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

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.

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.

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.

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 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

In this prospective cohort study, 8,024 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 were undertaken.

RESULTS

During an average of 6.8 years of follow-up, 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 minutes/week for light-intensity PA (LPA), 320 minutes/week for moderate-intensity PA (MPA) and 15 minutes/week for vigorous-intensity PA (VPA). The highest quartile of PA associated 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 PAF 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 larger magnitude of the associations than that in previous studies based on self-reported PA.

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.

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.

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.

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.

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 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.

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.

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.

Impact of a history of cardiovascular disease and physical activity habits on the incidence of functional disability

We examined the impact of a history of coronary artery disease (CAD) or cerebrovascular disease (CVD) and physical activity habits on functional disability among community-dwelling Japanese adults. This population-based retrospective cohort study included 10,661 people aged 39-98 years in Japan (5054, men). Median follow-up was 3.7 years. During the study period, 209 functional disabilities occurred in the overall study population. In multivariable analysis, a history of CVD (hazard ratio [HR] 1.57 [95% CI: 1.00-2.45]) and no physical activity habit (HR 1.74 [1.27-2.39]) presented increased risks for functional disability. HRs for functional disability among patients with a CVD history with and without a physical activity habit were 1.68 (0.75-3.74) and 2.65 (1.49-4.71), respectively, compared with individuals without a history of CVD with a physical activity habit. Similar results were observed for CAD. We found no significant difference in the incidence of functional disability between the group with a history of CAD or CVD and physical activity habits and the group with no history of CAD or CVD and without physical activity habits. Physical activity habits had a favorable influence on avoiding functional disability regardless of a history of CAD or CVD. Future prospective studies are needed to clarify these associations.

Physical Activity, Body Composition, Serum Myokines and the Risk of Death in Hemodialysis Patients

Background and Objectives: The aim of this study was to assess the relationship between habitual physical activity, body composition, serum myokine concentration, and all-cause mortality in chronic hemodialysis patients. Materials and Methods: A prospective cohort study with a 7-year follow-up was conducted in a group of 38 patients (24 men, 14 women, mean age 65.6 ± 13.9 years, dialysis vintage 1.17 ± 1.25 years). Baseline serum concentrations of myokines-follistatin and myostatin-were assessed along with a measurement of physical activity with multidimensional accelerometery, body composition, and the force of forearm muscle contraction. Survival analysis was performed using the Kaplan-Meier method for tertiles of follistatin, serum myostatin, body composition, and physical activity expressed in metabolic equivalents (MET). Results: The mean physical activity among patients was 81 min/24 h (median 38.5 min), and the mean weekly 3MET activity was 493 min (median 218 min). The probability of survival of patients was significantly lower in the subgroup with 3MET/24 h less than 26 min/24 h and 3METt less than 148 min per week compared to the other subgroup (p = 0.006 and p = 0.006, respectively). During the 70-month follow-up, the subgroup with the lowest baseline follistatin concentration showed a significantly lower risk of death (p = 0.02). Baseline myostatin levels were not significant risk factors for mortality, nor were BMI or lean and fat tissue index categories. Conclusions: Physical activity and low plasma follistatin, but not body composition indexes or plasma myostatin, could serve as predictors of all-cause mortality in hemodialysis patients.

Associations of family income and healthy lifestyle with all-cause mortality

Background

There is a lack of evidence on whether combined lifestyle factors mediate the association between family income and all-cause mortality, as well as the joint relations between family income and lifestyle factors with mortality.

Methods

Using data on family income and lifestyle factors of participants in the US National Health Interview Survey 2016-2018, we performed multivariable logistic regression models to estimate the odds ratios (ORs) and 95% confidence intervals (CI) for the association of all-cause mortality with said data.

Results

We included 73 729 participants with a mean age of 47.1 years (standard deviation (SD) = 18.0), 51% of whom were women and 65% of whom were non-Hispanic Whites. There were 2284 deaths documented. After multivariable adjustment, middle-income participants had an OR of 0.73 (95% CI = 0.61-0.88) for mortality, while high-income participants had an OR of 0.47 (95% CI = 0.37-0.60) compared with low-income participants. We found that lower all-cause mortality was related to higher lifestyle scores. Adults from high-income families with lifestyle scores of 3 and 4 had an OR for mortality of 0.44 (95% CI = 0.30-0.65) compared to those from low-income families and lifestyle scores of 0 or 1. When comparing those in highest vs lowest income groups in the mediation analysis, 9.8% (95% CI = 7.4-13.0) of the relation for all-cause mortality was mediated by lifestyles. Adults from high-income families with lifestyle scores of 3 or 4 had an OR of 0.23 (95% CI = 0.17-0.33) for mortality compared with those from low-income families and lifestyle scores of 0 or 1.

