Occupational, Commuting, and Leisure-Time Physical Activity in Relation to Heart Failure Among Finnish Men and Women

Ambient air pollution does not diminish the beneficial effects of active commuting on heart failure: a prospective study in UK Biobank

BACKGROUND

Evidence on active commuting and heart failure (HF) under levels of air pollution exposure is limited, and little is known on the potential mediation roles of inflammation. The objective of this study was to investigate the association between active commuting and HF, as well as to ascertain whether air pollution may influence this relationship.

METHODS

This prospective study included 241,786 participants without HF at baseline in UK Biobank. The commuting mode was recorded using questionnaire. We examined long-term exposure to air pollution, including particulate matter with an aerodynamic diameter smaller than 2.5 μm (PM2.5) or 10 μm (PM10), PM2.5-10, nitrogen dioxide (NO2), and nitrogen oxide (NOx). The incident HF was identified through linkages with medical records. Cox proportional hazard models were used to estimate the association of active commuting on HF under different air pollution concentrations. Furthermore, mediation analysis was performed to test the mediated role of inflammation.

RESULTS

A median follow-up period of 13.7 years yielded 4485 incident cases of HF. Compared with non-active commuting, both cycling (HR = 0.66, 95%CI: 0.57-0.76) and walking mode (HR = 0.86, 95%CI: 0.78-0.94) were found to be associated with the reduced risk of HF, following the full adjustment for covariates, including PM2.5. The beneficial effect of cycling (HR = 0.68, 95%CI: 0.56-0.81) and walking mode (HR = 0.82, 95%CI: 0.72-0.92) on HF was also observed in the context of high PM2.5 exposure. The inflammatory response was responsible for mediating 21.97% and 13.83% of the effect of the association between cycling mode and walking mode and HF.

CONCLUSIONS

For those residing in regions with relatively elevated air pollution levels, active commuting may still be a viable strategy for the prevention of HF.

Mobility Infrastructures and Health: Scoping Review of studies in Europe

Objectives

Movement-friendly environments with infrastructure favouring active mobility are important for promoting physical activity. This scoping literature review aims at identifying the current evidence for links between mobility infrastructures and (a) behaviour regarding active mobility, (b) health outcomes and (c) co-benefits.

Method

This review was conducted in accordance with the PRISMA scoping review guidelines using PubMed and EMBASE databases. Studies included in this review were conducted in Europe, and published between 2000 and March 2023.

Results

146 scientific articles and grey literature reports were identified. Connectivity of sidewalks, walkability, and accessibility of shops, services and work are associated with walking. Cycling is positively associated with cycle-paths, separation of cycling from traffic and proximity to greenspaces, and negatively associated with traffic danger. Increased active transportation has a protective effect on cardiovascular and respiratory health, obesity, fitness, and quality of life. Co-benefits result from the reduction of individual motorized transportation including reduced environmental pollution and projected healthcare expenditure.

Conclusion

Mobility infrastructure combined with social and educational incentives are effective in promoting active travel and reducing future healthcare expenses. A shift to active transportation would increase both individual and community health and decrease greenhouse gas emissions.

Leisure time and occupational physical activity, overall and cardiovascular mortality: a 24-year follow-up in the OPERA study

BACKGROUND

In earlier studies, the health benefits of physical activity have only been related to leisure time physical activity (LTPA). High occupational physical activity (OPA) might even be harmful. The current physical activity recommendations do not separate the OPA and LTPA. We investigated the effect of LTPA and OPA on cardiovascular morbidity and mortality during long-term follow-up. We also examined how heavy work affects the benefits of leisure time exercise.

MATERIAL AND METHODS

The study was part of the OPERA study and the baseline examinations were conducted between the years 1991 and 1993. The Follow-up of events continued until the end of the year 2020. Study subjects (n = 1044) were divided into four groups according to their LTPA ("no exercise", "irregular", "regular" and "heavy regular") and into three groups according to their OPA ("no activity", "mild" and "heavy"). The amount of exercise was self-reported and the exercise status was defined at the beginning of the study. Study subjects were followed up for their overall mortality (26 years), fatal and non-fatal CVD events (24 and 20 years) and heart failure (20 years). The survival analysis was performed using Kaplan-Meier curves and Cox-proportional hazard models.

RESULTS

"Heavy" OPA group subjects belonging to the "irregular" (less than 1-2 times 30 min exercise per week) LTPA group experienced the lowest overall mortality compared to other LTPA groups. Also, overall mortality was increased in the "mild" (p = 0.002) and CVD mortality in the" heavy" (p = 0.005) OPA group compared to "no activity". The incidence of heart failure was increased in the "no exercise" LTPA compared to the "heavy regular" (p = 0.015) group.

CONCLUSIONS

Study subjects who were in physically demanding occupations (heavy OPA) seemed to benefit from less LTPA than WHO currently recommends. Thus we suggest targeting different LTPA recommendations to different OPA groups.

The effects of ambient fine particulate matter exposure and physical activity on heart failure: A risk-benefit analysis of a prospective cohort study

BACKGROUND

Evidence supporting the adverse effects of air pollution and the benefits of physical activity (PA) on heart failure (HF) has continued to grow. However, their joint effects remain largely unknown.

METHODS

Our investigation included a total of 321,672 participants free of HF at baseline from the UK Biobank. Participants were followed up till March 2021. Information on participants' PA levels and additional covariates was collected by questionnaire. The annual fine particulate matter (PM_2.5) concentration was estimated using a Land Use Regression (LUR) model. Cox proportional hazards models were used to assess the associations of PA and PM_2.5 exposure with incident HF, as well as their interaction on both additive and multiplicative scales.

RESULTS

During a median follow-up of 12.0 years, 8212 cases of HF were uncovered. Compared with participants with low PA, the hazard ratios (HRs) were 0.69 (95 % CI: 0.65, 0.73) and 0.61 (95 % CI: 0.58, 0.65) for those with moderate and high PA, respectively. PM_2.5 was associated with an elevated risk of incident HF with an HR of 1.11 (95 % CI: 1.08, 1.14) per interquartile range (IQR) increment. The synergistic additive interaction between low PA and high PM_2.5 exposure on HF was observed. Compared with participants with high PA and low PM_2.5 exposure, those with low PA and high PM_2.5 exposure had the highest risk of HF [HR (95 % CI): 1.90 (1.76, 2.06)].

CONCLUSIONS

Our findings indicate that PA might still be an appropriate strategy to prevent HF for those living in areas with relatively high air pollution. Individuals with low PA may pay more attention to air pollution.

Associations Between Active Commuting and Cardiovascular Disease in the United States

BACKGROUND

Active commuting is inversely related with cardiovascular disease (CVD) risk factors yet associations with CVD prevalence in the US population are unknown.

METHODS

Aggregate data from national surveys conducted in 2017 provided state-level percentages of adults who have/had coronary heart disease, myocardial infarction, and stroke, and who actively commuted to work. Associations between active commuting and CVD prevalence rates were assessed using Pearson correlations and generalized additive models controlling for covariates.

RESULTS

Significant correlations were observed between active commuting and all CVD rates (r range = -.31 to -.47; P < .05). The generalized additive model analyses for active commuting (walking, cycling, or public transport) in all adults found no relationships with CVD rates; however, a significant curvilinear association was observed for stroke within men. The generalized additive model curves when examining commuting via walking or cycling in all adults demonstrated nuanced, generally negative linear or curvilinear associations between coronary heart disease, myocardial infarction, and stroke.

