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Ueno K, Kaneko H, Kamiya K, Suzuki Y, Okada A, Takeda N, Fujiu K, Morita H, Ako J, Node K, Yasunaga H, Komuro I. Age-Dependent Relationship of Physical Inactivity with Incident Cardiovascular Disease: Analysis of a Large Japanese Cohort. Can J Cardiol 2024:S0828-282X(24)00501-4. [PMID: 38906248 DOI: 10.1016/j.cjca.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND There have been limited studies examining age-dependent associations between physical inactivity and cardiovascular disease (CVD). We aimed to clarify the age-dependent relationship of physical inactivity with incident CVD. METHODS We analyzed 1,097,424 participants aged 18-105 years without a history of CVD enrolled in the DeSC database (median age, 63 years; 46.4% men). We categorized participants into the following 4 groups based on age: ≤44 years (n=203,835), 45-64 years (n=403,619), 65-79 years (n=437,236), ≥80 years (n=52,734). We used three physical inactivity components gained from the self-reported questionnaire during a health checkup. The outcomes were composite CVD events including myocardial infarction, stroke, and heart failure, and each CVD event. RESULTS During a mean follow-up of 3.2±1.9 years, 81,649 CVD events were observed. The hazard ratios of three physical inactivity components for CVD events increased with age category (P for interaction <0.001). For example, the hazard ratio (95% confidence interval) of physical inactivity defined as not doing light, sweaty exercise for 30 minutes at least twice a week for incident CVD in the groups aged ≤44 years, 45-64 years, 65-79 years, and ≥80 years were 0.97 (0.88-1.05), 1.08 (1.05-1.12), 1.12 (1.10-1.15), and 1.17 (1.12-1.21), respectively (P for interaction <0.001). This association was consistent across subtypes of CVD, including heart failure, myocardial infarction, and stroke. CONCLUSIONS The association of physical inactivity with a higher risk of developing CVD increased with age. Preventive efforts for physical activity optimization may be more valuable in older people.
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Affiliation(s)
- Kensuke Ueno
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Yuta Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Frontier Cardiovascular Science, The University of Tokyo, Tokyo, Japan; International University of Health and Welfare, Tokyo, Japan
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Kazemi A, Soltani S, Aune D, Hosseini E, Mokhtari Z, Hassanzadeh Z, Jayedi A, Pitanga F, Akhlaghi M. Leisure-time and occupational physical activity and risk of cardiovascular disease incidence: a systematic-review and dose-response meta-analysis of prospective cohort studies. Int J Behav Nutr Phys Act 2024; 21:45. [PMID: 38659024 PMCID: PMC11044601 DOI: 10.1186/s12966-024-01593-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 04/14/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Physical activity has benefits for the cardiovascular system, however, what levels and types of activity provide optimal cardiovascular health is unclear. We aimed to determine the level of physical activity that has the most benefits against cardiovascular diseases (CVD). METHODS PubMed, Scopus, and Web of Science were searched for prospective cohort studies on leisure-time (LTPA) or occupational physical activity (OPA) as the exposure and major types of CVD (total CVD, coronary heart disease [CHD], stroke, and atrial fibrillation [AF]) incidence as the outcome. Risk of bias of studies was evaluated using the ROBINS-I tool. Summary hazard ratios (HR) were calculated using random-effects pairwise model. RESULTS A total of 103 studies were included in the analysis. The highest versus the lowest LTPA was associated with a lower risk of overall CVD (HR = 0.81; 95% CI: 0.77-0.86), CHD (HR = 0.83; 0.79-0.88), and stroke (HR = 0.83; 0.79-0.88), but not AF (HR = 0.98; 0.92-1.05). Linear dose-response analyses showed a 10%, 12%, 9%, and 8% risk reduction in CVD, CHD, stroke, and AF incidence, respectively, for every 20 MET-hours/week increase in LTPA. In nonlinear dose-response analyses, there were inverse associations up to 20 MET-hours/week with 19% and 20% reduction in CVD and CHD risk, and up to 25 MET-hours/week with 22% reduction in stroke, with no further risk reduction at higher LTPA levels. For AF, there was a U-shaped nonlinear association with the maximum 8% risk reduction at 10 MET-hours/week of LTPA. Higher levels of OPA were not associated with risk of CVD, CHD, stroke, or AF. CONCLUSIONS Overall, results showed an inverse dose-response relationship between LTPA and risk of CVD, CHD, stroke, and AF. Running was the most beneficial LTPA but the risk was similar among various LTPA intensities. OPA showed no benefits in total or any type of CVD.
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Affiliation(s)
- Asma Kazemi
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sepideh Soltani
- Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Oslo New University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Elham Hosseini
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zeinab Mokhtari
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Hassanzadeh
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Jayedi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Masoumeh Akhlaghi
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Razi Blvd, 7153675541, Shiraz, Iran.
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Garcia L, Pearce M, Abbas A, Mok A, Strain T, Ali S, Crippa A, Dempsey PC, Golubic R, Kelly P, Laird Y, McNamara E, Moore S, de Sa TH, Smith AD, Wijndaele K, Woodcock J, Brage S. Non-occupational physical activity and risk of cardiovascular disease, cancer and mortality outcomes: a dose-response meta-analysis of large prospective studies. Br J Sports Med 2023; 57:979-989. [PMID: 36854652 PMCID: PMC10423495 DOI: 10.1136/bjsports-2022-105669] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To estimate the dose-response associations between non-occupational physical activity and several chronic disease and mortality outcomes in the general adult population. DESIGN Systematic review and cohort-level dose-response meta-analysis. DATA SOURCES PubMed, Scopus, Web of Science and reference lists of published studies. ELIGIBILITY CRITERIA Prospective cohort studies with (1) general population samples >10 000 adults, (2) ≥3 physical activity categories, and (3) risk measures and CIs for all-cause mortality or incident total cardiovascular disease, coronary heart disease, stroke, heart failure, total cancer and site-specific cancers (head and neck, myeloid leukaemia, myeloma, gastric cardia, lung, liver, endometrium, colon, breast, bladder, rectum, oesophagus, prostate, kidney). RESULTS 196 articles were included, covering 94 cohorts with >30 million participants. The evidence base was largest for all-cause mortality (50 separate results; 163 415 543 person-years, 811 616 events), and incidence of cardiovascular disease (37 results; 28 884 209 person-years, 74 757 events) and cancer (31 results; 35 500 867 person-years, 185 870 events). In general, higher activity levels were associated with lower risk of all outcomes. Differences in risk were greater between 0 and 8.75 marginal metabolic equivalent of task-hours per week (mMET-hours/week) (equivalent to the recommended 150 min/week of moderate-to-vigorous aerobic physical activity), with smaller marginal differences in risk above this level to 17.5 mMET-hours/week, beyond which additional differences were small and uncertain. Associations were stronger for all-cause (relative risk (RR) at 8.75 mMET-hours/week: 0.69, 95% CI 0.65 to 0.73) and cardiovascular disease (RR at 8.75 mMET-hours/week: 0.71, 95% CI 0.66 to 0.77) mortality than for cancer mortality (RR at 8.75 mMET-hours/week: 0.85, 95% CI 0.81 to 0.89). If all insufficiently active individuals had achieved 8.75 mMET-hours/week, 15.7% (95% CI 13.1 to 18.2) of all premature deaths would have been averted. CONCLUSIONS Inverse non-linear dose-response associations suggest substantial protection against a range of chronic disease outcomes from small increases in non-occupational physical activity in inactive adults. PROSPERO registration number CRD42018095481.
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Affiliation(s)
- Leandro Garcia
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Matthew Pearce
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ali Abbas
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Alexander Mok
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Tessa Strain
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Sara Ali
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Alessio Crippa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paddy C Dempsey
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Rajna Golubic
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre, University of Edinburgh Institute for Sport, Physical Education and Health Sciences, Edinburgh, UK
| | - Yvonne Laird
- Sydney School of Public Health, Prevention Research Collaboration, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Eoin McNamara
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Economic and Social Research Institute, Dublin, Ireland
| | - Samuel Moore
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Thiago Herick de Sa
- Center for Epidemiological Research in Nutrition and Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Andrea D Smith
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - Katrien Wijndaele
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - James Woodcock
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Anderson BM, Qasim M, Correa G, Evison F, Gallier S, Ferro CJ, Jackson TA, Sharif A. Somatic Symptoms of Depression Lose Association with Mortality upon Adjustment for Frailty: Analysis from the Fitness Haemodialysis Cohort. Int J Nephrol 2023; 2023:4518843. [PMID: 37388527 PMCID: PMC10307017 DOI: 10.1155/2023/4518843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/25/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction The somatic symptom component of depression is associated with increased hospitalisation and mortality and poorer health-related quality of life (HRQOL). However, the relationship of subsets of depression symptoms with frailty and outcomes is not known. This study aimed to (1) explore the relationship between the Clinical Frailty Scale (CFS) and components of depression and (2) their association with mortality, hospitalisation, and HRQOL in haemodialysis recipients. Methods We conducted a prospective cohort study of prevalent haemodialysis recipients, with deep bio-clinical phenotyping including CFS and PHQ-9 somatic (fatigue, poor appetite, and poor sleep) and cognitive component scores. EuroQol EQ-5D summary index assessed HRQOL at the baseline. Electronic linkage to English national administration datasets ensured robust follow-up data for hospitalisation and mortality events. Findings. Somatic (β = 0.067; 95% C.I. 0.029 to 0.104; P < 0.001) and cognitive (β = 0.062; 95% C.I. 0.034 to 0.089; P<0.001) components were associated with increased CFS scores. Both somatic (β = -0.062; 95% C.I. -0.104 to -0.021; P<0.001) and cognitive (β = 0.052; 95% C.I. -0.081 to -0.024; P < 0.001) scores were associated with lower HRQOL. Somatic scores lost mortality association on addition of CFS to the multivariable model (HR1.06; 95% C.I. 0.977 to 1.14; P=0.173). Cognitive symptoms were not associated with mortality. Neither the component score was associated with hospitalisation on multivariable analyses. Conclusions Both somatic and cognitive depression symptoms are associated with frailty and poorer HRQOL in haemodialysis recipients but were not associated with mortality or hospitalisation when adjusted for frailty. The risk profile of depression somatic scores may be related to overlap with symptoms of frailty.
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Affiliation(s)
- Benjamin M. Anderson
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Muhammad Qasim
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Gonzalo Correa
- Department of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Felicity Evison
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
| | - Suzy Gallier
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
- PIONEER HDR-UK Hub in Acute Care, Edgbaston, Birmingham, UK
| | - Charles J. Ferro
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Thomas A. Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Adnan Sharif
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Anderson BM, Wilson DV, Qasim M, Correa G, Evison F, Gallier S, Ferro CJ, Jackson TA, Sharif A. Gender Disparity in Expression of Sarcopenia in Haemodialysis Recipients: Analysis from the FITNESS Cohort. Int J Nephrol 2023; 2023:5885059. [PMID: 37363696 PMCID: PMC10290558 DOI: 10.1155/2023/5885059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/01/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
Background There has been little exploration of the interplay between sarcopenia and frailty in haemodialysis, particularly regarding gender difference. We aimed to (1) assess whether ultrasound-derived low muscle mass (LMM) and sarcopenia are more common in male or female haemodialysis recipients; (2) assess whether age influences any observed gender difference, and (3) explore the interplay between sarcopenia, frailty, and gender in haemodialysis recipients. Methods This was an exploratory analysis of a subgroup of adult prevalent (≥3 months) haemodialysis with frailty phenotype (FP) scores. Bilateral anterior thigh thickness (BATT) was obtained according to an established ultrasound protocol. Associations with frailty were explored via both linear and logistic regressions for BATT, LMM, and sarcopenia with a priori covariables, stratified by gender. Results In total of 223 studies, participants had ultrasound measurements. Males showed greater prevalence of LMM. On adjusted analyses, LMM was associated with lower hand grip strength in males (β = -4.17; 95% C.I. -7.57 to -0.77; P=0.02), but not females (β = -1.88; 95% C.I. -5.41 to 1.64; P=0.29). LMM was also associated with slower walking speed in both males (β = -0.115; 95% C.I. -0.258 to -0.013; P=0.03) and females (β = -0.152; 95% C.I. -0.300 to -0.005; P=0.04). Sarcopenia was associated with greater odds of frailty on adjusted models in males (OR = 9.86; 95% C.I. 1.8 to 54.0; P=0.01), but not females (OR = 5.16; 95% C.I. 0.22 to 124; P=0.31). Conclusions The clinical expression and significance of sarcopenia differ substantially between males and females on haemodialysis. Further work is required to elucidate underlying mechanisms and guide tailored treatment.
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Affiliation(s)
- Benjamin M. Anderson
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Daisy V. Wilson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Muhammad Qasim
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Felicity Evison
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
| | - Suzy Gallier
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
- PIONEER HDR-UK Hub in Acute Care, Edgbaston, Birmingham, UK
| | - Charles J. Ferro
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Thomas A. Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Adnan Sharif
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Anderson BM, Wilson DV, Qasim M, Correa G, Evison F, Gallier S, Ferro CJ, Jackson TA, Sharif A. Ultrasound quadriceps muscle thickness is variably associated with frailty in haemodialysis recipients. BMC Nephrol 2023; 24:16. [PMID: 36653750 PMCID: PMC9847024 DOI: 10.1186/s12882-022-03043-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Ultrasonographic quantitation of quadriceps muscle mass is increasingly used for assessment of sarcopenia, but its relationship with frailty in haemodialysis recipients is not known. This study explores the relationship between ultrasound-derived bilateral anterior thigh thickness (BATT), sarcopenia, and frailty by common frailty tools (Frailty Phenotype [FP], Frailty Index [FI], Edmonton Frailty [EFS], and Clinical Frailty Scale [CFS]). METHODS This was an exploratory analysis of a subgroup of adult prevalent (≥3 months) haemodialysis recipients deeply phenotyped for frailty. Ultrasound assessment of BATT was obtained with participants at an angle of ≤45°, with legs outstretched and knees resting at 10°-20°, according to an established protocol. Associations with frailty were explored via both linear and logistic regressions for BATT, Low Muscle Mass (LMM), and sarcopenia with stepwise adjustment for a priori covariables. RESULTS In total 223 study participants had ultrasound measurements. Frailty ranged from 34% for FP to 58% for FI. BATT was associated with increasing frailty on simple linear regression by all frailty tools, but lost significance on addition of covariables. Upon dichotomising frailty tools into Frail/Not Frail, BATT was associated with frailty by all tools on univariable analyses, but only retained association for EFS on the fully adjusted model (OR 0.97, 95% C.I. 0.94-1.00, P = 0.05). CONCLUSIONS Ultrasound measures of quadriceps thickness is variably associated with frailty in prevalent haemodialysis recipients, dependent upon the frailty tool used, but not independent of other variables. Further work is required to establish the added value of sarcopenia measurement in frail haemodialysis patients. TRIAL REGISTRATION Clinicaltrials.gov : NCT03071107 registered 06/03/2017.