Conclusions

A lower risk of all-cause mortality was linked to higher family income and healthier lifestyles. Furthermore, lifestyle factors mediated a small proportion of the association between family income and mortality among US adults. Economic disparity in health may not be eliminated by changing only one's lifestyle. Therefore, besides promoting a healthy lifestyle, we should stress how family income inequality affects health outcomes.

Whether weekend warrior activity and other leisure-time physical activity pattern reduce the risk of depression symptom in the representative adults? A population-based analysis of NHANES 2007-2020

BACKGROUND

The rapid pace of life nowadays has seen a gradual increase in public involvement in weekend warrior (WW), a physical activity (PA) pattern that allows people to exercise once or twice a week, the recommended moderate-to-vigorous PA per week, since regular PA takes much time. We aim at exploring the effect of WW activity and other PA patterns on depression symptoms in U.S adults.

METHODS

The level of PA was measured by self-reporting activity patterns, (inactive, insufficiently active, WW and regularly active). Participants with Patient Health Questionnaire-9 (PHQ-9) scores above 10 are considered to have depression symptoms.

RESULTS

A weighted sample of 23,258 participants representing 1049.8 million non-institutionalized U.S adults aged from 20 to 80. Compared with the inactive group, general adults who met the PA guidelines with PA once or twice per week [WW, adjusted odds ratio (AOR) = 0.790, 95%CI: 0.638, 0.987] or more frequent PA [Regularly active, (AOR = 0.761, 95%CI: 0.671, 0.864)], were inversely associated with depression symptoms, while the association has not been observed in adults with insufficiently active PA (AOR = 0.892, 95%CI: 0.783, 1.017). Increase in minutes, sessions and intensity of PA in regularly active and WW groups brought additional benefits for depression symptoms.

CONCLUSION

WW and other equivalent PA intensities patterns may be sufficient to reduce the risk of depression symptom. With the same recommended levels of PA, whether spread over the week or done in fewer days, adults may achieve the same benefits.

Exercise and microbiome: From big data to therapy

Exercise is a vital component in maintaining optimal health and serves as a prospective therapeutic intervention for various diseases. The human microbiome, comprised of trillions of microorganisms, plays a crucial role in overall health. Given the advancements in microbiome research, substantial databases have been created to decipher the functionality and mechanisms of the microbiome in health and disease contexts. This review presents an initial overview of microbiomics development and related databases, followed by an in-depth description of the multi-omics technologies for microbiome. It subsequently synthesizes the research pertaining to exercise-induced modifications of the microbiome and diseases that impact the microbiome. Finally, it highlights the potential therapeutic implications of an exercise-modulated microbiome in intestinal disease, obesity and diabetes, cardiovascular disease, and immune/inflammation-related diseases.

Relationship of Daily Step Counts to All-Cause Mortality and Cardiovascular Events

BACKGROUND

The minimal and optimal daily step counts for health improvements remain unclear.

OBJECTIVES

A meta-analysis was performed to quantify dose-response associations of objectively measured step count metrics in the general population.

METHODS

Electronic databases were searched from inception to October 2022. Primary outcomes included all-cause mortality and incident cardiovascular disease (CVD). Study results were analyzed using generalized least squares and random-effects models.

RESULTS

In total, 111,309 individuals from 12 studies were included. Significant risk reductions were observed at 2,517 steps/d for all-cause mortality (adjusted HR [aHR]: 0.92; 95% CI: 0.84-0.999) and 2,735 steps/d for incident CVD (aHR: 0.89; 95% CI: 0.79-0.999) compared with 2,000 steps/d (reference). Additional steps resulted in nonlinear risk reductions of all-cause mortality and incident CVD with an optimal dose at 8,763 (aHR: 0.40; 95% CI: 0.38-0.43) and 7,126 steps/d (aHR: 0.49; 95% CI: 0.45-0.55), respectively. Increments from a low to an intermediate or a high cadence were independently associated with risk reductions of all-cause mortality. Sex did not influence the dose-response associations, but after stratification for assessment device and wear location, pronounced risk reductions were observed for hip-worn accelerometers compared with pedometers and wrist-worn accelerometers.