CONCLUSION

Significant negative correlations were observed between active commuting and prevalence rates of coronary heart disease, myocardial infarction, and stroke. Controlling for covariates influenced these associations and highlights the need for future research to explore the potential of active commuting modes to reduce CVD in the United States.

The effect of leisure time physical activity and sedentary behaviour on the health of workers with different occupational physical activity demands: a systematic review

BACKGROUND

Although it is generally accepted that physical activity reduces the risk for chronic non-communicable disease and mortality, accumulating evidence suggests that occupational physical activity (OPA) may not confer the same health benefits as leisure time physical activity (LTPA). It is also unclear if workers in high OPA jobs benefit from LTPA the same way as those in sedentary jobs. Our objective was to determine whether LTPA and leisure time sedentary behaviour (LTSB) confer the same health effects across occupations with different levels of OPA.

METHODS

Searches were run in Medline, Embase, PsycINFO, ProQuest Public Health and Scopus from inception to June 9, 2020. Prospective or experimental studies which examined the effects of LTPA or LTSB on all-cause and cardiovascular mortality and cardiovascular disease, musculoskeletal pain, diabetes, metabolic syndrome, arrhythmias and depression among adult workers grouped by OPA (low OPA/sitters, standers, moderate OPA/intermittent movers, high OPA/heavy labourers) were eligible. Results were synthesized using narrative syntheses and harvest plots, and certainty of evidence assessed with GRADE.

RESULTS

The review includes 38 papers. Across all outcomes, except cardiovascular mortality, metabolic syndrome and atrial fibrillation, greater LTPA was consistently protective among low OPA, but conferred less protection among moderate and high OPA. For cardiovascular mortality and metabolic syndrome, higher levels of LTPA were generally associated with similar risk reductions among all OPA groups. Few studies examined effects in standers and none examined effects of LTSB across OPA groups.

CONCLUSIONS

Evidence suggests that LTPA is beneficial for all workers, but with larger risk reductions among those with low compared to high OPA jobs. This suggests that, in our attempts to improve the health of workers through LTPA, tailored interventions for different occupational groups may be required. More high-quality studies are needed to establish recommended levels of LTPA/LTSB for different OPA groups.

PROTOCOL REGISTRATION

PROSPERO # CRD42020191708 .

Social and environmental risks as contributors to the clinical course of heart failure

Heart failure is a major contributor to healthcare expenditures. Many clinical risk factors for the development and exacerbation of heart failure had been reported, including diabetes, renal dysfunction, and respiratory disease. In addition to these clinical parameters, the effects of social factors, such as occupation or lifestyle, and environmental factors may have a great impact on disease development and progression of heart failure. However, the current understanding of social and environmental factors as contributors to the clinical course of heart failure is insufficient. To present the knowledge of these factors to date, this comprehensive review of the literature sought to identify the major contributors to heart failure within this context. Social factors for the risk of heart failure included occupation and lifestyle, specifically in terms of the effects of specific occupations, occupational exposure to toxicities, work style, and sleep deprivation. Socioeconomic factors focused on income and education level, social status, the neighborhood environment, and marital status. Environmental factors included traffic and noise, air pollution, and other climate factors. In addition, psychological stress and behavior traits were investigated. The development of heart failure may be closely related to these factors; therefore, these data should be summarized for the context to improve their effects on patients with heart failure. The present study reviews the literature to summarize these influences.

Work-related factors among people with diabetes and the risk of cardiovascular diseases: A systematic review

BACKGROUND

Diabetes is a major risk factor for cardiovascular diseases (CVD). This systematic review aims to explore the work-related factors among people with diabetes in developing CVD.

METHODS

Four electronic databases were searched on 1 February 2021 using a comprehensive search strategy without any time restriction. Two independent researchers screened the articles and extracted data. The risk of bias was assessed independently using the risk of bias assessment tool for non-randomized studies (RoBANS). A narrative synthesis was conducted considering the heterogeneity of the included articles.

RESULTS

A total of five articles incorporating 4 409 810 participants from three geographic regions were included that highlights the research gap. As per the included studies, Occupational drivers with diabetes were at a higher risk of CVD in comparison to the nondrivers, workers with diabetes having a long working hour were at a higher risk of CVD mortality, workers with a lower occupational status were at a higher risk of 10-years stroke risk, and occupational physical activity and occupational commuting lowered the risk of CVD deaths.

CONCLUSIONS

This systematic review summarized the available evidence on work-related factors influencing the risk of CVD in people with diabetes. The findings should be interpreted cautiously pondering the limited evidence and imprecision. We identified only five articles related to the topic, and there were no studies from Japan. The scarcity of studies on work-related factors on the prognosis of diabetic patients implies the need for more research in this field. We recommend further exploration of the topic designing primary studies.

Physical activity and the risk of heart failure: a systematic review and dose-response meta-analysis of prospective studies

Although physical activity is an established protective factor for cardiovascular diseases such as ischemic heart disease and stroke, less is known with regard to the association between specific domains of physical activity and heart failure, as well as the association between cardiorespiratory fitness and heart failure. We conducted a systematic review and meta-analysis of prospective observational studies to clarify the relations of total physical activity, domains of physical activity and cardiorespiratory fitness to risk of heart failure. PubMed and Embase databases were searched up to January 14th, 2020. Summary relative risks (RRs) were calculated using random effects models. Twenty-nine prospective studies (36 publications) were included in the review. The summary RRs for high versus low levels were 0.77 (95% CI 0.70–0.85, I² = 49%, n = 7) for total physical activity, 0.74 (95% CI 0.68–0.81, I² = 88.1%, n = 16) for leisure-time activity, 0.66 (95% CI 0.59–0.74, I² = 0%, n = 2) for vigorous activity, 0.81 (95% CI 0.69–0.94, I² = 86%, n = 3) for walking and bicycling combined, 0.90 (95% CI 0.86–0.95, I² = 0%, n = 3) for occupational activity, and 0.31 (95% CI 0.19–0.49, I² = 96%, n = 6) for cardiorespiratory fitness. In dose–response analyses, the summary RRs were 0.89 (95% CI 0.83–0.95, I² = 67%, n = 4) per 20 MET-hours per day of total activity and 0.71 (95% CI 0.65–0.78, I² = 85%, n = 11) per 20 MET-hours per week of leisure-time activity. Nonlinear associations were observed in both analyses with a flattening of the dose–response curve at 15–20 MET-hours/week for leisure-time activity. These findings suggest that high levels of total physical activity, leisure-time activity, vigorous activity, occupational activity, walking and bicycling combined and cardiorespiratory fitness are associated with reduced risk of developing heart failure.

A theory-based multicomponent intervention to reduce occupational sedentary behaviour in professional male workers: protocol for a cluster randomised crossover pilot feasibility study

BACKGROUND

Prolonged sitting, a significant risk factor for increased morbidity and mortality, is accumulated mostly in the workplace. There is limited research targeting specific at-risk populations to reduce occupational sedentary behaviour. A recent study found that professional males have the longest workplace sitting times. Current evidence supports the use of multi-level interventions developed using participative approaches. This study's primary aims are to test the viability of a future definitive intervention trial using a randomised pilot study, with secondary aims to explore the acceptability and feasibility of a multicomponent intervention to reduce workplace sitting.

METHODS

Two professional companies in Dublin, Ireland, will take part in a cluster randomised crossover pilot study. Office-based males will be recruited and randomised to the control or the intervention arms. The components of the intervention target multiple levels of influence including individual determinants (via mHealth technology to support behaviour change techniques), the physical work environment (via provision of an under-desk pedal machine), and the organisational structures and culture (via management consultation and recruitment to the study). The outcomes measured are recruitment and retention, minutes spent sedentary, and physical activity behaviours, work engagement, and acceptability and feasibility of the workplace intervention.