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Affiliation(s)
- Benjamin M. Anderson
- grid.415490.d0000 0001 2177 007XDepartment of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2WB UK ,grid.6572.60000 0004 1936 7486Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Daisy V. Wilson
- grid.6572.60000 0004 1936 7486Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK ,grid.415490.d0000 0001 2177 007XDepartment of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Muhammad Qasim
- grid.415490.d0000 0001 2177 007XDepartment of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2WB UK ,grid.6572.60000 0004 1936 7486Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Gonzalo Correa
- grid.414618.e0000 0004 6005 2224Hospital del Salvador, Santiago, Chile
| | - Felicity Evison
- grid.415490.d0000 0001 2177 007XDepartment of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
| | - Suzy Gallier
- grid.415490.d0000 0001 2177 007XDepartment of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK ,PIONEER: HDR-UK hub in Acute Care, Edgbaston, Birmingham, UK
| | - Charles J. Ferro
- grid.415490.d0000 0001 2177 007XDepartment of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2WB UK ,grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Thomas A. Jackson
- grid.6572.60000 0004 1936 7486Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK ,grid.415490.d0000 0001 2177 007XDepartment of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Adnan Sharif
- grid.415490.d0000 0001 2177 007XDepartment of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2WB UK ,grid.6572.60000 0004 1936 7486Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Edimo Dikobo SJ, Lemieux I, Poirier P, Després JP, Alméras N. Leisure-time physical activity is more strongly associated with cardiometabolic risk than occupational physical activity: Results from a workplace lifestyle modification program. Prog Cardiovasc Dis 2022:S0033-0620(22)00157-8. [PMID: 36565734 DOI: 10.1016/j.pcad.2022.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Regular physical activity (PA) plays a key role in the management and prevention of numerous chronic diseases. However, recent studies have suggested that occupational physical activity (OPA) may not always have health benefits. The aim of the present study was to examine the respective contributions of OPA vs. leisure-time physical activity (LTPA) to the variation in the cardiometabolic profile, including cardiorespiratory fitness (CRF), of employees involved in a workplace lifestyle modification program. Our study hypothesis was that LTPA would show a stronger association with indices of cardiometabolic health than OPA. METHODS A mobile health assessment unit was used to assess 5145 workers (3397 men and 1748 women) on site at their workplace. Assessments included lifestyle questionnaires (overall diet quality, type of OPA and level of LTPA), blood pressure measurements, blood tests, anthropometric measurements, and a submaximal treadmill exercise test to assess CRF. Results were adjusted for education, household income and age. RESULTS When workers were classified on the basis of their OPA (sedentary work, standing work, physical work, and heavy manual work), only a few significant differences in the cardiometabolic profile were observed in men, with those in the physical work category having more favorable values than sedentary workers. However, substantial and significant differences were observed among employees classified on the basis of their LTPA, these differences being observed in both men and women. For instance, waist circumference, the cholesterol/HDL cholesterol ratio, triglyceride concentrations and resting heart rate were lower in active individuals compared to inactive and moderately inactive individuals (p < 0.01). Furthermore, irrespective of whether or not employees were sedentary at work, a high level of LTPA was associated with a greater CRF (p < 0.001). Finally, we found that the lowest prevalence of hypertriglyceridemic waist (p < 0.01) and the highest score of overall diet quality (p < 0.001) were observed in active individuals, irrespective of their OPA category. CONCLUSION Levels of LTPA were more strongly associated with cardiometabolic health than OPA in a cohort of blue- and white-collar employees. Furthermore, high levels of LTPA were found to counteract the potentially deleterious effects of a sedentary work on cardiometabolic health.
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Affiliation(s)
- Sandrine J Edimo Dikobo
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, QC, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Isabelle Lemieux
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, QC, Canada
| | - Paul Poirier
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, QC, Canada; Faculty of Pharmacy, Université Laval, Québec, QC, Canada
| | - Jean-Pierre Després
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, QC, Canada; VITAM - Centre de recherche en santé durable, CIUSSS de la Capitale-Nationale, Québec, QC, Canada; Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Natalie Alméras
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, QC, Canada; Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada.
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Anderson BM, Qasim M, Correa G, Evison F, Gallier S, Ferro CJ, Jackson TA, Sharif A. Depression is associated with frailty and lower quality of life in haemodialysis recipients, but not with mortality or hospitalization. Clin Kidney J 2022; 16:342-354. [PMID: 36755846 PMCID: PMC9900564 DOI: 10.1093/ckj/sfac241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Indexed: 11/12/2022] Open
Abstract
Background Frailty and depression are highly prevalent in haemodialysis recipients, exhibit a reciprocal relationship, and are associated with increased mortality and hospitalization, and lower quality of life. Despite this, there has been little exploration of the relationship between depression and frailty upon patient outcomes. We aimed to explore the relationship between depression and frailty, and their associations with mortality, hospitalization and quality of life. Methods We performed a prospective cohort study of prevalent haemodialysis recipients linked to national datasets for outcomes including mortality and hospitalization. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), frailty using the Clinical Frailty Scale (CFS) and quality of life using the EuroQol 5-Dimension (EQ-5D) Summary Index. Results A total of 485 prevalent haemodialysis recipients were recruited, with 111 deaths and 1241 hospitalizations during follow-up. CFS was independently associated with mortality [hazard ratio (HR) 1.31; 95% confidence interval (CI) 1.08, 1.59; P = .006], hospitalization [incidence rate ratio (IRR) 1.13; 95% CI 1.03, 1.25; P = .010] and lower quality of life (Coef. -0.401; 95% CI -0.511, -0.292; P < .001). PHQ-9 score was independently associated with lower quality of life (Coef. -0.042; 95% CI -0.063, -0.021; P < .001), but not mortality (HR 1.00; 95% CI 0.96, 1.04; P = .901) or hospitalization (IRR 0.99; 95% CI 0.97, 1.01; P = .351). In an adjusted model including CFS, moderate depression was associated with reduced hospitalization (IRR 0.72; 95% CI 0.56, 0.93; P = .013). Conclusions With the addition of frailty, depression was associated with lower hospital admissions, but poorer quality of life. The relationship between frailty and depression, and their influence on outcomes is complex, requiring further study.
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Affiliation(s)
- Benjamin M Anderson
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Muhammad Qasim
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK,Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Gonzalo Correa
- Department of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Felicity Evison
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
| | - Suzy Gallier
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK,PIONEER: HDR-UK hub in Acute Care, Edgbaston, Birmingham, UK
| | - Charles J Ferro
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Thomas A Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK,Department of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Adnan Sharif
- Correspondence to: Adnan Sharif; E-mail: , Twitter: @AdnanSharif1979
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9
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Targeting Diet Quality at the Workplace: Influence on Cardiometabolic Risk. Nutrients 2021; 13:nu13072283. [PMID: 34209458 PMCID: PMC8308315 DOI: 10.3390/nu13072283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
The American Heart Association criteria for cardiovascular health include overall diet quality (DQ). The present study evaluated the effect of a workplace health promotion program targeting DQ and physical activity on features of cardiometabolic risk (CMR). Before and after the 3-month intervention, 2260 employees (1462 men and 798 women) completed a health and fitness evaluation including assessment of DQ using a validated food-based questionnaire. After the 3-month lifestyle modification program, DQ increased significantly in both sexes (p < 0.0001) as well as physical activity level (p < 0.0001). A reduction in waist circumference (p < 0.0001) and improved lipid levels were also observed. Significant associations were found between changes in DQ index and changes in CMR variables in both men (standardized regression coefficients ranged from −0.19 (95% confidence interval: −0.26 to −0.12) to −0.29 (95% confidence interval: −0.34 to −0.25)) and women (standardized regression coefficients ranged from −0.18 (95% confidence interval: −0.25 to −0.11) to −0.27 (95% confidence interval: −0.41 to −0.13)). Multiple linear regression analyses showed a significant contribution of changes in the DQ index to the variation in some CMR variables, independent from changes in physical activity level and cardiorespiratory fitness. This study provides evidence that targeting DQ at the workplace is relevant to improve cardiometabolic health.
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10
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Chua SYL, Luben RN, Hayat S, Broadway DC, Khaw KT, Warwick A, Britten A, Day AC, Strouthidis N, Patel PJ, Khaw PT, Foster PJ, Khawaja AP. Alcohol Consumption and Incident Cataract Surgery in Two Large UK Cohorts. Ophthalmology 2021; 128:837-847. [PMID: 33571551 PMCID: PMC8162662 DOI: 10.1016/j.ophtha.2021.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose To examine the association of alcohol consumption and type of alcoholic beverage with incident cataract surgery in 2 large cohorts. Design Longitudinal, observational study. Participants We included 469 387 participants of UK Biobank with a mean age of 56 years and 23 162 participants of European Prospective Investigation of Cancer (EPIC)-Norfolk with a mean age of 59 years. Methods Self-reported alcohol consumption at baseline was ascertained by a touchscreen questionnaire in UK Biobank and a food-frequency questionnaire in EPIC-Norfolk. Cases were defined as participants undergoing cataract surgery in either eye as ascertained via data linkage to National Health Service procedure statistics. We excluded participants with cataract surgery up to 1 year after the baseline assessment visit or those with self-reported cataract at baseline. Cox proportional hazards models were used to examine the associations of alcohol consumption with incident cataract surgery, adjusted for age, sex, ethnicity, Townsend deprivation index, body mass index (BMI), smoking, and diabetes status. Main Outcome Measures Incident cataract surgery. Results There were 19 011 (mean cohort follow-up of 95 months) and 4573 (mean cohort follow-up of 193 months) incident cases of cataract surgery in UK Biobank and EPIC-Norfolk, respectively. Compared with nondrinkers, drinkers were less likely to undergo cataract surgery in UK Biobank (hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.85–0.93) and EPIC-Norfolk (HR, 0.90; 95% CI, 0.84–0.97) after adjusting for covariables. Among alcohol consumers, greater alcohol consumption was associated with a reduced risk of undergoing cataract surgery in EPIC-Norfolk (P < 0.001), whereas a U-shaped association was observed in the UK Biobank. Compared with nondrinkers, subgroup analysis by type of alcohol beverage showed the strongest protective association with wine consumption; the risk of incident cataract surgery was 23% and 14% lower among those in the highest category of wine consumption in EPIC-Norfolk and UK Biobank, respectively. Conclusions Our findings suggest a lower risk of undergoing cataract surgery with low to moderate alcohol consumption. The association was particularly apparent with wine consumption. We cannot exclude the possibility of residual confounding, and further studies are required to determine whether this association is causal in nature.
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Affiliation(s)
- Sharon Y L Chua
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom.
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Shabina Hayat
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - David C Broadway
- Department of Ophthalmology, Norfolk & Norwich University Hospital, Norwich, United Kingdom
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | | | - Abigail Britten
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Alexander C Day
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - Nicholas Strouthidis
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - Praveen J Patel
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - Peng T Khaw
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - Paul J Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - Anthony P Khawaja
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom; Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
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11
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Mulligan AA, Hayhoe RPG, Luben RN, Welch AA. Positive Associations of Dietary Intake and Plasma Concentrations of Vitamin E with Skeletal Muscle Mass, Heel Bone Ultrasound Attenuation and Fracture Risk in the EPIC-Norfolk Cohort. Antioxidants (Basel) 2021; 10:antiox10020159. [PMID: 33499166 PMCID: PMC7911901 DOI: 10.3390/antiox10020159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 02/02/2023] Open
Abstract
The prevalence of sarcopenia, frailty and fractures is increasing. Prevention options are limited, but dietary factors including vitamin E have the potential to confer some protection. This study investigated cross-sectional associations between dietary and plasma concentrations of vitamin E with indices of skeletal muscle mass (SMM) (n = 14,179 and 4283, respectively) and bone density (n = 14,694 and 4457, respectively) and longitudinal fracture risk (n = 25,223 and 7291, respectively) in European Prospective Investigation Into Cancer and Nutrition (EPIC)-Norfolk participants, aged 39-79 years at baseline. Participants completed a health and lifestyle questionnaire, a 7-day diet diary (7dDD) and had anthropometric measurements taken. Fat-free mass (as a SMM proxy) was measured using bioimpedance and bone density was measured using calcaneal broadband ultrasound attenuation (BUA) and incident fractures over 18.5 years of follow-up. Associations between indices of SMM, BUA and fracture risk were investigated by quintiles of dietary vitamin E intake or plasma concentrations. Positive trends in SMM indices and BUA were apparent across dietary quintiles for both sexes, with interquintile differences of 0.88%-1.91% (p < 0.001), and protective trends for total and hip fracture risk. Circulating plasma α- and γ-tocopherol results matched the overall dietary findings. Dietary vitamin E may be important for musculoskeletal health but further investigation is required to fully understand the relationships of plasma tocopherols.
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Affiliation(s)
- Angela A. Mulligan
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridgeshire CB1 8RN, UK;
- NIHR BRC Diet, Anthropometry and Physical Activity Group, MRC Epidemiology Unit, University of Cambridge, Cambridgeshire CB2 0AH, UK
- Correspondence: or
| | - Richard P. G. Hayhoe
- Department of Epidemiology and Public Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (R.P.G.H.); (A.A.W.)
| | - Robert N. Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridgeshire CB1 8RN, UK;
| | - Ailsa A. Welch
- Department of Epidemiology and Public Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (R.P.G.H.); (A.A.W.)
