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Mirzaei M, Mirzaei M, Gholami S, Abolhosseini H. Prevalence of hypertension and related risk factors in central Iran: Results from Yazd Health Study. ARYA ATHEROSCLEROSIS 2021; 17:1-9. [PMID: 34703488 PMCID: PMC8519624 DOI: 10.22122/arya.v17i0.2045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 06/02/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND The prevalence of hypertension (HTN) varies across countries due to differences in its related risk factors. This study aimed to investigate the prevalence of HTN and related risk factors among adults. METHODS This study was conducted on the data from the recruitment phase of Yazd Health Study. Using multi-stage random cluster sampling, 10000 adults of 20-69 years were selected. Self-reported HTN (diagnosed by a physician) was recorded in a home visit. Blood pressure (BP) was measured using a standard protocol and categorized based on the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and ýTreatment of High Blood Pressure (JNC-7) classification. T-test was used to examine the gender differences. Qualitative variables were presented as number (frequency). Chi-square test and bivariate logistic regression were carried out to determine the association between risk factors. RESULTS The response rate was 95% (n = 9975). The prevalence of positive history of HTN was 18.5%. The mean systolic and diastolic BP was 126.5 ± 18.4 and 80.2 ± 12.5 mmHg, respectively. The prevalence of HTN was 36.0% (95%CI: 35.1-36.9). Its prevalence reduced by high-education, physical activity, lower BMI, and lack of history of diabetes mellitus (DM) (P < 0.0001). HTN is less common in smokers (P < 0.0001). Logistic regression analysis showed that HTN was higher among men (OR: 1.83; 95%CI: 1.64-2.03), the elderly (OR: 5.15; 95%CI: 4.20-6.31), low-educated (OR: 1.40; 95%CI: 1.17-1.67), and diabetics (OR: 1.20; 95%CI: 1.05-1.38). The prevalence of HTN was 2 times higher in obeses. HTN did not have a significant relationship with inactivity, smoking, and hypercholesterolemia. CONCLUSION The prevalence of HTN was high. By identifying modifiable risk factors, health policymakers can prioritize intervention programs. It is necessary to inform younger adult groups how these factors can be managed through a healthy lifestyle and nutritional habits.
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Affiliation(s)
- Masoud Mirzaei
- Professor, Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohsen Mirzaei
- PhD Candidate, Yazd Cardiovascular Research Centre, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Somaye Gholami
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Abolhosseini
- PhD Candidate, School of Traditional Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Sócrates J, Browne RAV, Macêdo GAD, Araújo MBF, Paulo-Pereira R, Cabral LLP, Lucena BEB, Farias-Junior LF, Costa EC. Short-Term Effect of Self-Selected Training Intensity on Ambulatory Blood Pressure in Hypertensive Older Women: A Randomized Controlled Trial. Clin Interv Aging 2020; 15:1449-1460. [PMID: 32904579 PMCID: PMC7457386 DOI: 10.2147/cia.s260134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/04/2020] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To investigate the short-term effect of self-selected training intensity (SSTI) on ambulatory blood pressure (BP) in hypertensive older women. PARTICIPANTS AND METHODS This is a randomized, single-blind, two-arm, parallel-group controlled trial that included 40 medicated hypertensive older women (64.4±3.6 years; resting systolic 118±19 and diastolic BP 68±9 mmHg). SSTI intervention was performed three times per week, 30-50 minutes per session (n=20). The control group participated in health education meetings once per week (n=20). Ambulatory BP (primary outcome) and six-minute walking test performance (secondary outcome) were assessed at baseline and following 8 weeks of intervention. Heart rate (HR), rating of perceived exertion (RPE, 6-20), and affective valence (ie, feeling scale, -5/+5) were recorded during all SSTI sessions. Intention-to-treat and per-protocol analyses were used for data analyses. RESULTS Fifteen participants from the SSTI group and 17 from the control group completed the study. No differences in ambulatory BP (24-h, awake, and asleep) were observed between SSTI and control groups (intention-to-treat and per-protocol analyses; p>0.05). The SSTI group showed a greater six-minute walking test performance than the control group in the intention-to-treat and per-protocol analyses (p<0.05). The participants exercised at 52±10% of HR reserve reported an RPE of 11±1 and an affective valence of 3.4±1.1 over the 8-week period. CONCLUSION SSTI is a feasible approach to induce a more active lifestyle and increase health-related fitness in hypertensive older women, although it does not improve BP control over a short-term period.