DISCUSSION

This study will establish the acceptability and feasibility of a workplace intervention which aims to reduce workplace SB and increase PA. It will identify key methodological and implementation issues that need to be addressed prior to assessing the effectiveness of this intervention in a definitive cluster randomised controlled trial.

Association between Different Modes of Travelling and Adiposity in Chilean Population: Findings from the Chilean National Health Survey 2016-2017

BACKGROUND

Active travel has been suggested as a feasible way of increasing physical activity levels. Although international studies have demonstrated its effect over different health outcomes and adiposity, there is still limited evidence on this topic in developing countries, such as Chile.

AIM

To investigate the associations between different types of travelling and markers of obesity in the Chilean adult population.

METHODS

5411 participants from the Chilean National Health Survey 2016-2017 (CNHS) were included in this study. Active travel was assessed using a questionnaire. Car commuters, public transport (PT), walking and cycling were the four forms of travelling assessed. Bodyweight, body mass index and waist circumference were used as markers of adiposity.

RESULTS

Compared to car travellers, body weight, WC and BMI levels were lower for PT walking and cycling travellers. The odds for obesity (Odds ratio (OR): 0.41 (95% CI: 0.28; 0.61 p ≤ 0.001) were lower for walking and the odds (OR: 0.56 (95%CI: 0.35; 0.89 p = 0.014) for central obesity were significantly lower for cyclist in comparison to car travellers. Additionally, participation in any form of active travel (walking or cycling) was low, with only 20.9% of the population reporting being active travellers.

CONCLUSION

Active travel, such as walking and cycling, was associated with lower adiposity levels in the Chilean adult population. Promoting active travel could be a feasible strategy to tackle the high prevalence of obesity and physical inactivity in the Chilean population.

Time Spent Sitting as an Independent Risk Factor for Cardiovascular Disease

Sedentary behavior is highly prevalent despite growing evidence of adverse effects on the cardiovascular and metabolic system that are independent of the level of recreational physical activity (PA). We present results for the association between sitting time and cardiovascular disease (CVD) from selected cohort and cross-sectional studies published in or after the year 2010 according to the domains where sitting time is accumulated during the day. These include TV viewing, occupational sitting, and sitting during transportation as well as overall sitting. The outcomes considered in this review are total CVD, coronary heart disease, and stroke as well as CVD risk factors-namely, hypertension, hypercholesterolemia, and type 2 diabetes and their associated biomarkers. Finally, several current issues with regard to studying the effects of sitting time on CVD are discussed, including how sedentary behavior is assessed, isotemporal substitution modeling, examination of joint associations for sitting and PA, and benefits of breaks in sitting time. Overall, the scientific evidence supports public health recommendations that encourage adults to limit their sedentary time in order to improve their cardiovascular health.

Domain and intensity of physical activity are associated with metabolic syndrome: A population-based study

Introduction

Little is known on how the domain and intensity of physical activity (PA) associates with metabolic syndrome (MetS). The aim of this study was to examine associations between PA domains (leisure-time, domestic, active transport, total walking and total PA), PA intensities (light, moderate and vigorous) and PA levels with MetS in the general adult population.

Methods

Cross-sectional study. Anthropometry, blood biochemistry, 79-item PA-questionnaire, lifestyle and medical history were evaluated in a representative sample of Canary Island adults (n = 6,729). MetS was diagnosed using the harmonized IDF-NHLBI-AHA criteria. T-test and multivariable logistic regression was used to analyse associations between PA domains and intensities with MetS vs. no MetS, controlling for socio-demographic, lifestyle, family antecedents and body mass index (BMI).

Results

For each MET-h/day spent in moderate-vigorous PA intensities, as well as in recreational domain, active transport, total walking and total PA, the odds of MetS decreased between 3–10%. Energy expenditure exclusively in light and domestic PAs was not associated with MetS, however it was important to achieve a total PA level of 3 MET-h/day, which reduced the odds of MetS by 23%. This reduction was blunted in those with more than 2 h/d of TV watching time. A PA level of 3 MET-h/d also nullified the risk of MetS in those with low PA and high TV consumption.

Conclusions

Some types of leisure time PAs may contribute more than others to reducing MetS. Light and domestic PA play a complementary role in enhancing energy expenditure in the general population. TV watching time above 2 h/d counteracted the MetS risk reduction associated with PA level, but PA level also reduced the risk of METs presented by those with a low level of PA and an excess TV watching time. Physical activity explains a greater amount of the variance of MetS than any other factors of lifestyle, education, sex and family history, and substantially mitigates the strong association of age and BMI with MetS.

Physical Activity and Incidence of Heart Failure in Postmenopausal Women

OBJECTIVES

This study prospectively examined physical activity levels and the incidence of heart failure (HF) in 137,303 women, ages 50 to 79 years, and examined a subset of 35,272 women who, it was determined, had HF with preserved ejection fraction (HFpEF) and HF with reduced EF (HFrEF).

BACKGROUND

The role of physical activity in HF risk among older women is unclear, particularly for incidence of HFpEF or HFrEF.

METHODS

Women were free of HF and reported ability to walk at least 1 block without assistance at baseline. Recreational physical activity was self-reported. The study documented 2,523 cases of total HF, and 451 and 734 cases of HFrEF and HFpEF, respectively, during a mean 14-year follow-up.

RESULTS

After controlling for age, race, education, income, smoking, alcohol, hormone therapy, and hysterectomy status, compared with women who reported no physical activity (reference group), inverse associations were observed across incremental tertiles of total physical activity for overall HF (hazard ratio [HR]: Tertile 1 = 0.89, Tertile 2 = 0.74, Tertile 3 = 0.65; trend p < 0.001), HFpEF (HR: 0.93, 0.70, 0.68; p < 0.001), and HFrEF (HR: 0.81, 0.59, 0.68; p = 0.01). Additional controlling for potential mediating factors included attenuated time-varying coronary heart disease (CHD) (nonfatal myocardial infarction, coronary revascularization) diagnosis but did not eliminate the inverse associations. Walking, the most common form of physical activity in older women, was also inversely associated with HF risks (overall: 1.00, 0.98, 0.93, 0.72; p < 0.001; HFpEF: 1.00, 0.98, 0.87, 0.67; p < 0.001; HFrEF: 1.00, 0.75, 0.78, 0.67; p = 0.01). Associations between total physical activity and HF were consistent across subgroups, defined by age, body mass index, diabetes, hypertension, physical function, and CHD diagnosis. Analysis of physical activity as a time-varying exposure yielded findings comparable to those of baseline physical activity.

CONCLUSIONS

Higher levels of recreational physical activity, including walking, are associated with significantly reduced HF risk in community-dwelling older women.

Physical Activity and Heart Failure: Taking Steps to Control a Major Public Health Burden

Heart failure (HF) is a complex clinical syndrome that is increasingly prevalent among US adults and accounts for substantial burden of healthcare costs and morbidity. HF is commonly associated with prior myocardial infarction as well as prolonged exposure to hypertension, diabetes, and coronary atherosclerosis. Exercise training is becoming established in the management of HF because of its beneficial effect on both central (cardiac) and peripheral (skeletal muscle) HF mechanisms. The role of habitual physical activity in the primary prevention of HF is less clear. Recent prospective observational studies suggest there is lower risk of developing HF in adults who are more physically activity and have higher cardiorespiratory fitness compared with their less active and fit peers. This article reviews the published evidence on physical activity and HF prevention, discusses potential mechanisms for this benefit, and suggests areas where further research is needed to establish recommendations on the type, amount, and intensity of physical activity required to prevent occurrence of HF.

