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Deng S, Liang J, Peng Y, Liu W, Su J, Zhu S. Spatial analysis of the impact of urban built environment on cardiovascular diseases: a case study in Xixiangtang, China. BMC Public Health 2024; 24:2368. [PMID: 39217314 PMCID: PMC11366168 DOI: 10.1186/s12889-024-19884-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The built environment, as a critical factor influencing residents' cardiovascular health, has a significant potential impact on the incidence of cardiovascular diseases (CVDs). METHODS Taking Xixiangtang District in Nanning City, Guangxi Zhuang Autonomous Region of China as a case study, we utilized the geographic location information of CVD patients, detailed road network data, and urban points of interest (POI) data. Kernel density estimation (KDE) and spatial autocorrelation analysis were specifically employed to identify the spatial distribution patterns, spatial clustering, and spatial correlations of built environment elements and diseases. The GeoDetector method (GDM) was used to assess the impact of environmental factors on diseases, and geographically weighted regression (GWR) analysis was adopted to reveal the spatial heterogeneity effect of environmental factors on CVD risk. RESULTS The results indicate that the built environment elements and CVDs samples exhibit significant clustering characteristics in their spatial distribution, with a positive correlation between the distribution density of environmental elements and the incidence of CVDs (Moran's I > 0, p < 0.01). Further factor detection revealed that the distribution of healthcare facilities had the most significant impact on CVDs (q = 0.532, p < 0.01), followed by shopping and consumption (q = 0.493, p < 0.01), dining (q = 0.433, p < 0.01), and transportation facilities (q = 0.423, p < 0.01), while the impact of parks and squares (q = 0.174, p < 0.01) and road networks (q = 0.159, p < 0.01) was relatively smaller. Additionally, the interaction between different built environment elements exhibited a bi-factor enhancement effect on CVDs. In the local analysis, the spatial heterogeneity of different built environment elements on CVDs further revealed the regional differences and complexities. CONCLUSIONS The spatial distribution of built environment elements is significantly correlated with CVDs to varying degrees and impacts differently across regions, underscoring the importance of the built environment on cardiovascular health. When planning and improving urban environments, elements and areas that have a more significant impact on CVDs should be given priority consideration.
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Affiliation(s)
- Shuguang Deng
- School of Geographical and Planning, Nanning Normal University, Nanning, 530100, Guangxi, China
| | - Jinlong Liang
- School of Geographical and Planning, Nanning Normal University, Nanning, 530100, Guangxi, China.
| | - Ying Peng
- School of Architecture, Guangxi Arts University, Nanning, 530009, Guangxi, China
| | - Wei Liu
- Fatulty of Innovation and Design, City University of Macau, Macau, 999078, China
| | - Jinhong Su
- School of Geographical and Planning, Nanning Normal University, Nanning, 530100, Guangxi, China
| | - Shuyan Zhu
- School of Geographical and Planning, Nanning Normal University, Nanning, 530100, Guangxi, China
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2
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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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Oja P, Memon AR, Titze S, Jurakic D, Chen ST, Shrestha N, Em S, Matolic T, Vasankari T, Heinonen A, Grgic J, Koski P, Kokko S, Kelly P, Foster C, Podnar H, Pedisic Z. Health Benefits of Different Sports: a Systematic Review and Meta-Analysis of Longitudinal and Intervention Studies Including 2.6 Million Adult Participants. SPORTS MEDICINE - OPEN 2024; 10:46. [PMID: 38658416 PMCID: PMC11043276 DOI: 10.1186/s40798-024-00692-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/28/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Several reviews have examined the health benefits of participation in specific sports, such as baseball, cricket, cross-country skiing, cycling, downhill skiing, football, golf, judo, rugby, running and swimming. However, new primary studies on the topic have recently been published, and the respective meta-analytic evidence needs to be updated. OBJECTIVES To systematically review, summarise and appraise evidence on physical health benefits of participation in different recreational sports. METHODS Searches for journal articles were conducted in PubMed/MEDLINE, Scopus, SpoLit, SPORTDiscus, Sports Medicine & Education Index and Web of Science. We included longitudinal and intervention studies investigating physical health outcomes associated with participation in a given sport among generally healthy adults without disability. RESULTS A total of 136 papers from 76 studies conducted among 2.6 million participants were included in the review. Our meta-analyses of available evidence found that: (1) cycling reduces the risk of coronary heart disease by 16% (pooled hazard ratio [HR] = 0.84; 95% confidence interval [CI]: 0.80, 0.89), all-cause mortality by 21% (HR = 0.79; 95% CI: 0.73, 0.84), cancer mortality by 10% (HR = 0.90; 95% CI: 0.85, 0.96) and cardiovascular mortality by 20% (HR = 0.80; 95% CI: 0.74, 0.86); (2) football has favourable effects on body composition, blood lipids, fasting blood glucose, blood pressure, cardiovascular function at rest, cardiorespiratory fitness and bone strength (p < 0.050); (3) handball has favourable effects on body composition and cardiorespiratory fitness (p < 0.050); (4) running reduces the risk of all-cause mortality by 23% (HR = 0.77; 95% CI: 0.70, 0.85), cancer mortality by 20% (HR = 0.80; 95% CI: 0.72, 0.89) and cardiovascular mortality by 27% (HR = 0.73; 95% CI: 0.57, 0.94) and improves body composition, cardiovascular function at rest and cardiorespiratory fitness (p < 0.010); and (5) swimming reduces the risk of all-cause mortality by 24% (HR = 0.76; 95% CI: 0.63, 0.92) and improves body composition and blood lipids (p < 0.010). CONCLUSIONS A range of physical health benefits are associated with participation in recreational cycling, football, handball, running and swimming. More studies are needed to enable meta-analyses of health benefits of participation in other sports. PROSPERO registration number CRD42021234839.
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Affiliation(s)
- Pekka Oja
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Aamir Raoof Memon
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Sylvia Titze
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Danijel Jurakic
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Si-Tong Chen
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Nipun Shrestha
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Sowannry Em
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Tena Matolic
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Tommi Vasankari
- UKK Institute for Health Promotion Research, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jozo Grgic
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Pasi Koski
- Department of Teacher Education, University of Turku, Rauma, Finland
| | - Sami Kokko
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Paul Kelly
- Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Charlie Foster
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Hrvoje Podnar
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
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de Boer WI, Mierau JO, Koning RH. Do differences in sport participation contribute to socioeconomic health inequalities? Evidence from the Lifelines cohort study on all-cause mortality, diabetes and obesity. Prev Med Rep 2023; 36:102479. [PMID: 37965127 PMCID: PMC10641690 DOI: 10.1016/j.pmedr.2023.102479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
Little is known about the role of sport participation in socioeconomic health inequalities. We studied the association between different aspects of sport participation with all-cause mortality, type 2 diabetes mellitus (T2DM) and obesity, including inequalities between socioeconomic subpopulations. Using the Dutch Lifelines cohort study (n = 84,230), we assessed the associations of sport participation, as well as the amount, intensity, type and number of sports, with all-cause mortality, T2DM and obesity in individuals. We studied the effect of sport participation on health outcomes within and between educational categories. Outcomes were compared with moderate to vigorous physical activity (MVPA). Sport participation was significantly associated with lower mortality (HR = 0.81), T2DM (HR = 0.70), and obesity (HR = 0.77). No significant additional effects of the amount or intensity of sport participation were found, while participating in teams sport was associated with significantly lower mortality (HR = 0.53) compared with other types of sport. These effects were similar among educational categories. Sport participation explained between 11% (T2DM and obesity) and 22% (mortality) of health inequalities between educational categories. This was more than twice the effect size of MVPA. The sensitivity analysis with net income as the socioeconomic indicator showed similar results. Our results suggest that to reduce socioeconomic differences in health, public health policies should focus on increasing sport participation in groups with a low socioeconomic status, rather than increasing the amount or intensity of sport participation, or MVPA in general.
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Affiliation(s)
- Willem I.J. de Boer
- University of Groningen, Faculty of Economics and Business, Nettelbosje 2, 9747 AE Groningen, the Netherlands
- School of Sport and Exercise, HAN University of Applied Sciences, Heyendaalseweg 141, 6525 AJ Nijmegen, the Netherlands
| | - Jochen O. Mierau
- University of Groningen, Faculty of Economics and Business, Nettelbosje 2, 9747 AE Groningen, the Netherlands
- Aletta Jacobs School of Public Health, Postbus 716, 9700 AS Groningen, the Netherlands
| | - Ruud H. Koning
- University of Groningen, Faculty of Economics and Business, Nettelbosje 2, 9747 AE Groningen, the Netherlands
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Logan G, Somers C, Baker G, Connell H, Gray S, Kelly P, McIntosh E, Welsh P, Gray CM, Gill JMR. Benefits, risks, barriers, and facilitators to cycling: a narrative review. Front Sports Act Living 2023; 5:1168357. [PMID: 37795314 PMCID: PMC10546027 DOI: 10.3389/fspor.2023.1168357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/05/2023] [Indexed: 10/06/2023] Open
Abstract
There is large potential to increase cycling participation worldwide. Participation in cycling is associated with lower risk of mortality from any cause, and incidence of cardiovascular disease and type 2 diabetes, as well as positive mental health and well-being. The largest potential for health gains likely to come from increasing participation amongst those who do not currently cycle regularly, rather than encouraging those who already cycle regularly to cycle more. Replacing car journeys with cycling can lead to reductions in air pollution emissions and lower pollutant exposure to the general population. Important gaps and uncertainties in the existing evidence base include: the extent to which the health benefits associated with cycling participation are fully causal due to the observational nature of much of the existing evidence base; the real-world economic cost-benefits of pragmatic interventions to increase cycling participation; and the most effective (combination of) approaches to increase cycling participation. To address these uncertainties, large-scale, long-term randomised controlled trials are needed to: evaluate the effectiveness, and cost-effectiveness, of (combinations of) intervention approaches to induce sustained long-term increases in cycling participation in terms of increases in numbers of people cycling regularly and number of cycling journeys undertaken, across a range of population demographic groups; establish the effects of such interventions on relevant outcomes related to health and wellbeing, economic productivity and wider societal impacts; and provide more robust quantification of potential harms of increasing cycling participation, such as collision risks.