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Affiliation(s)
- Júlio Sócrates
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | | | - Ronildo Paulo-Pereira
- Department of Physical Education, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | | | - Eduardo Caldas Costa
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Graduate Program in Physical Education, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Physical Education, Federal University of Rio Grande do Norte, Natal, Brazil
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Ribeiro UES, Fernandes RDCP. Hypertension in Workers: The Role of Physical Activity and its Different Dimensions. Arq Bras Cardiol 2020; 114:755-761. [PMID: 32491065 PMCID: PMC8386995 DOI: 10.36660/abc.20190065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/08/2019] [Accepted: 06/23/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Physical activity, each type in its own manner, whether occupational, domestic or leisure, can play a significant role regarding high blood pressure (HBP). However, practicing physical activity only at leisure time, or in specific situations, can be insufficient to achieve the effective control of HBP. OBJECTIVE To analyze the isolated and cumulative effect of different types of physical activity and the prevalence of HBP among workers. METHODS A cross-sectional study with 1,070 Urban Cleaning and Footwear Industry workers in Bahia, who answered a survey, conducted by an interviewer on sociodemographic, occupational, lifestyle and hypertensive morbidity aspects. Weight, height, waist circumference and blood pressure were measured. Case of HBP: Systolic blood pressure ≥140 or diastolic blood pressure ≥90, or regular treatment for HBP. The occupational, domestic and leisure aspects of Physical Activity were studied. A multivariate analysis with Cox Regression was performed for cross-sectional studies. RESULTS The prevalence of HBP was 24%, being 37% among workers aged between 35-44 years, and 51% among workers aged between 45-54 years. The multivariate model showed that workers who were active in one form of physical activity only or no forms had 62% higher BP levels and that these levels were 25% higher among workers who were active in two out of three physical activity forms. Being a male, being older (> 31 years old) and being overweight were characteristics associated with HBP, with prevalence ratios of 1.62, 2.10 and 2.26, respectively. CONCLUSIONS There was a cumulative effect of the form of physical activity on the occurrence of HBP. Classifying active subjects at work or at home as inactive persons by relying only on the leisure form can lead to methodological errors. (Arq Bras Cardiol. 2020; 114(5):755-761).
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Affiliation(s)
- Uelito Everaldo Souza Ribeiro
- Universidade Federal da BahiaPrograma de Pós-Graduação em Saúde, Ambiente e TrabalhoSalvadorBABrasilUniversidade Federal da Bahia - Programa de Pós-Graduação em Saúde, Ambiente e Trabalho, Salvador, BA - Brasil
| | - Rita de Cassia Pereira Fernandes
- Universidade Federal da BahiaFaculdade de Medicina da BahiaSalvadorBABrasilUniversidade Federal da Bahia - Faculdade de Medicina da Bahia, Salvador, BA – Brasil
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Werneck AO, Silva DR, Collings PJ, Fernandes RA, Ronque ERV, Sardinha LB, Cyrino ES. Prenatal, biological and environmental factors associated with physical activity maintenance from childhood to adolescence. CIENCIA & SAUDE COLETIVA 2019; 24:1201-1210. [PMID: 30892539 DOI: 10.1590/1413-81232018243.11442017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 06/23/2017] [Indexed: 11/22/2022] Open
Abstract
Our aim was to identify prenatal, biological and environmental correlates of child to adolescence physical activity maintenance in 1,186 Brazilian youth (525 boys) aged between 10 and 16 years. Current and former physical activity levels were obtained cross-sectionally through questionnaires. As potential correlates, parent's activity levels, socioeconomic status and offspring's birth weight were self-reported by parents. Somatic maturation was estimated by the peak of height velocity. Logistic regression analyses revealed that, regardless of chronological age, males were more likely to be active in childhood (OR = 1.73 [CI 95% = 1.33 to 2.27]) and to maintain physical activity (adjusted by chronological age, sex, birth weight and mother's physical activity) (OR = 3.58 [CI 95% = 2.32 to 5.54]), as well as late maturing adolescents (OR = 2.52 [CI 95% = 1.02 to 6.22]). Adolescents whose mother was inactive (OR = 0.31 [CI 95% = 0.11 to 0.86]) also had a lower probability of maintaining physical activity. Thus, girls, adolescents born with low weight and those with inactive mother are less likely to maintain physical activity levels from childhood to adolescence.