Relationships between different types of physical activity and metabolic syndrome among Taiwanese workers

This study aimed to investigate the relationships between different types of physical activity (PA) and metabolic syndrome (MetS). In this cross-sectional study, 3,296 Taiwanese workers were enrolled. A self-reported questionnaire was used to assess nutritional health behavior and PA levels related to occupation, leisure time, and commuting. Anthropometric measures, blood pressure and biochemical determinations of the blood were also obtained. Multiple logistic regression was used to evaluate the adjusted odds ratios (ORs) and 95% confidence intervals (CI) of MetS and its components associated with different types of PA. The prevalence of MetS was 16.6% in workers. Compared with a low level of leisure-time PA, a high level of leisure-time PA showed a significantly lower risk of high triglycerides (OR 0.73, 95% CI 0.61-0.87) and MetS (OR 0.76, 95% CI 0.62-0.95). Compared with a low level of occupational PA, a high level of occupational PA represented a significantly lower risk of both abdominal adiposity (OR 0.64, 95% CI 0.49-0.84) and high triglycerides (OR 0.71, 95% CI 0.55-0.90). However, commuting PA levels were not significantly associated with MetS and its components. In conclusion, occupational PA as well as leisure-time PA could be important for the prevention of MetS.

Relationship Between Occupational Physical Activity and Subclinical Vascular Damage in Moderate-Altitude Dwellers

Ujka, Kristian, Rosa Maria Bruno, Luca Bastiani, Eva Bernardi, Paolo Sdringola, Nenad Dikic, Bikash Basyal, Sanjeeb Sundarshan Bhandari, Buddha Basnyat, Annalisa Cogo, and Lorenza Pratali. Relationship between occupational physical activity and subclinical vascular damage in moderate-altitude dwellers. High Alt Med Biol. 18:249-257, 2017.

BACKGROUND

Occupational physical activity (OPA) has been associated with increased cardiovascular (CV) events. The aim of this study was to investigate the association between OPA and markers of subclinical vascular damage among a moderate-altitude population living in the rural village of Chaurikharka (Nepal; 2600 m sea level).

METHODS

Seventy-two individuals (age 42 ± 15 years, ranges 15-85 years, 23 men) were enrolled. Physical activity (PA) was evaluated using the International Physical Activity Questionnaire (IPAQ). Carotid-femoral pulse wave velocity (PWV), carotid ultrasound assessment, and flow-mediated dilation (FMD) were performed.

RESULTS

OPA was 9860 ± 5385 Metabolic Equivalent of Task (MET)-minutes/week, representing 77% of total energy expenditure, with 97% of the population performing high-intensity PA. In the univariate analysis, OPA was significantly associated with PWV (β = 0.474, p = 0.001) and carotid stiffness (CS) (β = 0.29, p = 0.019). In the multivariate analysis, including age, sex, oxygen saturation, mean blood pressure, low-density lipoprotein (LDL), and OPA, OPA remained an independent predictor of PWV (β = 0.403, p = 0.001) but not of CS (β = 0.028, p = 0.8). OPA remained an independent predictor of PWV independently from the Framingham risk score (FRS).

CONCLUSION

High-intensity OPA shows a positive, independent association with aortic stiffness in Himalayan moderate-altitude dwellers. This study suggests how vigorous OPA performed in moderate altitude may be a CV risk factor.

The Effects of Workplace Physical Activity Programs on Musculoskeletal Pain: A Systematic Review and Meta-Analysis

This article reviews the effectiveness of physical activity (PA) interventions at the workplace to reduce musculoskeletal pain among employees and assesses the effect size of these programs using meta-analysis. Four databases (i.e., PubMed, EBSCO, Web of Science, and Cochrane) were searched for research trials, which included comparison groups of employees that assessed PA programs, musculoskeletal pain, and health-related behaviors, published between January 1990 and March 2013. The meta-analysis estimates of standardized mean differences (Hedges' g) present significant evidence of less general pain (g = -.40 with a 95% confidence interval [CI] = [-0.78, -0.02]) and neck and shoulder pain (g = -.37 with a 95% CI = [-0.63, -0.12]) in intervention groups. The few studies of low back pain and arm, elbow, wrist, hand, or finger pain did not present sufficient statistically significant evidence. Consistent evidence demonstrates that workplace PA interventions significantly reduce general musculoskeletal pain and neck and shoulder pain. More studies are needed to determine the effectiveness of work-related PA interventions for arm, elbow, wrist, hand or finger, and low back pain.

Cardiac structure and function and leisure-time physical activity in the elderly: The Atherosclerosis Risk in Communities Study

AIMS

Adults who engage in leisure-time physical activity (LTPA) have a reduced risk of developing heart failure. We hypothesized that high levels of LTPA are associated with diminished adverse age-related changes in cardiac structure and function.

METHODS AND RESULTS

We studied 4342 Atherosclerosis Risk in Communities Study participants free of cardiovascular disease who underwent standardized echocardiography. In a cross-sectional analysis, we related LTPA (poor, intermediate, or ideal) to cardiac structure and function. We also related cumulative average LTPA over 24 years and changes in LTPA categories to echocardiographic measures. Cross-sectional analysis demonstrated that ideal LTPA, compared with poor LTPA, was associated with better diastolic function [prevalence of normal diastolic function: 39.8% vs. 31.5%, P < 0.001; mean E/E' ratio (95% CI): 9.8 (9.6, 9.9) vs. 10.4 (10.2, 10.5), P = 0.001] and better systolic function [left-ventricular (LV) longitudinal strain: -18.3 (-18.4, -18.2) vs. -17.9 (-18.0, -17.8), P < 0.001] after adjusting for age, sex, race, and centre. Higher cumulative average LTPA over 24 years or an improvement in LTPA category were also, respectively, related to a more favourable E/E' ratio (P < 0.0001, P = 0.004) and longitudinal LV strain (P = 0.0002, P = 0.002).

CONCLUSION

Ideal LTPA, higher average levels of LTPA over a 24-year period, and an improvement in LTPA even later in life were associated with more favourable indices of LV diastolic and systolic function in older adults. Sustaining higher levels of LTPA, and even increasing physical activity later in life, may be beneficial for older adults in attenuating expected age-related changes in cardiac structure and function.

Midlife Occupational Physical Activity and Risk of Disability Later in Life: National Health and Aging Trends Study

OBJECTIVES

To determine whether midlife occupational physical activity (PA) is associated with disability in older adults and to test disease as a mediating variable.

DESIGN

Cross-sectional study.

SETTING

National Health and Aging Trends Study.

PARTICIPANTS

Individuals aged 65 and older (N = 7,307).

MEASUREMENTS

Participants were classified as to occupational PA levels by linking information from the Occupational Information Network database using standard occupation codes. Disability outcomes and covariates were obtained through in-person interviews. Logistic regression models were used to examine the association between occupational PA and disability. Structural equation modeling (SEM) was fitted to examine the mediating effect of disease.

RESULTS

Occupations with high physically demands were associated with greater decline in functional capacity later in life. Individuals with occupations with high and very high PA were less likely to be able to perform activities of daily living than those with occupations with low PA. SEM showed that occupational PA has a very strong direct effect on disability (P < .001) and has an indirect effect on disability through disease (P = .003). The population attributable fraction for high occupational PA was 11%.