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Affiliation(s)
- Greig Logan
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Camilla Somers
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Graham Baker
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Hayley Connell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Stuart Gray
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Paul Kelly
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Emma McIntosh
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Cindy M. Gray
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jason M. R. Gill
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
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6
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Ding P, Ding C, Feng S. The health benefits of bicycling to school among adolescents in China: A propensity score matching study. Front Public Health 2023; 11:1049254. [PMID: 37081956 PMCID: PMC10110905 DOI: 10.3389/fpubh.2023.1049254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/14/2023] [Indexed: 04/22/2023] Open
Abstract
Background A large number of high-income countries are now promoting active commuting to school as an opportunity for adolescents to increase physical activity (PA) and improve their health. Few studies have examined the multiple benefits of active travel to school among adolescents in developing countries, especially in China. Hence, this study aims to estimate the effects of bicycling to school on adolescents' subjective health, physical health, and sickness absence. Methods Self-reported and cross-sectional data from 6,353 school-aged children (12-19 years old) in the 2014-2015 China Education Panel Survey (CEPS2014-2015) were used. The independent variable was a binary, self-reported indicator of whether children bicycled to school. The dependent variables included subjective health (self-reported health, mental stress), physical health (BMI, kidney disease, lung disease, heart disease, brain disease, upper limb fracture, lower limb fracture, and sickness frequency), and sickness absence. Propensity score matching (PSM) was used to estimate the causal effects of bicycling to school on adolescents' health. Results Bicycling to school positively affects both subjective and physical health. Those students who biked to school were associated with a higher self-rated health status, a healthier weight, a lower level of mental stress, and a lower risk of developing brain diseases. No significant relation is found between bicycling and sickness frequency, and sickness absence. Moreover, we separately compared the bicycling group with the walking group and the non-active travel group. There is still evidence that cycling is beneficial for students. Compared with walking to school, cycling to school resulted in a higher self-rated health score and a lower mental stress score. Physically, students who bicycled to school were less likely to be absent from school and suffer from kidney and brain diseases than students who walked to school. However, we do not find a significant difference in health outcomes from cycling compared to non-active modes of transportation. Further, differentiation of the health effects of bicycling across living areas shows that health effects are more pronounced for those living in edge and rural areas. Conclusion These findings provide evidence of the value of promoting bicycling to school in improving various adolescents' health outcomes in transitional China.
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Affiliation(s)
- Pengxiang Ding
- School of Public Economics and Administration, Shanghai University of Finance and Economics, Shanghai, China
| | - Chang Ding
- School of Science and Information, Qingdao Agricultural University, Qingdao, China
| | - Suwei Feng
- School of Public Economics and Administration, Shanghai University of Finance and Economics, Shanghai, China
- *Correspondence: Suwei Feng,
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Schubert-Olesen O, Kröger J, Siegmund T, Thurm U, Halle M. Continuous Glucose Monitoring and Physical Activity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12296. [PMID: 36231598 PMCID: PMC9564842 DOI: 10.3390/ijerph191912296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
Continuous glucose monitoring (CGM) use has several potential positive effects on diabetes management. These benefits are, e.g., increased time in range (TIR), optimized therapy, and developed documentation. Physical activity is a recommended intervention tool in diabetes management, especially for people with type 2 diabetes (T2D). The benefits of physical activity for people with diabetes can be seen as an improvement of glycemic control, glycemic variability, and the reduction of insulin resistance. In relation to the physical activity of people with T2D, the benefits of CGM use can even be increased, and CGM can be a helpful tool to prevent adverse events due to physical activity of people with diabetes, such as hypoglycemic events and nocturnal hypoglycemia after sports. This narrative review aims to provide solid recommendations for the use of CGM in everyday life physical activities based on the noted benefits and to give a general overview of the guidelines on physical activity and CGM use for people with diabetes.
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Affiliation(s)
| | - Jens Kröger
- Center of Digital Diabetology Hamburg, 21029 Hamburg, Germany
| | - Thorsten Siegmund
- Diabetes, Hormones and Metabolism Center, Private Practice at the Isar Clinic, 80331 Munich, Germany
| | - Ulrike Thurm
- IDAA, Diabetic Athletes Association, 12621 Berlin, Germany
| | - Martin Halle
- Department of Preventive Sports Medicine and Sports Cardiology, University Hospital Klinikum Rechts der Isar, Technical University of Munich, 80992 Munich, Germany
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Peruzzi M, Sanasi E, Pingitore A, Marullo AG, Carnevale R, Sciarretta S, Sciarra L, Frati G, Cavarretta E. An overview of cycling as active transportation and as benefit for health. Minerva Cardioangiol 2021; 68:81-97. [PMID: 32429627 DOI: 10.23736/s0026-4725.20.05182-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Active transportation is defined as travelling on foot, by bicycle or other non-motorized means, sometimes in combination with other forms of public transportation, in contrast with the use of motor vehicles. The prevalence of sedentary lifestyle and physical inactivity is a growing epidemic in most developed countries that spread over the last three decades; active transportation may be a promising approach to increase physical activity and reduce the risk of non-communicable diseases improving cardiorespiratory fitness and cardiometabolic health. The health benefits of physical activity in reducing mortality and morbidity have been proved by several publications. Cardiorespiratory fitness can be improved by regular physical activity with an amelioration of insulin sensitivity, blood lipid profile, body composition, inflammation, and blood pressure. Active transportation as a daily physical activity is less expensive compared to motor vehicle use. The advantages are remarkable in terms of contrasting obesity and sedentary lifestyle, decrease motor traffic congestion and mitigate climate change. Massive investments in policies and interventions aimed to increase active transportation are not generally promoted and there are differences in the prevalence of active transportation in the daily routine among different areas. As in the literature several studies as randomized trials or observational studies have been published, with different end-points, in order to investigate if active commuting may be the right answer to improve cardiorespiratory fitness and cardiometabolic health, we aimed to review the available evidences of cycling as an active transportation and to consider its benefits on health.
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Affiliation(s)
| | - Elena Sanasi
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | | | - Antonino G Marullo
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Roberto Carnevale
- Mediterranea Cardiocentro, Naples, Italy.,Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Sebastiano Sciarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Department of Angio-Cardio-Neurology, IRCCS NeuroMed, Pozzilli, Isernia, Italy
| | - Luigi Sciarra
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Department of Angio-Cardio-Neurology, IRCCS NeuroMed, Pozzilli, Isernia, Italy
| | - Elena Cavarretta
- Mediterranea Cardiocentro, Naples, Italy - .,Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
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9
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Lamu AN, Jbaily A, Verguet S, Robberstad B, Norheim OF. Is cycle network expansion cost-effective? A health economic evaluation of cycling in Oslo. BMC Public Health 2020; 20:1869. [PMID: 33287754 PMCID: PMC7720509 DOI: 10.1186/s12889-020-09764-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expansion of designated cycling networks increases cycling for transport that, in turn, increases physical activity, contributing to improvement in public health. This paper aims to determine whether cycle-network construction in a large city is cost-effective when compared to the status-quo. We developed a cycle-network investment model (CIM) for Oslo and explored its impact on overall health and wellbeing resulting from the increased physical activity. METHODS First, we applied a regression technique on cycling data from 123 major European cities to model the effect of additional cycle-networks on the share of cyclists. Second, we used a Markov model to capture health benefits from increased cycling for people starting to ride cycle at the age of 30 over the next 25 years. All health gains were measured in quality-adjusted life years (QALYs). Costs were estimated in US dollars. Other data to populate the model were derived from a comprehensive literature search of epidemiological and economic evaluation studies. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses. RESULTS Our regression analysis reveals that a 100 km new cycle network construction in Oslo city would increase cycling share by 3%. Under the base-case assumptions, where the benefits of the cycle-network investment relating to increased physical activity are sustained over 25 years, the predicted average increases in costs and QALYs per person are $416 and 0.019, respectively. Thus, the incremental costs are $22,350 per QALY gained. This is considered highly cost-effective in a Norwegian setting. CONCLUSIONS The results support the use of CIM as part of a public health program to improve physical activity and consequently avert morbidity and mortality. CIM is affordable and has a long-term effect on physical activity that in turn has a positive impact on health improvement.
