Association of Physical Activity Intensity With Mortality: A National Cohort Study of 403 681 US Adults

Associations of Physical Activity with Long-Term Mortality Among Peripheral Artery Disease Patients: A Population-Based Cohort Study

BACKGROUND

To investigate the relationship between physical activity and risk of all-cause and cardiovascular disease (CVD) mortality in patients with peripheral artery disease (PAD).

METHODS

We recruited 561 PAD cases of National Health and Nutrition Examination Survey from 1999 to 2004 and linked mortality data through December 31, 2019. We explored the effect of aerobic physical activity and muscle-strengthening activity on the risk of all-cause and CVD mortality employing cox proportional hazard ratios (HRs) with 95% confidence intervals (CIs) from 1999 to 2019.

RESULTS

During an average of 9.8-year follow-up, a total of 435 deaths from all causes of the 561 PAD patients were recorded including 165 CVD deaths. Meeting the guidelines about physical activity released by World Health Organization in 2020 is not related to a lower risk for mortality in PAD patients. PAD patients engaging in moderate-to-vigorous intensity aerobic physical activity (MVPA) ≥ 60 min/week exhibited a significantly 45% (HR = 0.55; 95% CI = 0.37-0.85; P < 0.001) lower all-cause mortality risk and 60% (HR = 0.40; 95% CI = 0.27-0.70; P < 0.001) lower CVD mortality risk. PAD patients reached their maximal survival benefit of HR at 120-239 min/week of MVPA. The survival benefit of aerobic physical activity was notably greater in men and age < 65 years. Furthermore, PAD patients with muscle-strengthening activity 1-4 times/week had a 66% reduction risk of CVD mortality (HR = 0.34; 95% CI = 0.17-0.90; P = 0.011).

CONCLUSIONS

Aerobic physical activity (MVPA ≥ 60 min/week) decreases the all-cause and CVD mortality risk among PAD patients. Muscle-strengthening activity (1-4 times/week) may provide survival benefits of CVD mortality in PAD patients.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and hepatic steatosis and liver fibrosis among US adults based on NHANES

Recently, the non-high-density to high-density lipoprotein cholesterol ratio (NHHR) has gained growing attention as an indicator for predicting diseases associated with lipid metabolism. Hepatic steatosis and fibrosis are tightly associated lipid metabolism. Our study aims to analyze the correlations among NHHR, hepatic steatosis, and fibrosis. This study analysed data from 14,578 adults in the US National Health and Nutrition Examination Survey (2005-2018). The degree of hepatic steatosis was measured through the Fatty Liver Index (FLI), while liver fibrosis severity was evaluated with the Fibrosis-4 (FIB-4) index. Multivariate linear regression assessed the association between NHHR and the FLI and FIB-4 score. Smooth curve describing the relationship between NHHR and FLI or FIB-4. Additionally, a two-part linear regression model adopted in order to more accurately account for the nonlinear relationship, with threshold effects estimated through its two components. To confirm the robustness of the findings, interaction tests and subgroup analyses were conducted. The multivariate logistic regression analysis demonstrated a significantly positive correlation of lnNHHR with FLI across all three models. In Model 3, the association was (β = 11.14, 95%CI:10.38,11.90). Curve fitting indicated a nonlinear relationship. The positive correlation between lnNHHR and FLI persists across gender, BMI, and physical activity groups. Nevertheless, a notable negative correlation between lnNHHR and FIB-4 was observed in all three models. In Model 3, the relationship between lnNHHR and FIB-4 was as follows: (β = -0.20; 95% CI: -0.22, -0.17). Curve fitting revealed a V-shaped relationship, with threshold effect analysis identifying a breakpoint at 1.51. Above this threshold, the relationship was found to be statistically insignificant (p-value = 0.424). Receiver operating characteristic (ROC) curve analysis demonstrated that NHHR exhibited better predictive performance for MASLD compared to non-HDL-C, HDL-C, and LDL-C/HDL-C. The current study's findings suggest that elevated levels of NHHR correlate with a greater risk of hepatic steatosis among adults in the U.S. Our findings imply that NHHR may be a valuable tool in improving MASLD prevention strategies in the general population.

High Intensity Interval Training and Arterial Hypertension: Quality of Reporting

The benefits of exercise have been well described for the treatment of hypertension. Poor reporting quality impairs quality appraisal and replicability. High intensity interval training (HIIT) has been shown to be an effective alternative to traditional aerobic exercise in patients with hypertension. We evaluated the completeness of reporting of randomized controlled trials (RCTs) with HIIT for hypertension and to compare both exercise modes in reporting quality. RCTs of HIIT with a minimum duration of 6 weeks in adults with at least high normal blood pressure (≥130 mmHg/≥85 mmHg) were evaluated using the Consensus on Exercise Reporting Template (CERT). Nine RCTs conducting HIIT in hypertensive patients (N=718; 51.8 years) were evaluated. A mean of 62.6% of items were sufficiently described, compared with 49.2% in moderate intensity training interventions. Exercise dose was adequately reported in 8 out of 9 studies. Only one study reported information on adverse events. In a small sample of RCTs with HIIT in patients with hypertension we found a better reporting quality than in moderate intensity training interventions. However, reporting completeness is not optimal for a good replicability in clinical practice. The lack of reporting of adverse events in interventions using high intensities is particularly unfavourable.

Social Determinants of Health, Cardiovascular Health, and Mortality in Sexual Minority Individuals in the United States

BACKGROUND

Despite recent efforts to address health disparities regarding social determinants of health (SDOH), the intersection between SDOH and cardiovascular health (CVH) outcomes in sexual minority (SM) individuals remain largely underexplored.

OBJECTIVES

This study sought to investigate associations between SDOH profile and CVH and mortality outcomes among SM individuals in the United States.

METHODS

All participants aged ≥18 years surveyed in the 2013 to 2017 National Health Interview Survey were included, except those with missing data on SM status, any CVH or SDOH domain, or any other covariate. SM status was self-reported and categorized as lesbian/gay, bisexual, or uncertain. Participants' SDOH profile was quantified using a 6-domain (economic stability, neighborhood/physical environment/social cohesion, community and social context, food, education, and health care system), 38-item score, with higher scores indicating greater social deprivation. CVH was adapted from the American Heart Association's Life's Essential 8 framework. Because detailed dietary data were unavailable, a 7-item (hypertension, diabetes mellitus, hypercholesterolemia, smoking, physical inactivity, inadequate sleep, and obesity) CVH score was used, with higher scores indicating worse CVH. Additionally, cardiovascular mortality was ascertained through the National Death Index using death certificate information.

RESULTS

The study sample consisted of 57,182 participants, representing a population of 82,826,690 persons. A worse composite SDOH score was associated with a worse CVH score in both heterosexual (adjusted rate ratio: 1.14; 95% CI: 1.13-1.15; P < 0.001) and SM individuals (adjusted rate ratio: 1.16; 95% CI: 1.12-1.20; P < 0.001), with associations appearing to be potentially stronger in the latter (Pinteraction = 0.042). Subgroup analysis demonstrated consistent associations among gay/lesbian individuals and bisexual individuals, but not in those with other or uncertain sexual orientations. Further exploratory analysis showed that a worse composite SDOH score was significantly associated with higher risk of cardiovascular mortality in both heterosexual (adjusted HR: 1.17; 95% CI: 1.06-1.28; P = 0.002) and SM individuals (adjusted HR: 2.25; 95% CI: 1.24-4.08; P = 0.008), with associations being significantly stronger in the latter (P interaction = 0.006).

CONCLUSIONS

An unfavorable SDOH profile was associated with worse CVH scores and higher cardiovascular mortality risk among SM individuals in the United States compared to their heterosexual counterparts.

Association between physical activity energy expenditure and bone mineral density in U.S. adults: A cross-sectional analysis of NHANES 2011-2018

OBJECTIVES

Osteoporosis is a global disease characterized by decreased bone mineral density (BMD) and impaired bone metabolism. The Physical Activity Metabolic Equivalent of Task (PA-MET) quantifies energy expenditure during physical activities. This study aims to investigate the relationship between energy expenditure, BMD, and the risk of developing osteoporosis. By exploring how varying levels of physical activity impact BMD, we seek to better understand the role of energy expenditure in osteoporosis prevention and management.

STUDY DESIGN

Cross-sectional study.

METHODS

This was a cross-sectional study that included 6599 adult participants who took part in the National Health and Nutrition Examination Survey (NHANES) from 2011 to March 2018. We used multivariate weighted linear model analysis to reveal the association between PA-MET levels and BMD.

RESULTS

Multivariable weighted linear model analysis showed a positive correlation between PA-MET and total BMD. Compared to the lower PA-MET group, the fourth quartile of the PA-MET group had a β = 0.02 (95 % CI, 0.01 to 0.03). Similarly, in the analysis with thoracic spine BMD as the outcome, the fourth quartile of the PA-MET group had a β = 0.02 (95 % CI, 0.01 to 0.02) compared to the lower PA-MET group. For lumbar spine BMD, the fourth quartile of the PA-MET group had a β = 0.02 (95 % CI, 0.01 to 0.03). In the analysis with trunk BMD as the outcome, the fourth quartile of the PA-MET group had a β = 0.02 (95 % CI, 0.02 to 0.03) compared to the lower PA-MET group.

CONCLUSIONS

Our results show that the energy expenditure from physical activity has a positive relationship with BMD, which serves as a protective factor against the risk of osteoporosis.

Assessment of cardiovascular risk and physical activity: the role of cardiac-specific biomarkers in the general population and athletes

The first part of this Inter-Society Document describes the mechanisms involved in the development of cardiovascular diseases, particularly arterial hypertension, in adults and the elderly. It will also examine how consistent physical exercise during adolescence and adulthood can help maintain blood pressure levels and prevent progression to symptomatic heart failure. The discussion will include experimental and clinical evidence on the use of specific exercise programs for preventing and controlling cardiovascular diseases in adults and the elderly. In the second part, the clinical relevance of cardiac-specific biomarkers in assessing cardiovascular risk in the general adult population will be examined, with a focus on individuals engaged in sports activities. This section will review recent studies that suggest a significant role of biomarkers in assessing cardiovascular risk, particularly the presence of cardiac damage, in athletes who participate in high-intensity sports. Finally, the document will discuss the potential of using cardiac-specific biomarkers to monitor the effectiveness of personalized physical activity programs (Adapted Physical Activity, APA). These programs are prescribed for specific situations, such as chronic diseases or physical disabilities, including cardiovascular diseases. The purposes of this Inter-Society Document are the following: 1) to discuss the close pathophysiological relationship between physical activity levels (ranging from sedentary behavior to competitive sports), age categories (from adolescence to elderly age), and the development of cardiovascular diseases; 2) to review in detail the experimental and clinical evidences supporting the role of cardiac biomarkers in identifying athletes and individuals of general population at higher cardiovascular risk; 3) to stimulate scientific societies and organizations to develop specific multicenter studies that may take into account the role of cardiac biomarkers in subjects who follow specific exercise programs in order to monitor their cardiovascular risk.

