (n = 42; idade = 62 ± 9 anos). Foram analisados os níveis de pressão arterial, aptidão física (peso corporal, percentual de gordura, IMC, somatório de dobras, relação cintura-quadril, capacidade cardiorrespiratória) e variáveis bioquímicas (colesterol total, LDL, HDL, triglicerídeos e glicemia). O programa extramuros consistia em atividades programadas para serem feitas em casa (caminhada e flexibilidade), três vezes por semana, com treinamento dos sujeitos para controle da intensidade e duração das atividades e preenchimento de fichas individuais, que eram entregues periodicamente à equipe de pesquisa. O programa comunitário envolvia atividades ginásticas em grupo, ministradas por profissionais de educação física, também feitas três vezes por semana. Em ambos os programas, as variáveis foram medidas trimestralmente e os dados tratados por meio de ANOVA para medidas repetidas (p < 0,05). Resultados e conclusão: Os resultados indicaram que ambos os programas tiveram efeitos positivos, principalmente na composição corporal (quantitativa e distribuição regional) e perfil lipídico sanguíneo. As repercussões sobre a pressão arterial, apesar de identificadas estatisticamente, revelaram-se menos consistentes. Não houve efeitos importantes sobre o perfil bioquímico sanguíneo. Conclui-se que programas não-formais de atividades físicas podem ter influências benéficas sobre a condição geral de hipertensos, mas seu potencial quanto a efeitos mais específicos deve ser melhor apreciado em estudos futuros.

Association of the metabolic syndrome with both vigorous and moderate physical activity

BACKGROUND

Cross-sectional relationships between moderate and vigorous physical activity and the metabolic syndrome (MS) were examined in the Whitehall II study of civil servants (age 45-68 years). We assessed cardiovascular fitness and body mass index (BMI) as possible mediators of the observed association.

METHODS

Measures of 2-hour glucose, systolic blood pressure, fasting triglycerides, waist-hip ratio, and high density lipoprotein (HDL) cholesterol were obtained in 5153 white European participants. Participants in the most adverse sex-specific quintile for three or more of these risk factors were classified as having MS. Self-reported leisure-time physical activity was categorized into separate moderate and vigorous activity classes. BMI and resting heart rate (HR) were used to estimate body fatness and cardiovascular fitness respectively.

RESULTS

The odds ratios (95% CI) for having the metabolic syndrome in the top categories of vigorous and moderate activity were 0.52 (95% CI: 0.40, 0.67) and 0.78 (95% CI: 0.63, 0.96) respectively, adjusted for age, sex, smoking, alcohol intake, socioeconomic status, and other activity. Adjustment for BMI and resting HR substantially attenuated both of the above associations.

CONCLUSIONS

Moderate and vigorous physical leisure-time activity are each associated with reduced risk of being classified with MS independently of age, smoking, and high alcohol intake. Both vigorous and moderate activities may be beneficial to the MS cluster of risk factors among middle-aged populations. Reduced BMI and increased cardiovascular fitness may be important mediators of this association for both intensities of activity.

Physical activity and the prevention of cardiovascular disease

This article summarizes recent evidence on the role of physical activity in the prevention of overt and subclinical vascular disease. Epidemiologic data suggest that as little as 30 minutes per day of moderate-intensity physical activity, including brisk walking, reduces the incidence of clinical cardiovascular events in men and women. Regular exercise may also retard the progression of asymptomatic coronary and peripheral arteriosclerosis. Cardioprotective mechanisms of physical activity include reducing adiposity, blood pressure, diabetes incidence, dyslipidemia, and inflammation, and enhancing insulin sensitivity, glycemic control, fibrinolysis, and endothelial function. In a sedentary society such as the United States, public health initiatives that promote moderate increases in activity represent the optimal balance between efficacy and feasibility to achieve desired improvements in cardiovascular health.

The illusion of improved physical fitness and reduced mortality

PURPOSE

To conduct a computer simulation to assess the effects of measurement error on prospective epidemiological studies that attribute mortality outcomes to apparent changes in the independent variable (e.g., physical fitness or activity) at baseline.