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Affiliation(s)
- Admassu N Lamu
- Department of Global Public Health and Primary Care, University of Bergen, Post box 7804, N-5020, Bergen, Norway.
| | - Abdulrahman Jbaily
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bjarne Robberstad
- Department of Global Public Health and Primary Care, University of Bergen, Post box 7804, N-5020, Bergen, Norway
| | - Ole Frithjof Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Post box 7804, N-5020, Bergen, Norway.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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10
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Abstract
Walking and cycling are not only frequently-used modes of transport but also popular physical activities. They are beneficial to traffic congestion mitigation, air pollution reduction, and public health promotion. Hence, examining and comparing the built environment correlates of the propensity of walking and cycling is of great interest to urban practitioners and decision-makers and has attracted extensive research attention. However, existing studies mainly look into the two modes separately or consider them as an integral (i.e., active travel), and few compare built environment correlates of their propensity in a single study, especially in the developing world context. Thus, this study, taking Xiamen, China, as a case, examines the built environment correlates of the propensity of walking and cycling simultaneously and compares the results wherever feasible. It found (1) built environment correlates of the propensity of walking and cycling differ with each other largely in direction and magnitude; (2) land use mix, intersection density, and bus stop density are positively associated with walking propensity, while the distance to the CBD (Central Business District) is a negative correlate; (3) as for cycling propensity, only distance to CBD is a positive correlate, and job density, intersection density, and bus stop density are all negative correlates. The findings of this study have rich policy implications for walking and cycling promotion interventions.
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11
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Munyombwe T, Lovelace R, Green M, Norman P, Walpole S, Hall M, Timmis A, Batin P, Brownlee A, Brownlee J, Oliver G, Gale CP. Association of prevalence of active transport to work and incidence of myocardial infarction: A nationwide ecological study. Eur J Prev Cardiol 2020; 27:822-829. [PMID: 31851832 DOI: 10.1177/2047487319876228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND There is a paucity of population-based geospatial data about the association between active transport and myocardial infarction. We investigated the association between active transport to work and incidence of myocardial infarction. DESIGN This ecological study of 325 local authorities in England included 43,077,039 employed individuals aged 25-74 years (UK Census, 2011), and 117,521 individuals with myocardial infarction (Myocardial Ischaemia National Audit Project, 2011-2013). METHODS Bayesian negative binomial regression models were used to investigate the association of active transport to work and incidence of myocardial infarction adjusting for local levels of deprivation, obesity, smoking, diabetes and physical activity. RESULTS In 2011, the prevalence of active transportation to work for people in employment in England aged 25-74 years was 11.4% (4,531,182 active transporters; 8.6% walking and 2.8% cycling). Active transport in 2011 was associated with a reduced incidence of myocardial infarction in 2012 amongst men cycling to work (incidence rate ratio (95% credible interval) 0.983 (0.967-0.999); and women walking to work (0.983 (0.967-0.999)) after full adjustments. However, the prevalence of active transport for men and women was not significantly associated with the combined incidence of myocardial infarction between 2011-2013 after adjusting for physical activity, smoking and diabetes. CONCLUSIONS In England, the prevalence of active transportation was associated with a reduced incidence of myocardial infarction for women walking and men cycling to work in corresponding local geographic areas. The overall association of active transport with myocardial infarction was, however, explained by local area levels of smoking, diabetes and physical activity.
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Affiliation(s)
- Theresa Munyombwe
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, UK
| | - Robin Lovelace
- Leeds Institute for Data Analytics, University of Leeds, UK
- Institute for Transport Studies, University of Leeds, UK
| | - Mark Green
- Department of Geography and Planning, University of Liverpool, UK
| | - Paul Norman
- School of Geography, University of Leeds, UK
| | | | - Marlous Hall
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, UK
| | - Adam Timmis
- NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, UK
| | - Phil Batin
- Department of Cardiology, Mid Yorkshire Hospitals NHS Trust, UK
| | | | | | | | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, UK
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12
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Porter AK, Schilsky S, Evenson KR, Florido R, Palta P, Holliday KM, Folsom AR. The Association of Sport and Exercise Activities With Cardiovascular Disease Risk: The Atherosclerosis Risk in Communities (ARIC) Study. J Phys Act Health 2019; 16:698-705. [PMID: 31369998 PMCID: PMC6994359 DOI: 10.1123/jpah.2018-0671] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/25/2019] [Accepted: 06/03/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study assessed the independent associations between participation in self-reported sport and exercise activities and incident cardiovascular disease (CVD). METHODS Data were from 13,204 participants in the Atherosclerosis Risk in Communities Study cohort (1987-2015). Baseline sport and exercise activities were assessed via the modified Baecke questionnaire. Incident CVD included coronary heart disease, heart failure, or stroke. Multivariable-adjusted Cox proportional hazard models assessed the association of participation in specific sport and exercise activities at enrollment with risk of CVD. RESULTS During a median follow-up time of 25.2 years, 30% of the analytic sample (n = 3966) was diagnosed with incident CVD. In fully adjusted models, participation in racquet sports (hazard ratio [HR] 0.75; 95% confidence interval [CI], 0.61-0.93), aerobics (HR 0.75; 95% CI, 0.63-0.88), running (HR 0.68; 95% CI, 0.54-0.85), and walking (HR 0.89; 95% CI, 0.83-0.95) was significantly associated with a lower risk of CVD. There were no significant associations for bicycling, softball/baseball, gymnastics, swimming, basketball, calisthenics exercises, golfing with cart, golfing with walking, bowling, or weight training. CONCLUSIONS Participation in specific sport and exercises may substantially reduce the risk for CVD.
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Grøntved A, Rasmussen MG, Blond K, Østergaard L, Andersen ZJ, Møller NC. Bicycling for Transportation and Recreation in Cardiovascular Disease Prevention. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0623-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Nordengen S, Andersen LB, Solbraa AK, Riiser A. Cycling is associated with a lower incidence of cardiovascular diseases and death: Part 1 – systematic review of cohort studies with meta-analysis. Br J Sports Med 2019; 53:870-878. [DOI: 10.1136/bjsports-2018-099099] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2018] [Indexed: 11/04/2022]
Abstract
ObjectivesPhysical inactivity is a risk factor for cardiovascular disease (CVD). Cycling as a physical activity holds great potential to prevent CVD. We aimed to determine whether cycling reduces the risk of CVD and CVD risk factors and to investigate potential dose-response relationships.DesignSystematic review and meta-analysis of quantitative studies.Eligibility criteria for selecting studiesWe searched four databases (Web of Science, MEDLINE, SPORTDiscus and Scopus). All quantitative studies, published until August 2017, were included when a general population was investigated, cycling was assessed either in total or as a transportation mode, and CVD incidence, mortality or risk factors were reported. Studies were excluded when they reported continuous outcomes or when cycling and walking were combined in them. We pooled adjusted relative risks (RR) and OR. Heterogeneity was investigated using I.ResultsThe search yielded 5174 studies; 21 studies which included 1,069,034 individuals. We found a significantly lower association in combined CVD incidence, mortality and physiological risk factors with total effect estimate 0.78 (95% CI (CI): 0.74–0.82; P<0.001; I2=58%). Separate analyses for CVD incidence, mortality and risk factors showed estimates of RR 0.84 (CI, 0.80 to 0.88; P<0.001; I2=29%), RR 0.83 (CI, 0.76 to 0.90; P<0.001; I2=0%), and OR 0.75 (CI, 0.69 to 0.82; P<0.001; I2=66%), respectively. We found no dose-response relationship or sex-specific difference.ConclusionsAny form of cycling seems to be associated with lower CVD risk, and thus, we recommend cycling as a health-enhancing physical activity.Systematic review registrationProspero CRD42016052421.
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15
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King JC, Franklin RC, Devine S, Watt K, Leggat PA. Exploring Australian residents cycling engagement - Differences in self-reported cycling behaviour between urban and rural dwelling Queenslanders. Health Promot J Austr 2019; 31:93-103. [PMID: 31002469 DOI: 10.1002/hpja.254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/12/2019] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED Cycling participation rates in Australia and Queensland remain low. Rural residents typically do not have distinct cycling infrastructure available for use. Investigating current cycling participation and barriers to cycling engagement will inform future work to promote cycling engagement. METHODS Data were collected through the inclusion of cycling-related questions in the 2012 Queensland Social Survey. RESULTS The majority of the sample had not cycled in the previous 12 months (66%; n = 831). Significantly more rural residents reported not cycling due to environmental concerns (P < 0.05) and preferring other modes of transport or exercise (P < 0.01). Rural cyclists (31.4%; n = 113) had higher levels of cycling engagement in the previous week (41.6% to 32.6% urban; χ2 = 7.83; n = 420; P < 0.05) but lower cycling durations than urban cyclists (41.6% rural residents cycling for 30+ minutes vs 57.4% urban residents; χ2 = 8.25; n = 418; P < 0.01). Rural cycling engagement was independently associated with being male (OR = 2.34; 95% CI = 1.40-3.91); sufficient physical activity engagement (OR = 1.86; 95% CI = 1.10-3.15); and having children at place of residence (1-2 children: OR = 3.21; 95% CI = 1.88-5.49; 3+ children: OR = 3.01; 95% CI = 1.17-7.75). CONCLUSIONS One-third of all adults cycled in the previous 12 months irrespective of location; however reasons for not cycling varied by urban/rural location. Results indicate that environmental factors appear to be inhibiting cycling participation in rural areas. Advocating for government commitment for infrastructure development to support safe cycling across Queensland including outside of metropolitan areas is required. SO WHAT?: This research explores self-reported cycling engagement amongst a sample of urban and rural dwelling Queenslanders. Differences in cycling exposure and reasons for lack of engagement offer insights into what may encourage greater cycling participation.