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12
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Bahls M, Ittermann T, Ewert R, Stubbe B, Völzke H, Friedrich N, Felix SB, Dörr M. Physical activity and cardiorespiratory fitness-A ten-year follow-up. Scand J Med Sci Sports 2020; 31:742-751. [PMID: 33205518 DOI: 10.1111/sms.13882] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/21/2020] [Accepted: 11/15/2020] [Indexed: 12/29/2022]
Abstract
Physical activity (PA) may influence cardiorespiratory fitness (CRF). Yet, PA takes place in different domains (i.e., sports-related physical activity [SPA], leisure time related physical activity [LTPA], and work-related physical activity [WPA]) and not all domain-specific PA may help to maintain high CRF levels throughout life. We assessed the relationship between changes in domain-specific PA and the age-related decline in CRF. We analyzed data of 353 men (median age 50 years; inter-quartile range [IQR] 40 to 60) and 335 women (median age 50 years; IQR 41 to 59) with data for domain-specific PA as well as CRF testing measured ten years apart. CRF was assessed with cardiorespiratory exercise testing. Domain-specific PA was measured using the Baecke questionnaire. During the 10-year follow-up, CRF decreased in men from 29.3 (IQR 25.0 to 34.7) mL/min/kg to 24.3 (IQR 20.8 to 27.3) mL/min/kg. In women, CRF declined from 26.0 (IQR 21.0 to 30.9) to 21.4 (IQR 18.3 to 25.6) mL/min/kg. A one point higher SPA at baseline was related to a 1.14 (95% confidence interval [CI] -1.50 to -0.53) mL/min/kg greater decrease in VO2peak . A one point greater SPA and LTPA over time was associated with a 1.68 (95% CI 1.06 to 2.29) mL/min/kg and 1.24 (95% CI 0.57 to 1.90) mL/min/kg lower decrease in VO2peak , respectively. Neither baseline values nor changes of WPA were associated with CRF. Sports and leisure time related PA may attenuate the age-related decline in CRF.
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Affiliation(s)
- Martin Bahls
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Till Ittermann
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ralf Ewert
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Beate Stubbe
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Nele Friedrich
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
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13
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Lapointe A, Laramée C, Belanger-Gravel A, Buckeridge DL, Desroches S, Garriguet D, Gauvin L, Lemieux S, Plante C, Lamarche B. NutriQuébec: a unique web-based prospective cohort study to monitor the population's eating and other lifestyle behaviours in the province of Québec. BMJ Open 2020; 10:e039889. [PMID: 33115902 PMCID: PMC7594370 DOI: 10.1136/bmjopen-2020-039889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION The epidemic of non-communicable diseases including cardiovascular diseases and type 2 diabetes is attributable in large part to unhealthy eating and physical inactivity. In the fall of 2016, the Québec government launched its first-ever Government Health Prevention Policy (Politique gouvernementale de prévention en santé (PGPS)) to influence factors that lead to improved health status and quality of life as well as reduced social inequalities in health in the population of Québec. NutriQuébec is a web-based prospective open cohort study whose primary aim is to provide essential data for the evaluation of the PGPS on the Québec population's eating and other lifestyle behaviours over time. METHODS AND ANALYSIS Over a first phase of 3 years, NutriQuébec will enrol 20 000 adults living in the province of Québec in Canada through a multimedia campaign designed to reach different segments of the population, including subgroups with lower socioeconomic status. Participants will be invited to complete on a web platform nine core questionnaires on a yearly basis. Questionnaires will assess several dimensions related to lifestyle, including eating and physical activity behaviours, as well as a large number of personal characteristics and global health status. Temporal trends in eating and lifestyle behaviours will be analysed in relation to the implementation of the PGPS to provide essential data for its evaluation at a population level. Data analyses will use sociodemographic weights to adjust responses of participants to achieve, so far as is possible, representativeness of the adult Québec population. ETHICS AND DISSEMINATION Université Laval Research Ethics Board approved the NutriQuébec project. Data analysis, presentations in conferences and publication of manuscripts are scheduled to start in 2020. TRIAL REGISTRATION NUMBER NCT04140071.
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Affiliation(s)
- Annie Lapointe
- Centre NUTRISS, INAF, Université Laval, Quebec City, Quebec, Canada
| | | | - Ariane Belanger-Gravel
- Centre NUTRISS, INAF, Université Laval, Quebec City, Quebec, Canada
- Department of Information and Communication, Université Laval, Quebec city, Quebec, Canada
- Quebec Heart and Lung Institute, Quebec city, Quebec, Canada
| | - David L Buckeridge
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Sophie Desroches
- Centre NUTRISS, INAF, Université Laval, Quebec City, Quebec, Canada
- School of Nutrition, Université Laval, Quebec City, Quebec, Canada
| | - Didier Garriguet
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Lise Gauvin
- Centre de recherche du CHUM, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Simone Lemieux
- Centre NUTRISS, INAF, Université Laval, Quebec City, Quebec, Canada
- School of Nutrition, Université Laval, Quebec City, Quebec, Canada
| | - Céline Plante
- Institut national de santé publique du Québec, Quebec City, Quebec, Canada
| | - Benoit Lamarche
- Centre NUTRISS, INAF, Université Laval, Quebec City, Quebec, Canada
- School of Nutrition, Université Laval, Quebec City, Quebec, Canada
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14
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Luben R, Hayat S, Wareham N, Pharoah PP, Khaw KT. Sociodemographic and lifestyle predictors of incident hospital admissions with multimorbidity in a general population, 1999-2019: the EPIC-Norfolk cohort. BMJ Open 2020; 10:e042115. [PMID: 32963074 PMCID: PMC7509968 DOI: 10.1136/bmjopen-2020-042115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The ageing population and prevalence of long-term disorders with multimorbidity are a major health challenge worldwide. The associations between comorbid conditions and mortality risk are well established; however, few prospective community-based studies have reported on prior risk factors for incident hospital admissions with multimorbidity. We aimed to explore the independent associations for a range of demographic, lifestyle and physiological determinants and the likelihood of subsequent hospital incident multimorbidity. METHODS We examined incident hospital admissions with multimorbidity in 25 014 men and women aged 40-79 in a British prospective population-based study recruited in 1993-1997 and followed up until 2019. The determinants of incident multimorbidity, defined as Charlson Comorbidity Index ≥3, were investigated using multivariable logistic regression models for the 10-year period 1999-2009 and repeated with independent measurements in a second 10-year period 2009-2019. RESULTS Between 1999 and 2009, 18 179 participants (73% of the population) had a hospital admission. Baseline 5-year and 10-year incident multimorbidities were observed in 6% and 12% of participants, respectively. Age per 10-year increase (OR 2.19, 95% CI 2.06 to 2.33) and male sex (OR 1.32, 95% CI 1.19 to 1.47) predicted incident multimorbidity over 10 years. In the subset free of the most serious diseases at baseline, current smoking (OR 1.86, 95% CI 1.60 to 2.15), body mass index >30 kg/m² (OR 1.48, 95% CI 1.30 to 1.70) and physical inactivity (OR 1.16, 95% CI 1.04 to 1.29) were positively associated and plasma vitamin C (a biomarker of plant food intake) per SD increase (OR 0.86, 95% CI 0.81 to 0.91) inversely associated with incident 10-year multimorbidity after multivariable adjustment for age, sex, social class, education, alcohol consumption, systolic blood pressure and cholesterol. Results were similar when re-examined for a further time period in 2009-2019. CONCLUSION Age, male sex and potentially modifiable lifestyle behaviours including smoking, body mass index, physical inactivity and low fruit and vegetable intake were associated with increased risk of future incident hospital admissions with multimorbidity.
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Affiliation(s)
- Robert Luben
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Shabina Hayat
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Nicholas Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Paul P Pharoah
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Kay-Tee Khaw
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
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15
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Hayat SA, Luben R, Wareham N, Khaw KT, Brayne C. Cross-sectional and prospective relationship between occupational and leisure-time inactivity and cognitive function in an ageing population: the European Prospective Investigation into Cancer and Nutrition in Norfolk (EPIC-Norfolk) study. Int J Epidemiol 2020; 49:1338-1352. [PMID: 32629466 PMCID: PMC7660150 DOI: 10.1093/ije/dyaa067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The current evidence for higher physical activity and better cognitive function and lower risk of dementia is strong but not conclusive. More robust evidence is needed to inform public-health policy. We provide further insight into discrepancies observed across studies, reporting on habitual inactivity including that during work. METHODS We examined cross-sectional and prospective relationships of physical inactivity during leisure and occupation time, with cognitive performance using a validated physical-activity index in a cohort of 8585 men and women aged 40-79 years at baseline (1993-1997) for different domains using a range of cognitive measures. Cognitive testing was conducted between 2006 and 2011 (including a pilot phase 2004-2006). Associations were examined using multinomial logistic-regression adjusting for socio-demographic and health variables as well total habitual physical activity. RESULTS Inactivity during work was inversely associated with poor cognitive performance (bottom 10th percentile of a composite cognition score): odds ratio (OR) = 0.68 [95% confidence interval (CI) 0.54, 0.86], P = 0.001. Results were similar cross-sectionally: OR = 0.65 (95% CI 0.45, 0.93), P = 0.02. Manual workers had increased risk of poor performance compared with those with an occupation classified as inactive. Inactivity during leisure time was associated with increased risk of poor performance in the cross-sectional analyses only. CONCLUSIONS The relationship between inactivity and cognition is strongly confounded by education, social class and occupation. Physical activity during leisure may be protective for cognition, but work-related physical activity is not protective. A greater understanding of the mechanisms and confounding underlying these paradoxical findings is needed.
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Affiliation(s)
- Shabina A Hayat
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Robert Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
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16
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Luben R, Hayat S, Wareham N, Pharoah P, Khaw KT. Usual physical activity and subsequent hospital usage over 20 years in a general population: the EPIC-Norfolk cohort. BMC Geriatr 2020; 20:165. [PMID: 32375672 PMCID: PMC7204050 DOI: 10.1186/s12877-020-01573-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/29/2020] [Indexed: 11/28/2022] Open
Abstract
Background While physical activity interventions have been reported to reduce hospital stays, it is not clear if, in the general population, usual physical activity patterns may be associated with subsequent hospital use independently of other lifestyle factors. Objective We examined the relationship between reported usual physical activity and subsequent admissions to hospital and time spent in hospital for 11,228 men and 13,786 women aged 40–79 years in the general population. Methods Participants from a British prospective population-based cohort study were followed for 20 years (1999–2019) using record linkage to document hospital usage. Total physical activity was estimated by combining workplace and leisure time activity reported in a baseline lifestyle questionnaire and repeated in a subset at a second time point approximately 12 years later. Results Compared to those reporting no physical activity, participants who were the most active had a lower likelihood of spending more than 20 days in hospital odds ratio (OR) 0.88 (95% confidence interval (CI) 0.81–0.96) over the next 20 years after multivariable adjustment for age, sex, smoking status, education, social class and body mass index. Participants reporting any activity had a mean of 0.42 fewer hospital days per year between 1999 and 2009 compared to inactive participants, an estimated potential saving to the National Health Service (NHS) of £247 per person per year, or approximately 7% of UK health expenditure. Participants who remained physically active or became active 12 years later had lower risk of subsequent hospital usage than those who remained inactive or became inactive, p-trend < 0.001. Conclusion Usual physical activity in this middle-aged and older population predicts lower future hospitalisations - time spent in hospital and number of admissions independently of behavioural and sociodemographic factors. Small feasible differences in usual physical activity in the general population may potentially have a substantial impact on hospital usage and costs.
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Affiliation(s)
- Robert Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Shabina Hayat
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Nicholas Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Paul Pharoah
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
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Le TT, Bryant JA, Ang BWY, Pua CJ, Su B, Ho PY, Lim S, Huang W, Lee PT, Tang HC, Chin CT, Tan BY, Cook SA, Chin CWL. The application of exercise stress cardiovascular magnetic resonance in patients with suspected dilated cardiomyopathy. J Cardiovasc Magn Reson 2020; 22:10. [PMID: 32008575 PMCID: PMC6996168 DOI: 10.1186/s12968-020-0598-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 01/05/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The imaging features of dilated cardiomyopathy (DCM) overlap with physiological exercise-induced cardiac remodeling in active and otherwise healthy individuals. Distinguishing the two conditions is challenging. This study examined the diagnostic and prognostic roles of exercise stress imaging in asymptomatic patients with suspected DCM. METHODS Exercise stress cardiovascular magnetic resonance (CMR) was performed in 60 asymptomatic patients with suspected DCM (dilated left ventricle and/or impaired systolic function on CMR), who also underwent DNA sequencing for DCM-causing genetic variants. Confirmed DCM was defined as genotype- and phenotype-positive (G+P+). Another 100 healthy subjects were recruited to establish normal exercise capacities (peak exercise cardiac index; PeakCI). The primary outcome was a composite of all-cause mortality, cardiac decompensation and ventricular arrhythmic events. RESULTS No patients with confirmed G+P+ DCM had PeakCI exceeding the 35th percentile specific for age and sex. Applying this threshold in G-P+ patients, those with PeakCI below 35th percentile had characteristics similar to confirmed DCM while patients with higher PeakCI were younger, more active and higher longitudinal strain. Adverse cardiovascular events occurred only in patients with low exercise capacity (P = 0.004). CONCLUSIONS In individuals with suspected DCM, exercise stress CMR demonstrates diagnostic and prognostic potential in distinguishing between pathological DCM and physiological exercise-induced cardiac remodeling.