METHODS

As an example, we evaluated the design of the Aerobics Center Longitudinal Study (ACLS). This study compared apparent changes in fitness between two baseline visits to mortality during a subsequent 5-yr follow-up period. Unfit men who were reclassified as fit at the second baseline examination (6.6% of sample) and fit men who were reclassified as unfit (2.3%) had follow-up mortality rates that were between those of men who were consistently classified as fit or unfit. This study design was simulated assuming that differences between baseline treadmill test durations were due to measurement error alone. Based on our own data, we estimated that repeat measurements of treadmill test duration have correlation of r = 0.89 in the absence of any real fitness change.

RESULTS

There is excellent agreement between the published ACLS risk reductions and our simulated reductions for both cardiovascular disease (CVD) and total mortality. Compared with the "Unfit-->Unfit" (the referent group), the estimated relative risks from the simulations for men who were reclassified as fit (i.e., "Unfit-->Fit") were 0.57 for total mortality and 0.52 for CVD mortality, and for men who remained classified as fit ("Fit-->Fit"), they were 0.33 for total mortality and 0.20 for CVD mortality.

CONCLUSION

The imprecision of the fitness measurement alone (i.e., measurement error) is sufficient to produce the reported ACLS risk reductions in initially unfit men who get reclassified as fit in a subsequent clinic visit. This statistical artifact will apply to other studies that use this design.

What level of physical activity protects against premature cardiovascular death? The Caerphilly study

OBJECTIVE

To examine the optimal intensity of leisure time physical activity (LTPA) to decrease the risk of all cause, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality in a population sample of middle aged British men.

DESIGN

Prospective study of middle aged men with an 11 year follow up.

SETTING

A whole population sample of men from Caerphilly, South Wales, UK.

SUBJECTS

1975 men aged 49-64 years without historical or clinical evidence of CHD at baseline examination.

MAIN OUTCOME MEASURES

All cause, CVD, and CHD mortality.

RESULTS

Total (cumulative) LTPA had a graded, significant relation with all cause, CVD, and CHD mortality but no trend with cancer deaths. When different intensities of activity were considered, light and moderate intensity LTPA had inconsistent and non-significant relations with all cause, CVD, or CHD mortality whether adjusted only for age or for other cardiovascular risk factors. In contrast a significant dose-response relation was found for heavy intensity LTPA for all cause, CVD, and CHD mortality fully adjusted for other risk factors.

CONCLUSIONS

These data suggest that, in a population of men without evidence of CHD at baseline, only leisure exercise classified as heavy or vigorous was independently associated with reduced risk of premature death from CVD.

Alcohol, body weight, and weight gain in middle-aged men

BACKGROUND

There is uncertainty as to whether regular alcohol consumption contributes directly to weight gain and the risk of obesity.

OBJECTIVE

We examined the relation between alcohol intake and body weight and the association between changes in alcohol intake and in body weight over 5 y of follow-up.

DESIGN

This was a prospective study of 7608 men aged 40-59 y drawn from general practices in 24 British towns, excluding persons with known diabetes. Five years after screening, 6832 men then aged 45-64 y and without diabetes completed a postal questionnaire on changes in alcohol intake and body weight.

RESULTS

Mean body mass index (BMI; in kg/m(2)) and the prevalence of men with a high BMI (>or= 28; top quintile of the BMI distribution) increased significantly from the light-moderate to the very heavy alcohol intake group even after adjustment for potential confounders. Similar patterns were seen for all types and combinations of alcohol. After 5 y of follow-up, stable and new heavy drinkers (including very heavy drinkers of >or= 30 g/d) showed the greatest weight gain and had the highest prevalence rates of high BMI. Weight change patterns in heavy drinkers at baseline who reduced their intake were not significantly different from those in the stable none-occasional group but showed more weight loss and less weight gain than in the stable or new heavy drinkers.

CONCLUSION

Heavy alcohol intake (>or= 30 g/d) contributes directly to weight gain and obesity, irrespective of the type of alcohol consumed.