CONCLUSIONS

As few as about 2,600 and about 2,800 steps/d yield significant mortality and CVD benefits, with progressive risk reductions up to about 8,800 and about 7,200 steps/d, respectively. Additional mortality benefits were found at a moderate to high vs a low step cadence. These findings can extend contemporary physical activity prescriptions given the easy-to-understand concept of step count. (Dose-Response Relationship Between Daily Step Count and Health Outcomes: A Systematic Review and Meta-Analyses; CRD42021244747).

Effects of an mHealth physical activity intervention to prevent osteoporosis in premenopausal women. A randomized controlled trial

OBJECTIVES

It is critical to develop prevention strategies for osteoporosis that reduce the burden fractures place on individuals and health systems. This study evaluated the effects of an mHealth intervention that delivered and monitored a non-supervised exercise program on bone mineral density (BMD).

DESIGN

Randomized controlled trial.

METHODS

60 premenopausal women aged 35-50 years were divided into an intervention group (IG) and a control group (CG). The IG followed a 6-month intervention aimed at increasing osteogenic physical activity, guided by two daily goals: walking at least 10,000 steps and completing 60 impacts over 4 g of acceleration. These goals were monitored using a wearable accelerometer linked to an mHealth app. The CG maintained their regular lifestyle and wore the accelerometer without feedback. BMD was estimated using dual-energy X-ray absorptiometry (DXA) scans at baseline and after 6 months, with group-by-time analyses conducted using ANCOVA. The intervention's impact on physical fitness and activity habits was also evaluated.

RESULTS

46 participants completed the study (IG = 24; CG = 22). The IG showed significant improvements compared to the CG in femoral neck BMD (IG: +0.003 ± 0.029 g/cm2 vs CG: -0.027 ± 0.031 g/cm2), trochanter BMD (IG: +0.004 ± 0.023 g/cm2 vs CG: -0.026 ± 0.030 g/cm2), and total hip BMD (IG: +0.006 ± 0.043 g/cm2 vs CG: -0.040 ± 0.048 g/cm2). The IG also demonstrated significant improvements in physical fitness measures, including peak torque and power at various speeds and positions. No adverse events related to the intervention were reported.

CONCLUSIONS

This non-supervised physical activity intervention delivered by wearable-technology and an mHealth app was effective in improving BMD, suggesting its potential for osteoporosis prevention.

Association between long working hours and cigarette smoking, leisure-time physical activity, and risky alcohol use: Findings from the Korea National Health and Nutrition Examination Survey (2014-2021)

BACKGROUND

Long working hours cause adverse health outcomes; however, the precise mechanisms underlying this relationship remain unknown. We examined the association between long working hours and health behaviors, as well as gender differences in this association.

METHODS

A nationally representative sample of 26,385 Korean workers was analyzed. The exposure variable was self-reported weekly working hours. The outcomes examined were cigarette smoking, high-level physical activity (defined as engaging in ≥150 min/week of moderate-to-vigorous leisure-time physical activity), and risky alcohol use (defined as consuming seven glasses for men or five glasses for women of alcohol in a single sitting, twice or more per week). Logistic regression models were utilized, and gender differences were examined by incorporating interaction terms into the regression models.

RESULTS

Among 26,385 workers, 4,109 (16%) worked ≥55 h/week. The prevalence of cigarette smoking, high-level physical activity, and risky alcohol use was 19%, 18%, and 14%, respectively. The odds ratio (OR) (95% confidence interval [CI]) of the association between working ≥55 h/week and outcomes was 1.26 (1.12-1.43) for cigarette smoking, 0.73 (0.65-0.83) for high-level physical activity, and 0.95 (0.83-1.08) for risky alcohol use compared to working 35-40 h/week. A moderating effect of gender on the association between long working hours and risky alcohol use was observed. The OR (95% CI) of the association between working ≥55 h/week was 0.88 (0.76-1.02) in men and 1.51 (1.12-2.05) in women.

CONCLUSION

Our findings emphasize the need for policy interventions aimed at reducing excessive working hours and fostering healthy lifestyle behaviors among individuals engaged in long working hours.