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Affiliation(s)
- Jemma C King
- World Safety Organisation Collaborating Centre for Injury Prevention and Safety Promotion, James Cook University, Townsville, Qld, Australia.,Dislipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia
| | - Richard C Franklin
- World Safety Organisation Collaborating Centre for Injury Prevention and Safety Promotion, James Cook University, Townsville, Qld, Australia.,Dislipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia
| | - Sue Devine
- Dislipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia
| | - Kerrianne Watt
- World Safety Organisation Collaborating Centre for Injury Prevention and Safety Promotion, James Cook University, Townsville, Qld, Australia.,Dislipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia
| | - Peter A Leggat
- World Safety Organisation Collaborating Centre for Injury Prevention and Safety Promotion, James Cook University, Townsville, Qld, Australia.,Dislipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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16
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Blond K, Jensen MK, Rasmussen MG, Overvad K, Tjønneland A, Østergaard L, Grøntved A. Prospective Study of Bicycling and Risk of Coronary Heart Disease in Danish Men and Women. Circulation 2018; 134:1409-1411. [PMID: 27799259 DOI: 10.1161/circulationaha.116.024651] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kim Blond
- From Department of Sports Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, University of Southern Denmark, Campusvej (K.B., M.R.G., L.Ø., A.G.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (M.K.J.); Department of Medicine, Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA (M.K.J.); Department of Cardiology, Aalborg University Hospital, Denmark (K.O.); Department of Public Health, Section for Epidemiology, Aarhus University, Denmark (K.O.); and Danish Cancer Society Research Center, Copenhagen, Denmark (A.T.)
| | - Majken K Jensen
- From Department of Sports Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, University of Southern Denmark, Campusvej (K.B., M.R.G., L.Ø., A.G.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (M.K.J.); Department of Medicine, Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA (M.K.J.); Department of Cardiology, Aalborg University Hospital, Denmark (K.O.); Department of Public Health, Section for Epidemiology, Aarhus University, Denmark (K.O.); and Danish Cancer Society Research Center, Copenhagen, Denmark (A.T.)
| | - Martin G Rasmussen
- From Department of Sports Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, University of Southern Denmark, Campusvej (K.B., M.R.G., L.Ø., A.G.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (M.K.J.); Department of Medicine, Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA (M.K.J.); Department of Cardiology, Aalborg University Hospital, Denmark (K.O.); Department of Public Health, Section for Epidemiology, Aarhus University, Denmark (K.O.); and Danish Cancer Society Research Center, Copenhagen, Denmark (A.T.)
| | - Kim Overvad
- From Department of Sports Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, University of Southern Denmark, Campusvej (K.B., M.R.G., L.Ø., A.G.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (M.K.J.); Department of Medicine, Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA (M.K.J.); Department of Cardiology, Aalborg University Hospital, Denmark (K.O.); Department of Public Health, Section for Epidemiology, Aarhus University, Denmark (K.O.); and Danish Cancer Society Research Center, Copenhagen, Denmark (A.T.)
| | - Anne Tjønneland
- From Department of Sports Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, University of Southern Denmark, Campusvej (K.B., M.R.G., L.Ø., A.G.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (M.K.J.); Department of Medicine, Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA (M.K.J.); Department of Cardiology, Aalborg University Hospital, Denmark (K.O.); Department of Public Health, Section for Epidemiology, Aarhus University, Denmark (K.O.); and Danish Cancer Society Research Center, Copenhagen, Denmark (A.T.)
| | - Lars Østergaard
- From Department of Sports Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, University of Southern Denmark, Campusvej (K.B., M.R.G., L.Ø., A.G.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (M.K.J.); Department of Medicine, Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA (M.K.J.); Department of Cardiology, Aalborg University Hospital, Denmark (K.O.); Department of Public Health, Section for Epidemiology, Aarhus University, Denmark (K.O.); and Danish Cancer Society Research Center, Copenhagen, Denmark (A.T.)
| | - Anders Grøntved
- From Department of Sports Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, University of Southern Denmark, Campusvej (K.B., M.R.G., L.Ø., A.G.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (M.K.J.); Department of Medicine, Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA (M.K.J.); Department of Cardiology, Aalborg University Hospital, Denmark (K.O.); Department of Public Health, Section for Epidemiology, Aarhus University, Denmark (K.O.); and Danish Cancer Society Research Center, Copenhagen, Denmark (A.T.).
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17
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Bauman AE, Grunseit AC, Rangul V, Heitmann BL. Physical activity, obesity and mortality: does pattern of physical activity have stronger epidemiological associations? BMC Public Health 2017; 17:788. [PMID: 28982371 PMCID: PMC5629749 DOI: 10.1186/s12889-017-4806-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/28/2017] [Indexed: 02/08/2023] Open
Abstract
Background Most studies of physical activity (PA) epidemiology use behaviour measured at a single time-point. We examined whether ‘PA patterns’ (consistently low, consistently high or inconsistent PA levels over time) showed different epidemiological relationships for anthropometric and mortality outcomes, compared to single time-point measure of PA. Methods Data were the Danish MONICA (MONItoring Trends and Determinants in CArdiovascular Disease) study over three waves 1982–3 (time 1), 1987–8 (time 2) and 1993–4 (time 3). Associations between leisure time single time-point PA levels at time 1 and time 3, and sport and active travel at times 1 and 2 with BMI, waist, hip circumference and mortality (death from coronary heart disease (CHD) and cardiovascular disease (CVD)) were compared to ‘PA patterns’ spanning multiple time points. PA pattern classified participants’ PA as either 1) inactive or low PA at both time points; 2) moderate level PA at time 1 and high activity at time 3; or 3) a ‘mixed PA pattern’ indicating a varying levels of activity over time. Similarly, sport and active travel were also classified as indicating stable low, stable high and mixed patterns. Results The moderately and highly active groups for PA at times 1 and 3 had up to 1.7 cm lower increase in waist circumference compared with the inactive/low active group. Across ‘PA patterns’, ‘active maintainers’ had a 2.0 cm lower waist circumference than ‘inactive/low maintainers’. Waist circumference was inversely related to sport but not active travel. CHD risk did not vary by activity levels at time 1, but was reduced significantly by 43% for high PA at time 3 (vs ‘inactive’ group) and among ‘active maintainers’ (vs ‘inactive/low maintainers’) by 62%. ‘Sport pattern’ showed stronger reductions in mortality for cardiovascular disease and CHD deaths among sport maintainers, than the single time point measures. Conclusions PA patterns demonstrated a stronger association with a number of anthropometric and mortality outcomes than the single time-point measures. Operationalising PA as a sustained behavioural pattern may address some of the known under-estimation of risk for poor health in PA self-report measurements and better reflect exposure for epidemiological analysis of risk of health outcomes. Electronic supplementary material The online version of this article (10.1186/s12889-017-4806-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adrian E Bauman
- Prevention Research Collaboration, School of Public Health, University of Sydney, Level 6, Charles Perkins Centre, Johns Hopkins Drive, Sydney, NSW, 2006, Australia
| | - Anne C Grunseit
- Prevention Research Collaboration, School of Public Health, University of Sydney, Level 6, Charles Perkins Centre, Johns Hopkins Drive, Sydney, NSW, 2006, Australia.
| | - Vegar Rangul
- HUNT Research Centre, Faculty of Medicine, Department of Public health and General practice, NTNU - Norwegian University of Science and Technology, Levanger, Norway
| | - Berit L Heitmann
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, NSW, 2006, Australia.,Research Unit for Dietary Studies at the Parker Institute and Institute of Preventive Medicine, Frederiksberg and Bispebjerg Hospital, Copenhagen, Denmark.,Institute of Public Health, University of Southern Denmark, Odense, Denmark.,Copenhagen Center for Preventive Medicine, Glostrup Hospital, Copenhagen Capital Region, Denmark
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18
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Jakovljevic V, Djordjevic D. Physical Activity for the Prevention of Cardiovascular Diseases. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2017. [DOI: 10.1515/sjecr-2016-0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Abstract
Over the last decade, the quantity and quality of scientific literature examining the relationship between physical activity (PA) and cardiovascular diseases (CVD) have significantly increased. Data from the literature now unequivocally show that physical inactivity is one of the major risk factors for CVD. It is believed that obesity, the prevalence of which has tripled over the last three decades, and physical inactivity among children are the main factors that will increase the prevalence of CVD in this century. The cardiovascular benefits of exercise are multifactorial and include important systemic effects on skeletal muscle, the peripheral vasculature, metabolism, and neurohumoral systems, as well as beneficial alterations within the myocardium itself. Thus, exercise does much more than change traditional risk factors, such as blood pressure, blood lipids, glucose tolerance and insulin resistance, metabolic syndrome, and overweight and obesity. Evidence from epidemiologic studies suggests that the preventive effects of PA may be achieved by 150 minutes of moderate PA a week, while increases in the intensity and volume of exercise lead to further health benefits. This dose–response gradient is curvilinear, with the largest gains from the first hour of weekly exercise. However, although much progress has been made in this field, existing studies performed on human subjects do not clearly show what type, intensity, and duration of exercise is most beneficial to cardiovascular fitness and metabolic optimization. Animal-based exercise studies may provide more information and help to elucidate the abilities of different training regimens to reduce the risk of CVD.