CONCLUSION

Higher midlife occupational PA levels were significantly associated with poorer ability to perform activities of daily living in older age. Performing the optimal level of occupational PA may be instrumental in reducing disability later in life.

Socioeconomic position and work, travel, and recreation-related physical activity in Japanese adults: a cross-sectional study

Background

The aim of this study was to examine the association between socioeconomic position and the domains of physical activity connected with work, travel, and recreation in Japanese adults.

Methods

A total of 3269 subjects, 1651 men (mean ± standard deviation; 44.2 ± 8.1 years) and 1618 women (44.1 ± 8.1 years), responded to an Internet-based cross-sectional survey. Data on socioeconomic (household income, educational level) and demographic variables (age, size of household, and household motor vehicles) were obtained. To examine the associations between socioeconomic position and physical activity, logistic regression analysis was used to calculate the odds ratio (OR) and confidence interval (CI) for “active” domains of physical activity.

Results

Men with a household income of ≥7 million yen had significantly lower work-related physical activity than the lowest income group (OR 0.51; 95 % CI, 0.35–0.75), but significantly greater travel-related (OR 1.37; 1.02–1.85), recreational (OR 2.00; 1.46–2.73) and total physical activity (OR 1.56; 1.17–2.08). Women with a household income of ≥7 million yen had significantly greater recreational physical activity (OR 1.43; 1.01–2.04) than the lowest income group. Their total physical activity was borderline significant, with slightly more activity in the high-income group (OR 1.36; 1.00–1.84), but no significant differences for work- and travel-related physical activity. Men with higher educational level (4-year college or higher degree) had significantly lower work-related (OR 0.62; 0.46–0.82), and greater travel-related physical activity (OR 1.33; 1.04–1.71) than the lowest educated group, but there were no significant differences in recreational and total physical activity. Women with a 4-year college or higher degree had significantly greater travel-related physical activity than the lowest educated group (OR 1.49; 1.12–1.97), but there were no significant differences in any other physical activity. There was no relation between working full time and physical activity in men, but women working full-time have significantly lower and not higher travel related physical activity. (OR 0.75; 0.59–0.96).

Conclusions

This study suggests that lower socioeconomic position is associated with more work-related physical activity, and less travel-related, recreational and total physical activity, and that this was more pronounced in men than in women.

[Domains of physical activity and education in São Paulo, Brazil: a serial cross-sectional study in 2003 and 2008]

This study aimed to estimate the prevalence of physical activity in different domains and the association with schooling, using a serial cross-sectional population-based design comparing data from two editions of a health survey in the city of São Paulo, Brazil. Participation included 1,667 adults in 2003 and 2,086 in 2008. Probabilistic sampling was performed by two-stage clusters. The long version of International Physical Activity Questionnaire (IPAQ) allowed evaluating multiple domains of physical activity. Poisson regression was used. Men were more active in their leisure time and at work and women in the home. Schooling was associated directly with leisure-time activity (2003 and 2008) and inversely with work-related physical activity (2003) for men and for women in housework. The studies showed that Brazilians with less schooling are becoming less active, so that intervention strategies should consider different educational levels. Interventions in the urban space and transportation can increase the opportunities for physical activity and broaden access by the population.

Physical Activity and Heart Failure Risk in a Prospective Study of Men

OBJECTIVES

This study investigated if total physical activity, as well as different types of physical activity, were associated with heart failure risk.

BACKGROUND

Physical activity has shown to be associated with reduced risks of coronary heart disease and stroke. Studies have also suggested that physical activity is associated with heart failure development.

METHODS

A study population of 33,012 men was followed from beginning of 1998 until the end of 2012. First event of heart failure was ascertained through linkage to the Swedish National Patient Register and Cause of Death Register. The data were analyzed by using Cox proportional hazards regression and Laplace regression.

RESULTS

During a mean follow-up of 13 years, we ascertained a total of 3,609 first events of heart failure. The average age at study baseline was 60 ± 9 years of age. When examining the entire study population, a U-shaped association between total physical activity and heart failure risk was detected, with both extremely high (57 metabolic equivalent [MET] h/day) and extremely low (38 MET h/day) levels of total physical activity associated with an increased risk of heart failure. When investigating different types of physical activity, we found that walking/bicycling at least 20 min/day was associated with 21% lower risk of heart failure (95% confidence interval: 0.72 to 0.87); corresponding to a median age at heart failure 8 months later for those who had actively walked or biked daily. When looking at long-term behavior of walking/bicycling, the results suggested a trend toward more recent active behavior being more related to heart failure protection than past physical activity levels.

CONCLUSIONS

This study suggests that both low levels and high levels of total physical activity, in comparison with moderate levels, could increase heart failure risk in men and that certain types of physical activity are associated with a protective effect on heart failure in men. When examining different types of physical activity, walking/bicycling at least 20 min per day was associated with the largest risk reduction of heart failure.

Associations between individual socioeconomic position, neighbourhood disadvantage and transport mode: baseline results from the HABITAT multilevel study

BACKGROUND

Understanding how different socioeconomic indicators are associated with transport modes provide insight into which interventions might contribute to reducing socioeconomic inequalities in health. The purpose of this study was to examine associations between neighbourhood-level socioeconomic disadvantage, individual-level socioeconomic position (SEP), and usual transport mode.

METHODS

This investigation included 11,036 residents from 200 neighbourhoods in Brisbane, Australia. Respondents self-reported their usual transport mode (car or motorbike, public transport, walking or cycling). Indicators for individual-level SEP were education, occupation and household income; and neighbourhood disadvantage was measured using a census-derived index. Data were analysed using multilevel multinomial logistic regression. High SEP respondents and residents of the most advantaged neighbourhoods who used a private motor vehicle as their usual form of transport was the reference category.

RESULTS

Compared with driving a motor vehicle, the odds of using public transport were higher for white collar employees (OR 1.68, 95% CrI 1.41-2.01), members of lower income households (OR 1.71 95% CrI 1.25-2.30) and residents of more disadvantaged neighbourhoods (OR 1.93, 95% CrI 1.46-2.54); and lower for respondents with a certificate-level education (OR 0.60, 95% CrI 0.49-0.74) and blue collar workers (OR 0.63, 95% CrI 0.50-0.81). The odds of walking for transport were higher for the least educated (OR 1.58, 95% CrI 1.18-2.11), those not in the labour force (OR 1.94, 95% CrI 1.38-2.72), members of lower income households (OR 2.10, 95% CrI 1.23-3.64) and residents of more disadvantaged neighbourhoods (OR 2.73, 95% CrI 1.46-5.24). The odds of cycling were lower among less educated groups (OR 0.31, 95% CrI 0.19-0.48).

CONCLUSIONS

The relationships between socioeconomic characteristics and transport modes are complex, and provide challenges for those attempting to encourage active forms of transportation. Further work is required exploring the individual-level and neighbourhood-level mechanisms behind choice of transport mode, and what factors might influence individuals from different socioeconomic backgrounds to change to more active transport modes.

Association of Physical Activity or Fitness With Incident Heart Failure: A Systematic Review and Meta-Analysis

BACKGROUND

Previous studies have shown that high levels of physical activity are associated with lower risk of risk factors for heart failure (HF), such as coronary heart disease, hypertension, and diabetes mellitus. However, the effects of physical activity or fitness on the incidence of HF remain unclear.