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Affiliation(s)
- André Oliveira Werneck
- Grupo de Estudo e Pesquisa em Metabolismo, Nutrição e Exercício , Universidade Estadual de Londrina . Rodovia Celso Garcia Cid - Pr 445 Km 380, Campus Universitário. 86057-970 Londrina PR Brasil .
| | - Danilo Rodrigues Silva
- Grupo de Estudo e Pesquisa em Metabolismo, Nutrição e Exercício , Universidade Estadual de Londrina . Rodovia Celso Garcia Cid - Pr 445 Km 380, Campus Universitário. 86057-970 Londrina PR Brasil .
| | - Paul James Collings
- Bradford Institute for Health Research , Bradford Teaching Hospitals Foundation Trust . Bradford UK
| | - Rômulo Araújo Fernandes
- Departamento de Educação Física , Faculdade de Ciências e Tecnologia de Presidente Prudente , Universidade Estadual Paulista . Presidente Prudente SP Brasil
| | - Enio Ricardo Vaz Ronque
- Grupo de Estudo e Pesquisa em Metabolismo, Nutrição e Exercício , Universidade Estadual de Londrina . Rodovia Celso Garcia Cid - Pr 445 Km 380, Campus Universitário. 86057-970 Londrina PR Brasil .
| | | | - Edilson Serpeloni Cyrino
- Grupo de Estudo e Pesquisa em Metabolismo, Nutrição e Exercício , Universidade Estadual de Londrina . Rodovia Celso Garcia Cid - Pr 445 Km 380, Campus Universitário. 86057-970 Londrina PR Brasil .
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Police Officers Who Are Physically Active and Have Low Levels of Body Fat Show Better Reaction Time. J Occup Environ Med 2017; 60:e1-e5. [PMID: 29065055 DOI: 10.1097/jom.0000000000001205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To analyze the relationship between reaction time (RT), level of physical activity (PA), and anthropometric indicators in police officers in Special Operation Units. METHODS Twenty-two police officers (34.5 ± 9.1 years old) from Santa Catarina, Brazil, who were members of a Special Operation Coordination Unit. RT was measured by the Vienna Test System. Were obtained values of body mass index (BMI), body fat (BF), and waist-to-hip ratio. PA was investigated using the Physical Activity Evaluation Questionnaire. RESULTS Younger police officers (less than 34 years) and BF less than 15% presented better performance in RT when compared with older, and BF more than 15%, respectively. RT was negatively related to PA (rho = -0.48, P < 0.05), and positively related to BF (rho = 0.76, P < 0.01) and to BMI (rho = 0.46, P < 0.05). CONCLUSIONS Participants from the group with greater BF and insufficient PA reacted significantly slower than others.
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Association of hypertension with depression and generalized anxiety symptoms in a large population-based sample of older adults. J Hypertens 2016; 34:1711-20. [DOI: 10.1097/hjh.0000000000001006] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND The relationship between socioeconomic status (SES) and hypertension has been studied in a number of reviews. However, the impact of SES on hypertension has been reported in several studies with conflicting results. METHODS A systematic search was performed in PubMed, Proquest and Cochrane databases for observational studies on hypertension prevalence and SES, published in English, until March 2014. Hypertension was defined as a mean SBP of at least 140 mmHg or a DBP of at least 90 mmHg, or use of antihypertensive medication. The inverse variance method with a random-effects model was used to pool the risk estimates from the individual studies. Data abstraction was conducted independently by two authors. RESULTS Among the 2404 references, 51 studies fulfilled the inclusion criteria. An overall increased risk of hypertension among the lowest SES was found for all three indicators: income [pooled odds ratio (OR) 1.19, 95% confidence interval (CI) 0.96-1.48], occupation (pooled OR 1.31, 95% CI 1.04-1.64) and education (pooled OR 2.02, 95% CI 1.55-2.63). The associations were significant in high-income countries, and the increased risk of hypertension for the lowest categories of all SES indicators was most evident for women, whereas men revealed less consistent associations. CONCLUSION Low SES is associated with higher blood pressure, and this association is particularly evident in the level of education. It is important to identify and monitor hypertension to reduce the risk of this disease among the most vulnerable groups in different countries and among different societies.