Physical activity, Vitamin D, and all-cause/cardiovascular mortality: a prospective study in older Chinese adults

BACKGROUND

Physical activity was associated with the risk of all-cause and cardiovascular mortality. However, little is known about older adults, especially those aged over 80 years.

METHODS

2863 older adults in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were enrolled. Physical activity score was used to evaluate the physical activity. Serum 25-hydroxyvitamin D and demographic characteristics were collected at baseline. We used multivariable-adjusted Cox regression models and stratified analysis to determine the association between physical activity, vitamin D and all-cause/cardiovascular mortality. Mediation analysis was performed to evaluate the mediating effect of vitamin D between physical activity and all-cause/cardiovascular mortality.

RESULTS

The median age of this population was 87 years, and 70.27% were the oldest-old (age ≥ 80 years). We observed a tendency for a higher vitamin D concentration in participants with higher physical activity score levels. Both physical activity and vitamin D levels were inversely associated with all-cause and cardiovascular mortality in all participants. Between physical activity and all-cause/cardiovascular mortality, the mediation proportions of vitamin D were 7.76% (P < 0.001) and 4.13% (P < 0.001), respectively. The mediating effect of vitamin D remained all significant in various types of physical activities. Furthermore, vitamin D accounted for a greater mediating proportion in the physical activities of housework and raising domestic animals/pets.

CONCLUSIONS

Physical activity could reduce the risk of all-cause/cardiovascular mortality and was mediated by vitamin D in older Chinese adults.

Association between the intensity of statin therapy and physical activity 1 year after acute coronary syndrome: a multicentre prospective cohort study in Switzerland

OBJECTIVES

To assess the association between the intensity of statin therapy and the level of physical activity in patients 1 year after an acute coronary syndrome (ACS).

DESIGN

Prospective cohort study from the Special Program University Medicine-Acute Coronary Syndromes.

SETTING

Four university hospital centres in Switzerland.

PARTICIPANTS

2274 patients with a main diagnosis of ACS between 2009 and 2017 who were available for a 1-year follow-up visit 1 year after hospital discharge.

OUTCOME MEASURES

Self-reported physical activity was assessed with the International Physical Activity Questionnaire. The level of physical activity in metabolic equivalent-minutes per week (MET-min/week) was first stratified into sedentary and physically active categories and then analysed continuously among physically active patients. Analyses were performed using a propensity score weighting approach.

RESULTS

One year after ACS, 1222 (53.7%) patients were on high-intensity statin therapy, 890 (39.1%) were on low/moderate-intensity statin therapy and 162 (7.1%) were not on statin therapy. Compared with non-statin users, low-/moderate-intensity statin users and high-intensity statin users were more likely to be physically active than sedentary, with a fully adjusted OR of 2.86 (95% CI 1.12 to 7.26) and 4.52 (95% CI 1.68 to 12.20), respectively. Among physically active patients, physical activity level was similar across all statin user categories, with median levels of 2792.5, 2712.0 and 2839.5 MET-min/week in non-statin, moderate/low-statin and high-statin users, respectively (p=0.307).

CONCLUSIONS

One year after ACS, neither low-/moderate-intensity nor high-intensity statin uses were associated with reduced self-reported physical activity compared with non-statin use. The concern that statin therapy may impair physical activity among ACS patients was not confirmed in this study.

Association of accelerometer-derived physical activity with all-cause and cause-specific mortality among individuals with cardiovascular diseases: a prospective cohort study

AIMS

To investigate the association of accelerometer-measured intensity-specific physical activity (PA) with all-cause and cause-specific mortality among individuals with cardiovascular disease (CVD).

METHODS AND RESULTS

In this prospective cohort study, 8024 individuals with pre-existing CVD (mean age: 66.6 years, female: 34.1%) from the UK Biobank had their PA measured using wrist-worn accelerometers over a 7-day period in 2013-2015. All-cause, cancer, and CVD mortality was ascertained from death registries. Cox regression modelling and restricted cubic splines were used to assess the associations. Population-attributable fractions (PAFs) were used to estimate the proportion of preventable deaths if more PA was undertaken. During a median follow-up of 6.8 years, 691 deaths (273 from cancer and 219 from CVD) were recorded. An inverse non-linear association was found between PA duration and all-cause mortality risk, irrespective of PA intensity. The hazard ratio (HR) of all-cause mortality plateaued at 1800 min/week for light-intensity PA (LPA), 320 min/week for moderate-intensity PA (MPA), and 15 min/week for vigorous-intensity PA (VPA). The highest quartile of PA was associated with lower risks for all-cause mortality, with HRs of 0.63 (95% confidence interval [CI]: 0.51-0.79), 0.42 (0.33-0.54), and 0.47 (0.37-0.60) for LPA, MPA, and VPA, respectively. Similar associations were observed for cancer and CVD mortality. Additionally, the highest PAFs were noted for VPA, followed by MPA.

CONCLUSION

We found an inverse non-linear association between all intensities of PA (LPA, MPA, VPA, and MVPA) and mortality risk in CVD patients using accelerometer-derived data, but with a larger magnitude of the associations than that in previous studies based on self-reported PA.

The triad of physical activity: An optimal combination for cardiovascular health

The combination of moderate to vigorous physical activity with muscle-strengthening physical activity is increasingly recognized for its significant impact on cardiovascular health. This narrative review synthesizes current evidence to compare the cardiovascular benefits of combined physical activity versus singular forms, especially in primary prevention. The main focus is on hormonal, nervous, genetic, and molecular adaptations, critical mechanisms underlying the body's response to physical activity. Our findings endorse superior benefits for combined moderate to vigorous and muscle-strengthening physical activity for preventing cardiovascular disease (CVD). This combined approach synergistically enhances cardiovascular function and more effectively reduces risk factors than either activity alone. While more research is needed to distinguish between moderate and vigorous activity levels in combination with muscle-strengthening physical activity, current evidence supports comprehensive physical activity guidelines that maximize cardiovascular health. These findings highlight the importance of integrated physical activity regimens in public health strategies and clinical practice to mitigate the global CVD burden.

Joint association of anti-inflammatory diet and vigorous leisure-time physical activity on all-cause and cardiovascular disease mortality in U.S. adults: findings from NHANES, 2007-2014

PURPOSE

Balanced dietary patterns, sufficient physical activity, and other healthy lifestyle behaviors are increasingly recognized as a complimentary strategy for the prevention of cardiovascular disease (CVD). We aim to explore the joint association of anti-inflammatory diet and vigorous leisure-time physical activity (LTPA) on all-cause and CVD mortality.

METHODS

This retrospective cohort study included 16,068 adults from the National Health and Nutrition Examination Survey (2007-2014). Participants were categorized into four lifestyle patterns based on the inflammatory properties of the diet and the degree of vigorous LTPA: pro-inflammatory diet and insufficient vigorous LTPA (pattern 1), anti-inflammatory diet and insufficient vigorous LTPA (pattern 2), pro-inflammatory diet and sufficient vigorous LTPA (pattern 3), anti-inflammatory diet and sufficient vigorous LTPA (pattern 4). Multivariable Cox proportional hazards models were used to estimate the hazards ratio (HR) and 95% confidence intervals (CI).

RESULTS

Compared to pattern 1, pattern 4 showed an obvious lower risk of all-cause (HR, 0.51; 95% CI 0.32-0.81) and CVD mortality (HR, 0.31; 95% CI 0.12-0.80). In addition, pattern 2 also had a significantly decreased all-cause (0.80; 0.69-0.92) and CVD mortality risk (0.71; 0.53-0.95). However, t there was no significant reduction in all-cause mortality (0.75; 0.54-1.06) and CVD mortality (0.60; 0.32-1.13) among pattern 3. Consistent results were obtained in subgroup and sensitivity analyses.

CONCLUSION

Adhering to the anti-inflammatory diet and sufficient vigorous LTPA was associated with lowest all-cause and CVD mortality. Anti-inflammatory diet can counteract the hazards caused by insufficient vigorous LTPA, while sufficient vigorous LTPA fails to offset the detrimental effect of pro-inflammatory diet.

Sitting Time, Physical Activity and Mortality: A Cohort Study In Low-Income Older Americans

INTRODUCTION

Physical inactivity and sedentary behavior are recognized as independent risk factors for many diseases. However, studies investigating their associations with total and cause-specific mortality in low-income and Black populations are limited, particularly among older adults.

METHODS

A prospective cohort study was conducted among 8,337 predominantly low-income and Black Americans aged ≥65 years residing in the southern United States. Participants reported their daily sitting time and leisure-time physical activity (LTPA) at baseline (2002-2009), and mortality data were collected through 2019. Analysis was conducted from September 2022 to October 2023.

RESULTS

During a median follow-up of 12.25 years, nearly 50% (n=4,111) were deceased. A prolonged sitting time (>10 hours/day versus <4 hours/day) was associated with elevated all-cause mortality (hazard ratios [HR], 1.15; 95% confidence intervals [CI], 1.04-1.27) after adjusting for LTPA and other potential confounders. LTPA was associated with a reduced risk of all-cause mortality, with an adjusted HR of 0.75 (95% CI 0.64, 0.88) associated with 150-300 minutes per week of moderate-intensity physical activity. Individuals who were physically inactive and had a sitting time of >10 hours/day had the highest mortality risk (HR, 1.48; 95% CI, 1.23-1.78), compared with those who were physically active and had low sitting time. These associations were more pronounced for mortality due to cardiovascular diseases.

CONCLUSIONS

High sitting time is an independent risk factor for all-cause and cardiovascular disease mortality, and LTPA could partially attenuate the adverse association of prolonged sitting time with mortality.

Association between work-related physical activity and mortality among US Cohort

PURPOSE

The benefits of leisure-time physical activity (LTPA) in reducing mortality are well-known, while the relationship between work-related physical activity (WRPA) and mortality remains controversial. The study aimed to investigate the association between WRPA and mortality, and to determine whether LTPA should be recommended in a population with a high level of WRPA.