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Affiliation(s)
- Vladimir Jakovljevic
- Department of Physiology , Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Dusica Djordjevic
- Department of Physiology , Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
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19
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Loef B, Hulsegge G, Wendel-Vos GCW, Verschuren WMM, Vermeulen RCH, Bakker MF, van der Beek AJ, Proper KI. Non-occupational physical activity levels of shift workers compared with non-shift workers. Occup Environ Med 2017; 74:328-335. [PMID: 27872151 PMCID: PMC5520260 DOI: 10.1136/oemed-2016-103878] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/24/2016] [Accepted: 09/06/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Lack of physical activity (PA) has been hypothesised as an underlying mechanism in the adverse health effects of shift work. Therefore, our aim was to compare non-occupational PA levels between shift workers and non-shift workers. Furthermore, exposure-response relationships for frequency of night shifts and years of shift work regarding non-occupational PA levels were studied. METHODS Data of 5980 non-shift workers and 532 shift workers from the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) were used in these cross-sectional analyses. Time spent (hours/week) in different PA types (walking/cycling/exercise/chores) and intensities (moderate/vigorous) were calculated based on self-reported PA. Furthermore, sports were operationalised as: playing sports (no/yes), individual versus non-individual sports, and non-vigorous-intensity versus vigorous-intensity sports. PA levels were compared between shift workers and non-shift workers using Generalized Estimating Equations and logistic regression. RESULTS Shift workers reported spending more time walking than non-shift workers (B=2.3 (95% CI 1.2 to 3.4)), but shift work was not associated with other PA types and any of the sports activities. Shift workers who worked 1-4 night shifts/month (B=2.4 (95% CI 0.6 to 4.3)) and ≥5 night shifts/month (B=3.7 (95% CI 1.8 to 5.6)) spent more time walking than non-shift workers. No exposure-response relationships were found between years of shift work and PA levels. CONCLUSIONS Shift workers spent more time walking than non-shift workers, but we observed no differences in other non-occupational PA levels. To better understand if and how PA plays a role in the negative health consequences of shift work, our findings need to be confirmed in future studies.
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Affiliation(s)
- Bette Loef
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Gerben Hulsegge
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - G C Wanda Wendel-Vos
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - W M Monique Verschuren
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roel C H Vermeulen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Marije F Bakker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Allard J van der Beek
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Karin I Proper
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
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20
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Grøntved A, Koivula RW, Johansson I, Wennberg P, Østergaard L, Hallmans G, Renström F, Franks PW. Bicycling to Work and Primordial Prevention of Cardiovascular Risk: A Cohort Study Among Swedish Men and Women. J Am Heart Assoc 2016; 5:e004413. [PMID: 27799235 PMCID: PMC5210355 DOI: 10.1161/jaha.116.004413] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/14/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Bicycling to work may be a viable approach for achieving physical activity that provides cardiovascular health benefits. In this study we investigated the relationship of bicycling to work with incidence of obesity, hypertension, hypertriglyceridemia, and impaired glucose tolerance across a decade of follow-up in middle-aged men and women. METHODS AND RESULTS We followed 23 732 Swedish men and women with a mean age of 43.5 years at baseline who attended a health examination twice during a 10-year period (1990-2011). In multivariable adjusted models we calculated the odds of incident obesity, hypertension, hypertriglyceridemia, and impaired glucose tolerance, comparing individuals who commuted to work by bicycle with those who used passive modes of transportation. We also examined the relationship of change in commuting mode with incidence of these clinical risk factors. Cycling to work at baseline was associated with lower odds of incident obesity (odds ratio [OR]=0.85, 95% CI 0.73-0.99), hypertension (OR=0.87, 95% CI 0.79-0.95), hypertriglyceridemia (OR=0.85, 95% CI 0.76-0.94), and impaired glucose tolerance (OR=0.88, 95% CI 0.80-0.96) compared with passive travel after adjusting for putative confounding factors. Participants who maintained or began bicycling to work during follow-up had lower odds of obesity (OR=0.61, 95% CI 0.50-0.73), hypertension (OR=0.89, 95% CI 0.80-0.98), hypertriglyceridemia (OR=0.80, 95% CI 0.70-0.90), and impaired glucose tolerance (OR=0.82, 95% CI 0.74-0.91) compared with participants not cycling to work at both times points or who switched from cycling to other modes of transport during follow-up. CONCLUSIONS These data suggest that commuting by bicycle to work is an important strategy for primordial prevention of clinical cardiovascular risk factors among middle-aged men and women.
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Affiliation(s)
- Anders Grøntved
- Research Unit for Exercise Epidemiology, Department of Sport Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Odense M, Denmark
| | - Robert W Koivula
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University Skåne University Hospital Malmö, Malmö, Sweden
| | | | - Patrik Wennberg
- Department of Public Health & Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Østergaard
- Research Unit for Exercise Epidemiology, Department of Sport Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Odense M, Denmark
| | - Göran Hallmans
- Department of Public Health & Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Biobank Research, Umeå University, Umeå, Sweden
| | - Frida Renström
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University Skåne University Hospital Malmö, Malmö, Sweden
- Department of Biobank Research, Umeå University, Umeå, Sweden
| | - Paul W Franks
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University Skåne University Hospital Malmö, Malmö, Sweden
- Department of Public Health & Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
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Dhana K, Koolhaas CM, Berghout MA, Peeters A, Ikram MA, Tiemeier H, Hofman A, Nusselder W, Franco OH. Physical activity types and life expectancy with and without cardiovascular disease: the Rotterdam Study. J Public Health (Oxf) 2016; 39:e209-e218. [DOI: 10.1093/pubmed/fdw110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 09/01/2016] [Indexed: 11/12/2022] Open
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22
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Brown BB, Tharp D, Tribby CP, Smith KR, Miller HJ, Werner CM. Changes in bicycling over time associated with a new bike lane: relations with kilocalories energy expenditure and body mass index. JOURNAL OF TRANSPORT & HEALTH 2016; 3:357-365. [PMID: 27672561 PMCID: PMC5034937 DOI: 10.1016/j.jth.2016.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Although bicycling has been related to positive health indicators, few studies examine health-related measures associated with non-competitive community cycling before and after cycling infrastructure improvements. This study examined cycling changes in a neighborhood receiving a bike lane, light rail, and other "complete street" improvements. Participants wore accelerometers and global positioning system (GPS) data loggers for one week in both 2012 and 2013, pre- and post- construction completion. Participants sampled within 2 km of the complete street improvements had the following patterns of cycling: never cyclists (n=434), continuing cyclists (n= 29), former cyclists (n=33, who bicycled in 2012 but not 2013), and new cyclists (n=40, who bicycled in 2013 but not 2012). Results show that all three cycling groups, as identified by GPS/accelerometry data, expended more estimated kilocalories (kcal) of energy per minute during the monitoring week than those who were never detected cycling, net of control variables. Similar but attenuated results emerged when cycling self-report measures were used. BMI was not related to cycling group but those who cycled longer on the new path had lower BMI. Although cyclists burn more calories than non-cyclists across the week, among cyclists, their cycling days involved more calories expended than their non-cycling days. The new cyclists account for 39% of the cyclists identified in this study and former cyclists account for 32% of cyclists. These results suggest that cycling is healthy, but that sustaining rates of cycling will be an important goal for future policy and research.
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Affiliation(s)
- Barbara B. Brown
- Department of Family and Consumer Studies; Cancer Control and Population Sciences, Huntsman Cancer Institute, 225 S 1400 E RM 228, University of Utah, Salt Lake City, UT, USA
| | - Douglas Tharp
- Department of Family & Consumer Studies, 225 S 1400 E RM 228, University of Utah, Salt Lake City, UT, USA
| | - Calvin P. Tribby
- Department of Geography; Ohio State University, 1036 Derby Hall, 154 N. Oval Mall, The Ohio State University, Columbus, OH, USA
| | - Ken R. Smith
- Department of Family and Consumer Studies; Cancer Control and Population Sciences, Huntsman Cancer Institute, 225 S 1400 E RM 228, University of Utah, Salt Lake City, UT, USA
| | - Harvey J. Miller
- Department of Geography; Ohio State University, 1036 Derby Hall, 154 N. Oval Mall, The Ohio State University, Columbus, OH, USA
| | - Carol M. Werner
- Department of Psychology, 380 S. 1530 E., RM 502 BSB, University of Utah, Salt Lake City, UT, USA
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Rasmussen MG, Grøntved A, Blond K, Overvad K, Tjønneland A, Jensen MK, Østergaard L. Associations between Recreational and Commuter Cycling, Changes in Cycling, and Type 2 Diabetes Risk: A Cohort Study of Danish Men and Women. PLoS Med 2016; 13:e1002076. [PMID: 27403867 PMCID: PMC4942105 DOI: 10.1371/journal.pmed.1002076] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/03/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cycling is a recreational activity and mode of commuting with substantial potential to improve public health in many countries around the world. The aim of this study was to examine prospective associations between recreational and commuter cycling, changes in cycling habits, and risk of type 2 diabetes (T2D) in Danish adults from the Diet, Cancer and Health cohort study. METHODS AND FINDINGS At baseline from 1993 to 1997, 24,623 men and 27,890 women from Denmark, 50-65 y of age and free of T2D and other chronic diseases, underwent a number of assessments, including completing a lifestyle questionnaire also addressing cycling habits. Approximately 5 y later, at a second examination, participants completed a new, updated lifestyle questionnaire. Cox regression was used to estimate hazard ratios (HRs) of incident T2D registered in the Danish National Diabetes Registry, according to recreational and commuter cycling and changes in cycling habits, with adjustment for a priori known T2D risk factors. During 743,245.4 person-years of follow-up (mean follow-up 14.2 y), 6,779 incident cases of T2D were documented. Multivariable adjusted HRs (95% confidence interval [CI]) were 1, 0.87 (0.82, 0.93), 0.83 (0.77, 0.89), 0.80 (0.74, 0.86) and 0.80 (0.74, 0.87) (p for trend = <0.001) for 0, 1-60, 61-150, 151-300, and >300 min/wk of total cycling (recreational and commuter cycling), respectively. In analysis of seasonal cycling, multivariable adjusted HRs (95% CI) were 1, 0.88 (0.83, 0.94), and 0.80 (0.76, 0.85) for non-cyclists, seasonal cyclists (those cycling only in summer or winter), and those cycling during both summer and winter, respectively. How changes in total cycling from baseline to the second examination affected risk was also investigated, and multivariable adjusted HRs (95% CI) were 1, 0.88 (0.78, 1.01), 0.80 (0.69, 0.91), and 0.71 (0.65, 0.77) for non-cyclists and for those who ceased, initiated, or continued cycling between baseline and the second examination, respectively. Lastly, in the analysis of commuter cycling, multivariable HRs (95% CI) were 1, 0.72 (0.60, 0.87), 0.83 (0.69, 1.00), and 0.70 (0.57, 0.85) (p for trend = <0.001) for cycling 0, 1-60, 61-150, and >150 min/wk to work, respectively. The main limitation of the current study is the use of self-reported physical activity. CONCLUSIONS Commuter and recreational cycling was consistently associated with lower risk of T2D in Danish adults. Our results also provide evidence that late-in-life initiation of or continued engagement in cycling lowers risk of T2D.