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Sarki AM, Nduka CU, Stranges S, Kandala NB, Uthman OA. Prevalence of Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2015; 94:e1959. [PMID: 26683910 PMCID: PMC5058882 DOI: 10.1097/md.0000000000001959] [Citation(s) in RCA: 206] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/09/2015] [Accepted: 10/13/2015] [Indexed: 11/26/2022] Open
Abstract
We aimed to obtain overall and regional estimates of hypertension prevalence, and to examine the pattern of this disease condition across different socio-demographic characteristics in low-and middle-income countries. We searched electronic databases from inception to August 2015. We included population-based studies that reported hypertension prevalence using the current definition of blood pressure ≥140/90 mm Hg or self-reported use of antihypertensive medication. We used random-effects meta-analyses to pool prevalence estimates of hypertension, overall, by World Bank region and country income group. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. A total of 242 studies, comprising data on 1,494,609 adults from 45 countries, met our inclusion criteria. The overall prevalence of hypertension was 32.3% (95% confidence interval [CI] 29.4-35.3), with the Latin America and Caribbean region reporting the highest estimates (39.1%, 95% CI 33.1-45.2). Pooled prevalence estimate was also highest across upper middle income countries (37.8%, 95% CI 35.0-40.6) and lowest across low-income countries (23.1%, 95% CI 20.1-26.2). Prevalence estimates were significantly higher in the elderly (≥65 years) compared with younger adults (<65 years) overall and across the geographical regions; however, there was no significant sex-difference in hypertension prevalence (31.9% vs 30.8%, P = 0.6). Persons without formal education (49.0% vs 24.9%, P < 0.00001), overweight/obese (46.4% vs 26.3%, P < 0.00001), and urban settlers (32.7% vs 25.2%, P = 0.0005) were also more likely to be hypertensive, compared with those who were educated, normal weight, and rural settlers respectively. This study provides contemporary and up-to-date estimates that reflect the significant burden of hypertension in low- and middle-income countries, as well as evidence that hypertension remains a major public health issue across the various socio-demographic subgroups. On average, about 1 in 3 adults in the developing world is hypertensive. The findings of this study will be useful for the design of hypertension screening and treatment programmes in low- and middle-income countries.
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Affiliation(s)
- Ahmed M Sarki
- From the Division of Health Sciences, University of Warwick Medical School, Coventry, UK (AMS, CUN); Family and Youth Health Initiative (FAYOHI), Nigeria (AMS); Department of Population Health, Luxembourg Institute of Health, Luxembourg (SS, N-BK); Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of health Sciences, University of Warwick Medical School, Coventry, UK (OAU); and Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, International Health Group, Liverpool, UK (OAU); Department of Mathematics and Information sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK (N-BK)
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Dos Santos ES, Asano RY, Filho IG, Lopes NL, Panelli P, Nascimento DDC, Collier SR, Prestes J. Acute and chronic cardiovascular response to 16 weeks of combined eccentric or traditional resistance and aerobic training in elderly hypertensive women: a randomized controlled trial. J Strength Cond Res 2015; 28:3073-84. [PMID: 24845208 DOI: 10.1519/jsc.0000000000000537] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Both aerobic (AT) and resistance training (RT) are recommended as nonpharmacological treatments to prevent hypertension. However, there is a paucity of literature investigating the effects of combined exercise modes (RT combined with AT) in elderly hypertensive women. Thus, our aim was to compare the postexercise hypotension (PEH) response to both protocol models and to assess the correlation between the degree of PEH after acute and chronic training. Furthermore, we also compared several biochemical variables for each training group. Sixty hypertensive older women were randomly assigned into nonexercised control (no systematic exercise training throughout the study), eccentric RT (ERT), and traditional RT (TRT). The training programs consisted of 16 weeks of RT combined with AT. Blood pressure (BP), biochemical profiles, and 1 repetition maximum (1RM) were evaluated. There was a significant increase in high-density lipoprotein (HDL) after both training regimens pre- to posttraining (combined ERT +5% and TRT +7%; p = 0.001 for both). There was a decrease in systolic BP (SBP) (combined ERT -19% and TRT -21%; p = 0.001 for both) and diastolic BP (DBP) (-13% for both; p = 0.001 for both). There was an increase in bench press 1RM (combined ERT +54% and TRT +35%; p = 0.001 for both) and leg press 1RM (combined ERT +52% and TRT +33%; p = 0.001 for both). The magnitude of decrease in SBP after acute exercise was moderately correlated with the drop in SBP after chronic training for the ERT combined with AT group (r = 0.64). Both combined training protocols are effective in promoting benefits in health-related factors (HDL, SBP, DBP, and 1RM). Considering the lower cardiovascular stress experienced during combined ERT, this type of training seems to be the most suitable for elders, deconditioned individuals, and hypertensives.