METHOD

Data were obtained from a sample of adults aged 20-80 years included in the National Health and Nutrition Examination Survey (NHANES) cohort from 2007 to 2018. Hazard ratios (HRs) for the association between WRPA and all-cause mortality were estimated using Cox proportional regression models. All analyses were performed in accordance with NHANES guidelines, in which data were complex-weighted first and then analyzed in the next step, Statistical significance was defined as a two-sided P-value < 0.05.

RESULTS

A total of 27,567 participants were included in the study. Over a median follow-up period of 78 months, a total of 2,553 (weighted ratio, 6.5%) participants were assumed dead. The mean age (SD) of this cohort was 47.5 (16.7), and 48.5% were men. Compared to participants without WRPA (as the reference group), participants engaged in WRPA exhibited a significantly reduced risk of all-cause mortality over different time periods. Specifically, the HR for participants with less than 17.5 h of weekly participation were 0.70 (95% CI: 0.62-0.78). For those participating between 17.5 and 35 h per week, the HR was 0.80 (95% CI: 0.64-1.00), while participants engaging in more than 35 h of weekly participation had an HR of 0.71 (95% CI: 0.56-0.91).

CONCLUSIONS

WRPA is a protective factor that reduces the risk of all-cause death, especially in people without LTPA.

A Physical Activity and Sitting Time Balance Index and All-Cause Mortality Risk

INTRODUCTION

Achieving a healthier balance of more time spent in physical activity (PA) and less time in sedentary behavior is now widely advocated for achieving multiple health benefits. This study introduces a Physical Activity and Sitting Time Balance Index (PASTBI), a potential risk identification tool addressing the interplay between PA and sedentary behavior; and aims to explore its association with the risk of all-cause mortality in Australian adults.

METHODS

This prospective cohort study analyzed the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) data on 5,836 Australian adults. The PASTBI was calculated by dividing the total duration of PA (minutes/day) by the duration of sitting time (ST) (hours/day), both self-reported at baseline (2004-2005). The PASTBI was expressed in quartiles ranging from Q1 - low PA/high ST to Q4 - high PA/low ST. The association between PASTBI and all-cause mortality was explored (in 2022) using the Cox proportional hazards regression models adjusted for socio-demographics, lifestyle factors, waist circumference, and the number of comorbidities.

RESULTS

During 78,406 person-years of follow-up (median follow-up of 14.3 years), there were 885 deaths (15%). In the fully adjusted model, compared to those in the highest PASTBI category (Quartile 4 - high PA/low ST), participants from the lowest PASTBI category (Quartile 1 - low PA/high ST) were at a higher risk of all-cause mortality [HR (95% CI) = 1.47 (1.21-1.79)].

CONCLUSIONS

A less favorable balance of time spent in PA and ST (as characterized by a parsimonious PASTBI index approach) was associated with a higher risk of all-cause mortality.

The vices and virtues of medical models of obesity

Despite numerous public health organizations supporting the pathologization of obesity and considering recent obesity rates a health crisis, many researchers in the humanities, social sciences, and even in the health sciences remain unconvinced. In this paper, we address a set of arguments coming from these academic fields that criticize medical models of obesity for their supposedly flawed diagnostic categories that shift focus onto individuals and support moralizing judgements. Clarifying some key claims in these models and explicating the view of obesity in terms of energy dysregulation, we aim to tease apart misunderstandings and argue that not only do these models not say what they are often accused of saying, but their apparent vices may actually be virtues in helping to combat stigma. Building on the social psychology of stigma and disease labeling, we then suggest that current medical models are largely supportive of many moral and political aims promoted by critics of these models.

Immersive Virtual Reality Decreases Work Rate and Manipulates Attentional Focus During Self-Regulated Vigorous Exercise

To determine the effect of immersive virtual reality use on finishing time of a vigorous-intensity self-regulated exercise task, and on relevant psychological variables. Healthy untrained adults (N = 21; 10 men/11 women; age = 22.9 ± 7.2 years; BMI = 24.0 ± 4.5 kg/m2) completed 1500-m exercise bouts on a rowing ergometer in a counterbalanced and randomized order, with and without use of a headset-delivered virtual reality fitness program. Heart rate, rating of perceived exertion, affective valence, and attentional focus were collected every 300 m, in addition to finishing time. Data were analyzed with repeated measures as appropriate. Intensity of both exercise bouts was considered vigorous according to heart rate results (>77% maximal heart rate). Finishing time was faster in the control condition (449.57 ± 82.39 s) than in the virtual reality condition (463.00 ± 91.78 s), p = .007. Compared to the control condition, the virtual reality condition was characterized by a more external attentional focus (52.38 ± 18.22 vs. 38.76 ± 17.81, p < .001). No differences were observed for remaining variables as a result of condition (p > .05 for all). When a headset-delivered VR program was used during a self-regulated vigorous-intensity exercise task, participants were 13.6 seconds (~3%) slower than in a control condition. Attentional focus was manipulated to be more external with VR use, which may have ultimately distracted from the exercise objective. Recommendations for selecting an appropriate virtual reality experience for a given exercise task are discussed.

Associations of temporal patterns of objectively measured moderate-to-vigorous physical activity with mortality in the general population and people with abnormal glucose metabolism or hypertension

To investigate the association between temporal patterns of objectively measured moderate-to-vigorous physical activity (MVPA) and all-cause and cause-specific mortality in the general population and people with abnormal glucose metabolism (AGM) or hypertension. This prospective cohort study collected accelerometer data from the National Health and Nutrition Examination Survey from 2003 to 2006 with linkage to the National Death Index records through 31 December 2019 in the United States. Baseline 7-day accelerometry data were analysed and participants were categorized into 5 groups: morning/midday (05:00-13:59), afternoon (14:00-16:59), evening (17:00-19:59), night (20:00-00:59), and mixed MVPA timing groups. Cox regression analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) between temporal patterns and mortality. A total of 5976 adults (mean [SE] age, 46.4 [0.5] years; 52.1% women) were included and 1371 participants died during a median follow-up of 14.6 years. Compared with the mixed group, the night group had 22% to 77% higher risks of all-cause and cardiovascular mortality in the overall sample and AGM and hypertension subsamples. In people with hypertension, the morning/midday group showed a 31% higher risk of cardiovascular mortality. For those with AGM, the evening group had 90% to 185% higher risks of all-cause and cardiovascular mortality.

Titration of Sedentary Behavior With Varying Physical Activity Levels Reduces Mortality in Patients With Type 2 Diabetes

CONTEXT

Both physical activity (PA) and sedentary behavior (SB) exert an important impact on type 2 diabetes, but it remains unclear regarding how the maximum impact on improving mortality by an optimized proportion of the two lifestyles can be achieved.

OBJECTIVE

To explore the impacts of PA/SB combinations on mortality in patients with diabetes.

METHODS

Patients with type 2 diabetes samplings were collected from the National Health and Nutrition Examination Survey dataset. Their lifestyles were categorized into 8 groups based on combinations of the PA and SB levels. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals.

RESULTS

During the follow-up period, 1148 deaths (18.94%) were recorded. High SB (sedentary time ≥6 hours/day) was significantly associated with higher all-cause mortality [hazards ratio (HR) 1.65]. In participants with low SB (<6 hours/day), low PA was associated with lower all-cause mortality (HR 0.43), while a further increase of PA level did not show further reductions in either all-cause or cardiovascular mortality. In contrast, in participants with high SB, all levels of PA were associated with lower all-cause mortality (P < .05), but only moderate PA was associated with lower cardiovascular mortality (HR 0.30).

CONCLUSION

In patients with type 2 diabetes, different combinations of various levels of PA and SB are associated with different degrees of risk for all-cause or cardiovascular mortality.

Association of aerobic and muscle-strengthening physical activity with chronic kidney disease in participants with hypertension

BACKGROUND

In Korea, chronic kidney disease (CKD) is increasingly prevalent among adults with hypertension, of which approximately 30% of the population is affected. Despite the recognized benefits of adherence to physical activity (PA) recommendations, including aerobic and muscle-strengthening activities (MSA), the impact of such adherence on the prevalence of CKD in individuals with hypertension has not been extensively studied. This study aimed to investigate the association between aerobic PA and MSA levels, and the prevalence of CKD in individuals with hypertension.

METHODS

This study included 5,078 individuals with hypertension using data from the Korean National Health and Nutrition Examination Survey (2019-2021). PA levels were measured as min/week of moderate-to-vigorous PA (MVPA) based on self-reports, and MSA was quantified as the number of days per week. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m². Logistic regression analysis evaluated the association between meeting PA guidelines and CKD after adjusting for potential confounders. Additionally, a joint analysis was conducted to assess the combined effects of MVPA and MSA on CKD.

RESULTS

After adjusting for all covariates, higher MVPA was associated with a lower prevalence of CKD. Compared to the group with inactive, the group with MVPA 1-149 min/week had an odds ratio (OR) of 0.80 (95% confidence interval [CI], 0.61-1.05), the group that met the MVPA 150-299 min/week criteria had an OR of 0.85 (95% CI, 0.62-1.17), and the group that met the MVPA ≥ 300 min/week criteria had an OR of 0.53 (95% CI, 0.37-0.76). MSA alone did not show a significant association with CKD. In the joint analysis, the group that met the MVPA and MSA guidelines had the lowest OR of 0.54 (95% CI, 0.34-0.86), compared to the group that did not meet either.

CONCLUSIONS

MVPA was associated with the prevalence of CKD in participants with hypertension but not in those with MSA alone. However, compared with the group that did not meet both guidelines, the group that met both guidelines showed the lowest prevalence of CKD.

Friends, neighbors, country, and respect: Status ladders and health behaviors in the United States

Efforts to understand the relationship between socioeconomic status (SES) and health have expanded beyond traditional indicators of education, income, occupation, and wealth to individuals' own reports of where they stand. This more contemporary approach has enjoyed considerable success, in that self-reported SES standing, often measured on a ladder representing the entire U.S. socioeconomic hierarchy, is associated strongly with health even when traditional SES indicators are controlled. However, disparities in self-rated health across ladder measures typically are not assessed with regard to health behavior disparities. Here, we draw on two US national probability samples assessing diverse ladder reference groups, as well as a new ladder asking people to report how much respect, honor, or esteem they receive from other people. Respect or honor offers a distinct potential to measure social influence across circles of recognition. We find that U.S.-based ladder status is related to smoking currently or ever and to days of exercise. While friend, neighbor, and respect-based ladders do not relate to health behaviors net of U.S. ladder standing, they show relationships to ever smoking and physical activity, and self-rated health, in their own right. Physical activity accounts for 12-18% of self-rated health disparities by friend, neighbor, or country ladder status. Smoking and drinking do not robustly contribute to ladder-based disparities in self-rated health. Contrasting what is typically found for traditional SES measures, physical activity merits further research, as does the receipt of respect or honor. That status ladder health disparities go largely unexplained by behaviors suggests the potential roles of non-behavioral pathways including inflammation, hopelessness, or classism.

