Non-vigorous physical activity and all-cause mortality: systematic review and meta-analysis of cohort studies

An evaluation of the effectiveness and cost effectiveness of the National Exercise Referral Scheme in Wales, UK: a randomised controlled trial of a public health policy initiative

BACKGROUND

The Wales National Exercise Referral Scheme (NERS) is a 16-week programme including motivational interviewing, goal setting and relapse prevention.

METHOD

A pragmatic randomised controlled trial with nested economic evaluation of 2160 inactive participants with coronary heart disease risk (CHD, 1559, 72%), mild to moderate depression, anxiety or stress (79, 4%) or both (522, 24%) randomised to receive (1) NERS or (2) normal care and brief written information. Outcome measures at 12 months included the 7-day physical activity recall, the hospital anxiety and depression scale.

RESULTS

Ordinal regression identified increased physical activity among those randomised to NERS compared with those receiving normal care in all participants (OR 1.19, 95% CI 0.99 to 1.43), and among those referred for CHD only (OR 1.29, 95% CI 1.04 to 1.60). For those referred for mental health reason alone, or in combination with CHD, there were significantly lower levels of anxiety (-1.56, [corrected] 95% CI -2.75 to -0.38) and depression (-1.39, [corrected] 95% CI -2.60 to -0.18), but no effect on physical activity. The base-case incremental cost-effectiveness ratio was £12,111 per quality adjusted life year, falling to £9741 if participants were to contribute £2 per session.

CONCLUSIONS

NERS was effective in increasing physical activity among those referred for CHD risk only. Among mental health referrals, NERS did not influence physical activity but was associated with reduced anxiety and depression. Effects were dependent on adherence. NERS is likely to be cost effective with respect to prevailing payer thresholds. Trial registration Current Controlled Trials ISRCTN47680448.

Low vigorous physical activity at ages 15, 19 and 27: childhood socio-economic position modifies the tracking pattern

BACKGROUND

The present study examines (i) if the level of vigorous physical activity (VPA) at age 15 predicts low VPA at ages 19 and 27 and (ii) whether the observed prediction pattern differs by childhood socio-economic position (SEP). In this way, prediction analyses are applied to study tracking behaviour.

METHODS

Data are from The Danish Longitudinal Health Behaviour Study. The baseline survey was conducted in 1990 at age 15, the first follow-up in 1994 at age 19, and the second follow-up in 2002 at age 27, n = 561. The study population was a random sample of the Danish population selected from the National Civic Registration System, and data were collected by anonymous postal questionnaires. The indicator of childhood SEP was family occupational social class. Prediction analyses are conducted by stratified logistic regression analyses.

RESULTS

There was a significant and marked predictive power of low levels of VPA in mid adolescence (aged 15) for low VPA in late adolescence (age 19) [odds ratio (OR)=4.95 (2.83-8.66)], from late adolescence (age 19) into early adulthood (age 27) [OR = 2.71 (1.61-4.55)] and also over the full study period from age 15 to age 27 [2.91 (1.72-4.94)]. Analyses stratified by SEP revealed that the predictive power of VPA at age 19 for low VPA at age 27 was only significant among participants from low SEP.

CONCLUSION

These findings suggest that low VPA tracks through adolescence while tracking into adulthood only occurs among individuals with low childhood SEP.

Addressing the nonexercise part of the activity continuum: a more realistic and achievable approach to activity programming for adults with mobility disability?

Participation in physical activity is fundamental for the maintenance of metabolic health and the prevention of major chronic diseases, particularly type 2 diabetes and cardiovascular disease. A whole-of-day approach to physical activity promotion is increasingly advocated and includes not only increasing moderate-intensity physical activity but also reducing sedentary time and increasing light-intensity activity (the "nonexercise" part of the activity continuum). This whole-of-day approach to tackling the challenge of inactivity may be particularly relevant for adults with mobility disabilities, who are among the most inactive segment of the population. Focusing on nonexercise activity by striving to reduce sedentary time and increase light-intensity activity may be a more successful place to begin to change behavior in someone with mobility disability. This article discusses what is known about the metabolic health consequences of sedentary behavior and light-intensity activity in adults with and without mobility disability. The concept of inactivity physiology is presented, along with possible applications or evidence from studies with adults with mobility disability. Mobility disability discussions and examples focus on stroke and spinal cord injury. Finally, clinical implications and future research directions related to sedentary behavior in adults with mobility disability are discussed.

Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials

OBJECTIVES

To determine whether trials of physical activity promotion based in primary care show sustained effects on physical activity or fitness in sedentary adults, and whether exercise referral interventions are more effective than other interventions.

DESIGN

Systematic review and meta-analysis of randomised controlled trials.

DATA SOURCES

Medline, CINAHL, PsycINFO, EMBASE, SPORTDiscus, Centre for Reviews and Dissemination, the Cochrane Library, and article reference lists.

REVIEW METHODS

Review of randomised controlled trials of physical activity promotion in sedentary adults recruited in primary care, with minimum follow-up of 12 months, reporting physical activity or fitness (or both) as outcomes, and using intention to treat analyses. Two reviewers independently assessed studies for inclusion, appraised risk of bias, and extracted data. Pooled effect sizes were calculated using a random effects model.

RESULTS

We included 15 trials (n=8745). Most interventions took place in primary care, included health professionals in delivery, and involved advice or counselling given face to face or by phone (or both) on multiple occasions. Only three trials investigated exercise referral. In 13 trials presenting self reported physical activity, we saw small to medium positive intervention effects at 12 months (odds ratio 1.42, 95% confidence interval 1.17 to 1.73; standardised mean difference 0.25, 0.11 to 0.38). The number needed to treat with an intervention for one additional sedentary adult to meet internationally recommended levels of activity at 12 months was 12 (7 to 33). In four trials reporting cardiorespiratory fitness, a medium positive effect at 12 months was non-significant (standardised mean difference 0.51, -0.18 to 1.20). Three trials of exercise referral found small non-significant effects on self reported physical activity at 12 months (odds ratio 1.38; 0.98 to 1.95; standardised mean difference 0.20, -0.21 to 0.61).

CONCLUSIONS

Promotion of physical activity to sedentary adults recruited in primary care significantly increases physical activity levels at 12 months, as measured by self report. We found insufficient evidence to recommend exercise referral schemes over advice or counselling interventions. Primary care commissioners should consider these findings while awaiting further trial evaluation of exercise referral schemes and other primary care interventions, with longer follow-up and use of objective measures of outcome.

Indoor physical activity reduces all-cause and cardiovascular disease mortality among elderly women

OBJECTIVES

The aim of this study was to investigate whether a medium to high degree of total physical activity and indoor physical activity were associated with reduced all-cause and cardiovascular mortality among elderly Korean women.

METHODS

A prospective cohort study was done to evaluate the association between physical activity and mortality. The cohort was made up of elderly (≥ 65 years of age) subjects. Baseline information was collected with a self-administered questionnaire and linked to death certificates retrieved from a database. Cox proportional hazard models were used to estimate the hazard ratios (HRs) with 95% confidence interval (CI) levels.

RESULTS

Women who did not suffer from stroke, cancer, or ischemic heart disease were followed for a median of 8 years (n=5079). A total of 1798 all-cause deaths were recorded, of which 607 (33.8%) were due to cardiovascular disease. The group with the highest level of total physical activity and indoor physical activity was significantly associated to a reduced all-cause mortality (HR, 0.60; 95% CI, 0.51 to 0.71 and HR, 0.58; 95% CI, 0.50 to 0.67, respectively) compared to the group with the lowest level of total physical activity and indoor physical activity. Additionally, the group with the highest level of total physical activity and indoor physical activity was significantly associated to a lower cardiovascular disease mortality (HR, 0.53; 95% CI, 0.40 to 0.71 and HR, 0.51; 95% CI, 0.39 to 0.67, respectively) compared to the group with the lowest level of total physical activity and indoor physical activity.