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Affiliation(s)
- Eduardo S Dos Santos
- 1Graduate Program on Physical Education, Catholic University of Brasilia, Brasilia, Brazil; 2Research Group in Exercise Physiology (GEFEFIS), North-Northeast Cardiology Institute, Bahia, Brazil; 3Dom Pedro of Alcantara Hospital, Bahia, Brazil; and 4Vascular Biology and Autonomic Studies Laboratory, Appalachian State University, Boone, North Carolina
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Prevalent Long-Term Trends of Hypertension in Austria: The Impact of Obesity and Socio-Demography. PLoS One 2015; 10:e0140461. [PMID: 26469176 PMCID: PMC4607455 DOI: 10.1371/journal.pone.0140461] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 09/25/2015] [Indexed: 12/31/2022] Open
Abstract
Background Globally there are only less long-term-studies on hypertension available to provide reliable estimates and identify risk groups. This study aims to analyse the prevalence and long-term-trend of hypertension in Austria, recognize affected subpopulations and investigate social inequalities. Methods This representative population-based study is based on self-reported data of adults (mean age: 47.7 ± 17.5; n = 178,818) that were taken from five health surveys between 1973 and 2007. An adjustment of self-reported BMI was performed based on a preliminary validation study. Absolute changes (AC) and aetiologic fractions (AF) were calculated from logistic regressions in order to measure trends. To quantify the extent of social inequality, a relative index of inequality (RII) was computed. Results During the study period the age-standardized hypertension prevalence increased from 1.0% to 18.8%, with a considerable rise from 1991 onwards. There was a positive trend in all subpopulations, with the highest AC among obese women (+50.2%) and obese subjects aged 75 years and older (+54.4%), whereas the highest risk was observed among the youngest obese adults (AF: 99.4%). The RII for hypertension was higher for women than men, but in general unstable during the investigation period. Conclusions Obesity and older age are significant factors for increased morbidity of hypertension. The most undesirable trends occurred in obese women and obese subjects aged 75 years and older. These risk groups should be given special attention when planning hypertension prevention programs. The high increase in the prevalence of hypertension is due to different aspects, e.g. a demographic change and a change in the definition of hypertension. These findings help to understand why hypertension is becoming more common in the Austrian population.
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Fernandes RA, Zanesco A. Early physical activity promotes lower prevalence of chronic diseases in adulthood. Hypertens Res 2010; 33:926-31. [PMID: 20574424 DOI: 10.1038/hr.2010.106] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Epidemiological studies have shown high rates of occurrence of arterial hypertension and type 2 diabetes mellitus among adults, and early preventive actions are extremely relevant for public policy strategies. The purpose of this study was to analyze the relationship between the prevalence of arterial hypertension and type 2 diabetes in adulthood and physical activity (currently and in childhood/adolescence). A retrospective study was carried out from March to November of 2009. Data were collected through interviews, and both diseases were assessed through self-report and confirmed by previous medical diagnosis. Current physical activity and that performed in childhood (7-10 years old) and adolescence (11-17 years old) were analyzed. Of the 1436 adults analyzed in this survey, approximately 61% were women (n=881). Respondents' ages ranged from 18 to 94.8 years, and 20.2% of the total participants were >/=65 years old. Our results show that men (18%) were more physically active than women (9.4%), whereas younger respondents and those with more formal education exhibited greater physical activity levels (P<0.001). Obese subjects presented lower physical activity levels (P=0.027). Physical activity in youth was associated with lower rates of occurrence of arterial hypertension (odds ratio (OR)=0.42 (95% confidence interval (CI)=0.29-0.62)) and type 2 diabetes mellitus (OR=0.29 (95% CI=0.15-0.56)) in adulthood, but current physical activity was not related to these outcomes. Our study reveals a positive relationship between early physical activity in both childhood and adolescence and lower rates of occurrence of endocrine and cardiovascular diseases in adulthood.
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Affiliation(s)
- Rômulo A Fernandes
- Institute of Bioscience, UNESP Univ Estadual Paulista, Rio Claro-São Paulo, Brazil
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