The association of diet quality and physical activity with cardiovascular disease and mortality in 85,545 older Australians: A longitudinal study

BACKGROUND

A quality diet and an active lifestyle are both important cornerstones of cardiovascular disease (CVD) prevention. However, despite their interlinked effects on metabolic health, the 2 behaviors are rarely considered jointly, particularly within the context of CVD prevention. We examined the independent, interactive, and joint associations of diet and physical activity with CVD hospitalization, CVD mortality, and all-cause mortality.

METHODS

CVD-free Australian participants aged 45-74 years (n = 85,545) reported physical activity, diet, sociodemographic, and lifestyle characteristics at baseline (2006-2009) and follow-up (2012-2015), and data were linked to hospitalization and death registries (03/31/2019 for CVD hospitalization and all-cause mortality and 12/08/2017 for CVD mortality). Diet quality was categorized as low, medium, and high based on meeting dietary recommendations. Physical activity was operationalized as (a) total moderate-to-vigorous physical activity (MVPA) as per guidelines, and (b) the composition of MVPA as the ratio of vigorous-intensity physical activity (VPA) to total MVPA. We used a left-truncated cause-specific Cox proportional hazards model using time-varying covariates.

RESULTS

During a median of 10.7 years of follow-up, 6576 participants were admitted to the hospital for CVD and 6581 died from all causes (876 from CVD during 9.3 years). A high-quality diet was associated with a 17% lower risk of all-cause mortality than a low-quality diet, and the highest MVPA category (compared with the lowest) was associated with a 44% and 48% lower risk of CVD and all-cause mortality, respectively. Multiplicative interactions between diet and physical activity were non-significant. For all outcomes, the lowest risk combinations involved a high-quality diet and the highest MVPA categories. Accounting for total MVPA, some VPA was associated with further risk reduction of CVD hospitalization and all-cause mortality.

CONCLUSION

For CVD prevention and longevity, one should adhere to both a healthy diet and an active lifestyle and incorporate some VPA when possible.

Exercise intensity and mortality in overweight and obese patients with chronic kidney disease: longitudinal analysis (1999-2016)

BACKGROUND

Chronic kidney disease (CKD) and overweight/obesity are significant global public health issues. Appropriate free-time physical activity (PA) is essential for overweight/obese patients with chronic kidney disease, but specific guidelines are lacking. The present study was conducted to determine the association between PA and all-cause mortality in these patients.

METHODS

Data from 3,434 overweight/obese adults with CKD from the 1999-2016 National Health and Nutrition Examination Surveys were analyzed. Associations between clinical/laboratory findings and PA intensity (moderate and vigorous) were investigated. The all-cause mortality of patients in different PA categories were compared by Kaplan-Meier analysis. Factors associated with all-cause mortality were determined using a Cox proportional hazards model. A restricted cubic spline was employed to obtain a more flexible and detailed representation of the relationship between PA intensity and all-cause mortality, with better predictive capability.

RESULTS

The Kaplan-Meier analysis revealed that greater all-cause mortality was associated with < 10 min/week moderate/vigorous PA (log-rank p < 0.001). A greater survival probability was associated with ≥ 150 min/week vigorous PA or 10-149 min/week moderate PA (log-rank p < 0.001). Age, gender, vigorous PA, smoking status, alcohol consumption, diabetes status, eGFR, serum albumin level, uric acid level, and blood urea nitrogen level were identified as factors associated independently with mortality in the Cox proportional hazards analysis. The restricted cubic splines revealed that these relationships were non-linear (all p < 0.05). Kaplan-Meier analysis of data from patients who engaged in 10-450 min/week moderate/vigorous PA revealed significant differences between the 0-74-min/week and other vigorous PA groups (all log-rank p < 0.001).

CONCLUSIONS

Extended durations of vigorous PA are associated with reduced all-cause mortality in overweight/obese patients with CKD. Clinicians should recommend vigorous free-time PA to these patients, and public health interventions should target this goal to maximize patient health.

Bridging Generations Through Movement: "How and Why" Intergenerational Programs Operate-A Systematic and Narrative Review

Well-being and social interaction are among the primary goals to be achieved for the elderly. Intergenerational physical activity (PA) has gained increasing attention due to its potential to encourage PA and social interaction, providing both social and physical benefits to both younger and older individuals. This review aimed to gain a deeper understanding of the potential roles of PA in facilitating intergenerational interactions and provide practical insights. Methods: Following PRISMA guidelines, the systematic review identified specific keywords to search for articles that met the chosen inclusion and exclusion criteria (n. 5 RCT articles, selected between 2009 and 2024), conducted by three independent reviewers. Scopus, PubMed, EBSCOhost, and Web of Science were consulted to identify relevant articles. Risk of bias was assessed using Cochrane RoB 2. For the narrative dissertation, articles were identified across three key areas of focus: types of PA, age groups, and intended goals. Results: Few studies have specifically implemented PA protocols in intergenerational relationships, and most have planned remote activities without monitoring outcomes. The main advantages of intergenerational PA are oriented towards the social and relational sphere rather than simple PA involvement. Conclusions: For the elderly, these programs may help mitigate age-related deficits, while children and adolescents, when adapting to their older counterparts, experience greater effectiveness when provided with clear guidance during shared activities. Considering the characteristics and needs of individuals of different ages, different activities must be proposed to obtain different results. The organization of workshops and preparatory sessions will help in facilitating relationships and interactions among participants.

Comment on "physical activity volume, intensity and life expectancy"

•Higher combinations of volume and intensity of physical activity are associated with increased longevity in older adults enrolled in the UK Biobank study. •Compared to more active older adults, the least active gain the most longevity by adding a 10-min and a 30-min brisk walk to their usual daily physical activity habits. •Researchers and practitioners may need to familiarize themselves with new accelerometer scoring metrics, which use average acceleration units and intensity gradients. •Analyzing research on physical activity and life expectancy by gender is crucial due to differences between men and women in their physiological responses and mortality rates.

Community-based dementia risk management and prevention program for Aboriginal Australians (DAMPAA): a randomised controlled trial study protocol

INTRODUCTION

Aboriginal and Torres Strait Islander peoples are the First Peoples of Australia. Up to 45% of dementia in these populations is due to potentially modifiable risk factors. The Dementia Prevention and Risk Management Program for Aboriginal Australians (DAMPAA) is an Aboriginal Health Practitioner led programme that aims to reduce cognitive decline and functional impairment in older Aboriginal people.

METHODS

Design: DAMPAA is a multisite, randomised controlled trial aiming to deliver and evaluate a culturally appropriate risk factor management programme.

POPULATION

Community-dwelling Aboriginal people aged 45-90 years.

INTERVENTION

Participants will be randomly assigned to either usual care (control) or to a group programme comprising exercise and health education yarning sessions and pharmacist-delivered medication reviews delivered over a 12-month period.

PRIMARY OUTCOME

Cognitive function (Kimberley Indigenous Cognitive Assessment (KICA)-Cog score), daily function (KICA-Activities of Daily Living (ADL) score) and quality of life (Good Spirit, Good Life and EQ-5D-5L scores).

SECONDARY OUTCOMES

Process evaluation interviews, cardiovascular risk factors, falls and death. Process evaluation will be conducted with qualitative methods. Quantitative outcomes will be analysed with generalised linear mixed models.

ETHICS AND DISSEMINATION

The study was approved by the Western Australian Aboriginal Health Ethics Committee and the University of Western Australia Human Research Ethics Committee. Study results will be published in peer-reviewed journals and presented at scientific meetings. We will also develop and disseminate a comprehensive DAMPAA toolkit for health services. The study's findings will guide future prevention strategies and outline a comprehensive process evaluation that may be useful in other Aboriginal health research to contextualise findings.

Association between weekend warrior physical activity pattern and all-cause mortality among adults living with type 2 diabetes: a prospective cohort study from NHANES 2007 to 2018

BACKGROUND

It is uncertain whether the weekend warrior pattern is associated with all-cause mortality among adults living with type 2 diabetes. This study explored how the 'weekend warrior' physical activity (PA) pattern was associated with all-cause mortality among adults living with type 2 diabetes.

METHODS

This prospective cohort study investigated US adults living with type 2 diabetes in the National Health and Nutrition Examination Survey (NHANES). Mortality data was linked to the National Death Index. Based on self-reported leisure-time and occupational moderate-to-vigorous PA (MVPA), participants were categorized into 3 groups: physically inactive (< 150 min/week of MVPA), weekend warrior (≥ 150 min/week of MVPA in 1 or 2 sessions), and physically active (≥ 150 min/week of MVPA in 3 or more sessions).

RESULTS

A total of 6067 participants living with type 2 diabetes [mean (SD) age, 61.4 (13.5) years; 48.0% females] were followed for a median of 6.1 years, during which 1206 deaths were recorded. Of leisure-time and occupational activity, compared with inactive individuals, hazard ratios (HRs) for all-cause mortality were 0.49 (95% CI 0.26-0.91) and 0.57 (95% CI 0.38-0.85) for weekend warrior individuals, and 0.55 (95% CI 0.45-0.67) and 0.64 (95% CI 0.53-0.76) for regularly active individuals, respectively. However, when compared leisure-time and occupational weekend warrior with regularly active participants, the HRs were 0.82 (95% CI 0.42-1.61) and 1.00 (95% CI 0.64-1.56) for all-cause mortality, respectively.

CONCLUSIONS

Weekend warrior PA pattern may have similar effects on lowering all-cause mortality as regularly active pattern among adults living with type 2 diabetes, regardless of leisure-time or occupational activity. Therefore, weekend warrior PA pattern may be sufficient to reduce all-cause mortality for adults living with type 2 diabetes.

A comparison of the physical activity levels of 3-to-6-year-old children with autism spectrum disorder and children with typical development

Background

Physical activity during early development is closely related to health. Differences in physical activity between young children with autism spectrum disorder and those with typical development are unclear. The purpose of this study was to compare the physical activity levels in children with autism spectrum disorder and typically developing children from the same area, including their sedentary physical activity, light physical activity, moderate-to-vigorous physical activity, and number of days in which the moderate-to-vigorous physical activity guideline recommendation of 60 min per day was met.