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Affiliation(s)
- Thu-Thao Le
- National Heart Research Institute Singapore, National Heart Center Singapore, 5 Hospital Drive, Singapore, Singapore
- Cardiovascular Sciences ACP, Duke NUS Medical School, Singapore, Singapore
| | - Jennifer Ann Bryant
- National Heart Research Institute Singapore, National Heart Center Singapore, 5 Hospital Drive, Singapore, Singapore
| | - Briana Wei Yin Ang
- National Heart Research Institute Singapore, National Heart Center Singapore, 5 Hospital Drive, Singapore, Singapore
| | - Chee Jian Pua
- National Heart Research Institute Singapore, National Heart Center Singapore, 5 Hospital Drive, Singapore, Singapore
| | - Boyang Su
- National Heart Research Institute Singapore, National Heart Center Singapore, 5 Hospital Drive, Singapore, Singapore
| | - Pei Yi Ho
- National Heart Research Institute Singapore, National Heart Center Singapore, 5 Hospital Drive, Singapore, Singapore
| | - Shiqi Lim
- National Heart Research Institute Singapore, National Heart Center Singapore, 5 Hospital Drive, Singapore, Singapore
| | - Weiting Huang
- Cardiovascular Sciences ACP, Duke NUS Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Phong Teck Lee
- Cardiovascular Sciences ACP, Duke NUS Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Hak Chiaw Tang
- Cardiovascular Sciences ACP, Duke NUS Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Chee Tang Chin
- Cardiovascular Sciences ACP, Duke NUS Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Boon Yew Tan
- Cardiovascular Sciences ACP, Duke NUS Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
| | - Stuart Alexander Cook
- National Heart Research Institute Singapore, National Heart Center Singapore, 5 Hospital Drive, Singapore, Singapore
- Cardiovascular Sciences ACP, Duke NUS Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
- National Heart and Lung Institute, Imperial College, London, UK
| | - Calvin Woon-Loong Chin
- National Heart Research Institute Singapore, National Heart Center Singapore, 5 Hospital Drive, Singapore, Singapore
- Cardiovascular Sciences ACP, Duke NUS Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Center Singapore, Singapore, Singapore
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18
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Residential neighbourhood greenspace is associated with reduced risk of cardiovascular disease: A prospective cohort study. PLoS One 2020; 15:e0226524. [PMID: 31899764 PMCID: PMC6941810 DOI: 10.1371/journal.pone.0226524] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/26/2019] [Indexed: 11/19/2022] Open
Abstract
Background Living in a greener neighbourhood may reduce the risk of developing incident cardiovascular disease, but evidence is limited by reliance on cross-sectional comparisons. We use data from a longitudinal study with a time-independent measure of risk to explore the association between exposure to greenspace and cardiovascular disease. Methods Data was from the European Prospective Investigation of Cancer Norfolk UK cohort, baseline 1993–1997 (n = 24,420). Neighbourhoods were defined as 800m radius zones around participants’ home, according to their home postcode (zip code) in the year 2000. Greenspace exposure was identified using classified satellite imagery. Adjusted Cox proportional hazards regression examined associations between greenspace and incident cardiovascular disease. Mediation analysis assessed if physical activity mediated associations, whilst modification by rurality, socio-economic status and age was explored. Results The mean age of participants was 59.2 years at baseline, 54.7% were female, and mean follow-up time was 14.5 years. Individuals living in the greenest neighbourhood quartile had a 7% lower relative hazard of developing cardiovascular disease than other neighbourhoods (HR 0.93; 95% CI 0.88, 0.97; p = 0.003) after adjusting for age, sex, BMI, prevalent diabetes and socio-economic status (SES). Physical activity did not mediate the relationship (greenest compared to the least green quartile HR 0.99; 95% CI 0.97, 1.01; p = 0.416). Models predicted incidence of cardiovascular disease in the least green neighbourhoods (19.4% greenspace on average) would fall by 4.8% (95% CI 1.6%, 8.2% p = 0.003) if they were as green as the average neighbourhood (59.0% greenspace). Occupation moderated the relationship, whereby exposure to greenspace was not associated with incident CVD for participants engaged in manual occupations. Conclusions Greener home neighbourhoods may protect against risk of cardiovascular disease even after accounting for SES, whilst the mechanism does not appear to be strongly associated with physical activity. Putative causal mechanisms require investigation.
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Mulligan AA, Lentjes MAH, Luben RN, Wareham NJ, Khaw KT. Changes in waist circumference and risk of all-cause and CVD mortality: results from the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) cohort study. BMC Cardiovasc Disord 2019; 19:238. [PMID: 31660867 PMCID: PMC6819575 DOI: 10.1186/s12872-019-1223-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/10/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Measures of abdominal adiposity are strongly associated with all-cause mortality and cardiovascular disease (CVD). However, data are limited and conflicting regarding the consequences of changes in body fat distribution. The main aims of this paper are to investigate the association between changes in waist circumference (WC) and all-cause and CVD mortality and to examine these changes in relation to concurrent changes in weight. METHODS The European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) study recruited 25,639 participants between 1993 and 1997, aged 39-79, a number of whom also attended a second examination (1998-2000), and were followed up to 2016 for mortality. Participants were eligible for inclusion if they had WC, weight and height measurements at both time-points; those with a self-reported history of CVD or cancer, body mass index < 18.5 kg/m2 or missing data on covariates were excluded, leaving 12,337 participants for analyses. The median (IQR) follow-up time was 16.4 (15.7, 17.2) years. Hazard Ratios (HRs) for all-cause (2866 deaths) and CVD mortality (822 deaths), by categories of WC change, were determined using Cox proportional hazards analyses. RESULTS After multivariable adjustment, the HRs (95% CIs) for all-cause mortality for men and women with a WC gain (WCG) > 5 cm were 1.51 (1.29-1.75) and 1.25 (1.06-1.46) respectively. For CVD mortality in men and women with a WCG > 5 cm, the HRs were 1.84 (1.39-2.43) and 1.15 (0.85-1.55) respectively. In analyses of concurrent changes in WC and weight, the greatest risk (HRs) (95% CIs) in men occurred with weight loss and WCG: 1.80 (1.13-2.86) for all-cause and 2.22 (1.03-4.82) for CVD mortality. In women, the greatest risk for both all-cause (HR 1.50 (1.16-1.95)) and CVD mortality (HR 1.81 (1.15-2.85)) was observed in those with weight loss and maintenance of WC (WCM). CONCLUSIONS Objectively measured WCG > 5 cm, was associated with subsequent higher total mortality risk and higher CVD mortality risk in men. Interventions focusing on preventing increase in central adiposity rather than lowering weight per se in later life may potentially have greater health benefits.
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Affiliation(s)
- Angela A. Mulligan
- European Prospective Investigation into Cancer and Nutrition, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Worts Causeway, Cambridge, UK
- European Prospective Investigation into Cancer and Nutrition, MRC Epidemiology Unit, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Marleen A. H. Lentjes
- European Prospective Investigation into Cancer and Nutrition, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Worts Causeway, Cambridge, UK
| | - Robert N. Luben
- European Prospective Investigation into Cancer and Nutrition, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Worts Causeway, Cambridge, UK
| | - Nicholas J. Wareham
- European Prospective Investigation into Cancer and Nutrition, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Worts Causeway, Cambridge, UK
- MRC Epidemiology Unit, Cambridge, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Kay-Tee Khaw
- European Prospective Investigation into Cancer and Nutrition, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Worts Causeway, Cambridge, UK
- EPIC, Department of Gerontology, Addenbrooke’s Hospital, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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20
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Côté CE, Rhéaume C, Poirier P, Després JP, Alméras N. Deteriorated Cardiometabolic Risk Profile in Individuals With Excessive Blood Pressure Response to Submaximal Exercise. Am J Hypertens 2019; 32:945-952. [PMID: 31136645 DOI: 10.1093/ajh/hpz087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/19/2018] [Accepted: 05/27/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early identification of individuals at increased cardiometabolic risk is an essential step to improve primary preventive interventions. Excessive maximal exercise blood pressure (EBP) has been associated with several adverse outcomes. We examined how submaximal EBP could help us to identify individuals with a deteriorated cardiometabolic risk profile. METHODS Data from an observational study of 3,913 participants from a convenience sample were used. Subjects included in the analyses completed a comprehensive cardiometabolic health assessment (resting blood pressure [BP]; waist circumference; lipid profile; HbA1c; submaximal treadmill exercise test including a standardized stage [3.5 mph and 2% slope] with BP and heart rate measurements). Participants were classified on BP response at the standardized stage (Normal or Excessive Response). Excessive response was defined as systolic BP ≥ 80th percentile or diastolic BP ≥ 90 mmHg. Subjects were also classified into five resting BP subgroups according to current guidelines. RESULTS The Excessive Response group had more deteriorated cardiometabolic and cardiorespiratory profiles than the Normal Response group (P ≤ 0.01). The Excessive Response group also showed a greater proportion of carriers of the hypertriglyceridemic waist phenotype in most resting BP subgroups (P ≤ 0.05). Finally, excessive BP response to submaximal exercise showed an independent contribution on cardiometabolic and cardiorespiratory factors beyond age, sex, and resting BP. CONCLUSIONS This study demonstrates that an excessive BP response to a submaximal exercise is associated with a deteriorated cardiometabolic risk profile beyond resting BP profile. Therefore, submaximal EBP represents a simple screening tool to better identify at-risk individuals requiring aggressive preventive lifestyle interventions.
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Affiliation(s)
- Charles-Emanuel Côté
- Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, QC, Canada
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Caroline Rhéaume
- Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, QC, Canada
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, QC, Canada
- Faculty of Pharmacy, Université Laval, QC, Canada
| | - Jean-Pierre Després
- Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, QC, Canada
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Natalie Alméras
- Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, QC, Canada
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada
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21
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Abstract
OBJECTIVE To assess the prospective associations of baseline and long term trajectories of physical activity on mortality from all causes, cardiovascular disease, and cancer. DESIGN Population based cohort study. SETTING Adults from the general population in the UK. PARTICIPANTS 14 599 men and women (aged 40 to 79) from the European Prospective Investigation into Cancer and Nutrition-Norfolk cohort, assessed at baseline (1993 to 1997) up to 2004 for lifestyle and other risk factors; then followed to 2016 for mortality (median of 12.5 years of follow-up, after the last exposure assessment). MAIN EXPOSURE Physical activity energy expenditure (PAEE) derived from questionnaires, calibrated against combined movement and heart rate monitoring. MAIN OUTCOME MEASURES Mortality from all causes, cardiovascular disease, and cancer. Multivariable proportional hazards regression models were adjusted for age, sex, sociodemographics, and changes in medical history, overall diet quality, body mass index, blood pressure, triglycerides, and cholesterol levels. RESULTS During 171 277 person years of follow-up, 3148 deaths occurred. Long term increases in PAEE were inversely associated with mortality, independent of baseline PAEE. For each 1 kJ/kg/day per year increase in PAEE (equivalent to a trajectory of being inactive at baseline and gradually, over five years, meeting the World Health Organization minimum physical activity guidelines of 150 minutes/week of moderate-intensity physical activity), hazard ratios were: 0.76 (95% confidence interval 0.71 to 0.82) for all cause mortality, 0.71 (0.62 to 0.82) for cardiovascular disease mortality, and 0.89 (0.79 to 0.99) for cancer mortality, adjusted for baseline PAEE, and established risk factors. Similar results were observed when analyses were stratified by medical history of cardiovascular disease and cancer. Joint analyses with baseline and trajectories of physical activity show that, compared with consistently inactive individuals, those with increasing physical activity trajectories over time experienced lower risks of mortality from all causes, with hazard ratios of 0.76 (0.65 to 0.88), 0.62 (0.53 to 0.72), and 0.58 (0.43 to 0.78) at low, medium, and high baseline physical activity, respectively. At the population level, meeting and maintaining at least the minimum physical activity recommendations would potentially prevent 46% of deaths associated with physical inactivity. CONCLUSIONS Middle aged and older adults, including those with cardiovascular disease and cancer, can gain substantial longevity benefits by becoming more physically active, irrespective of past physical activity levels and established risk factors. Considerable population health impacts can be attained with consistent engagement in physical activity during mid to late life.
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Affiliation(s)
- Alexander Mok
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Robert Luben
- Department of Public Health and Primary Care, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
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22
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Abstract
High overall nutritional quality (NQ) is an important component of ideal cardiovascular health, a concept introduced in 2010 by the American Heart Association. However, data on the independent contribution of overall NQ to the variation in the cardiometabolic risk (CMR) profile are limited. This observational study aimed to investigate the association between overall NQ and the CMR profile in 4785 participants (65⋅4 % of men, age 43⋅3 (sd 10⋅8) years) who underwent a cardiometabolic health evaluation, including lifestyle habits, anthropometric measurements, blood pressure, lipid profile and HbA1c concentrations. In addition, a submaximal exercise test was conducted to assess cardiorespiratory fitness (CRF). Using a standardised NQ questionnaire (twenty-five items food-based questionnaire), participants were classified into three subgroups: (1) low, (2) moderate or (3) high NQ and variance and multiple linear regression analyses were performed. Results showed that less than 15 % of participants presented a high NQ. A high NQ was associated with a healthier lifestyle habits and a more favourable CMR profile (lower values of waist circumference and cholesterol:HDL-cholesterol ratio, lower concentrations of non-HDL-cholesterol, TAG and HbA1c). Some of these associations were independent of age, physical activity level (PAL) and CRF. A better NQ was also associated with a lower proportion of participants presenting the hypertriacylglycerolaemic waist phenotype independently of both PAL and CRF. The present study suggests that overall NQ can be assessed with a short food-based questionnaire and should be considered in clinical practice as a new 'vital sign' associated with other health behaviours and cardiometabolic health.
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23
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Ferrario MM, Veronesi G, Roncaioli M, Holtermann A, Krause N, Clays E, Borchini R, Grassi G, Cesana G. Exploring the interplay between job strain and different domains of physical activity on the incidence of coronary heart disease in adult men. Eur J Prev Cardiol 2019; 26:1877-1885. [PMID: 31109187 DOI: 10.1177/2047487319852186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS The aim of this study was to investigate the independent associations of occupational (OPA) and sport physical activity (SpPA) and job strain on the incidence of coronary heart disease (CHD) events, and to explore their interplay. METHODS The study sample included 3310 25-64-year-old employed men, free of CHD at baseline, recruited in three population-based and one factory-based cohorts. OPA and SpPA, and job strain were assessed by the Baecke and the Job Content Questionnaires, respectively. We estimated the associations between different domains of physical activity and job strain with CHD, adjusting for major risk factors using Cox models. RESULTS During follow-up (median=14 years), 120 CHD events, fatal and non-fatal, occurred. In the entire sample, a higher CHD risk was found for high job strain (hazard ratio=1.55, 95% confidence interval: 1.05-2.31). The joint effect of low OPA and high job strain was estimated as a hazard ratio of 2.53 (1.29-4.97; reference intermediate OPA with non-high strain). With respect to intermediate OPA workers, in stratified analysis when SpPA is none, low OPA workers had a hazard ratio of 2.13 (95% confidence interval: 1.19-3.81), increased to 3.95 (1.79-8.78) by the presence of high job strain. Low OPA-high job strain workers take great advantage from SpPA, reducing their risk up to 90%. In contrast, the protective effect of SpPA on CHD in other OPA-job strain categories was modest or even absent, in particular when OPA is high. CONCLUSIONS Our study shows a protective effect of recommended and intermediate SpPA levels on CHD risk among sedentary male workers. When workers are jointly exposed to high job strain and sedentary work their risk further increases, but this group benefits most from regular sport physical activity.