Brief bouts of device-measured intermittent lifestyle physical activity and its association with major adverse cardiovascular events and mortality in people who do not exercise: a prospective cohort study

BACKGROUND

Guidelines emphasise the health benefits of bouts of physical activity of any duration. However, the associations of intermittent lifestyle physical activity accumulated through non-exercise with mortality and major adverse cardiovascular events (MACE) remain unclear. We aimed to examine the associations of bouts of moderate-to-vigorous intermittent lifestyle physical activity (MV-ILPA) and the proportion of vigorous activity contributing within these bouts with mortality and MACE.

METHODS

In this prospective cohort study, we used data from the UK Biobank on adults who do not exercise (ie, those who did not report leisure-time exercise) who had wrist-worn accelerometry data available. Participants were followed up until Nov 30, 2022, with the outcome of interest of all-cause mortality obtained through linkage with NHS Digital of England and Wales, and the NHS Central Register and National Records of Scotland, and MACE obtained from inpatient hospitalisation data provided by the Hospital Episode Statistics for England, the Patient Episode Database for Wales, and the Scottish Morbidity Record for Scotland. MV-ILPA bouts were derived using a two-level Random Forest classifier and grouped as short (<1 min), medium (1 to <3 min; 3 to <5 min), and long (5 to <10 min). We further examined the dose-response relationship of the proportion of vigorous physical activity contributing to the MV-ILPA bout.

FINDINGS

Between June 1, 2013, and Dec 23, 2015, 103 684 Biobank participants wore an accelerometer on their wrist. 25 241 adults (mean age 61·8 years [SD 7·6]), of whom 14 178 (56·2%) were women, were included in our analysis of all-cause mortality. During a mean follow-up duration of 7·9 years (SD 0·9), 824 MACE and 1111 deaths occurred. Compared with bouts of less than 1 min, mortality risk was lower for bouts of 1 min to less than 3 min (hazard ratio [HR] 0·66 [0·53-0·81]), 3 min to less than 5 min (HR 0·56 [0·46-0·69]), and 5 to less than 10 min (HR 0·48 [0·39-0·59]). Similarly, compared with bouts of less than 1 min, risk of MACE was lower for bouts of 1 min to less than 3 min (HR 0·71 [0·54-0·93]), 3 min to less than 5 min (0·62 [0·48-0·81]), and 5 min to less than 10 min (0·59 [0·46-0·76]). Short bouts (<1 min) were associated with lower MACE risk only when bouts were comprised of at least 15% vigorous activity.

INTERPRETATION

Intermittent non-exercise physical activity was associated with lower mortality and MACE. Our results support the promotion of short intermittent bouts of non-exercise physical activity of moderate-to-vigorous intensity to improve longevity and cardiovascular health among adults who do not habitually exercise in their leisure time.

FUNDING

Australian National Health, Medical Research Council, and Wellcome Trust.

Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials

OBJECTIVE

To perform a large-scale pairwise and network meta-analysis on the effects of all relevant exercise training modes on resting blood pressure to establish optimal antihypertensive exercise prescription practices.

DESIGN

Systematic review and network meta-analysis.

DATA SOURCES

PubMed (Medline), the Cochrane library and Web of Science were systematically searched.

ELIGIBILITY CRITERIA

Randomised controlled trials published between 1990 and February 2023. All relevant work reporting reductions in systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) following an exercise intervention of ≥2 weeks, with an eligible non-intervention control group, were included.

RESULTS

270 randomised controlled trials were ultimately included in the final analysis, with a pooled sample size of 15 827 participants. Pairwise analyses demonstrated significant reductions in resting SBP and DBP following aerobic exercise training (-4.49/-2.53 mm Hg, p<0.001), dynamic resistance training (-4.55/-3.04 mm Hg, p<0.001), combined training (-6.04/-2.54 mm Hg, p<0.001), high-intensity interval training (-4.08/-2.50 mm Hg, p<0.001) and isometric exercise training (-8.24/-4.00 mm Hg, p<0.001). As shown in the network meta-analysis, the rank order of effectiveness based on the surface under the cumulative ranking curve (SUCRA) values for SBP were isometric exercise training (SUCRA: 98.3%), combined training (75.7%), dynamic resistance training (46.1%), aerobic exercise training (40.5%) and high-intensity interval training (39.4%). Secondary network meta-analyses revealed isometric wall squat and running as the most effective submodes for reducing SBP (90.4%) and DBP (91.3%), respectively.