Methods

A total of 77 participants aged 3-6 years were included: 41 children with autism spectrum disorder (mean age = 61.41 ± 10.69 months) and 36 children with typical development (mean age = 60.36 ± 10.16 months). The physical activity of the children was measured using an ActiGraph GT3x accelerometer.

Results

There were no significant differences in daily sedentary physical activity (439.70 ± 54.98 vs. 450.42 ± 53.67) or moderate-to-vigorous physical activity (46.62 ± 18.93 vs. 47.47 ± 18.26) between the two groups. The average daily moderate-to-vigorous physical activity of the two groups did not reach 60 min, and they had similar proportions of participants who reached 60 min a given number of times (24.4% vs. 25%). Daily light physical activity was significantly higher in the autism spectrum disorder group (263.96 ± 43.17 vs. 242.32 ± 37.91, p < 0.05). The moderate-to-vigorous physical activity of both groups was similar and lower than the recommended minimum physical activity.

Conclusion

Targeted interventions should be considered in early intervention programs for children with autism spectrum disorder to increase their moderate-to-vigorous physical activity.

Physical activity volume, frequency, and intensity: Associations with hypertension and obesity over 21 years in Australian women

BACKGROUND

Optimal patterns of accrual of recommended levels of physical activity (PA) for prevention of hypertension and obesity are not known. The overall aim of this study was to investigate whether different patterns of accumulation of PA are differentially associated with hypertension and obesity in Australian women over 21 years. Specifically, we investigated whether, for the same weekly volume of PA, the number of sessions (frequency) and vigorousness of PA (intensity) were associated with a reduction in the occurrence of hypertension and obesity in women.

METHODS

Data from the 1973-1978 and 1946-1951 cohorts of the Australian Longitudinal Study on Women's Health were analyzed (n = 20,588; 12%-16% with a Bachelor's or higher degree). Self-reported PA, hypertension, height, and weight were collected using mail surveys every 3 years from 1998/2000 to 2019/2021. Generalized Estimating Equation models with a 3-year lag model were used to investigate the association of PA volume (metabolic equivalent min/week) (none; 33-499; 500-999; ≥1000, weekly frequency (none; 1-2 times; 3-4 times; 5-7 times; ≥8 times), and the proportion of vigorous PA to total volume of PA (none; 0%; 1%-33%; 34%-66%; 67%-100%) with odds of hypertension and obesity from 2000 to 2021.

RESULTS

The cumulative incidence of hypertension was 6% in the 1973-1978 and 23% in the 1946-1951 cohort; 27% of women in the 1973-1978; and 15% in the 1946-1951 cohort developed obesity over the period. Overall, a higher volume of PA was associated with reduced odds of hypertension and obesity. When the volume of PA was considered, the odds of hypertension did not vary according to the frequency or intensity of PA. However, increased proportion of vigorous PA to the total volume of PA was associated with a small additional reduction in the risk of obesity.

CONCLUSION

PA volume appears to be more important than the pattern of accumulation for the prevention of hypertension and obesity. Incorporating more sessions, particularly of vigorous-intensity PA, may provide extra benefits for the prevention of obesity.

Can Functional Motor Capacity Influence Mortality in Advanced Chronic Kidney Disease Patients?

Alterations in the body's nutritional status or composition may be observed as the kidney disease advances, which could influence the kidney's functional capacity and, consequently, could increase the risk of mortality. The aim of the study is to determine the influence of functional capacity on mortality assessed by different functional tests in patients with advanced chronic kidney disease (ACKD). A prospective observational study was designed, which included 225 patients followed for 8 years in a CKD clinic. The study assessed functional capacity by using a range of tests, which included the Short Physical Performance Battery, the 6 minutes walking gait test, the timed up and go, and the four versions of the sit-to-stand test. Additionally, body composition and nutritional conditions were considered, taking into consideration various biochemical indicators such as albumin, prealbumin, c-reactive protein (CRP), lymphocytes, and transferrin, muscle strength, comorbidity, and frailty. The relationship between functionality and all-cause mortality was investigated using a Cox proportional hazard model. A total of fifty patients died during the duration of the study. Patients who performed worse on the function and muscle strength tests showed a worse body composition and nutritional status, and exhibited a reduced life expectancy. Inflammation (CRP) was associated with an increased risk of mortality (model 1: hazard ratio (HR) = 1.246; 95% confidence interval (95% CI = 1.014-1.531; model 2: HR = 1.333; 95% CI = 1.104-1.610). Good functional capacity as determined by the SPPB test decreased the risk of mortality (model 1: HR = 0.764; 95% CI = 0.683-0.855; model 2 HR = 0.778; 95% CI = 0.695-0.872). Cut-off points of maximum sensitivity and specificity for mortality were obtained with different tests. The study demonstrated that functional capacity influences mortality in patients with ACKD, being higher in those patients with impaired functionality regardless of the test used, although the SPPB allows a larger number of patients to be assessed. Therefore, it is essential to incorporate the assessment of functionality into the comprehensive care of patients with CKD.

Comparing cadence-based and machine learning based estimates for physical activity intensity classification: The UK Biobank

OBJECTIVES

Cadence thresholds have been widely used to categorize physical activity intensity in health-related research. We examined the convergent validity of two cadence-based intensity classification approaches against a machine-learning-based intensity schema in 84,315 participants (≥40 years) with wrist-worn accelerometers.

DESIGN

Validity study.

METHODS

Both cadence-based methods (one-level cadence, two-level cadence) calculated intensity-specific time based on cadence-thresholds while the two-level cadence identified stepping behaviors first. We used an overlapping plot, mean absolute error, and Spearman's correlation coefficient to examine agreements between the cadence-based and machine-learning methods. We also evaluated agreements between methods based on practically-important-difference (moderate-to-vigorous-physical activity: ±20 min/day, moderate-physical activity: ±15, vigorous-physical activity: ±2.5, light-physical activity: ±30).

RESULTS

The group-level (median) minutes of moderate-to-vigorous- and moderate-physical activity estimated by one-level cadence were within the range of practically-important-difference compared to the machine-learning method (bias of median: moderate-to-vigorous-physical activity, -3.5, interquartile range [-15.8, 12.2]; moderate-physical activity, -6.0 [-17.2, 4.1]). The group-level vigorous- and light-physical activity minutes derived by two-level cadence were within practically-important-difference range (vigorous-physical activity: -0.9 [-3.1, 0.5]; light-physical activity, -1.3 [-28.2, 28.9]). The individual-level differences between the cadence-based and machine learning methods were high across intensities (e.g., moderate-to-vigorous-physical activity: mean absolute error [one-level cadence: 24.2 min/day; two-level cadence: 26.2]), with the proportion of participants within the practically-important-difference ranging from 8.4 % to 61.6 %.

CONCLUSIONS

One-level cadence showed acceptable group-level estimates of moderate-to-vigorous and moderate-physical activity while two-level cadence showed acceptable group-level estimates of vigorous- and light-physical activity. The cadence-based methods might not be appropriate for individual-level intensity-specific time estimation.

Intensity-specific physical activity measured by accelerometer and the risk of mortality among individuals with cardiometabolic diseases: A prospective study from the UK Biobank

BACKGROUND

While the health benefits of physical activity for general population are well-recognized, the prospective associations of physical activity volume and intensity with mortality among cardiometabolic disease individuals remain unclear.

OBJECTIVE

The objective of this study was to investigate the associations of accelerometer-measured intensity-specific physical activity with mortality risk among population with cardiometabolic disease.

DESIGN

Prospective cohort study.

SETTING

Participants were recruited from the United Kingdom (UK) across 22 assessment centers from 2006 to 2010.

PARTICIPANTS

A total of 9524 participants from the UK Biobank (median: 67.00 years, interquartile range: 61.00-70.00 years) were included in final study.

METHODS

Accelerometer-measured total volume, moderate-to-vigorous and light intensity physical activity collecting from 2013 to 2015 were quantified using a machine learning model. Multivariable restricted cubic splines and Cox proportional hazard models with hazard ratios (HRs) and 95 % confidence intervals (CIs) were employed to examine the associations of interests.

RESULTS

During the follow-up period (median: 6.87 years; interquartile range: 6.32-7.39 years), there were 659 (6.92 %) death events with 218 (2.29 %) cardiovascular disease-related deaths and 441 (4.63 %) non-cardiovascular disease-related deaths separately. In the fully adjusted models, compared with participants in the lowest quartiles of total volume, moderate-to-vigorous and light physical activities, the adjusted HRs (95 % CIs) of all-cause mortality for those in the highest quartiles were 0.40 (0.31, 0.52), 0.48 (0.37, 0.61), and 0.56 (0.44, 0.71) while those for cardiovascular diseases-related mortality were 0.35 (0.22, 0.55), 0.52 (0.35, 0.78) and 0.59 (0.39, 0.88), and for non-cardiovascular diseases-related mortality, they were 0.42 (0.30, 0.59), 0.40 (0.29, 0.54) and 0.54 (0.40, 0.73), separately. The optimal moderate-to-vigorous-intensity physical activity level for cardiovascular diseases-related mortality reduction was found to be in the third quartile (17.75-35.33 min/day). Furthermore, the observed inverse associations were mainly non-linear.

CONCLUSIONS

Promoting physical activity, regardless of intensity, is essential for individuals with cardiometabolic disease to reduce mortality risk. For both all-cause and cardiovascular disease-related and non-cardiovascular disease-related mortality, the observed decrease in risk seems to level off at a moderate level. The current findings deriving from precise device-based physical activity data provide inference for secondary prevention of cardiometabolic disease.

Joint Associations of Diet and Device-Measured Physical Activity with Mortality and Incident CVD and Cancer: A Prospective Analysis of the UK Biobank Study

BACKGROUND

We examined the joint associations of diet and device-measured intensity-specific physical activity (PA) with all-cause mortality (ACM), cardiovascular disease (CVD), and cancer incidence.

METHODS

We used data from 79,988 participants from the UK Biobank, a population-based prospective cohort study. Light PA (LPA), moderate-to-vigorous PA (MVPA), vigorous PA (VPA), and total PA (TPA) were measured using a wrist-worn accelerometer. Diet quality score (DQS) was based on 10 foods and ranged from 0 (unhealthiest) to 100 (healthiest) points. We derived joint PA and diet variables. Outcomes were ACM, CVD, and cancer incidence including PA, diet and adiposity-related (PDAR) cancer.