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Affiliation(s)
- Marco M Ferrario
- Research Centre in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, School of Medicine, University of Insubria at Varese, Italy.,Occupational Medicine Unit, University Hospital of Varese, Italy
| | - Giovanni Veronesi
- Research Centre in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, School of Medicine, University of Insubria at Varese, Italy
| | - Mattia Roncaioli
- School of Occupational Medicine, University of Insubria at Varese, Italy
| | - Andreas Holtermann
- The National Research Centre for Work Environment, Copenhagen, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Niklas Krause
- Department of Environmental Health Sciences and Department of Epidemiology, Fielding School of Public Health, and Southern California NIOSH Education and Research Center, University of California Los Angeles, USA
| | - Els Clays
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Rossana Borchini
- Research Centre in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, School of Medicine, University of Insubria at Varese, Italy.,Occupational Medicine Unit, University Hospital of Varese, Italy
| | - Guido Grassi
- Clinic Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giancarlo Cesana
- Research Centre on Public Health, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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24
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Mikkola TM, von Bonsdorff MB, Salonen MK, Kautiainen H, Ala-Mursula L, Solovieva S, Viikari-Juntura E, Eriksson JG. Physical heaviness of work and sitting at work as predictors of mortality: a 26-year follow-up of the Helsinki Birth Cohort Study. BMJ Open 2019; 9:e026280. [PMID: 31101697 PMCID: PMC6530310 DOI: 10.1136/bmjopen-2018-026280] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To examine the relationships of late-career physical heaviness of work and sitting at work with mortality. A national-level job exposure matrix was used to determine the occupation-specific level of physical heaviness and sitting. DESIGN Prospective cohort study between years 1990 and 2015. SETTING Community. PARTICIPANTS 5210 men and 4725 women from the Helsinki Birth Cohort Study with an occupational code at baseline (ages 45-57 years). PRIMARY AND SECONDARY OUTCOME MEASURES Total, cardiovascular (International Classification of Diseases 10th Revision I00-I99), cancer (C00-C97) and external (S00-Y84) mortality. RESULTS The exposures, physical heaviness and sitting had a non-linear, inverse relationship. During the 26-year follow-up, 1536 men and 759 women died. Among men, physical heaviness of work was positively associated and sitting at work was negatively associated with all-cause, cardiovascular and external cause mortality but they were not associated with cancer mortality. The HRs for men in the highest quartile of physical heaviness of work compared with men in the lowest quartile were 1.54 (1.31-1.80) for all-cause mortality, 1.70 (1.30-2.23) for cardiovascular mortality and 3.18 (1.75-5.78) for external cause mortality (adjusted for age and years of education). Compared with the lowest quartile, the HRs for the highest quartile of sitting at work among men were 0.71 (0.61-0.82) for all-cause mortality, 0.59 (0.45-0.77) for cardiovascular mortality and 0.38 (0.22-0.66) for external cause mortality. In women, neither physical heaviness of work nor sitting at work was associated with mortality. CONCLUSIONS Men in physically heavy work at their late-work career are at higher risk of death than men in physically light work.
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Affiliation(s)
| | - Mikaela B von Bonsdorff
- Folkhälsan Research Center, Helsinki, Finland
- Gerontology Research Centre, Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
| | - Minna K Salonen
- Folkhälsan Research Center, Helsinki, Finland
- Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Leena Ala-Mursula
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | | | | | - Johan G Eriksson
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
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25
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Bahls M, Groß S, Baumeister SE, Völzke H, Gläser S, Ewert R, Markus MRP, Medenwald D, Kluttig A, Felix SB, Dörr M. Association of domain-specific physical activity and cardiorespiratory fitness with all-cause and cause-specific mortality in two population-based cohort studies. Sci Rep 2018; 8:16066. [PMID: 30375472 PMCID: PMC6207740 DOI: 10.1038/s41598-018-34468-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/18/2018] [Indexed: 12/03/2022] Open
Abstract
Physical activity (PA) reduces the risk for mortality. Whether the beneficial effects of PA are domain specific is unclear. We associated leisure time (LTPA), sports (SPA) and work (WPA) related PA and cardiorespiratory fitness (CRF) with all-cause mortality in two German population-based cohorts. We used data of the Study of Health in Pomerania (SHIP, n = 2,935, median age 53; 48% male) and the Cardiovascular Disease, Living and Ageing in Halle study (CARLA, n = 1,776, median age 64 and 54% male). Mortality was determined after a median follow-up of 8.2 years in SHIP (n = 332) and 11.5 years in CARLA (n = 409). LTPA (SHIP: hazard ratio [HR] per standard deviation [SD] 0.82 95%-CI 0.73 to 0.91 and CARLA: HR per SD 0.70: 95%-CI 0.59 to 0.82) and SPA (SHIP: HR per SD 0.80 95%-CI 0.71 to 0.91 and CARLA: HR per SD 0.70 95%-CI 0.60 to 0.82) but not WPA were inversely associated with all-cause mortality. In a subsample CRF was inversely related to mortality and positively to LTPA and sports SPA. No association was found for WPA. Our results may suggest that the inverse association between PA and mortality are partly influenced by higher CRF.
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Affiliation(s)
- Martin Bahls
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.
| | - Stefan Groß
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Sebastian E Baumeister
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany
| | - Henry Völzke
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.,Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | | | - Ralf Ewert
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Marcello R P Markus
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Daniel Medenwald
- Martin-Luther-Universität Halle-Wittenberg Institute of Medical Epidemiology, Biometry and Informatics, Halle (Saale), Germany
| | - Alexander Kluttig
- Martin-Luther-Universität Halle-Wittenberg Institute of Medical Epidemiology, Biometry and Informatics, Halle (Saale), Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
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26
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Poggio R, Melendi S, Gutierrez L, Elorriaga N, Irazola V. Occupational Physical Activity and Cardiovascular Risk Factors Profile in the Adult Population of the Southern Cone of Latin America: Results From the CESCAS I Study. J Occup Environ Med 2018; 60:e470-e475. [PMID: 30020215 DOI: 10.1097/jom.0000000000001398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We explore the association between occupational physical activity (OPA) and cardiovascular risk factors in four cities of the Southern Cone. METHODS Robust multivariable linear regression models were used to examine the associations. RESULTS The working population was constituted by 1868 men and 1672 women. Men performing high levels of OPA showed higher levels of high-density lipoprotein (HDL; mean adj. diff. = 2.24 mg/dL; P = 0.004), lower levels of triglycerides (-24.59 mg/dL; P = 0.006), and total cholesterol (TC)/HDL ratio values (-0.21; P = 0.015) than reference. Women in the highest category of OPA had higher levels of HDL (2.85 mg/dL; P = 0.006), lower TC/HDL (0.27; P = 0.001), and low-density lipoprotein/HDL ratios (-0.18; P = 0.003) than sedentary activities. CONCLUSION Individuals who performed high levels of OPA did not exhibit a worse cardiovascular risk profile and an improvement on selected biomarkers was observed when compared with those performing sedentary activities.
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Affiliation(s)
- Rosana Poggio
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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Di Benedetto L, Michels G, Luben R, Khaw KT, Pfister R. Individual and combined impact of lifestyle factors on atrial fibrillation in apparently healthy men and women: The EPIC-Norfolk prospective population study. Eur J Prev Cardiol 2018; 25:1374-1383. [DOI: 10.1177/2047487318782379] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Lifestyle factors are important targets for prevention. The cumulative impact of healthy lifestyle on atrial fibrillation in the population has not been quantified. Design Prospective population-based cohort study. Methods Four lifestyle factors (normal weight, currently not smoking, no or moderate alcohol intake, and physically not inactive) were assessed in apparently healthy 21,499 men and women aged 39–79 years participating in the EPIC study in Norfolk, UK. The age and sex-adjusted hazard (95% confidence interval) of hospital admission with a diagnosis of atrial fibrillation during an average follow-up of 17.1 years was examined for each factor separately and for a health score comprising factors with significant impact. Results Normal weight, currently not smoking and low alcohol intake were associated with a significantly lower risk of atrial fibrillation, whereas not being physically inactive showed no significant association. We used a score of one point each for not smoking, low alcohol intake and body mass index 25 to 27.5 kg/m2, and two points for body mass index < 25 kg/m2. Compared with men and women with four health points, hazard ratios of atrial fibrillation were 1.25 (1.11–1.41), 1.56 (1.39–1.75), 1.83 (1.56–2.16) and 2.82 (1.85–4.29) for participants with three, two, one and no health points, respectively ( p < 0.0001 for trend). Results were consistent by sex, age, education level, social class and after excluding participants with hypertension and diabetes. Conclusion Three lifestyle factors combined predict an almost 2.8-fold difference in the risk of atrial fibrillation in men and women.
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Affiliation(s)
- Laura Di Benedetto
- Department III of Internal Medicine, Heart Centre of the University of Cologne, Germany
| | - Guido Michels
- Department III of Internal Medicine, Heart Centre of the University of Cologne, Germany
| | - Robert Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, UK
| | - Roman Pfister
- Department III of Internal Medicine, Heart Centre of the University of Cologne, Germany
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Ferrario MM, Roncaioli M, Veronesi G, Holtermann A, Clays E, Borchini R, Cavicchiolo M, Grassi G, Cesana G. Differing associations for sport versus occupational physical activity and cardiovascular risk. Heart 2018; 104:1165-1172. [PMID: 29440185 DOI: 10.1136/heartjnl-2017-312594] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/28/2017] [Accepted: 01/05/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES We investigate the independent and interacting long-term associations of occupational physical activity (OPA) and sport physical activity (SpPA) with the incidence of coronary heart disease (CHD) and cardiovascular diseases (CVD; CHD plus ischaemic stroke) in North Italian male workers. METHODS 3574 employed men aged 25-64 years, free of CVD at baseline, recruited in three population-based and one factory-based cohorts, were included in the analysis. The Baecke Questionnaire was used to assess OPA and SpPA in 'minutes per week' of moderate or vigorous PA. We estimated the associations between different domains of PA and the endpoints, adjusting for major CVD risk factors, using Cox models. RESULTS During a median follow-up of 14 years, 135 and 174 first CHD and CVD events, fatal and non-fatal, occurred. Compared with the intermediate OPA tertile, the HRs for CHD among low and high OPA workers were 1.66 (95% CI 1.06 to 2.59) and 1.18 (0.72 to 1.94), respectively (P value=0.07). Decreasing trends in CHD and CVD rates across increasing levels of SpPA were also found, with an HR for CVD of 0.68 (0.46 to 0.98) for intermediate/recommended SpPA compared with poor SpPA. We also found a statistically significant SpPA-OPA interaction, and the protective effect of SpPA was only found among sedentary workers, for both endpoints. Conversely, high OPA workers with intermediate/recommended SpPA levels had increased CHD and CVD rates compared with the poor SpPA category. CONCLUSIONS Our results provide further evidence on the health paradox of OPA, with higher CVD rates among workers with intense PA at work. Moreover, the protective effect on CVDs of SpPA is prominent in sedentary workers, but it attenuates and even reverses in moderate and strenuous OPA workers.
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Affiliation(s)
- Marco Mario Ferrario
- Department of Medicine and Surgery, School of Medicine, Research Center in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy.,Occupational Medicine Unit, University hospital of Varese, Varese, Italy.,School of Occupational Medicine, University of Insubria, Varese, Italy
| | - Mattia Roncaioli
- School of Occupational Medicine, University of Insubria, Varese, Italy
| | - Giovanni Veronesi
- Department of Medicine and Surgery, School of Medicine, Research Center in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
| | - Andreas Holtermann
- The National Research Centre for the Working Environment, Copenhagen, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Els Clays
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Rossana Borchini
- Occupational Medicine Unit, University hospital of Varese, Varese, Italy
| | - Marco Cavicchiolo
- Department of Medicine and Surgery, School of Medicine, Research Center in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,IRCCS Multimedica, Sesto San Giovanni, Italy
| | - Giancarlo Cesana
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Lachman S, Boekholdt SM, Luben RN, Sharp SJ, Brage S, Khaw KT, Peters RJG, Wareham NJ. Impact of physical activity on the risk of cardiovascular disease in middle-aged and older adults: EPIC Norfolk prospective population study. Eur J Prev Cardiol 2018; 25:200-208. [PMID: 29161890 PMCID: PMC5757406 DOI: 10.1177/2047487317737628] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 09/27/2017] [Indexed: 12/02/2022]
Abstract
Background There is broad consensus that regular physical activity yields major health benefits. However, current guidelines on physical activity are mainly aimed at middle-aged adults. It is unclear whether physical activity also translates into cardiovascular health benefits in older adults. Therefore, we aimed to compare the association between different levels of physical activity and the risk of cardiovascular disease (CVD) in elderly to middle-aged individuals. Methods We analysed data from the EPIC Norfolk prospective population study. Cox proportional hazards models were used to analyse the association between physical activity levels and time to CVD events in three age categories (<55, 55-65 and >65 years). Interaction between age categories and physical activity levels was assessed. Results Analyses were based on 24,502 study participants aged 39-79 years. A total of 5240 CVD events occurred during 412,954 person-years follow-up (median follow-up was 18.0 years). Among individuals aged over 65 years, hazard ratios for CVD were 0.86 (95% confidence interval (CI) 0.78-0.96), 0.87 (95% CI 0.77-0.99) and 0.88 (95% CI 0.77-1.02) in moderately inactive, moderately active and active people, respectively, compared to inactive people. Among people aged 55-65 and less than 55 years, the associations were directionally similar, but not statistically significant. The interaction term between physical activity levels and age categories was not significant ( P = 0.38). Conclusion The inverse association between physical activity and the risk of CVD was significant in elderly and comparable with middle-aged individuals. In addition, we observed that modest levels of physical activity confer benefits in terms of CVD risk, compared to being completely inactive.
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Affiliation(s)
- Sangeeta Lachman
- Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
| | | | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Soren Brage
- Medical Research Council Epidemiology Unit, Cambridge, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ron JG Peters
- Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
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Keevil VL, Luben R, Hayat S, Sayer AA, Wareham NJ, Khaw KT. Physical capability predicts mortality in late mid-life as well as in old age: Findings from a large British cohort study. Arch Gerontol Geriatr 2018; 74:77-82. [PMID: 29040888 PMCID: PMC5701965 DOI: 10.1016/j.archger.2017.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 09/27/2017] [Accepted: 10/02/2017] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Low physical capability predicts mortality, perhaps by association with co-morbidity. However, few studies include participants <70years old with lower co-morbidity burdens compared to older adults. We examined relationships between usual walking speed (UWS), timed chair stands speed, grip strength, standing balance and all-cause mortality in 8477 participants aged 48-92years enrolled in the European Prospective Investigation of Cancer-Norfolk study. METHODS Participants (55.1% female) were followed up for 6.0 years (inter-quartile range 4.6, 7.5). Associations were examined using Cox proportional hazards regression by age-group (<70years versus ≥70years) and then in the whole cohort adjusted for age, sex, anthropometry, history of diabetes/stroke/myocardial infarction/cancer, smoking, alcohol intake, socioeconomic status, television viewing time and physical activity. RESULTS Age and sex adjusted associations were similar in younger and older participants (Pinteraction all >0.05) and those with lower physical capability had higher mortality risk. For example, in those <70years old hazard ratios (95% confidence interval) for mortality in the third, second and lowest sex-specific quartiles of UWS compared to the highest were 1.21 (0.75, 1.96), 2.11 (1.35, 3.28) and 2.91 (1.84, 4.62) and in participants ≥70years old were 1.19 (0.73, 1.95), 2.09 (1.35, 3.24) and 2.64 (1.73, 4.02) respectively. In the whole cohort, strong associations between all physical capability tests and mortality persisted after multivariable adjustment and after excluding participants with co-morbidity. CONCLUSIONS Physical capability was independently predictive of future mortality risk with similar associations in late mid-life, when co-morbidity burden is lower, as at older age.