METHODS AND RESULTS

MEDLINE and EMBASE were systematically searched until November 30, 2014. Prospective cohort studies reporting measures of the association of physical activity (n=10) or fitness (n=2) with incident HF were included. Extracted effect estimates from the eligible studies were pooled using a random-effects model meta-analysis, with heterogeneity assessed with the I(2) statistic. Ten cohort studies on physical activity eligible for meta-analysis included a total of 282 889 participants followed for 7 to 30 years. For the physical activity studies, maximum versus minimal amount of physical activity groups were used for analyses; with a total number of participants (n=165 695). The pooled relative risk (95% confidence interval [CI]) for HF among those with a regular exercise pattern was 0.72 (95% CI, 0.67-0.79). Findings were similar for men (0.71 [95% CI, 0.61-0.83]) and women (0.72 [95% CI, 0.67-0.77]) and by type of exercise. There was no evidence of publication bias (P value for Egger test=0.34). The pooled associated effect of physical fitness on incident HF was 0.79 (95% CI, 0.75-0.83) for each unit increase in metabolic equivalent of oxygen consumption.

CONCLUSIONS

Published literature support a significant association between increased physical activity or fitness and decreased incidence of HF.

A Scoping Review of Observational Studies Examining Relationships between Environmental Behaviors and Health Behaviors

Individual lifestyles are key drivers of both environmental change and chronic disease. We undertook a scoping review of peer-reviewed studies which examined associations between environmental and health behaviors of individuals in high-income countries. We searched EconLit, Medline, BIOSIS and the Social Science Citation Index. A total of 136 studies were included. The majority were USA-based cross-sectional studies using self-reported measures. Most of the evidence related to travel behavior, particularly active travel (walking and cycling) and physical activity (92 studies) or sedentary behaviors (19 studies). Associations of public transport use with physical activity were examined in 18 studies, and with sedentary behavior in one study. Four studies examined associations between car use and physical activity. A small number included other environmental behaviors (food-related behaviors (n = 14), including organic food, locally-sourced food and plate waste) and other health behaviors ((n = 20) smoking, dietary intake, alcohol). These results suggest that research on individual environmental and health behaviors consists largely of studies examining associations between travel mode and levels of physical activity. There appears to be less research on associations between other behaviors with environmental and health impacts, and very few longitudinal studies in any domain.

Changes in mid-life fitness predicts heart failure risk at a later age independent of interval development of cardiac and noncardiac risk factors: the Cooper Center Longitudinal Study

AIMS

Low mid-life fitness is associated with higher risk for heart failure (HF). However, it is unclear to what extent this HF risk is modifiable and mediated by the burden of cardiac and noncardiac comorbidities. We studied the effect of cardiac and noncardiac comorbidities on the association of mid-life fitness and fitness change with HF risk.

METHODS

Linking individual subject data from the Cooper Center Longitudinal Study (CCLS) with Medicare claims files, we studied 19,485 subjects (21.2% women) who survived to receive Medicare coverage from 1999 to 2009. Fitness estimated by Balke treadmill time at mean age of 49 years was analyzed as a continuous variable (in metabolic equivalents [METs]) and according to age- and sex-specific quintiles. Associations of mid-life fitness and fitness change with HF hospitalization after age of 65 years were assessed by applying a proportional hazards recurrent events model to the failure time data with each comorbidity entered as time-dependent covariates.

RESULTS

After 127,110 person years of Medicare follow-up, we observed 1,038 HF hospitalizations. Higher mid-life fitness was associated with a lower risk for HF hospitalization (hazard ratio [HR] 0.82 [0.76-0.87] per MET) after adjustment for traditional risk factors. This remained unchanged after further adjustment for the burden of Medicare-identified cardiac and noncardiac comorbidities (HR 0.83 [0.78-0.89]). Each 1 MET improvement in mid-life fitness was associated with a 17% lower risk for HF hospitalization in later life (HR 0.83 [0.74-0.93] per MET).

CONCLUSIONS

Mid-life fitness is an independent and modifiable risk factor for HF hospitalization at a later age.

Factors associated with active commuting among parents-to-be in Karlskrona, Sweden

Aim: The purpose of the present study is to examine the prevalence of active commuting and factors associated with participation in active commuting in the municipality of Karlskrona, Sweden. Active commuting is defined here as walking or cycling to and from school/work for at least 15 minutes one-way. Method: A cross-sectional study was carried out, which included baseline data from parents-to-be. Pregnant females and their partners were invited to participate in the study when they contacted either of the municipality’s two antenatal clinics. Data collection ran from March 2008 to February 2009. When completing the questionnaire, the participants were asked to reflect on their situation one month before the female became pregnant. The final sample consisted of 432 participants (response rate 51.9% for females and 85.0% for males). Results: The main mode of commuting was motor vehicle (63.0%), with active commuters forming a minority (8.3%). The main facilitating factor for active commuting was living in an urban as opposed to a rural area. Regular participation in outdoor recreational physical activity was significantly positively associated with active commuting. Being Swedish and being surrounded by a green space environment were significantly negatively associated with active commuting. Conclusions: This study found that the number of people who are active commuters is modest and other modes of transportation are preferred. Several facilitating and impeding factors associated with active commuting were also found, indicating the importance of applying a broad health-promoting approach to encouraging active commuting.

Relationship between physical activity and heart failure risk in women

BACKGROUND

Physical activity is a modifiable health-related behavior shown to be associated with reduced risk of coronary heart disease and stroke. There is some evidence that this could also be the case for heart failure. We investigated whether total physical activity, as well as different domains of physical activity, was associated with heart failure risk.

METHODS AND RESULTS

The Swedish Mammography Cohort was used in which 27 895 women were followed up from 1997 to 2011. First event of heart failure was ascertained through the Swedish National Patient Register and Cause of Death Register. Cox proportional hazards regression analyses were conducted to estimate multivariable-adjusted hazard ratios and 95% confidence intervals. We also analyzed survival percentiles by applying Laplace regression. During an average follow-up time of 13 years (369 207 person-years), we ascertained 2402 first events of heart failure hospitalizations and deaths. We found that moderate to high levels of total physical activity were associated with a reduced risk of future heart failure. When looking into different domains of physical activity, walking/bicycling >20 minutes/d was associated with 29% lower risk of heart failure (95% confidence interval, -36% to -21%), when investigating survival percentiles this could be translated into 18 months longer heart failure-free survival.

CONCLUSIONS

Our study shows that physical activity could protect against heart failure in women. When looking closer into different domains of physical activity, walking or biking ≥20 minutes every day was associated with the largest risk reduction of heart failure.

Dose-response relationship of total and leisure time physical activity to risk of heart failure: a prospective cohort study

BACKGROUND

The nature of the association between levels of physical activity and risk of heart failure is little known. We investigated nonlinear associations of total and leisure time physical activity with risk of heart failure.

METHODS AND RESULTS

In 1997, 39 805 persons without heart failure completed a questionnaire of lifestyle factors and medical history. We used Cox regression models to investigate total (adjusting for education and previous myocardial infarction) and direct (multivariable-adjusted) effects of self-reported total and leisure time physical activity on risk of heart failure of any cause and heart failure of nonischemic origin. Heart failure diagnoses were obtained until December 31, 2010. Higher leisure time physical activity was associated with lower risk of heart failure of any cause; hazard ratio of the total effect of leisure time physical activity was for fifth versus first quintile 0.54; 95% confidence interval was 0.44 to 0.66. The direct effect was similar. High total daily physical activity level was associated with lower risk of heart failure, although the effect was less pronounced than for leisure time physical activity (total effect hazard ratio, 0.81; 95% confidence interval, 0.69-0.95; fifth versus first quintile). A similar direct effect observed.