RESULTS

During a median follow-up of 8 years, 2,863 deaths occurred, 11,053 participants developed CVD, 7,005 developed cancer, and 3,400 developed PDAR cancer. Compared with the least favorable referent group (bottom PA tertile/low DQS), participants with middle and high (total and intensity specific) PA, except for LPA, had lower ACM risk and incident CVD risk, regardless of DQS. For example, among middle and high VPA and high DQS groups, CVD HR were 0.79 (95% CI, 0.74-0.86) and 0.75 (95% CI, 0.69-0.82), respectively. The pattern of cancer results was less pronounced but in agreement with the ACM and CVD incidence findings (e.g., HR, 0.90, 95% CI, 0.81-0.99; 0.88, 0.79-0.98; and 0.82, 0.74-0.92 among high VPA for low, moderate, and high DQS groups, respectively).

CONCLUSIONS

Device-measured PA reveals novel joint associations with diet on health outcomes.

IMPACT

Our results emphasize the crucial role of PA in addition to a healthy diet for reducing chronic diseases and mortality risk.

Association of resting heart rate and physical activity with cardiovascular mortality: A population-based cohort study of Korean adults

To examine the independent and combined association of resting heart rate (RHR) and physical activity (PA) with risk of cardiovascular disease (CVD) mortality. RHR was categorized as < 60, 60-69, 70-79, and ≥ 80 bpm. Meeting PA guidelines was defined as ≥ 150 min/week of moderate to vigorous physical activity (MVPA). Cox proportional hazard models were used to calculate hazard ratios (HRs) for CVD mortality associated with RHR and PA. Among 31,697 participants, 311 CVD deaths occurred during 9.2 years of follow-up. Compared to RHR of 60-69 bpm, the risk of CVD mortality was higher in RHR of < 60 bpm (HR, 1.48; 95% CI, 1.05-2.10) and ≥ 80 bpm (HR, 1.42; 95% CI, 1.06-1.91). Participants who met PA guidelines had a lower risk of CVD mortality (HR, 0.59; 95% CI, 0.44-0.78). Among physically inactive adults compared to participants in RHR of 60-69 bpm with meeting PA guidelines, the adjusted HR for CVD mortality was 2.41 (95% CI, 1.42-4.08) for RHR of < 60 bpm, 1.59 (95% CI, 1.01-2.49) for RHR of 60-69 bpm, 1.98 (95% CI, 1.23-3.20) for RHR of 70-79 bpm and 2.41 (95% CI, 1.50-3.89) for RHR of ≥ 80 bpm Exceeding the minimum level of PA guidelines may attenuate the risk of CVD mortality associated with RHR.

Personalized heart rate management through data-driven dynamic exercise control

Maximizing healthy life expectancy is essential for enhancing well-being. Optimal exercise intensity is crucial in promoting health and ensuring safe rehabilitation. Since heart rate is related to exercise intensity, the required exercise intensity is achieved by controlling the heart rate. This study aims to control heart rate during exercise by dynamically adjusting the load on a bicycle ergometer using a proportional-integral (PI) control. The choice of PI parameters is very important because the PI parameters significantly affect the performance of heart rate control. Since the dynamic characteristics of heart rate relative to work rate vary widely from subject to subject, the PI parameters for each subject must be determined individually. In this study, PI parameters are optimized directly from exercise data using a data-driven design approach. Thus, the proposed method does not require excessive exercise of the subject to model heart rate dynamics. Using the proposed method, the heart rate can be controlled to follow a designed reference model so that the heart rate is safely increased to the desired value. The quantitative evaluation of the control results of fifteen healthy volunteers confirmed that the proposed method improved the control error of the target heart rate trajectory by approximately 40%, regardless of gender or age. In addition, it was shown that control parameters from the exercise experiment also indicate that females are more likely than males to have an elevated heart rate at the same load.

The association between physical activity and cardiovascular events, tumors and all-cause mortality in patients with maintenance hemodialysis with different nutritional status

The current research focuses on the effects of nutritional supplementation and exercise on dialysis patients, but whether physical activity (PA) can reduce the risk of adverse outcomes for patients with different nutritional status is not clear. The maintenance hemodialysis (MHD) patients were recruited from April 2021 to April 2022. The information of PA was obtained from the international physical activity questionnaire (IPAQ). The outcomes were cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor and all-cause death. We used COX proportional risk model to estimate the association between PA and the outcomes of MHD patients. Patients are classified into two groups based on geriatric nutritional risk index (GNRI) and classified by age, and we used COX proportional risk model to estimate the association of PA and outcomes in subgroups. The isotemporal substitution model (ISM) was used to estimate the effects of replacing light physical activity (LPA) with moderate physical activity (MPA) or vigorous physical activity (VPA) on risk of cardiovascular events, tumors, and all-cause death in different subgroups. The effects of PA on ankle-brachial index (ABI) and body fat content were analyzed in different IPAQ groups. A total of 241 maintenance hemodialysis patients were included, 105 peoples developed cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor and all-cause death (43.6%). The median follow-up time was 12 months. MPA reduced the risk of outcome in MHD patients or high GNRI patients (40% vs 39%).In MHD patients who was under 65 years with high GNRI, MPA reduced cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor and all-cause death by 55%.PA reduced the risk of cardiovascular event by 65%, but did not reduce the risk of tumor or all-cause death. Replacing LPA with VPA did not improve clinical outcomes. It actually increases the risk of heart failure 0.4%. MPA reduced the risk of cardiovascular death, myocardial infarction, stroke, heart failure, atrial fibrillation, tumor, all-cause death in MHD patients under 65 years, while VPA had no health benefit.Trial registration: ChiCTR210050998.

Physical activity is associated with lower mortality in adults with obesity: a systematic review with meta-analysis

BACKGROUND

Obesity is a complex chronic disease associated with several adverse health outcomes that increase mortality risk. Physical activity (PA) is recommended for the prevention and treatment of obesity and is related to a decreased risk of cardiovascular disease, cancer and all-cause mortality. This systematic review and meta-analysis estimates the effect of PA levels on mortality (cardiovascular, cancer and all-cause mortality) in adults with obesity.

METHODS

A systematic search was conducted in MEDLINE, Embase, Web of Science and SPORTDiscus from inception to June 2024. Prospective cohort studies that explored the association between PA and mortality in adults with obesity (according to their body mass index, ≥ 30 kg/m2) aged ≥ 18 years were included. Our main outcomes were all-cause mortality, and cardiovascular, and cancer mortality reported in primary studies by hazard ratios or relative risk, which were pooled for the meta-analysis when at least two studies reported the effect estimate for the same outcome. The PRISMA recommendations and the MOOSE guidelines were followed. The reported mortality risk estimates comparing insufficiently active versus active (moderate to very active) adults with obesity were pooled using the DerSimonian and Laird random-effects model.

RESULTS

A total of 9 prospective cohort studies involving 199,425 adults with obesity (age range: 35-85 years) were included, of which 59,873 were insufficiently active and 84,328 were active. Active individuals had a 21% lower risk of all-cause mortality (HR: 0.79, 95%CI: 0.74 to 0.84; I2 = 38.2%), and a 24% lower risk of cardiovascular mortality (HR: 0.76, 95%CI: 0.66 to 0.87; I2 = 0.0%) than insufficiently active individuals. The HR for cancer mortality was 0.91 (95%CI: 0.80 to 1.02; I2 = 0.0%), and although this was mostly consistent with a benefit, it was based on only two studies.

CONCLUSION

Our data support that moderate to high levels of PA are associated with a 21% lower risk of all-cause and 24% cardiovascular disease mortality in adults with obesity. Although data from the only two published studies seem to indicate a protective effect of PA on cancer risk, the estimates are not statistically significant.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022309346.

Associations of different combinations of moderate-vigorous physical activity and muscle-strengthening activity with mortality among US lung cancer survivors

BACKGROUND

To investigate the associations of different combinations of moderate to vigorous physical activity (MVPA) and muscle strengthening activity (MSA) with all-cause and cancer mortality among lung cancer survivors.

METHODS

This nationwide prospective cohort study used data from the US National Health Interview Survey 2009-2018. A total of 785 lung cancer survivors were included in the study. Participants were linked to the National Death Index through December 31, 2019. Self-reported MVPA and MSA frequency data were used to obtain 4 mutually exclusive exposure categories. Multivariate Cox proportional hazard models were applied to explore the association between exposure categories and outcomes.

RESULTS

The mean (standard deviation [SD]) age of the study population was 69.1 (11.3) years and 429 (54.6%) were female. Among them, 641 (81.7%) were White and 102 (13.0%) were Black. The median follow-up time was 3 years (2526 person-years), and 349 (44.5%) all-cause deaths and 232 (29.6%) cancer deaths occurred. Compared to the MVPA < 60 min/week and MSA < 2 sessions/week group, individuals in the MVPA ≥ 60 min/week and MSA < 2 sessions/week group showed hazard ratios (HRs) of 0.50 (95% CI, 0.36-0.69) for all-cause mortality and 0.37 (95% CI, 0.20-0.67) for cancer mortality after the adjustment of covariates. Those in the MVPA ≥ 60 min/week and MSA ≥ 2 sessions/week group exhibited HRs of 0.52 (95% CI, 0.35-0.77) for all-cause mortality and 0.27 (95% CI, 0.12-0.62) for cancer mortality when compared to the MVPA < 60 min/week and MSA < 2 sessions/week group. We also identified distinct non-linear relationships between MVPA and outcomes risk among two MSA frequency subgroups.

CONCLUSION

This cohort study demonstrated that higher levels of MVPA and MSA combined might be associated with optimal reductions of mortality risk in lung cancer survivors.

Device-measured sedentary time and intensity-specific physical activity in relation to all-cause and cardiovascular disease mortality: the UK Biobank cohort study

BACKGROUND AND AIMS

Understanding the amounts of intensity-specific movement needed to attenuate the association between sedentary time and mortality may help to inform personalized prescription and behavioral counselling. Herein, we examined the joint associations of sedentary time and intensity-specific physical activity with all-cause and cardiovascular disease (CVD) mortality.

METHODS

Prospective cohort study including 73,729 adults from the UK Biobank who wore an Axivity AX3 accelerometer on their dominant wrist for at least 3 days, being one a weekend day, between June 2013 and December 2015. We considered the median tertile values of sedentary time and physical activity in each intensity band to determine the amount of physical activity needed to attenuate the association between sedentary time and mortality.