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Affiliation(s)
- Martin G. Rasmussen
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anders Grøntved
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kim Blond
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kim Overvad
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | | | - Majken K. Jensen
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Medicine, Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Lars Østergaard
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Koolhaas CM, Dhana K, Golubic R, Schoufour JD, Hofman A, van Rooij FJA, Franco OH. Physical Activity Types and Coronary Heart Disease Risk in Middle-Aged and Elderly Persons: The Rotterdam Study. Am J Epidemiol 2016; 183:729-38. [PMID: 27022033 DOI: 10.1093/aje/kwv244] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/04/2015] [Indexed: 12/22/2022] Open
Abstract
Physical activity is associated with decreased risk of coronary heart disease (CHD). The specific physical activity types that provide beneficial effects in an older population remain unclear. We assessed the association of total physical activity, walking, cycling, domestic work, sports, and gardening with CHD by using Cox proportional hazard models among 5,901 participants aged >55 (median age, 67) years from the prospective population-based Rotterdam Study, enrolled between 1997 and 2001. Activities were categorized into tertiles, and the lowest tertiles were used as reference. In the multivariable model, we adjusted for age, sex, smoking, alcohol consumption, education, diet, and other physical activity types. During 15 years of follow-up (median, 10.3 (interquartile range, 8.0-11.8) years), 642 participants (10.9%) experienced a CHD event. In the multivariable model, the respective hazard ratios for the medium and high categories compared with the low category were 0.79 (95% confidence interval CI): 0.66, 0.96) and 0.71 (95% CI: 0.58, 0.87) for total physical activity, 0.76 (95% CI: 0.63, 0.92) and 0.70 (95% CI: 0.57, 0.88) for cycling, and 0.81 (95% CI: 0.66, 0.98) and 0.71 (95% CI: 0.56, 0.90) for domestic work. Walking, sports, and gardening were not associated with CHD. In conclusion, in this long-term follow-up study of older adults, domestic work and cycling were associated with reduced CHD risk. Physical activity should be promoted in this population with the aim to prevent CHD.
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Lerssrimongkol C, Wisetborisut A, Angkurawaranon C, Jiraporncharoen W, Lam KBH. Active commuting and cardiovascular risk among health care workers. Occup Med (Lond) 2016; 66:483-7. [PMID: 27060798 DOI: 10.1093/occmed/kqw029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Although the benefit of physical activity on cardiovascular health has been well demonstrated, being physically active can be difficult for health care workers. Active commuting such as walking or cycling may be a good way to promote physical activity. AIMS To investigate the relationship between active commuting and cardiovascular disease risk factors in health care workers. METHODS A cross-sectional study of health care workers conducted in Chiang Mai University Hospital, Thailand. Information on demographics and lifestyle, including active commuting, was obtained from questionnaires. Results were analysed with multiple logistic regression, adjusting for other physical activity and possible confounders. RESULTS Among 3204 participants, fewer than half engaged in active commuting. After adjustment for poss ible confounders, low active commuting was associated with increased risk of hypertension [adjusted odds ratio (aOR) 1.3, 95% confidence interval (CI) 1.1-1.7]. High active commuting was associated with central obesity (aOR 1.4, 95% CI 1.0-1.8). Compared with non-active commuters, younger active commuters (aged under 40) had reduced prevalence of hypertension (aOR 0.4, 95% CI 0.2-1.0), while older active commuters (aged 40 or over) demonstrated increased hypertension (aOR 1.6, 95% CI 1.1-2.3) and central obesity (aOR 1.5, 95% CI 1.1-2.1). CONCLUSIONS We found conflicting evidence on the relationship between active commuting and cardiovascular risk factors. Reverse causation may explain the association between active commuting and hypertension and central obesity and should be investigated further.
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Affiliation(s)
- C Lerssrimongkol
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - A Wisetborisut
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand,
| | - C Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - W Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - K B H Lam
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
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Scheepers C, Wendel-Vos G, van Wesemael P, den Hertog F, Stipdonk H, Int Panis L, van Kempen E, Schuit A. Perceived health status associated with transport choice for short distance trips. Prev Med Rep 2016; 2:839-44. [PMID: 26844158 PMCID: PMC4721281 DOI: 10.1016/j.pmedr.2015.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background This study examines the association between active transport and perceived general health, perceived psychological wellbeing and a healthy body weight in the Netherlands. Methods Data were collected by an online questionnaire (N = 3663) in the Netherlands. Data collection was conducted over a period of one calendar year starting July 2012. Logistic regression analyses were used to investigate the association between choice of transport mode (bicycling vs car use and walking vs car use) and perceived general health, perceived psychological wellbeing and having a healthy weight respectively. The presented OR's may be interpreted as the likelihood of an average person in our dataset to have a better perceived health or body weight when choosing active transport (either bicycling or walking) over using the car for trips up to 7.5 km. Results Cycling was found to be significantly associated with a better perceived general health (OR = 1.35, 95%CI:1.07–1.70) and having a healthy body weight (OR = 1.52, 95%CI:1.28–1.79), but not with a better perceived psychological wellbeing (OR = 1.12, 95%CI:0.93–1.34). Walking was found to be significantly associated with having a healthy body weight (OR = 1.35, 95%CI:1.09–1.69), but not with a better perceived general (OR = 1.12, 95%CI:0.84–1.51) or psychological wellbeing (OR = 0.85, 95%CI:0.67–1.08). Conclusion Our results suggest that active transport use has been associated with a better perceived general health and a healthy body weight. However, more research is needed to be able to elucidate which factors cause this better health. No associations were observed between transport choice and perceived psychological wellbeing. Active transport users experience a better perceived general health. Active transport users are more likely to have a healthy body weight. No association between transport choice and perceived psychological wellbeing in The Netherlands
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Affiliation(s)
- C.E. Scheepers
- VU University Amsterdam, Department of Health Sciences and EMGO institute for Health and Care Research, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, PO Box 1, 3720 BA Bilthoven, the Netherlands
- Corresponding author at: Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, the Netherlands. Fax: + 31 30 274 4407.Centre for Nutrition, Prevention and Health ServicesNational Institute for Public Health and the EnvironmentPO Box 1Bilthoven3720 BAthe Netherlands
| | - G.C.W. Wendel-Vos
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, PO Box 1, 3720 BA Bilthoven, the Netherlands
| | - P.J.V. van Wesemael
- Technical University Eindhoven, Department of the Built Environment, 5600 MB Eindhoven, the Netherlands
| | - F.R.J. den Hertog
- National Institute for Public Health and the Environment, Centre of Health and Society, 3720 BA Bilthoven, the Netherlands
| | - H.L. Stipdonk
- SWOV Institute for Road Safety Research, PO box 93113, 2509 AC Den Haag, the Netherlands
| | - L.L.R. Int Panis
- Flemish Institute for Technological Research (VITO), PHaRE, Mobile Health Unit, 2400 Mol, Belgium
- School for Mobility, Hasselt University, 3590 Diepenbeek, Belgium
| | - E.E.M.M. van Kempen
- National Institute for Public Health and the Environment, Centre for Sustainability, Environment and Health, PO Box 1, 3720 BA Bilthoven, the Netherlands
| | - A.J. Schuit
- VU University Amsterdam, Department of Health Sciences and EMGO institute for Health and Care Research, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, PO Box 1, 3720 BA Bilthoven, the Netherlands
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27
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Hulsegge G, Looman M, Smit HA, Daviglus ML, van der Schouw YT, Verschuren WM. Lifestyle Changes in Young Adulthood and Middle Age and Risk of Cardiovascular Disease and All-Cause Mortality: The Doetinchem Cohort Study. J Am Heart Assoc 2016; 5:e002432. [PMID: 26764411 PMCID: PMC4859361 DOI: 10.1161/jaha.115.002432] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/30/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The associations between overall lifestyle profile and cardiovascular disease (CVD) and death have been mainly investigated in cross-sectional studies. The full benefits of a healthy lifestyle may therefore be underestimated, and the magnitude of benefits associated with changes in lifestyle remains unclear. We quantified the association of changes in lifestyle profiles over 5 years with risk of CVD and all-cause mortality. METHODS AND RESULTS Lifestyle factors (ie, diet, physical activity, smoking, alcohol consumption) and body mass index were assessed and dichotomized as healthy/unhealthy among 5263 adults ages 26 to 66 in 1993-1997 and 5 years later (1998-2002). Multivariable-adjusted hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were estimated to quantify associations of change in lifestyle with fatal/nonfatal CVD and all-cause mortality that occurred 8 to 15 years after 1998-2002. Independent of baseline lifestyles, each decrement in number of healthy lifestyle factors was, on average, associated with 35% higher risk of CVD (HR, 1.35; 95% CI, 1.12-1.63) and 37% higher risk of all-cause mortality (HR, 1.37; 95% CI, 1.10-1.70); no association was noted with increase in the number of healthy lifestyle factors (P>0.5). Individuals who maintained 4 to 5 healthy lifestyle factors had 2.5 times lower risk of CVD (HR, 0.43; 95% CI, 0.25-0.63) and all-cause mortality (HR, 0.40; 95% CI, 0.22-0.73) than those who maintained only 0 to 1 healthy lifestyle factor. CONCLUSIONS Our findings suggest that the benefits of healthy lifestyles may be easier lost than gained over a 5-year period. This underscores the need for efforts to promote maintenance of healthy lifestyles throughout the life course.