CONCLUSIONS

Our study showed that regular indoor physical activity among elderly Korean women has healthy benefits.

Importance of characteristics and modalities of physical activity and exercise in defining the benefits to cardiovascular health within the general population: recommendations from the EACPR (Part I)

Over the last decades, more and more evidence is accumulated that physical activity (PA) and exercise interventions are essential components in primary and secondary prevention for cardiovascular disease. However, it is less clear whether and which type of PA and exercise intervention (aerobic exercise, dynamic resistive exercise, or both) or characteristic of exercise (frequency, intensity, time or duration, and volume) would yield more benefit in achieving cardiovascular health. The present paper, as the first of a series of three, will make specific recommendations on the importance of these characteristics for cardiovascular health in the population at large. The guidance offered in this series of papers is aimed at medical doctors, health practitioners, kinesiologists, physiotherapists and exercise physiologists, politicians, public health policy makers, and the individual member of the public. Based on previous and the current literature, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding type, volume, and intensity of PA and exercise.

Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study

BACKGROUND

The health benefits of leisure-time physical activity are well known, but whether less exercise than the recommended 150 min a week can have life expectancy benefits is unclear. We assessed the health benefits of a range of volumes of physical activity in a Taiwanese population.

METHODS

In this prospective cohort study, 416,175 individuals (199,265 men and 216,910 women) participated in a standard medical screening programme in Taiwan between 1996 and 2008, with an average follow-up of 8·05 years (SD 4·21). On the basis of the amount of weekly exercise indicated in a self-administered questionnaire, participants were placed into one of five categories of exercise volumes: inactive, or low, medium, high, or very high activity. We calculated hazard ratios (HR) for mortality risks for every group compared with the inactive group, and calculated life expectancy for every group.

FINDINGS

Compared with individuals in the inactive group, those in the low-volume activity group, who exercised for an average of 92 min per week (95% CI 71-112) or 15 min a day (SD 1·8), had a 14% reduced risk of all-cause mortality (0·86, 0·81-0·91), and had a 3 year longer life expectancy. Every additional 15 min of daily exercise beyond the minimum amount of 15 min a day further reduced all-cause mortality by 4% (95% CI 2·5-7·0) and all-cancer mortality by 1% (0·3-4·5). These benefits were applicable to all age groups and both sexes, and to those with cardiovascular disease risks. Individuals who were inactive had a 17% (HR 1·17, 95% CI 1·10-1·24) increased risk of mortality compared with individuals in the low-volume group.

INTERPRETATION

15 min a day or 90 min a week of moderate-intensity exercise might be of benefit, even for individuals at risk of cardiovascular disease.

FUNDING

Taiwan Department of Health Clinical Trial and Research Center of Excellence and National Health Research Institutes.

The health risks and benefits of cycling in urban environments compared with car use: health impact assessment study

OBJECTIVE

To estimate the risks and benefits to health of travel by bicycle, using a bicycle sharing scheme, compared with travel by car in an urban environment.

DESIGN

Health impact assessment study.

SETTING

Public bicycle sharing initiative, Bicing, in Barcelona, Spain.

PARTICIPANTS

181,982 Bicing subscribers. Main outcomes measures The primary outcome measure was all cause mortality for the three domains of physical activity, air pollution (exposure to particulate matter <2.5 µm), and road traffic incidents. The secondary outcome was change in levels of carbon dioxide emissions.

RESULTS

Compared with car users the estimated annual change in mortality of the Barcelona residents using Bicing (n = 181,982) was 0.03 deaths from road traffic incidents and 0.13 deaths from air pollution. As a result of physical activity, 12.46 deaths were avoided (benefit:risk ratio 77). The annual number of deaths avoided was 12.28. As a result of journeys by Bicing, annual carbon dioxide emissions were reduced by an estimated 9,062,344 kg.