RESULTS

During a median of 6.9 years of follow-up (628,807 person-years), we documented 1521 deaths, including 388 from CVD. Physical activity of any intensity attenuated the detrimental association of sedentary time with mortality. Overall, at least a median of 6 min/day of vigorous physical activity, 30 min/day of MVPA, 64 min/day of moderate physical activity, or 163 min/day of light physical activity (mutually-adjusted for other intensities) attenuated the association between sedentary time and mortality. High sedentary time was associated with higher risk of CVD mortality only among participants with low MVPA (HR 1.96; 95% CI 1.23 to 3.14).

CONCLUSIONS

Different amounts of each physical activity intensity may attenuate the association between high sedentary time and mortality.

Association Between Physical Activity and the Prevalence of Kidney Stones in American Adults: Results From a Multiyear National Survey

OBJECTIVE

To investigate the association between physical activity (PA) and the prevalence of kidney stones.

METHODS

A cross-section study was conducted using data from National Health and Nutrition Examination Survey 2007-2018. PA was evaluated based on the Global Physical Activity Questionnaire. Multivariable logistic regression was performed to elucidate the association between PA (patterns, intensity, duration, and frequency of moderate and vigorous PA) and the prevalence of kidney stones after adjusting for potential confounders. Stratified and interaction analyses were conducted to detect potential effect modifiers. In addition, PA was assessed using metabolic equivalent and physical volume, and followed the regression above. Water intake was obtained from the day 2 dietary recall and was included in the sensitivity analysis.

RESULTS

A total of 34,390 participants were included in the analysis. The multivariable logistic regression revealed that individuals who engaged in moderate PA for 30-60 minutes per day had a significant inverse association with the prevalence of kidney stones in the fully adjusted model (odds ratio=0.804, 95% confidence interval 0.700 to 0.923), while no more significant finding was observed for other PA parameters. Interaction and stratified analyses indicated no covariate modifying the association. The results above were robust in the sensitivity analysis.

CONCLUSION

The duration of moderate PA (30-60 min/d) is inversely associated with the prevalence of kidney stones, while no more significant association was observed between other PA parameters (including patterns, intensity, duration, and frequency of vigorous PA, frequency of moderate PA) and kidney stones.

Physical Activity Intensity and Risk of Dementia

INTRODUCTION

Regular participation in aerobic physical activity is associated with a reduced risk of dementia. It is currently unclear whether this association is due to the total volume or intensity of physical activity.

METHODS

This prospective cohort study analyzed 386,486 adults from the UK Biobank who were free of dementia and self-reported >0 minutes of moderate-to-vigorous intensity physical activity (MVPA) at baseline (2007-2010). Participants were categorized as performing 0%, >0%-30%, or >30% of their total MVPA in vigorous activity (VPA). Cox proportional hazards regression models were used to examine the associations between categories of VPA and incident dementia while adjusting for sociodemographic and lifestyle factors including total MVPA. Analyses were performed in 2022.

RESULTS

Over an average follow-up of 12.0 (1.7) years, there were 5,177 (1.3%) cases of dementia. Compared to the group reporting 0% VPA, the hazard ratios (95% confidence intervals) of dementia for the groups reporting >0%-30% and >30% VPA were 0.73 (0.68-0.78) and 0.81 (0.75-0.87), respectively, in the fully adjusted model. In a joint analysis, reporting some VPA was associated with a reduced risk of dementia regardless of meeting the aerobic physical activity guidelines (HR=0.78 [0.72-0.85]) or not (HR=0.76 [0.60-0.98]), while meeting the aerobic physical activity guidelines alone without VPA was not associated with incident dementia (HR=0.98 [0.90-1.07]), compared to the group that did not meet the guidelines and reported no VPA.

CONCLUSIONS

These results suggest that engaging in VPA as part of MVPA is associated with a lower risk of dementia.

Urban-rural differences in the association between occupational physical activity and mortality in Chinese working population: evidence from a nationwide cohort study

Background

Despite emerging studies suggesting that occupational physical activity (OPA) might be harmful to health, the available evidence is not definitive. Most of these research studies were conducted in high-income Western countries or in urbanized setting. In China, where over one-third of the population resides in rural area, the impact of OPA on health is not well understood. The goal of this study is to investigate how the association between OPA and mortality vary by urban-rural settings.

Methods

Baseline data on OPA was gathered using the Global Physical Activity Questionnaire from 30,650 urban and 49,674 rural working adults as part of the 2013-2014 China Chronic Disease and Risk Factor Surveillance. Participants were followed for a median of 6.2 years, and death records were retrieved from the National Mortality Surveillance System until December 31, 2019. The multivariable Cox proportional hazard model was used to examine urban-rural differences in the association between OPA and all-cause and cardiovascular disease (CVD) mortality. Subgroup analyses were performed by sex, socioeconomic status, leisure time, transportation, and non-occupational physical activity.

Findings

During the study period, 1342 deaths were recorded, of which 426 were caused by CVD. In rural area, working adults engaging in occupational moderate-to-vigorous physical activity (MVPA) for ≥40 h per week, compared to those without any, had an adjusted hazard ratio of 0.60 (95% CI: 0.49-0.73) for all-cause mortality and 0.55 (95% CI: 0.37-0.83) for CVD mortality. However, no significant association was found in urban area (0.84 [0.61-1.15] for all-cause mortality, Pinteraction = 0.036; and 0.94 [0.53-1.66] for CVD mortality, Pinteraction = 0.098). The negative associations of occupational MVPA with mortality were more pronounced in women, non-smokers, and those with less non-occupational physical activities. Hypertension, heart rate, and diabetes were important contributors to the relationship between occupational MVPA and mortality.

Interpretation

The findings from the current study did not support the notion that high levels of OPA would induce harm. On the contrary, in rural setting, higher levels of OPA were associated with lower mortality risks. Furthermore, the observed urban-rural differences in the association between OPA and mortality underscored the need for context-specific public health guidelines on physical activities.

Funding

R&D Program of Beijing Municipal Education Commission (KM202210025026),National Key Research and Development Program of China (2021YFC2500201), and Young Elite Scientist Sponsorship Program by BAST (BYESS2023385).

Association of cigarette and electronic cigarette use patterns with all-cause mortality: A national cohort study of 145,390 US adults

OBJECTIVE

While e-cigarette use is associated with adverse cardiopulmonary health effects, the mortality risks associated with e-cigarette use alone and combined with smoking remain unexamined.

METHODS

Data between 2014 and 2018 were obtained from the National Health Interview Survey (NHIS), an annual cross-sectional survey of US adults. All-cause mortality and date of death were obtained via linkage of the NHIS to the National Death Index through December 31, 2019. A 6-category composite cigarette (never, former, current) and e-cigarette (current, non-current) exposure variable was created. We examined the association of cigarette and e-cigarette use patterns with all-cause mortality using adjusted Cox models.

RESULTS

Among 145,390 participants (79,294 women [51.5%]; 60,560 aged 18-44 [47.4%]), 5220 deaths were observed over a median follow-up of 3.5 years (508,545 total person-years). Dual use of cigarettes and e-cigarettes was associated with higher mortality risk compared with non-current e-cigarette use in combination with never smoking (hazard ratio [HR] 2.44; 95% CI, 1.90-3.13) and had a risk that did not differ from current exclusive smoking (HR, 1.06; 95% CI, 0.83-1.37). Current e-cigarette use in combination with former smoking was associated with a lower mortality risk than current exclusive cigarette smoking (HR 0.64; 95% CI, 0.41-0.99).

CONCLUSIONS

The addition of e-cigarette use to smoking does not reduce mortality risk compared with exclusive smoking. However, transitioning completely from cigarettes to e-cigarettes may be associated with mortality risk reduction. Further research is needed to verify these findings in larger cohorts and over longer periods of follow-up.

All-cause mortality risks among participants in mass-participation sporting events

OBJECTIVES

Exercise transiently increases the risk for sudden death, whereas long-term exercise promotes longevity. This study assessed acute and intermediate-term mortality risks of participants in mass-participation sporting events.

METHODS

Data of participants in Dutch running, cycling and walking events were collected between 1995 and 2017. Survival status was obtained from the Dutch Population Register. A time-stratified, case-crossover design examined if deceased participants more frequently participated in mass-participation sporting events 0-7 days before death compared with the reference period (14-21 days before death). Mortality risks during follow-up were compared between participants and non-participants from the general population using Cox regression.

RESULTS

546 876 participants (median (IQR) age 41 (31-50) years, 56% male, 72% runners) and 211 592 non-participants (41 (31-50) years, 67% male) were included. In total, 4625 participants died of which more participants had partaken in a sporting event 0-7 days before death (n=23) compared with the reference period (n=12), and the mortality risk associated with acute exercise was greater but did not reach statistical significance (OR 1.92; 95% CI 0.95 to 3.85). During 3.3 (1.1-7.4) years of follow-up, participants had a 30% lower risk of death (HR 0.70; 95% CI 0.67 to 0.74) compared with non-participants after adjustment for age and sex. Runners (HR 0.65; 95% CI 0.62 to 0.69) and cyclists (HR 0.70; 95% CI 0.64 to 0.77) had the best survival during follow-up followed by walkers (HR 0.88; 95% CI 0.80 to 0.94).

CONCLUSION

Participating in mass-participation sporting events was associated with a non-significant increased odds (1.92) of mortality and a low absolute event rate (4.2/100 000 participants) within 7 days post-event, whereas a 30% lower risk of death was observed compared with non-participants during 3.3 years of follow-up. These results suggest that the health benefits of mass sporting event participation outweigh potential risks.

Cognition is selectively impaired in males with spinal pain: A retrospective analysis of data from the Longitudinal Study of Ageing Danish Twins

Cognitive decline and spinal pain (back pain [BP] and neck pain [NP]) represent a major public health challenge, yet the potential relationship between them remains elusive. A retrospective analysis of the Longitudinal Study of Ageing Danish Twins was performed to determine any potential relationships between BP/NP and cognitive function adjusting for age, sex, educational and socioeconomic status. A total of 4731 adults (2788 females/1943 males) aged 78 ± 6 (SD) years were included in the analysis. We observed a 1-month prevalence of 25% with BP, 21% with NP and 11% for combined BP/NP. While there were no differences in cognition scores for males and females reporting combined BP/NP, compared to those without combined BP/NP (34.38 points [95% confidence interval (CI) = 31.88, 36.88] vs. 35.72 points [95% CI = 35.19, 36.26]; P = 0.180; and 35.72 points [95% CI = 35.19, 36.26] vs. 35.85 points [95% CI = 35.39, 36.31]; P = 0.327; for male and females, respectively), an adjusted analysis revealed that males with combined BP/NP presented with lower cognitive scores compared to males without combined BP/NP (81.26 points [95% CI = 73.80, 88.72] vs. 79.48 points [95% CI = 70.31, 88.66]; P = 0.043). The findings of this hypothesis-generating study may highlight a potential sex-specific association between spinal pain and later-life neurodegeneration.