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Affiliation(s)
- Gerben Hulsegge
- Center for Nutrition, Prevention and Health ServicesNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Moniek Looman
- Center for Nutrition, Prevention and Health ServicesNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | - Henriëtte A. Smit
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Martha L. Daviglus
- Institute for Minority Health ResearchUniversity of Illinois at Chicago ChicagoIL
- Department of Preventive MedicineNorthwestern UniversityFeinberg School of MedicineChicagoIL
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - W.M. Monique Verschuren
- Center for Nutrition, Prevention and Health ServicesNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
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28
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Katchunga PB, Twagirumukiza M, Kluyskens Y, Kaishusha D, Baguma M, Bapolisi A, Cikomola J, Ntabure T, Callens S, M'Buyamba-Kabangu JR, Van Bortel L. Blood pressure in the Congolese adult population of South Kivu, Democratic Republic of Congo: Preliminary results from the Bukavu Observ Cohort Study. Rev Epidemiol Sante Publique 2015; 63:339-45. [PMID: 26586457 DOI: 10.1016/j.respe.2015.07.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 04/12/2015] [Accepted: 07/09/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Providing factual data about non-communicable diseases (NCDs) is of utmost importance in the sub-Saharan African countries where NCDs and arterial hypertension data remain scattered, scarce, and less representative given the region's heterogeneous population. Within this context, the interuniversity cooperation VLIR-UOS/Catholic University of Bukavu (Democratic Republic of Congo) has established an integrated project for monitoring hypertension and cardiovascular risk factors in the population of South Kivu. The aim of the study was to present the basic results of the determinants of blood pressure in the cohort studied. METHODS In 2013 and 2014, trained interviewers collected the anthropometric parameters, blood pressure, and medical history of 7405 adults (3060 in urban areas and 4345 in rural areas) including 3162 males and 4243 females; the cohort is expected to be followed for 9 years. RESULTS The average age of the entire group was 33.0±16.7 years. Compared to men, women had significantly higher obesity indices (P<0.0001), lower blood pressure between 20 and 39 years of age (P<0.0001) but higher blood pressure at 60 years of age and older (P<0.0001). Blood pressure was positively correlated with body mass index, waist circumference, and paradoxically with consumption of vegetables, but negatively correlated with the consumption of fruit, intense physical activity, and relaxation at home. CONCLUSIONS These results show that a cohort study is feasible in the Democratic Republic of Congo. The factual data analysis can contribute to health policy orientation and setting up of preventive measures. Since most correlated risk factors are preventable, recommendations can already be made in the fight against high blood pressure in this population.
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Affiliation(s)
- P B Katchunga
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Département de médecine interne, faculté de médecine, université catholique de Bukavu, Bukavu, The Democratic Republic of the Congo.
| | - M Twagirumukiza
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Université de Gand, Ghent, Belgium
| | - Y Kluyskens
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Université de Gand, Ghent, Belgium
| | - D Kaishusha
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Département de médecine interne, faculté de médecine, université catholique de Bukavu, Bukavu, The Democratic Republic of the Congo
| | - M Baguma
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Département de médecine interne, faculté de médecine, université catholique de Bukavu, Bukavu, The Democratic Republic of the Congo
| | - A Bapolisi
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Département de médecine interne, faculté de médecine, université catholique de Bukavu, Bukavu, The Democratic Republic of the Congo
| | - J Cikomola
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Département de médecine interne, faculté de médecine, université catholique de Bukavu, Bukavu, The Democratic Republic of the Congo
| | - T Ntabure
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Institut de technique médicale, hôpital général de référence de Katana, Katana, Sud-Kivu, The Democratic Republic of the Congo
| | - S Callens
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Université de Gand, Ghent, Belgium
| | - J R M'Buyamba-Kabangu
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Département de médecine interne, université de Kinshasa, Kinshasa, The Democratic Republic of the Congo
| | - L Van Bortel
- Observatoire des maladies non transmissibles VLIR/UOS/UCB, Bukavu, The Democratic Republic of the Congo; Université de Gand, Ghent, Belgium
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Hulsegge G, van der Schouw YT, Daviglus ML, Smit HA, Verschuren WMM. Determinants of attaining and maintaining a low cardiovascular risk profile--the Doetinchem Cohort Study. Eur J Public Health 2015; 26:135-40. [PMID: 26130798 DOI: 10.1093/eurpub/ckv125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND While maintenance of a low cardiovascular risk profile is essential for cardiovascular disease (CVD) prevention, few people maintain a low CVD risk profile throughout their life. We studied the association of demographic, lifestyle, psychological factors and family history of CVD with attainment and maintenance of a low risk profile over three subsequent 5-year periods. METHODS Measurements of 6390 adults aged 26-65 years at baseline were completed from 1993 to 97 and subsequently at 5-year intervals until 2013. At each wave, participants were categorized into low risk profile (ideal levels of blood pressure, cholesterol and body mass index, non-smoking and no diabetes) and medium/high risk profile (all others). Multivariable-adjusted modified Poisson regression analyses were used to examine determinants of attainment and maintenance of low risk; risk ratios (RR) and 95% confidence intervals (95% CI) were obtained. Generalized estimating equations were used to combine multiple 5-year comparisons. RESULTS Younger age, female gender and high educational level were associated with higher likelihood of both maintaining and attaining low risk profile (P < 0.05). In addition, likelihood of attaining low risk was 9% higher with each 1-unit increment in Mediterranean diet score (RR: 1.09, 95% CI: 1.02-1.16), twice as high with any physical activity versus none (RR: 2.17, 95% CI: 1.16-4.04) and 35% higher with moderate alcohol consumption versus heavy consumption (RR: 1.35, 95% CI: 1.06-1.73). CONCLUSION Healthy lifestyle factors such as adherence to a Mediterranean diet, physical activity and moderate as opposed to heavy alcohol consumption were associated with a higher likelihood of attaining a low risk profile.
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Affiliation(s)
- Gerben Hulsegge
- 1 Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yvonne T van der Schouw
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Martha L Daviglus
- 3 Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA 4 Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Henriëtte A Smit
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - W M Monique Verschuren
- 1 Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Taddei C, Gnesotto R, Forni S, Bonaccorsi G, Vannucci A, Garofalo G. Cycling promotion and non-communicable disease prevention: health impact assessment and economic evaluation of cycling to work or school in Florence. PLoS One 2015; 10:e0125491. [PMID: 25928421 PMCID: PMC4415918 DOI: 10.1371/journal.pone.0125491] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/19/2015] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To estimate the effects of cycling promotion on major non-communicable diseases (NCDs) and costs from the public healthcare payer's perspective. DESIGN Health impact assessment and economic evaluation using a dynamic model over a ten-year period and according to two cycling promotion scenarios. SETTING Cycling to work or school in Florence, Italy. POPULATION All individuals aged 15 and older commuting to work or school in Florence. MAIN OUTCOME MEASURES The primary outcome measures were changes in NCD incidence and healthcare direct costs for the Tuscany Regional Health Service (SST) due to increased cycling. The secondary outcome was change in road traffic accidents. RESULTS Increasing cycling modal share in Florence from 7.5% to about 17% (Scenario 1) or 27% (Scenario 2) could decrease the incidence of type 2 diabetes by 1.2% or 2.5%, and the incidence of acute myocardial infarction (AMI) and stroke by 0.6% or 1.2%. Within 10 years, the number of cases that can be prevented is 280 or 549 for type 2 diabetes, 51 or 100 for AMI, and 51 or 99 for stroke in Scenario 1 or Scenario 2, respectively. Average annual discounted savings for the SST are estimated to amount to €400,804 or €771,201 in Scenario 1 or Scenario 2, respectively. In Florence, due to the high use of vulnerable motorized vehicles (such as scooters, mopeds, and motorcycles), road traffic accidents are expected to decline in both our scenarios. Sensitivity analyses showed that health benefits and savings for the SST are substantial, the most sensitive parameters being the relative risk estimates of NCDs and active commuting. CONCLUSIONS Effective policies and programs to promote a modal shift towards cycling among students and workers in Florence will contribute to reducing the NCD burden and helping long-term economic sustainability of the SST.