CONCLUSIONS

Public bicycle sharing initiatives such as Bicing in Barcelona have greater benefits than risks to health and reduce carbon dioxide emissions.

Physical activity and mortality among Norwegian women - the Norwegian Women and Cancer Study

BACKGROUND

Physical activity (PA) and its relationship with all-cause mortality suggest a strong and consistent inverse association. This study prospectively investigated the association between PA level and mortality among participants of the Norwegian Women and Cancer (NOWAC) Study.

METHODS

A total of 66,136 NOWAC participants were followed-up until December 31st 2008. PA level and possible confounding factors were obtained through a self-administered questionnaire at enrolment. Cox proportional hazards regression was used to calculate adjusted relative risks (RRs) and 95% confidence intervals (CIs) for all-cause, cardiovascular disease (CVD) and cancer mortality and PA levels defined from 1 to 10 on a global scale.

RESULTS

PA levels 1-4 were associated with a significantly increased risk of all-cause mortality (level 1 RR = 2.35; 95% CI: 1.94-2.84, level 2 RR = 1.71; 95% CI: 1.45-2.00, level 3 RR = 1.30; 95% CI: 1.14-1.49, level 4 RR = 1.07; 95% CI: 0.95-1.22), compared with PA level 5. CVD mortality risk increased in PA levels 1-3 (level 1 RR = 3.50; 95% CI: 2.41-5.10, level 2 RR = 1.50; 95% CI: 0.99-2.25, level 3 RR = 1.12; 95% CI: 0.79-1.60) as did cancer mortality risk (RR = 1.32; 95% CI: 0.96-1.81, RR = 1.48; 95% CI: 1.19-1.84, RR = 1.26; 95% CI: 1.06-1.50, respectively). The magnitude of the associations was consistent across strata of age, smoking, and body mass index. The population attributable fractions for PA levels 1-4 were: all-cause mortality, 11.5%; CVD mortality, 11.3%; cancer mortality, 7.8%.

CONCLUSION

There is a significant trend of increased risk of all-cause, CVD and cancer mortality in relation to low PA levels among Norwegian women.

Correlates of physical activity in Morocco

PURPOSE

To estimate the prevalence of physical activity (PA) and associated variables in the Moroccan adult population.

METHODS

Population-based, May 2008 survey of a representative sample of Moroccan adults. PA was assessed using the International Physical Activity Questionnaire (IPAQ).

RESULTS

Mean age was 41.4 years (26.2-56.6). Of the 2613 subjects, 48.1% were women and 58% lived in urban areas. The prevalence of the lowest physically active category was 16.5% overall, 24% in women and 9% in men (p < 0.001). Unemployed (18.6%) and retired individuals (17.9%), housewives (28.2%) and married persons (19.7%) reported lower levels of physical activity. Older age, unemployment or retirement, having high income, and being overweight or obese were the main determinants of low PA levels in men. In women, the main determinants of low PA levels were living in an urban area and being a housewife.

CONCLUSION

This survey has identified that urbanization and having high income are main determinants of low physical activity in Moroccan adults in a country undergoing economic transition.

Higher Levels and Intensity of Physical Activity Are Associated with Reduced Mortality among Community Dwelling Older People

Introduction. There is limited evidence on physical activity and mortality in older people. Methods. People aged 75–84 years (n = 1449) participating in a randomized trial of health screening in UK general practice were interviewed about their physical activity (PA) and were assessed for a wide range of health and social problems. Mortality data were collected over 7 years of followup. Results. Full information on PA and potential confounders was available in 946 people. Those in the highest third of duration of PA had a lower mortality, confounder-adjusted Hazard Ratio (HR) = 0.74, and 95% Confidence Interval (CI) 0.56–0.97, compared to the lowest third. Similar benefits were seen when categorized by intensity of PA, with those in the highest group having a lower mortality, confounder-adjusted HR = 0.61, and 95% CI 0.47–0.79, compared to the lowest category. Conclusions. Our results suggest the importance of providing older people with opportunities for physical activity.