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Affiliation(s)
- Victoria L Keevil
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge, CB1 8RN, UK; Medicine for Older People, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
| | - Robert Luben
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge, CB1 8RN, UK
| | - Shabina Hayat
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge, CB1 8RN, UK
| | - Avan A Sayer
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, UK; AGE Research Group, Institute of Neuroscience and Institute for Ageing, Newcastle University, UK
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge, CB1 8RN, UK
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Weight change and 15 year mortality: results from the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) cohort study. Eur J Epidemiol 2017; 33:37-53. [PMID: 29264789 PMCID: PMC5803289 DOI: 10.1007/s10654-017-0343-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 12/09/2017] [Indexed: 11/24/2022]
Abstract
Studies have reported a higher mortality risk associated with weight loss, particularly in middle-aged and older adults, although some of these studies did find that gaining weight was also associated with an increased mortality risk. We examined changes in weight in relation to mortality in a prospective population-based cohort study of men and women, resident in Norfolk, UK. Participants were assessed at baseline (1993–1997) and at a second examination (1998–2000), as part of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) study, and followed up to 2015 for mortality. Participants with a self-reported history of cancer or cardiovascular disease, body mass index < 18.5 kg/m2 or missing data on adjustment variables, at either time-point were excluded, leaving 12,580 participants, aged 39–78 in 1993–1997, eligible for analyses. Cox proportional hazards models were used to determine Hazard Ratios (HRs) for all-cause (2603 deaths), cardiovascular (749 deaths), cancer (981 deaths), respiratory (226 deaths) and other causes of mortality (647 deaths) by categories of weight change. After multivariate adjustment, the HRs (95% CIs) for all-cause mortality for men and women who lost more than 5 kg were 1.85 (1.48–2.31) and 1.64 (1.31–2.05) respectively. Higher hazards were also found for specific causes of mortality and weight loss > 5 kg. Similar associations were observed after excluding deaths in the first 5 years of follow-up. Results for weight gain were inconclusive. We conclude that objectively measured weight loss, but not weight gain, was associated with subsequent higher mortality risk in this population-based study of middle-aged and elderly men and women. However, undiagnosed, pre-existing disease and the inability to account for weight cycling need to be remembered when interpreting these results. Unravelling the causal pathways underlying this association will require more detailed studies, including that of changes in body composition.
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Le TT, Bryant JA, Ting AE, Ho PY, Su B, Teo RCC, Gan JSJ, Chung YC, O'Regan DP, Cook SA, Chin CWL. Assessing exercise cardiac reserve using real-time cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017. [PMID: 28110638 DOI: 10.1186/s12968-0170322-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Exercise cardiovascular magnetic resonance (ExCMR) has great potential for clinical use but its development has been limited by a lack of compatible equipment and robust real-time imaging techniques. We developed an exCMR protocol using an in-scanner cycle ergometer and assessed its performance in differentiating athletes from non-athletes. METHODS Free-breathing real-time CMR (1.5T Aera, Siemens) was performed in 11 athletes (5 males; median age 29 [IQR: 28-39] years) and 16 age- and sex-matched healthy volunteers (7 males; median age 26 [interquartile range (IQR): 25-33] years). All participants underwent an in-scanner exercise protocol on a CMR compatible cycle ergometer (Lode BV, the Netherlands), with an initial workload of 25W followed by 25W-increment every minute. In 20 individuals, exercise capacity was also evaluated by cardiopulmonary exercise test (CPET). Scan-rescan reproducibility was assessed in 10 individuals, at least 7 days apart. RESULTS The exCMR protocol demonstrated excellent scan-rescan (cardiac index (CI): 0.2 ± 0.5L/min/m2) and inter-observer (ventricular volumes: 1.2 ± 5.3mL) reproducibility. CI derived from exCMR and CPET had excellent correlation (r = 0.83, p < 0.001) and agreement (1.7 ± 1.8L/min/m2). Despite similar values at rest (P = 0.87), athletes had increased exercise CI compared to healthy individuals (at peak exercise: 12.2 [IQR: 10.2-13.5] L/min/m2 versus 8.9 [IQR: 7.5-10.1] L/min/m2, respectively; P < 0.001). Peak exercise CI, where image acquisition lasted 13-17 s, outperformed that at rest (c-statistics = 0.95 [95% confidence interval: 0.87-1.00] versus 0.48 [95% confidence interval: 0.23-0.72], respectively; P < 0.0001 for comparison) in differentiating athletes from healthy volunteers; and had similar performance as VO2max (c-statistics = 0.84 [95% confidence interval = 0.62-1.00]; P = 0.29 for comparison). CONCLUSIONS We have developed a novel in-scanner exCMR protocol using real-time CMR that is highly reproducible. It may now be developed for clinical use for physiological studies of the heart and circulation.
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Affiliation(s)
- Thu-Thao Le
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
| | - Jennifer Ann Bryant
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Alicia Er Ting
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Pei Yi Ho
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Boyang Su
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | | | | | | | | | - Stuart A Cook
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- National Heart and Lung Institute, Imperial College, London, UK
| | - Calvin Woon-Loong Chin
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Le TT, Bryant JA, Ting AE, Ho PY, Su B, Teo RCC, Gan JSJ, Chung YC, O’Regan DP, Cook SA, Chin CWL. Assessing exercise cardiac reserve using real-time cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:7. [PMID: 28110638 PMCID: PMC5256575 DOI: 10.1186/s12968-017-0322-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/06/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Exercise cardiovascular magnetic resonance (ExCMR) has great potential for clinical use but its development has been limited by a lack of compatible equipment and robust real-time imaging techniques. We developed an exCMR protocol using an in-scanner cycle ergometer and assessed its performance in differentiating athletes from non-athletes. METHODS Free-breathing real-time CMR (1.5T Aera, Siemens) was performed in 11 athletes (5 males; median age 29 [IQR: 28-39] years) and 16 age- and sex-matched healthy volunteers (7 males; median age 26 [interquartile range (IQR): 25-33] years). All participants underwent an in-scanner exercise protocol on a CMR compatible cycle ergometer (Lode BV, the Netherlands), with an initial workload of 25W followed by 25W-increment every minute. In 20 individuals, exercise capacity was also evaluated by cardiopulmonary exercise test (CPET). Scan-rescan reproducibility was assessed in 10 individuals, at least 7 days apart. RESULTS The exCMR protocol demonstrated excellent scan-rescan (cardiac index (CI): 0.2 ± 0.5L/min/m2) and inter-observer (ventricular volumes: 1.2 ± 5.3mL) reproducibility. CI derived from exCMR and CPET had excellent correlation (r = 0.83, p < 0.001) and agreement (1.7 ± 1.8L/min/m2). Despite similar values at rest (P = 0.87), athletes had increased exercise CI compared to healthy individuals (at peak exercise: 12.2 [IQR: 10.2-13.5] L/min/m2 versus 8.9 [IQR: 7.5-10.1] L/min/m2, respectively; P < 0.001). Peak exercise CI, where image acquisition lasted 13-17 s, outperformed that at rest (c-statistics = 0.95 [95% confidence interval: 0.87-1.00] versus 0.48 [95% confidence interval: 0.23-0.72], respectively; P < 0.0001 for comparison) in differentiating athletes from healthy volunteers; and had similar performance as VO2max (c-statistics = 0.84 [95% confidence interval = 0.62-1.00]; P = 0.29 for comparison). CONCLUSIONS We have developed a novel in-scanner exCMR protocol using real-time CMR that is highly reproducible. It may now be developed for clinical use for physiological studies of the heart and circulation.
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Affiliation(s)
- Thu-Thao Le
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Jennifer Ann Bryant
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Alicia Er Ting
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Pei Yi Ho
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Boyang Su
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | | | | | | | | | - Stuart A. Cook
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
- Duke-NUS Medical School, Singapore, Singapore
- National Heart and Lung Institute, Imperial College, London, UK
| | - Calvin Woon-Loong Chin
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Keevil VL, Cooper AJM, Wijndaele K, Luben R, Wareham NJ, Brage S, Khaw KT. Objective Sedentary Time, Moderate-to-Vigorous Physical Activity, and Physical Capability in a British Cohort. Med Sci Sports Exerc 2017; 48:421-9. [PMID: 26501232 PMCID: PMC4762192 DOI: 10.1249/mss.0000000000000785] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Supplemental digital content is available in the text. Purpose Sedentariness has been proposed as an independent risk factor for poor health. However, few studies have considered associations of sedentary time (ST) with physical functional health independent of time spent in moderate-to-vigorous physical activity (MVPA). Methods Community-based men and women (n = 8623, 48–92 yr old) in the European Prospective Investigation of Cancer—Norfolk study attended a health examination for objective measurement of physical capability, including grip strength (Smedley dynamometer (kg)), usual walking speed (UWS (cm·s−1)), and timed chair stand speed (TCSS (stands per minute)). Of these, 4051 participants wore an accelerometer (GT1M ActiGraph) for 7 d to estimate time spent in MVPA (MVPA, ≥1952 counts per minute) and ST (ST, <100 counts per minute). Relations between physical capability outcomes and both MVPA and ST were explored using linear regression. The mutual independence of associations was also tested, and ST-MVPA interactions were explored using fractional polynomial models to account for nonlinear associations. Results Men in the highest compared with those in the lowest sex-specific quartile of MVPA were stronger (1.84 kg; 95% confidence interval (CI), 0.79–2.89), had faster UWS (11.7 cm·s−1; 95% CI, 8.4–15.1) and faster TCSS (2.35 stands per minute; 95% CI, 1.11–3.59) after multivariable adjustment. Similarly, women in the highest quartile of MVPA were stronger (2.47 kg; 95% CI, 1.79–3.14) and had faster UWS (15.5 cm·s−1; 95% CI, 12.4–18.6) and faster TCSS (3.27 stands per minute; 95% CI, 2.19–4.25). Associations persisted after further adjustment for ST. Associations between higher ST and lower physical capability were also observed, but these were attenuated after accounting for MVPA. Furthermore, no MVPA–ST interactions were observed (Pinteractions > 0.05). Conclusions More time spent in MVPA was associated with higher physical capability, but there were no independent ST associations.
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Affiliation(s)
- Victoria L Keevil
- 1Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge, UNITED KINGDOM; and 2MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Addenbrookes Biomedical Campus, Cambridge, UNITED KINGDOM
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Julian C, Lentjes MAH, Huybrechts I, Luben R, Wareham N, Moreno LA, Khaw KT. Fracture Risk in Relation to Serum 25-Hydroxyvitamin D and Physical Activity: Results from the EPIC-Norfolk Cohort Study. PLoS One 2016; 11:e0164160. [PMID: 27749911 PMCID: PMC5066971 DOI: 10.1371/journal.pone.0164160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/20/2016] [Indexed: 12/16/2022] Open
Abstract
Vitamin D deficiency and physical inactivity have been associated with bone loss and fractures, but their combined effect has scarcely been studied either in younger or older adults. Therefore, we aimed to assess the associations between physical activity, age and 25-hydroxyvitamin D (25(OH)D) status separately and in combination with the incidence of fracture risk in the EPIC-Norfolk cohort study. Baseline (1993-1998) self-reported physical activity and serum 25(OH)D concentrations at follow-up (1998-2000) were collected in 14,624 men and women (aged 42-82 y between 1998 and 2000). Fracture incidence was ascertained up to March 2015. Cox proportional hazard model was used to determine HRs of fractures by plasma 25(OH)D (<30, 30 to <50, 50 to <70, 70 to <90, >90 nmol/L), age (<65 y and >65 y) and physical activity (inactive and active) categories, by follow-up time per 20 nmol/L increase in serum 25(OH)D and to explore age-25(OH)D and physical activity-25(OH)D interactions. The age-, sex-, and month-adjusted HRs (95% CIs) for all fractures (1183 fractures) by increasing vitamin D category were not significantly different. With additional adjustment for body mass index, smoking status, alcohol intake, supplement use and history of fractures, the fracture risk was 29% lower in those participants with 50 to 70 nmol/L compared with those in the lowest quintile (<30 nmol/L). Physical inactivity based on a single baseline assessment was not associated with fracture risk. Vitamin D status appeared inversely related to fractures in middle aged adults. In older adults, the relationship between vitamin D status and fracture risk was observed to be J-shaped. Clinical and public health practice in vitamin D supplementation could partially explain these findings, although definitive conclusions are difficult due to potential changes in exposure status over the long follow up period.