Association of aerobic and muscle-strengthening physical activity with all-cause and cardiovascular disease mortality among adults with type 2 diabetes: A prospective cohort of US adults

OBJECTIVE

To investigate the relationship of moderate physical activity (MPA), vigorous physical activity (VPA), and muscle strengthening activity (MSA), independently and jointly, with all-cause, cardiovascular disease (CVD), and non-CVD mortality in individuals with type 2 diabetes (T2D).

MATERIAL AND METHODS

This cohort study included 47,538 adults with T2D and 561,963 adults without T2D from the National Health Interview Survey 1997-2018 who provided data on self-reported physical activity (PA). Mortality data were obtained from the National Death Index through 2019. Cox regression was used to estimate hazard ratio (HR) and 95% confidence interval (CI).

RESULTS

In analyses mutually adjusted, versus no MPA adults with T2D, performing the recommendations of MPA (150-299 min/week) associated with lower all-cause mortality (HR, 0.72; 95% CI, 0.66-0.78), CVD mortality (HR, 0.68; 95% CI, 0.58-0.79), and non-CVD mortality (HR, 0.72; 95% CI, 0.65-0.79). Similar benefits were observed in those meeting recommendations for VPA and MSA. Higher levels of PA beyond current recommendations may provide a few additional benefits without adverse effects on mortality risk, regardless of diabetes onset age, duration of diabetes, and medication status. The joint analysis indicates that combining MSA with aerobic PA could further lower mortality risk, and lowest all-cause mortality was observed among individuals engaging in either 75-150 min/week of VPA and 1 time/week of MSA (HR, 0.30; 95% CI, 0.13-0.70) or 150-299 min/week of MPA and 1 time/week of MSA (HR, 0.33; 95% CI, 0.20-0.55).

CONCLUSION

Our study supports the current PA guidelines and suggests that there may be limited benefits gained from exercising beyond recommended levels in adults with T2D, combining recommended levels of aerobic and resistance exercises could yield the greatest benefits.

Sex Differences in Association of Physical Activity With All-Cause and Cardiovascular Mortality

BACKGROUND

Although physical activity is widely recommended for reducing cardiovascular and all-cause mortality risks, female individuals consistently lag behind male individuals in exercise engagement.

OBJECTIVES

The goal of this study was to evaluate whether physical activity derived health benefits may differ by sex.

METHODS

In a prospective study of 412,413 U.S. adults (55% female, age 44 ± 17 years) who provided survey data on leisure-time physical activity, we examined sex-specific multivariable-adjusted associations of physical activity measures (frequency, duration, intensity, type) with all-cause and cardiovascular mortality from 1997 through 2019.

RESULTS

During 4,911,178 person-years of follow-up, there were 39,935 all-cause deaths including 11,670 cardiovascular deaths. Regular leisure-time physical activity compared with inactivity was associated with 24% (HR: 0.76; 95% CI: 0.73-0.80) and 15% (HR: 0.85; 95% CI: 0.82-0.89) lower risk of all-cause mortality in women and men, respectively (Wald F = 12.0, sex interaction P < 0.001). Men reached their maximal survival benefit of HR 0.81 from 300 min/wk of moderate-to-vigorous physical activity, whereas women achieved similar benefit at 140 min/wk and then continued to reach a maximum survival benefit of HR 0.76 also at ∼300 min/wk. Sex-specific findings were similar for cardiovascular death (Wald F = 20.1, sex interaction P < 0.001) and consistent across all measures of aerobic activity as well as muscle strengthening activity (Wald F = 6.7, sex interaction P = 0.009).

CONCLUSIONS

Women compared with men derived greater gains in all-cause and cardiovascular mortality risk reduction from equivalent doses of leisure-time physical activity. These findings could enhance efforts to close the "gender gap" by motivating especially women to engage in any regular leisure-time physical activity.

Joint associations of device-measured physical activity and abdominal obesity with incident cardiovascular disease: a prospective cohort study

OBJECTIVE

To examine the joint associations between physical activity and abdominal obesity with the risk of cardiovascular disease (CVD) events.

METHODS

We included 70 830 UK Biobank participants (mean age±SD=61.6 ± 7.9 years; 56.4% women) with physical activity measured by wrist-worn accelerometers and without major chronic diseases. Participants were jointly categorised into six groups based on their physical activity level (tertiles of total volume and specific intensity levels) and presence or absence of abdominal obesity based on measured waist circumference. Associations with incident CVD (fatal and non-fatal events) were determined using proportional subdistribution hazard models with multivariable adjustment.

RESULTS

After excluding events during the first 2 years of follow-up, participants were followed for a median of 6.8 years, during which 2795 CVD events were recorded. Compared with the low abdominal adiposity and highest tertile of physical activity, abdominal obesity was associated with higher risk of incident CVD, especially in those with low levels of vigorous-intensity physical activity (HR 1.42, 95% CI 1.22 to 1.64). Approximately 500 min per week of moderate-to-vigorous intensity and approximately 30-35 min of vigorous-intensity physical activity offset the association of abdominal obesity and the risk of having a CVD event.

CONCLUSION

Physical activity equivalent to approximately 30-35 min of vigorous intensity per week appears to offset the association between abdominal obesity and incident CVD. About 15 times more physical activity of at least moderate intensity is needed to achieve similar results.

Association Between Regular Moderate to Vigorous Physical Activity Initiation Following COPD Diagnosis and Mortality: An Emulated Target Trial Using Nationwide Cohort Data

BACKGROUND

Moderate to vigorous physical activity (MVPA) in patients with COPD affects their overall health outcomes, including symptom relief and improved quality of life. However, the magnitude of the effect of MVPA initiation on real-world clinical outcomes has not been well investigated.

RESEARCH QUESTION

How does MVPA initiation affect mortality and severe exacerbation in patients who have not engaged in MVPA prior to COPD diagnosis?

STUDY DESIGN AND METHODS

This study included patients with COPD aged ≥ 40 years who were not performing MVPA prior to COPD diagnosis and who had at least one health screening visit prior to and following their COPD diagnosis between January 1, 2010, and December 31, 2018. The main exposure was MVPA, defined as vigorous aerobic exercise > 20 min per day on ≥ 3 days per week or moderate aerobic exercise > 30 min per day on ≥ 5 days per week. The primary end point was all-cause mortality, and the secondary end point was initial severe exacerbation as the time to event following COPD diagnosis.

RESULTS

In total, 110,097 person-trials were included (27,564 MVPA increases and 82,533 control groups). No differences were observed between the covariates following matching. The adjusted hazards ratio of all-cause mortality for the MVPA group compared with the control group was 0.84 (95% CI, 0.79-0.89). In the subgroup analysis, patients aged > 65 years, female patients, those who had never smoked, and patients with a higher Charlson Comorbidity Index score displayed a stronger effect of MVPA on reducing mortality than younger male patients, those who had ever smoked, and patients with a lower Charlson Comorbidity Index score (Pinteraction < .05). The fully adjusted hazards ratio for the risk of severe exacerbation (MVPA group vs control) was 0.90 (95% CI, 0.87-0.94).

INTERPRETATION

Initiation of MVPA can potentially reduce mortality and severe exacerbations in patients with COPD, although personalized interventions and further clinical trials are necessary.

A low-inflammatory diet is associated with a lower incidence of diabetes: role of diabetes-related genetic risk

BACKGROUND

Whether a low-inflammatory diet relates to type 2 diabetes risk remains unclear. We examined the association between a low-inflammatory diet and risk of type 2 diabetes among normoglycemic and prediabetic participants. We also explored whether a low-inflammatory diet modifies genetic risk for type 2 diabetes.

METHODS

Among 142,271 diabetes-free UK Biobank participants (aged 39-72 years), 126,203 were normoglycemic and 16,068 were prediabetic at baseline. Participants were followed for up to 15 years to detect incident type 2 diabetes. At baseline, dietary intake was assessed with a 24-h dietary record. An inflammatory diet index (IDI) was generated based on high-sensitivity C-reactive protein levels and was a weighted sum of 34 food groups (16 anti-inflammatory and 18 pro-inflammatory). Participants were grouped into tertiles corresponding to inflammatory level (low, moderate, and high) based on IDI scores. Prediabetes at baseline was defined as HbA1c 5.7-6.4% in diabetes-free participants. Incident type 2 diabetes and age of onset were ascertained according to the earliest recorded date of type 2 diabetes in the Primary Care and Hospital inpatient data. A diabetes-related genetic risk score (GRS) was calculated using 424 single-nucleotide polymorphisms. Data were analyzed using Cox regression and Laplace regression.

RESULTS

During follow-up (median 8.40 years, interquartile range 6.89 to 11.02 years), 3348 (2.4%) participants in the normoglycemia group and 2496 (15.5%) in the prediabetes group developed type 2 diabetes. Type 2 diabetes risk was lower in normoglycemic (hazard ratio [HR] = 0.71, 95% confidence interval [CI] 0.65, 0.78) and prediabetic (HR = 0.81, 95% CI 0.73, 0.89) participants with low IDI scores compared to those with high IDI scores. A low-inflammatory diet may prolong type 2 diabetes onset by 2.20 (95% CI 1.67, 2.72) years among participants with normoglycemia and 1.11 (95% CI 0.59, 1.63) years among participants with prediabetes. In joint effect analyses, normoglycemic or prediabetes participants with low genetic predisposition to type 2 diabetes and low IDI scores had a significant 74% (HR = 0.26, 95% CI 0.21, 0.32) or 51% (HR = 0.49, 95% CI 0.40, 0.59) reduction in type 2 diabetes risk compared to those with high genetic risk plus high IDI scores. There were significant additive and multiplicative interactions between IDI and GRS in relation to type 2 diabetes risk in the normoglycemia group.

CONCLUSIONS

A low-inflammatory diet is associated with a decreased risk of type 2 diabetes and may delay type 2 diabetes onset among participants with normal blood glucose or prediabetes. A low-inflammatory diet might significantly mitigate the risk of genetic factors on type 2 diabetes development.