CONCLUSION

Various exercise training modes improve resting blood pressure, particularly isometric exercise. The results of this analysis should inform future exercise guideline recommendations for the prevention and treatment of arterial hypertension.

The Impact of Physical Activity Intensity on the Dynamic Progression of Cardiometabolic Multimorbidity: Prospective Cohort Study Using UK Biobank Data

BACKGROUND

Although many studies have reported on the associations between the amount of physical activity (PA) and the transitions of cardiometabolic multimorbidity (CMM), the evidence for PA intensity has not been fully evaluated.

OBJECTIVE

This study aimed to explore the impact of PA intensity on the dynamic progression of CMM.

METHODS

The prospective cohort of this study using data from the UK Biobank included 359,773 participants aged 37-73 years who were recruited from 22 centers between 2006 and 2010. The diagnoses of CMM, which included the copresence of type 2 diabetes (T2D), ischemic heart disease, and stroke, were obtained from first occurrence fields provided by the UK Biobank, which included data from primary care, hospital inpatient record, self-reported medical condition, and death registers. The PA intensity was assessed by the proportion of vigorous PA (VPA) to moderate to vigorous PA (MVPA). Multistate models were used to evaluate the effect of PA intensity on the dynamic progression of CMM. The first model (model A) included 5 transitions, namely free of cardiometabolic disease (CMD) to first occurrence of CMD (FCMD), free of CMD to death, FCMD to CMM, FCMD to mortality, and CMM to mortality. The other model (model B) used specific CMD, namely T2D, ischemic heart disease, and stroke, instead of FCMD and included 11 transitions in this study.

RESULTS

The mean age of the included participants (N=359,773) was 55.82 (SD 8.12) years at baseline, and 54.55% (196,271/359,773) of the participants were female. Compared with the participants with no VPA, participants with intensity levels of >0.75 to <1 for VPA to MVPA had a 13% and 27% lower risk of transition from free of CMD to FCMD (hazard ratio [HR] 0.87, 95% CI 0.83-0.91) and mortality (HR 0.73, 95% CI 0.66-0.79) in model A, respectively. The HR for the participants with no moderate PA was 0.82 (95% CI 0.73-0.92) compared with no VPA. There was a substantially protective effect of higher PA intensity on the transitions from free of CMD to T2D and from T2D to mortality, which reveals the importance of PA intensity for the transitions of T2D. More PA and greater intensity had a synergistic effect on decreasing the risk of the transitions from free of CMD to FCMD and mortality. Male participants, younger adults, adults with a higher BMI, current or previous smokers, and excessive alcohol drinkers could obtain more benefits from higher PA intensity for the lower risk of at least 1 transition from free of CMD, then to CMM, and finally to mortality.

CONCLUSIONS

This study suggests that higher PA intensity is an effective measure for preventing CMM and mortality in the early period of CMM development. Relevant interventions related to higher PA intensity should be conducted.

Life's Essential 8: Optimizing Health in Older Adults

The population worldwide is getting older as a result of advances in public health, medicine, and technology. Older individuals are living longer with a higher prevalence of subclinical and clinical cardiovascular disease (CVD). In 2010, the American Heart Association introduced a list of key prevention targets, known as "Life's Simple 7" to increase CVD-free survival, longevity, and quality of life. In 2022, sleep health was added to expand the recommendations to "Life's Essential 8" (eat better, be more active, stop smoking, get adequate sleep, manage weight, manage cholesterol, manage blood pressure, and manage diabetes). These prevention targets are intended to apply regardless of chronologic age. During this same time, the understanding of aging biology and goals of care for older adults further enhanced the relevance of prevention across the range of functions. From a biological perspective, aging is a complex cellular process characterized by genomic instability, telomere attrition, loss of proteostasis, inflammation, deregulated nutrient-sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication. These aging hallmarks are triggered by and enhanced by traditional CVD risk factors leading to geriatric syndromes (eg, frailty, sarcopenia, functional limitation, and cognitive impairment) which complicate efforts toward prevention. Therefore, we review Life's Essential 8 through the lens of aging biology, geroscience, and geriatric precepts to guide clinicians taking care of older adults.