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Affiliation(s)
- Cristina Julian
- Department of Public Health and Primary Care, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Instituto Agroalimentario de Aragón (IA2), Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Universidad de Zaragoza, Zaragoza, Spain
| | - Marleen A. H. Lentjes
- Department of Public Health and Primary Care, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Inge Huybrechts
- Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France
| | - Robert Luben
- Department of Public Health and Primary Care, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Nick Wareham
- Department of Public Health and Primary Care, Institute of Public Health, Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Luis A. Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Instituto Agroalimentario de Aragón (IA2), Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Universidad de Zaragoza, Zaragoza, Spain
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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Steene-Johannessen J, Anderssen SA, van der Ploeg HP, Hendriksen IJM, Donnelly AE, Brage S, Ekelund U. Are Self-report Measures Able to Define Individuals as Physically Active or Inactive? Med Sci Sports Exerc 2016; 48:235-44. [PMID: 26322556 DOI: 10.1249/mss.0000000000000760] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE Assess the agreement between commonly used self-report methods compared with objectively measured physical activity (PA) in defining the prevalence of individuals compliant with PA recommendations. METHODS Time spent in moderate and vigorous PA (MVPA) was measured at two time points in 1713 healthy individuals from nine European countries using individually calibrated combined heart rate and movement sensing. Participants also completed the Recent Physical Activity Questionnaire (RPAQ), short form of the International Physical Activity Questionnaire (IPAQ), and short European Prospective Investigation into Cancer and Nutrition Physical Activity Questionnaire (EPIC-PAQ). Individuals were categorized as active (e.g., reporting ≥150 min of MVPA per week) or inactive, based on the information derived from the different measures. Sensitivity and specificity analyses and Kappa statistics were performed to evaluate the ability of the three PA questionnaires to correctly categorize individuals as active or inactive. RESULTS Prevalence estimates of being sufficiently active varied significantly (P for all <0.001) between self-report measures (IPAQ 84.2% [95% confidence interval {CI}, 82.5-85.9], RPAQ 87.6% [95% CI, 85.9-89.1], EPIC-PAQ 39.9% [95% CI, 37.5-42.1] and objective measure 48.5% [95% CI, 41.6-50.9]. All self-report methods showed low or moderate sensitivity (IPAQ 20.0%, RPAQ 18.7%, and EPIC-PAQ 69.8%) to correctly classify inactive people and the agreement between objective and self-reported PA was low (ĸ = 0.07 [95% CI, 0.02-0.12], 0.12 [95% CI, 0.06-0.18], and 0.19 [95% CI, 0.13-0.24] for IPAQ, RPAQ, and EPIC-PAQ, respectively). CONCLUSIONS The modest agreement between self-reported and objectively measured PA suggests that population levels of PA derived from self-report should be interpreted cautiously. Implementation of objective measures in large-scale cohort studies and surveillance systems is recommended.
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Affiliation(s)
- Jostein Steene-Johannessen
- 1Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, NORWAY; 2VU University Medical Center, Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Amsterdam, THE NETHERLANDS; 3TNO Expertise Centre Lifestyle, Leiden, THE NETHERLANDS; 4Body@Work TNO-VUmc, Research Center Physical Activity, Work and Health, Amsterdam, THE NETHERLANDS; 5Department of Physical Education and Sport Sciences, University of Limerick, Limerick, IRELAND; and 6Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UNITED KINGDOM
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Edwards ES, Sackett SC. Psychosocial Variables Related to Why Women are Less Active than Men and Related Health Implications. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2016; 9:47-56. [PMID: 27398045 PMCID: PMC4933535 DOI: 10.4137/cmwh.s34668] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/12/2016] [Accepted: 05/15/2016] [Indexed: 12/22/2022]
Abstract
This article reviews psychosocial influences on women’s participation in physical activity as they differ from men and how associated activity differences impact women’s risk for a number of chronic diseases. This topic directly aligns with the mission of this special edition related to disparities in women’s health as the typically lower level of physical activity in females directly impacts their health. On average, females participate in physical activity at lower rates than their male counterparts. These lower rates of physical activity are directly related to both incidence of and outcomes from cardiovascular disease, type 2 diabetes, and breast and gynecological cancers. The relationship between psychosocial factors that are understood to affect physical activity differs between men and women. Specifically, self-efficacy, social support, and motivation are empirically substantiated factors that found to impact physical activity participation among women differently than men. Understanding these relationships is integral to designing effective interventions to target physical activity participation in women so that the related health risks are adequately addressed.
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Affiliation(s)
| | - Sarah Carson Sackett
- Department of Kinesiology, James Madison University, Morrison Bruce Center, Harrisonburg, VA, USA
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Huerta JM, Chirlaque MD, Tormo MJ, Buckland G, Ardanaz E, Arriola L, Gavrila D, Salmerón D, Cirera L, Carpe B, Molina-Montes E, Chamosa S, Travier N, Quirós JR, Barricarte A, Agudo A, Sánchez MJ, Navarro C. Work, household, and leisure-time physical activity and risk of mortality in the EPIC-Spain cohort. Prev Med 2016; 85:106-112. [PMID: 26861751 DOI: 10.1016/j.ypmed.2016.02.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 01/29/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Large-scale longitudinal data on the association of domain-specific physical activity (PA) and mortality is limited. Our objective was to evaluate the association of work, household (HPA), and leisure time PA (LTPA) with overall and cause-specific mortality in the EPIC-Spain study. METHODS 38,379 participants (62.4% women), 30-65years old, and free of chronic disease at baseline were followed-up from recruitment (1992 - 1996) to December 31st, 2008 to ascertain vital status and cause of death. PA was evaluated at baseline and at a 3-year follow-up with a validated questionnaire (EPIC-PAQ) and combined variables were used to classify the participants by sub-domains of PA. Associations with overall, cancer, and cardiovascular mortality risks were assessed using competing risk Cox regression models adjusted by potential confounders. RESULTS After 13.6years of mean follow-up, 1371 deaths were available for analyses. HPA was strongly associated to reduced overall (hazard ratio (HR) for Q4 vs. Q1=0.47 (0.34, 0.64)) and cause-specific mortalities in women and to lower cancer mortality in men (P for trend=0.004), irrespective of age, education, and lifestyle and morbidity variables. LTPA was associated with lower mortality in women (HR for Q4 vs. Q1=0.71 (0.52, 0.98)), but not men. No relationships were found between sedentariness at work and overall mortality. CONCLUSIONS HPA was associated to lower mortality risk in men and women from the EPIC-Spain cohort, whereas LTPA also contributed to reduce risk of death in women. Considering the large proportion of total daily PA that HPA represents in some population groups, these results are of public health importance.
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Affiliation(s)
- José Mª Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
| | - María Dolores Chirlaque
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Department of Health and Social Sciences, University of Murcia, Campus Universitario de Espinardo, 30100, Murcia, Spain.
| | - María José Tormo
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
| | - Genevieve Buckland
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Gran Via de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Eva Ardanaz
- CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Navarre Public Health Institute, Leyre, 15, 31003 Pamplona, Spain.
| | - Larraitz Arriola
- CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Public Health Division of Gipuzkoa, Health Research Institute BIO-Donostia, Basque Government, Avenida de Navarra, 4, 20013 Donostia-San Sebastián, Spain.
| | - Diana Gavrila
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
| | - Diego Salmerón
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Department of Health and Social Sciences, University of Murcia, Campus Universitario de Espinardo, 30100, Murcia, Spain.
| | - Lluís Cirera
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Department of Health and Social Sciences, University of Murcia, Campus Universitario de Espinardo, 30100, Murcia, Spain.
| | - Bienvenida Carpe
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain.
| | - Esther Molina-Montes
- CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Andalusian School of Public Health, Cuesta del Observatorio, 4, 18011, Granada, Spain.
| | - Saioa Chamosa
- Public Health Division of Gipuzkoa, Health Research Institute BIO-Donostia, Basque Government, Avenida de Navarra, 4, 20013 Donostia-San Sebastián, Spain.
| | - Noemie Travier
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Gran Via de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - José R Quirós
- Public Health Directorate, Ciriaco Miguel Vigil, 9, 33006 Oviedo, Spain.
| | - Aurelio Barricarte
- CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Navarre Public Health Institute, Leyre, 15, 31003 Pamplona, Spain.
| | - Antonio Agudo
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Gran Via de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - María José Sánchez
- CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Andalusian School of Public Health, Cuesta del Observatorio, 4, 18011, Granada, Spain.
| | - Carmen Navarro
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Department of Health and Social Sciences, University of Murcia, Campus Universitario de Espinardo, 30100, Murcia, Spain.
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Physical Activity Is not Associated with Estimated Glomerular Filtration Rate among Young and Middle-Aged Adults: Results from the Population-Based Longitudinal Doetinchem Study. PLoS One 2015; 10:e0133864. [PMID: 26465150 PMCID: PMC4605681 DOI: 10.1371/journal.pone.0133864] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/02/2015] [Indexed: 11/20/2022] Open
Abstract
There is debate as to whether physical inactivity is associated with reduced kidney function. We studied the prospective association of (changes in) physical activity with estimated glomerular filtration rate (eGFR) in adult men and women. We included 3,935 participants aged 26 to 65 years from the Doetinchem Cohort study, examined every 5 years for 15 years. Physical activity was assessed at each round using the Cambridge Physical Activity Index. Using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation, GFR was estimated from routinely measured cystatin C concentrations, examining all available samples per participant in one assay run. We determined the association between 1) physical activity and eGFR and 2) 5-year changes in physical activity (becoming inactive, staying inactive, staying active, becoming active) and eGFR, using time-lagged generalized estimating equation analyses. At baseline, 3.6% of the participants were inactive, 18.5% moderately inactive, 26.0% moderately active, and 51.9% active. The mean (± SD) eGFR was 107.9 (± 14.5) mL/min per 1.73 m2. Neither physical activity nor 5-year changes in physical activity were associated with eGFR at the subsequent round. The multivariate adjusted βeGFR was 0.57 mL/min per 1.73 m2 (95% Confidence Interval (CI) -1.70, 0.56) for inactive compared to active participants. Studying changes in physical activity between rounds, the adjusted βeGFR was -1.10 mL/min per 1.73 m2 (95% CI -4.50, 2.30) for those who stayed inactive compared with participants who became active. Physical activity was not associated with eGFR in this population-based study of adults.
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Hupin D, Roche F, Gremeaux V, Chatard JC, Oriol M, Gaspoz JM, Barthélémy JC, Edouard P. Even a low-dose of moderate-to-vigorous physical activity reduces mortality by 22% in adults aged ≥60 years: a systematic review and meta-analysis. Br J Sports Med 2015; 49:1262-7. [DOI: 10.1136/bjsports-2014-094306] [Citation(s) in RCA: 314] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2015] [Indexed: 11/04/2022]
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Gijón-Conde T, Graciani A, Guallar-Castillón P, Aguilera MT, Rodríguez-Artalejo F, Banegas JR. Valores de referencia y puntos de corte de leptina para identificar anormalidad cardiometabólica en la población española. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yip JLY, Khawaja AP, Chan MPY, Broadway DC, Peto T, Tufail A, Luben R, Hayat S, Bhaniani A, Wareham NJ, Khaw KT, Foster PJ. Cross Sectional and Longitudinal Associations between Cardiovascular Risk Factors and Age Related Macular Degeneration in the EPIC-Norfolk Eye Study. PLoS One 2015; 10:e0132565. [PMID: 26176222 PMCID: PMC4503731 DOI: 10.1371/journal.pone.0132565] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/16/2015] [Indexed: 12/03/2022] Open
Abstract
Purpose To examine the cross sectional and longitudinal relationship between cardiovascular risk factors and age-related macular degeneration (AMD) in a large British cohort study. Methods The EPIC Norfolk Eye study is nested in a larger prospective cohort study. Data on cardiovascular risk factors were collected at baseline (1993-1997) and follow up (2006-2011) via clinical examination, validated lifestyle questionnaires and serum blood samples. AMD was ascertained using standardised grading of fundus photographs at the follow up. Logistic regression was used to examine associations between baseline and follow up risk factors with AMD. Results 5,344 pairs (62.0% of total 8623) of fundus photographs were of sufficient quality for grading of AMD in participants with mean age of 67.4 years old (range 44-91) at diagnosis. There were 28 cases of late AMD (0.5%, 95% confidence interval (CI)=0.3-0.8%) and 645 cases of early AMD (12.1%, 95%CI=11.2-13.0.%). In multivariable analysis, older people with higher levels of baseline high density lipoprotein- cholesterol (HDL-C ) and C-reactive protein (CRP) were more likely to have any signs of AMD, after adjusting for sex, education, smoking, and systolic blood pressure. In cross sectional analysis, only older age and higher HDL were significantly associated with AMD. Conclusions We have found that older age and higher levels of CRP and HDL-C were associated with increased odds of AMD in this population in the longitudinal analysis, but older age and HDL-C, not CRP was significantly associated with AMD in the cross sectional analysis. The prevalence of AMD in this cohort was low compared to other cohorts in Europe, the US and Australia, and probably reflects the some selection biases in follow up participation as well as the low rate of smoking among our healthy participants.
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Affiliation(s)
- Jennifer L. Y. Yip
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
- * E-mail:
| | - Anthony P. Khawaja
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Michelle P. Y. Chan
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - David C. Broadway
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Tunde Peto
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Adnan Tufail
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Robert Luben
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Shabina Hayat
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Amit Bhaniani
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Nicholas J. Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Kay-Tee Khaw
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Paul J. Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
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Ramalho JRO, Mambrini JVM, César CC, de Oliveira CM, Firmo JOA, Lima-Costa MF, Peixoto SV. Physical activity and all-cause mortality among older Brazilian adults: 11-year follow-up of the Bambuí Health and Aging Study. Clin Interv Aging 2015; 10:751-8. [PMID: 25931817 PMCID: PMC4404991 DOI: 10.2147/cia.s74569] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the association between physical activity (eg, energy expenditure) and survival over 11 years of follow-up in a large representative community sample of older Brazilian adults with a low level of education. Furthermore, we assessed sex as a potential effect modifier of this association. Materials and methods A population-based prospective cohort study was conducted on all the ≥60-year-old residents in Bambuí city (Brazil). A total of 1,606 subjects (92.2% of the population) enrolled, and 1,378 (85.8%) were included in this study. Type, frequency, and duration of physical activity were assessed in the baseline survey questionnaire, and the metabolic equivalent task tertiles were estimated. The follow-up time was 11 years (1997–2007), and the end point was mortality. Deaths were reported by next of kin during the annual follow-up interview and ascertained through the Brazilian System of Information on Mortality, Brazilian Ministry of Health. Hazard ratios (95% confidence intervals [CIs]) were estimated by Cox proportional-hazard models, and potential confounders were considered. Results A statistically significant interaction (P<0.03) was found between sex and energy expenditure. Among older men, increases in levels of physical activity were associated with reduced mortality risk. The hazard ratios were 0.59 (95% CI 0.43–0.81) and 0.47 (95% CI 0.34–0.66) for the second and third tertiles, respectively. Among older women, there was no significant association between physical activity and mortality. Conclusion It was possible to observe the effect of physical activity in reducing mortality risk, and there was a significant interaction between sex and energy expenditure, which should be considered in the analysis of this association in different populations.