CONCLUSIONS

Leisure time physical activity was inversely related to risk of developing heart failure in a dose-response fashion. This was reflected in a similar but less pronounced association of total physical activity with risk of heart failure. Only part of the effects appeared to be mediated by traditional risk factors.

Low cardiorespiratory fitness in African Americans: a health disparity risk factor?

Low cardiorespiratory fitness (CRF) is a well-established risk factor for all-cause and cardiovascular disease mortality. African Americans have higher rates of cardiovascular disease compared with their Caucasian counterparts. However, the extent to which lower CRF levels contribute to the excess risk in African Americans has not been fully explored. The purpose of this review is to: (i) explore the literature evaluating the relationship between CRF and mortality specifically in African American populations; and (ii) critically evaluate the studies which have compared CRF between African American and Caucasians in epidemiological studies and clinical trials. We have further discussed several potential mechanisms that may contribute to the observation of lower CRF levels in African American compared with Caucasian adults, including potential racial differences in physical activity levels, muscle fiber type distribution, and hemoglobin levels. If lower CRF is generally present in African Americans compared with Caucasians, and is of a clinically meaningful difference, this may represent an important public health concern.

Speed and duration of walking and other leisure time physical activity and the risk of heart failure: a prospective cohort study from the Copenhagen City Heart Study

AIM

Physical activity (PA) confers some protection against development of heart failure (HF) but little is known of the role of intensity and duration of exercise.

METHODS AND RESULTS

In a prospective cohort study of men and women free of previous MI, stroke or HF with one or more examinations in 1976-2003, we studied the association between updated self-assessed leisure-time PA, speed and duration of walking and subsequent hospitalization or death from HF. Light and moderate/high level of leisure-time PA and brisk walking were associated with reduced risk of HF in both genders whereas no consistent association with duration of walking was seen. In 18,209 subjects age 20-80 with 1580 cases of HF, using the lowest activity level as reference, the confounder-adjusted hazard ratios (HR) for light and moderate/high leisure-time physical activity were 0.75 (0.66-0.86) and 0.80 (0.69-0.93), respectively. In 9,937 subjects with information on walking available and 542 cases of HF, moderate and high walking speed were associated with adjusted HRs of 0.53 (0.43-0.66) and 0.30 (0.21-0.44), respectively, and daily walking of ½-1 hrs, 1-2 and >2 hrs with HR of 0.80 (0.61-1.06), 0.82 (0.62-1.06), and 0.96 (0.73-1.27), respectively. Results were similar for both genders and remained robust after exclusion of HF related to coronary heart disease and after a series of sensitivity analyses.

CONCLUSIONS

Speed rather than duration of walking was associated with reduced risk of HF. Walking is the most wide-spread PA and public health measures to curb the increase in HF may benefit from this information.

Physical fitness and risk for heart failure and coronary artery disease

BACKGROUND

Multiple studies have demonstrated strong associations between cardiorespiratory fitness and lower cardiovascular disease mortality. In contrast, little is known about associations of fitness with nonfatal cardiovascular events.

METHODS AND RESULTS

Linking individual participant data from the Cooper Center Longitudinal Study with Medicare claims files, we studied 20642 participants (21% women) with fitness measured at the mean age of 49 years and who survived to receive Medicare coverage from 1999 to 2009. Fitness was categorized into age- and sex-specific quintiles (Q) according to Balke protocol treadmill time with Q1 as low fitness. Fitness was also estimated in metabolic equivalents according to treadmill time. Associations between midlife fitness and hospitalizations for heart failure and acute myocardial infarction after the age of 65 years were assessed by applying a proportional hazards model to the multivariate failure time data. After 133514 person-years of Medicare follow-up, we observed 1051 hospitalizations for heart failure and 832 hospitalizations for acute myocardial infarction. Compared with high fitness (Q4-5), low fitness (Q1) was associated with a higher rate of heart failure hospitalization (14.3% versus 4.2%) and hospitalization for myocardial infarction (9.7% versus 4.5%). After multivariable adjustment for baseline age, blood pressure, diabetes mellitus, body mass index, smoking status, and total cholesterol, a 1 unit greater fitness level in metabolic equivalents achieved in midlife was associated with ≈20% lower risk for heart failure hospitalization after the age of 65 years (men: hazard ratio [95% confidence intervals], 0.79 [0.75-0.83]; P<0.001 and women: 0.81 [0.68-0.96]; P=0.01) but just a 10% lower risk for acute myocardial infarction in men (0.91 [0.87-0.95]; P<0.001) and no association in women (0.97 [0.83-1.13]; P=0.68).

CONCLUSIONS

Fitness in healthy, middle-aged adults is more strongly associated with heart failure hospitalization than acute myocardial infarction outcomes decades later in older age.

Walking and running produce similar reductions in cause-specific disease mortality in hypertensives

To test prospectively in hypertensives whether moderate and vigorous exercise produces equivalent reductions in mortality, Cox-proportional hazard analyses were applied to energy expenditure (metabolic equivalents hours/d [METh/d]) in 6973 walkers and 3907 runners who used hypertensive medications at baseline. A total of 1121 died during 10.2-year follow-up: 695 cardiovascular disease (International Classification of Diseases, Tenth Revision [ICD10] I00-99; 465 underlying cause and 230 contributing cause), 124 cerebrovascular disease, 353 ischemic heart disease (ICD10 I20-25; 257 underlying and 96 contributing), 122 heart failure (ICD10 I50; 24 underlying and 98 contributing), and 260 dysrhythmias (ICD10 I46-49; 24 underlying and 236 contributing). Relative to <1.07 METh/d, running or walking 1.8 to 3.6 METh/d produced significantly lower all-cause (29% reduction; 95% confidence interval [CI], 17%-39%; P=0.0001), cardiovascular disease (34% reduction; 95% CI, 20%-46%; P=0.0001), cerebrovascular disease (55% reduction; 95% CI, 27%-73%; P=0.001), dysrhythmia (47% reduction; 95% CI, 27%-62%; P=0.0001), and heart failure mortality (51% reduction; 95% CI, 21%-70%; P=0.003), as did ≥ 3.6 METh/d with all-cause (22% reduction; 95% CI, 6%-35%; P=0.005), cardiovascular disease (36% reduction; 95% CI, 19%-50%; P=0.0002), cerebrovascular disease (47% reduction; 95% CI, 6%-71%; P=0.03), and dysrhythmia mortality (43% reduction; 95% CI, 16%-62%; P=0.004). Diabetes mellitus and chronic kidney disease mortality also decreased significantly with METh/d. All results remained significant when body mass index adjusted. Merely meeting guideline levels (1.07-1.8 METh/d) did not significantly reduced mortality. The dose-response was significantly nonlinear for all end points except diabetes mellitus, and cerebrovascular and chronic kidney disease. Results did not differ between running and walking. Thus, walking and running produce similar reductions in mortality in hypertensives.

Is midlife occupational physical activity related to disability in old age? The SNAC-Kungsholmen study

Objectives

Leisure-time physical activity (PA) has been established to be related to more years lived without disability. However, less is known about the relationship between occupational PA and disability in old age. The aim of the study was 1) to investigate whether midlife occupational PA is related to late-life disability, and 2) to test the hypothesis that the association differs according to the occupational categories of blue and white collar work.

Methods

The study population was derived from the Swedish National Study on Aging and Care, and consisted of a random sample of 1804 subjects aged 72 and above. The association of occupational PA during the longest held occupation with disability in old age was determined using logistic regression.