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Affiliation(s)
- Juciany R O Ramalho
- Rene Rachou Research Center, Oswaldo Cruz Foundation, Belo Horizonte, Brazil
| | | | - Cibele C César
- Rene Rachou Research Center, Oswaldo Cruz Foundation, Belo Horizonte, Brazil ; Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - César M de Oliveira
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Josélia O A Firmo
- Rene Rachou Research Center, Oswaldo Cruz Foundation, Belo Horizonte, Brazil
| | | | - Sérgio V Peixoto
- Rene Rachou Research Center, Oswaldo Cruz Foundation, Belo Horizonte, Brazil ; Nursing School, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Assah F, Mbanya JC, Ekelund U, Wareham N, Brage S. Patterns and correlates of objectively measured free-living physical activity in adults in rural and urban Cameroon. J Epidemiol Community Health 2015; 69:700-7. [PMID: 25841243 PMCID: PMC4484252 DOI: 10.1136/jech-2014-205154] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 02/01/2015] [Indexed: 11/30/2022]
Abstract
Background Urbanisation in sub-Saharan Africa is changing lifestyles and raising non-communicable disease burden. Understanding the underlying pattern of physical activity and its correlates may inform preventive interventions. We examined correlates of objectively-measured physical activity in rural and urban Cameroon. Methods Participants were 544 adults resident in rural (W-156, M-89) or urban (W-189, M-110) regions. Physical activity was measured using individually-calibrated combined heart rate and movement sensing over seven continuous days. Sociodemographic data were collected by self-report. Independent associations of sociodemographic correlates with physical activity energy expenditure (PAEE) or moderate-to-vigorous physical activity (MVPA) were analysed in multivariate regression models. Results Rural dwellers were significantly more active than their urban counterparts (PAEE: 58.0 vs 42.9 kJ/kg/day; MVPA: 107 vs 62 min/day; MVPA of 150 min/week in >10 min bouts: 62 vs 39%) and less sedentary (923 vs 1026 min/day); p<0.001. There was no significant seasonal difference (dry vs rainy) in activity in urban dwellers whereas in rural dwellers activity was higher during dry seasons compared to rainy seasons (p<0.001). Age, obesity and education showed significant inverse associations with activity. Urban dwellers who considered themselves adequately active were only as active as rural dwellers who thought they were not adequately active. Conclusions This is the first study providing data on sociodemographic patterning of objectively-measured physical activity in rural and urban sub-Saharan Africa. Age, urban residence, obesity and higher educational level are important correlates of lower levels of physical activity. These suggest targets for public health interventions to improve physical activity in Cameroon.
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Affiliation(s)
- Felix Assah
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jean Claude Mbanya
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Ulf Ekelund
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Galán I, Boix R, Medrano MJ, Ramos P, Rivera F, Moreno C. Individual factors and school-based policies related to adherence to physical activity recommendations in Spanish adolescents. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 15:588-99. [PMID: 23728581 DOI: 10.1007/s11121-013-0407-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Our objective was to identify individual- and school-level contextual factors related to adherence to the recommendations for physical activity in adolescents. The study used a representative sample of 15,902 students from 328 schools aged 11-18 years participating in the Spanish Health Behaviour in School-aged Children (HBSC) survey 2006. In addition to the student questionnaire, the school management board completed a questionnaire about school-based policies related to physical activity. Adherence to the recommendations was defined as "having carried out moderate and/or vigorous physical activity for at least 60 min a day on five or more days during the last week". Analysis was undertaken using multilevel logistic regression models. Individual factors associated in a statistically significant way with a higher non-compliance were: being female; being older; immigrants; tobacco smoking; being overweight or obese; low consumption of fruit and vegetables; low level of satisfaction with life; not having a high level of academic achievement; and spending a lot of time studying. The family variables were: not undertaking sports activities with the family; low socioeconomic status; and a low level of satisfaction with family relationships. Compared with schools that have a low level of policies to promote physical activities, those with a high level of promotion had an odds ratio of 0.76 (CI 95 %, 0.61-0.94). In summary, irrespective of personal and family factors, students from schools with better policies of promotion of physical activity showed a higher compliance with the recommendations.
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Affiliation(s)
- I Galán
- National Centre of Epidemiology, Carlos III Institute of Health, c/ Monforte de Lemos 5, CP 28029, Madrid, Spain,
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Harari G, Green MS, Zelber-Sagi S. Combined association of occupational and leisure-time physical activity with all-cause and coronary heart disease mortality among a cohort of men followed-up for 22 years. Occup Environ Med 2015; 72:617-24. [PMID: 25805756 DOI: 10.1136/oemed-2014-102613] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 03/04/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Leisure-time physical activity (LTPA) is a well-established protective factor for all-cause mortality and cardiovascular mortality while occupational physical activity (OPA) has shown contradictory results. We examined the association between OPA and all-cause and coronary heart disease (CHD) mortality, and tested its combined effect with LTPA. METHODS The CORDIS Study (Cardiovascular Occupational Risk Factor Determination in Israel Study) is a prospective cohort study of industrial workers examined during 1985-1989 and followed-up for 22 years. Data on self-reported OPA and LTPA among 4819 males (20-70 years old) were merged with data on all-cause and CHD mortality obtained from the National Death Registry. RESULTS A higher incidence rate of all-cause mortality and CHD mortality was observed among men who performed moderate-hard OPA compared with those who performed none-mild OPA. Multiple regression analysis based on the Cox proportional hazards model showed that moderate-hard OPA was associated with increased risk of all-cause mortality (HR=1.42, 95% CI 1.16 to 1.74, p<0.001), while LTPA (30 min at least twice a week vs less or none) was associated with reduced risk for all-cause mortality (HR=0.61, 95% CI 0.48 to 0.79, p<0.001), after adjusting for potential confounders, including sociodemographic variables, body mass index, comorbidity and lifestyle habits. Employees who performed moderate-hard OPA and no LTPA had the greatest risk for all-cause mortality and employees who performed none-light OPA and LTPA had the lowest risk. Similar but non-significant trends were observed for the association with CHD mortality. CONCLUSIONS Moderate-hard OPA among industrial male workers may be deleterious to health and should not be a substitute to LTPA.
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Affiliation(s)
- Gil Harari
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Manfred S Green
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Physical activity enhances metabolic fitness independently of cardiorespiratory fitness in marathon runners. DISEASE MARKERS 2015; 2015:806418. [PMID: 25821340 PMCID: PMC4363791 DOI: 10.1155/2015/806418] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 02/12/2015] [Indexed: 01/09/2023]
Abstract
High levels of cardiovascular fitness (CRF) and physical activity (PA) are associated with decreased mortality and risk to develop metabolic diseases. The independent contributions of CRF and PA to metabolic disease risk factors are unknown. We tested the hypothesis that runners who run consistently >50 km/wk and/or >2 marathons/yr for the last 5 years have superior metabolic fitness compared to matched sedentary subjects (CRF, age, gender, and BMI). Case-control recruitment of 31 pairs of runner-sedentary subjects identified 10 matched pairs with similar VO2max (mL/min/kg) (similar-VO2max). The similar-VO2max group was compared with a group of age, gender, and BMI matched pairs who had the largest difference in VO2max (different-VO2max). Primary outcomes that defined metabolic fitness including insulin response to an oral glucose tolerance test, fasting lipids, and fasting insulin were superior in runners versus sedentary controls despite similar VO2max. Furthermore, performance (velocity at VO2max, running economy), improved exercise metabolism (lactate threshold), and skeletal muscle levels of mitochondrial proteins were superior in runners versus sedentary controls with similar VO2max. In conclusion subjects with a high amount of PA have more positive metabolic health parameters independent of CRF. PA is thus a good marker against metabolic diseases.
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Yip JLY, Khawaja AP, Chan MPY, Broadway DC, Peto T, Luben R, Hayat S, Bhaniani A, Wareham N, Foster PJ, Khaw KT. Area deprivation and age related macular degeneration in the EPIC-Norfolk Eye Study. Public Health 2015; 129:103-9. [PMID: 25687711 PMCID: PMC4357435 DOI: 10.1016/j.puhe.2014.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 10/14/2014] [Accepted: 10/20/2014] [Indexed: 12/04/2022]
Abstract
Objectives To investigate the relationship between area deprivation, individual socio-economic status (SES) and age related macular degeneration (AMD). Study design Cross sectional study nested within a longitudinal cohort study. Methods Data were collected in the EPIC-Norfolk Eye Study by trained nurses, using standardized protocols and lifestyle questionnaires. The English Index of multiple deprivation 2010 (IMD) was derived from participants' postcodes. AMD was identified from standardized grading of fundus photographs. Logistic regression was used to examine associations between IMD, SES and AMD. Results 5344 pairs (62.0% of total 8623) of fundus photographs were of sufficient quality for grading of AMD. Of 5182 participants with complete data, AMD was identified in 653 participants (12.60%, 95%CI = 11.7–13.5%). Multivariable logistic regression showed that people living in the most affluent 5% of areas had nearly half the odds of AMD compared to those living in comparatively more deprived areas (OR = 0.56, 95% CI = 0.36–0.89, P = 0.02), after adjusting for age, sex, education, social class and smoking. Conclusions The authors found that living in the most affluent areas exerted a protective effect on AMD, independently of education and social class. Further investigation into underlying mechanisms will inform potential interventions to reduce health inequalities relating to AMD. The relationship between area deprivation and AMD diagnosed from fundus photographs was examined. Data from 5182 participants from the EPIC-Norfolk Eye study were analyzed. Predominantly early AMD was identified in 653 participants (12.6%). People living in more affluent areas had nearly half the risk of AMD. Results require interpretation with caution due to the healthy population studied.
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Affiliation(s)
- Jennifer L Y Yip
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.
| | - Anthony P Khawaja
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Michelle P Y Chan
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - David C Broadway
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Tunde Peto
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Robert Luben
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Shabina Hayat
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Amit Bhaniani
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Paul J Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Kay-Tee Khaw
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
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Gijón-Conde T, Graciani A, Guallar-Castillón P, Aguilera MT, Rodríguez-Artalejo F, Banegas JR. Leptin Reference Values and Cutoffs for Identifying Cardiometabolic Abnormalities in the Spanish Population. ACTA ACUST UNITED AC 2015; 68:672-9. [PMID: 25618563 DOI: 10.1016/j.rec.2014.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 08/20/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES Estimate leptin reference values and calculate leptinemia cutoff values for identifying cardiometabolic abnormalities in Spain. METHODS Cross-sectional study carried out between 2008 and 2010 in 11 540 individuals representing the Spanish population aged ≥ 18 years. Data were obtained by standardized physical examination and analyses were performed at a central laboratory. Leptinemia was measured using ELISA. Cardiometabolic abnormality was defined as the presence of at least two of the following: high blood pressure, high triglycerides, reduced high density lipoprotein cholesterol, high insulin resistance values, and elevated C-reactive protein and glucose. RESULTS Leptin values were higher in women than men (geometric mean, 21.9 and 6.6 ng/mL; P<.001). The median [interquartile range] was 24.5 [14.1-37.0] ng/mL in women, and 7.2 [3.3-14.3] ng/mL in men. In the multivariate analysis, leptin was significantly associated with anthropometric measures, insulin, and C-reactive protein, and inversely associated with age, smoking, and physical activity in women (r(2)=0.53; P<.001) and in men (r(2)=0.61; P<.001). The leptin values that identified cardiometabolic abnormality were 23.75 ng/mL in women (area under the curve, 0.722; sensitivity, 72.3%; specificity, 58.7%) and 6.45 ng/mL in men (area under the curve, 0.716; sensitivity, 71.4%; specificity, 60.2%). CONCLUSIONS These results facilitate the interpretation of leptin values in clinical and population studies. Leptin has moderate sensitivity and specificity for identifying cardiometabolic abnormalities.
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Affiliation(s)
- Teresa Gijón-Conde
- Centro de Salud Universitario Cerro del Aire, Majadahonda, Madrid, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/Idi Paz, CIBER de Epidemiología y Salud Pública CIBERESP, Madrid, Spain.
| | - Auxiliadora Graciani
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/Idi Paz, CIBER de Epidemiología y Salud Pública CIBERESP, Madrid, Spain
| | - Pilar Guallar-Castillón
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/Idi Paz, CIBER de Epidemiología y Salud Pública CIBERESP, Madrid, Spain
| | | | - Fernando Rodríguez-Artalejo
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/Idi Paz, CIBER de Epidemiología y Salud Pública CIBERESP, Madrid, Spain
| | - José R Banegas
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/Idi Paz, CIBER de Epidemiología y Salud Pública CIBERESP, Madrid, Spain
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Gillison F, Stathi A, Reddy P, Perry R, Taylor G, Bennett P, Dunbar J, Greaves C. Processes of behavior change and weight loss in a theory-based weight loss intervention program: a test of the process model for lifestyle behavior change. Int J Behav Nutr Phys Act 2015; 12:2. [PMID: 25592314 PMCID: PMC4304200 DOI: 10.1186/s12966-014-0160-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 12/19/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Process evaluation is important for improving theories of behavior change and behavioral intervention methods. The present study reports on the process outcomes of a pilot test of the theoretical model (the Process Model for Lifestyle Behavior Change; PMLBC) underpinning an evidence-informed, theory-driven, group-based intervention designed to promote healthy eating and physical activity for people with high cardiovascular risk. METHODS 108 people at high risk of diabetes or heart disease were randomized to a group-based weight management intervention targeting diet and physical activity plus usual care, or to usual care. The intervention comprised nine group based sessions designed to promote motivation, social support, self-regulation and understanding of the behavior change process. Weight loss, diet, physical activity and theoretically defined mediators of change were measured pre-intervention, and after four and 12 months. RESULTS The intervention resulted in significant improvements in fiber intake (M between-group difference = 5.7 g/day, p < .001) but not fat consumption (-2.3 g/day, p = 0.13), that were predictive of weight loss at both four months (M between-group difference = -1.98 kg, p < .01; R(2) = 0.2, p < 0.005), and 12 months (M difference = -1.85 kg, p = 0.1; R(2) = 0.1, p < 0.01). The intervention was successful in improving the majority of specified mediators of behavior change, and the predicted mechanisms of change specified in the PMBLC were largely supported. Improvements in self-efficacy and understanding of the behavior change process were associated with engagement in coping planning and self-monitoring activities, and successful dietary change at four and 12 months. While participants reported improvements in motivational and social support variables, there was no effect of these, or of the intervention overall, on physical activity. CONCLUSIONS The data broadly support the theoretical model for supporting some dietary changes, but not for physical activity. Systematic intervention design allowed us to identify where improvements to the intervention may be implemented to promote change in all proposed mediators. More work is needed to explore effective mechanisms within interventions to promote physical activity behavior.
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Affiliation(s)
- Fiona Gillison
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
| | - Afroditi Stathi
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
| | - Prasuna Reddy
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Rachel Perry
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK.
| | - Gordon Taylor
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
| | - Paul Bennett
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
| | - James Dunbar
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, PO Box 423, Warrnambool, Victoria, 3280, Australia.
| | - Colin Greaves
- University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK.
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