Results

There was no significant relationship between occupational PA and disability in personal or instrumental activities of daily living (ADL) after controlling for demographic and health-related factors. However, in stratified analyses moderate levels of occupational PA was associated with a lower odds ratio of dependency in personal ADL amongst white collar workers, compared to low level of occupational PA (OR = 0.34 95% C1 0.12–0.98).

Conclusions

Moderate levels of midlife occupational PA were associated with a decreased risk of personal ADL disability in old age among white collar workers, but not among blue collar workers. Our results highlight the importance of encouraging white collar workers to engage in physical activity during or outside work hours.

Prevention of heart failure in older adults may require higher levels of physical activity than needed for other cardiovascular events

BACKGROUND

Little is known if the levels of physical activity required for the prevention of incident heart failure (HF) and other cardiovascular events vary in community-dwelling older adults.

METHODS

We studied 5503 Cardiovascular Health Study (CHS) participants, age ≥ 65 years, free of baseline HF. Weekly metabolic equivalent task-minutes (MET-minutes), estimated using baseline total leisure-time energy expenditure, were used to categorize participants into four physical activity groups: inactive (0 MET-minutes; n=489; reference), low (1-499; n=1458), medium (500-999; n=1086) and high (≥ 1000; n=2470).

RESULTS

Participants had a mean (± SD) age of 73 (± 6) years, 58% were women, and 15% African American. During 13 years of follow-up, centrally-adjudicated incident HF occurred in 26%, 23%, 20%, and 19% of participants with no, low, medium and high physical activity, respectively (trend p<0.001). Compared with inactive older adults, age-sex-race-adjusted hazard ratios (95% confidence intervals) for incident HF associated with low, medium and high physical activity were 0.87 (0.71-1.06; p=0.170), 0.68 (0.54-0.85; p=0.001) and 0.60 (0.49-0.74; p<0.001), respectively (trend p<0.001). Only high physical activity had significant independent association with lower risk of incident HF (HR, 0.79; 95% CI, 0.64-0.97; p=0.026). All levels of physical activity had significant independent association with lower risk of incident acute myocardial infarction (AMI), stroke and cardiovascular mortality.

CONCLUSION

In community-dwelling older adults, high level of physical activity was associated with lower risk of incident HF, but all levels of physical activity were associated with lower risk of incident AMI, stroke, and cardiovascular mortality.

Active transportation and cardiovascular disease risk factors in U.S. adults

BACKGROUND

Evidence of associations between active transportation (walking and bicycling for transportation) and health outcomes is limited. Better understanding of this relationship would inform efforts to increase physical activity by promoting active transportation.

PURPOSE

This study examined associations between active transportation and cardiovascular disease risk factors in U.S. adults.

METHODS

Using the 2007-2008 and 2009-2010 cycles of the National Health and Nutrition Examination Survey (NHANES), adults (N=9933) were classified by level of active transportation. Multivariable linear and logistic regression analyses controlled for sociodemographic characteristics, smoking status, and minutes/week of non-active transportation physical activity. Analyses were conducted in 2011.

RESULTS

Overall, 76% reported no active transportation. Compared with no active transportation, mean BMI was lower among individuals with low (-0.9, 95% CI= -1.4, -0.5) and high (-1.2, 95% CI= -1.7, -0.8) levels of active transportation. Mean waist circumference was lower in the low (-2.2 cm, 95% CI= -3.2, -1.2) and high (-3.1 cm, 95% CI= -4.3, -1.9) active transportation groups. The odds of hypertension were 24% lower (AOR=0.76, 95% CI=0.61, 0.94) and 31% lower (AOR=0.69, 95% CI=0.58, 0.83) among individuals with low and high levels of active transportation, respectively, compared with no active transportation. High active transportation was associated with 31% lower odds of diabetes (AOR=0.69, 95% CI=0.54, 0.88). Active transportation was not associated with high-density lipoprotein level.

CONCLUSIONS

Active transportation was associated with more-favorable cardiovascular risk factor profiles, providing additional justification for infrastructure and policies that permit and encourage active transportation.

Physical activity, change in biomarkers of myocardial stress and injury, and subsequent heart failure risk in older adults

OBJECTIVES

The aim of this study was to evaluate the association between physical activity and changes in levels of highly sensitive troponin T (cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), and the subsequent risk of the development of heart failure (HF) in community-dwelling older adults.

BACKGROUND

Higher baseline levels of cTnT and NT-proBNP and increases over time correlate with the risk of HF in older adults. Factors modifying these levels have not been identified.

METHODS

NT-proBNP and cTnT were measured at baseline and 2 to 3 years later in adults 65 years of age and older free of HF participating in the Cardiovascular Health Study. Self-reported physical activity and walking pace were combined into a composite score. An increase was prespecified for NT-proBNP as a >25% increment from baseline to ≥190 pg/ml and for cTnT as a >50% increment from baseline in participants with detectable levels (≥3 pg/ml).

RESULTS

A total of 2,933 participants free of HF had NT-proBNP and cTnT measured at both time points. The probability of an increase in biomarker concentrations between baseline and follow-up visits was inversely related to the physical activity score. Compared with participants with the lowest score, those with the highest score had an odds ratio of 0.50 (95% confidence interval: 0.33 to 0.77) for an increase in NT-proBNP and an odds ratio of 0.30 (95% confidence interval: 0.16 to 0.55) for an increase in cTnT, after adjusting for comorbidities and baseline levels. A higher activity score associated with a lower long-term incidence of HF. Moreover, at each level of activity, an increase in either biomarker still identified those at higher risk.

CONCLUSIONS

These findings suggest that moderate physical activity has protective effects on early heart failure phenotypes, preventing cardiac injury and neurohormonal activation.

Resting heart rate and incident heart failure in apparently healthy men and women in the EPIC-Norfolk study

AIMS

Increasing levels of resting heart rate are associated with increased risk of developing hypertension and cardiovascular disease, and seem to play a role in the progression of heart failure. The shape of the association between resting heart rate and risk of developing heart failure has not been examined in healthy individuals of the general population.

METHODS AND RESULTS

Hazard ratios (HRs) of heart failure comparing categories of resting heart rate [51-60 b.p.m. (reference), 61-70 b.p.m., 71-80 b.p.m., 81-90 b.p.m., and 91-100 b.p.m.] were calculated in apparently healthy men (9805) and women (12 321) aged 39-79 participating in the 'European Prospective Investigation into Cancer and Nutrition' (EPIC) study in Norfolk. During a mean follow-up of 12.9 years, 1356 incident cases of heart failure occurred. In participants without potential heart rate-modifying medication, age- and sex-adjusted incidence rates of heart failure were 3.3, 3.7, 4.0, 5.1, and 5.5 per 1000 person-years for increasing categories of resting heart rate; compared with the reference category, HRs and 95% confidence intervals (CI) for increasing categories of resting heart rate were 1.08 (0.88-1.34), 1.17 (0.94-1.46), 1.39 (1.08-1.79), and 1.42 (1.00-2.03), respectively, in multivariable analysis adjusting for age, sex, body mass index, systolic blood pressure, prevalent diabetes, cholesterol concentration, social class, educational level, smoking, and physical activity. Within the reference range of resting heart rate (50-100 b.p.m.) each 10 b.p.m. increase was associated with an 11% increase in hazard of heart failure in multivariable analysis. The results did not change materially after adjusting for myocardial infarction and coronary heart disease events during follow up (1.12, 1.06-1.18).

CONCLUSION

Resting heart rate shows a graded association with hazard of heart failure in apparently healthy men and women which is not mediated by coronary heart disease. Further study is needed to examine the underlying mechanisms.