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Affiliation(s)
- Cristina Taddei
- Specialization School of Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Roberto Gnesotto
- Quality and Equity Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Silvia Forni
- Quality and Equity Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Guglielmo Bonaccorsi
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Andrea Vannucci
- Quality and Equity Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Giorgio Garofalo
- Department of Prevention, Florence Local Health Authority, Florence, Italy
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Kubesch N, De Nazelle A, Guerra S, Westerdahl D, Martinez D, Bouso L, Carrasco-Turigas G, Hoffmann B, Nieuwenhuijsen MJ. Arterial blood pressure responses to short-term exposure to low and high traffic-related air pollution with and without moderate physical activity. Eur J Prev Cardiol 2014; 22:548-57. [PMID: 25326542 DOI: 10.1177/2047487314555602] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 09/25/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Short-term exposure to traffic-related air pollution (TRAP) has been associated with adverse cardiovascular outcomes. Physical activity (PA) in polluted air may increase pollutant uptake and increase these effects. METHODS Crossover real-world exposure study in 28 healthy participants comparing systolic (SBP) and diastolic blood pressure (DBP) responses to four different exposure scenarios: 2 h exposure in high or low-TRAP environment, each at rest and combined with intermittent moderate PA consisting of 15 min intervals alternating rest and cycling on a stationary bicycle. Data was analyzed using mixed effect models for repeated measures. RESULTS Exposure to high TRAP was associated with higher DBP (1.1 mm/Hg, p = 0.002) post-exposure, irrespective of exercise status. Ultrafine particles (UFP) increased DBP post-exposure (0.9 mm/Hg, p = 0.004). Interquartile increases in black carbon (BC), fine particulate matter (PM10 and PMcoarse), UFP, and nitric oxides (NOx) were associated with statistically significantly higher SBP post-exposure (1.2, 1.0, 1.1, and 1.1 mm/Hg, respectively). Intermittent PA compared with rest was associated with lower SBP post-exposure (-2.4 mm/Hg, p < 0.001). PA lowered SBP more after exposure to the low-TRAP site (-2.3 mm/Hg) compared with the high-TRAP site (-1.6 mm/Hg). We only found evidence of an interaction between PA and both PM10 and PMcoarse, increasing SBP. CONCLUSION Both SBP and DBP increase after exposure to TRAP. Intermittent PA attenuates the TRAP-related increases in SBP, with the exception of PM10 and PMcoarse, which potentiate these increases. We showed that in low-TRAP environments intermittent PA has stronger beneficial effects on SBP than in high-TRAP environments.
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Affiliation(s)
- N Kubesch
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Universitat Pompeu Fabra (UPF), Barcelona, Spain Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - A De Nazelle
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain Centre for Environmental Policy, Imperial College London, London, UK
| | - S Guerra
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA
| | - D Westerdahl
- Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | - D Martinez
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Universitat Pompeu Fabra (UPF), Barcelona, Spain Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - L Bouso
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Universitat Pompeu Fabra (UPF), Barcelona, Spain Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - G Carrasco-Turigas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Universitat Pompeu Fabra (UPF), Barcelona, Spain Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - B Hoffmann
- Medical Faculty, Heinrich Heine University of Düsseldorf and IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - M J Nieuwenhuijsen
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Universitat Pompeu Fabra (UPF), Barcelona, Spain Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Hollingworth M, Harper A, Hamer M. Dose-response associations between cycling activity and risk of hypertension in regular cyclists: The UK Cycling for Health Study. J Hum Hypertens 2014; 29:219-23. [PMID: 25273856 PMCID: PMC4357858 DOI: 10.1038/jhh.2014.89] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/28/2014] [Accepted: 09/01/2014] [Indexed: 11/09/2022]
Abstract
Most population studies on physical activity and health have involved largely inactive men and women, thus making it difficult to infer if health benefits occur at exercise levels above the current minimum guidelines. The aim was to examine associations between cycling volume and classical cardiovascular risk markers, including hypertension and hypercholesterolemia, in a population sample of habitual cyclists. A nationwide sample comprising 6949 men and women (aged 47.6 years on average) completed questions about their cycling levels, demographics and health. Nearly the entire sample (96.3%) achieved the current minimum physical activity recommendation through cycling alone. There was a dose–response association between cycling volume and risk of diagnosed hypertension (P-trend =0.001), with odds ratios of 0.98 (95% confidence interval (CI), 0.80–1.21), 0.86 (0.70, 1.06), 0.67 (95% CI, 0.53–0.83) across categories of 23–40, 40–61 and >61 metabolic equivalent hours/week (MET-h/week) compared with <23 MET-h/week. These associations persisted in models adjusted for age, sex, smoking, alcohol, body mass index (BMI) and other moderatevigorous physical activities. We also observed inverse associations between cycling volume and other risk factors including BMI and hypercholesterolemia. In summary, results from a population sample of cyclists suggest that additional cardiovascular health benefits can be achieved beyond the current minimum physical activity recommendation.
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Affiliation(s)
| | - A Harper
- University College London Medical School, London, UK
| | - M Hamer
- Physical Activity Research Group, Department of Epidemiology and Public Health, University College London, London, UK
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Saevereid HA, Schnohr P, Prescott E. Speed and duration of walking and other leisure time physical activity and the risk of heart failure: a prospective cohort study from the Copenhagen City Heart Study. PLoS One 2014; 9:e89909. [PMID: 24621514 PMCID: PMC3951187 DOI: 10.1371/journal.pone.0089909] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 01/23/2014] [Indexed: 11/19/2022] Open
Abstract
AIM Physical activity (PA) confers some protection against development of heart failure (HF) but little is known of the role of intensity and duration of exercise. METHODS AND RESULTS In a prospective cohort study of men and women free of previous MI, stroke or HF with one or more examinations in 1976-2003, we studied the association between updated self-assessed leisure-time PA, speed and duration of walking and subsequent hospitalization or death from HF. Light and moderate/high level of leisure-time PA and brisk walking were associated with reduced risk of HF in both genders whereas no consistent association with duration of walking was seen. In 18,209 subjects age 20-80 with 1580 cases of HF, using the lowest activity level as reference, the confounder-adjusted hazard ratios (HR) for light and moderate/high leisure-time physical activity were 0.75 (0.66-0.86) and 0.80 (0.69-0.93), respectively. In 9,937 subjects with information on walking available and 542 cases of HF, moderate and high walking speed were associated with adjusted HRs of 0.53 (0.43-0.66) and 0.30 (0.21-0.44), respectively, and daily walking of ½-1 hrs, 1-2 and >2 hrs with HR of 0.80 (0.61-1.06), 0.82 (0.62-1.06), and 0.96 (0.73-1.27), respectively. Results were similar for both genders and remained robust after exclusion of HF related to coronary heart disease and after a series of sensitivity analyses. CONCLUSIONS Speed rather than duration of walking was associated with reduced risk of HF. Walking is the most wide-spread PA and public health measures to curb the increase in HF may benefit from this information.
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Affiliation(s)
| | - Peter Schnohr
- The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
- The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark
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Green J, Steinbach R, Jones A, Edwards P, Kelly C, Nellthorp J, Goodman A, Roberts H, Petticrew M, Wilkinson P. On the buses: a mixed-method evaluation of the impact of free bus travel for young people on the public health. PUBLIC HEALTH RESEARCH 2014. [DOI: 10.3310/phr02010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIn September 2005 London introduced a policy granting young people aged < 17 years access to free bus and tram travel. A year later this policy was extended to people aged < 18 years in education, work or training. This intervention was part of a broader environmental strategy in London to reduce private car use, but its primary aim was to decrease ‘transport exclusion’, and ensure that access to goods, services, education and training opportunities were not denied to some young people because of transport poverty. However, there were also likely to be positive and negative health implications, which were difficult to assess in the absence of a robust evidence base on the impact of transport policies on health and well-being.ObjectivesTo evaluate the impact of free bus travel for young people in London on the public health. Specifically, to provide empirical evidence for the impact of this ‘natural experiment’ on health outcomes and behaviours (e.g. injuries, active travel) for young people; explore the effects on the determinants of health; identify the effects on older citizens of increased access to bus travel for young people and to identify whether or not the intervention represented value for money.DesignQuasi-experimental design, using secondary analysis of routine data, primary qualitative data and literature reviews.SettingLondon, UK.ParticipantsYoung people aged 12–17 years and older citizens aged ≥ 60 years.InterventionThe introduction of free bus travel for those aged < 17 years living in London in 2005, extended to those aged < 18 years in 2006.Main outcome measuresQuantitative: number of journeys to school or work; frequency and distance of active travel (i.e. walking and/or cycling), bus travel, car travel; incidence of road traffic injuries and assaults and socioeconomic gradients in travel patterns. Qualitative: how free bus travel affected young people and older citizens’ travel and well-being.MethodsQuantitative component: change-on-change analysis comparing pre–post change in the target age group (12–17 years) against that seen in ‘non-exposed’ groups [for travel mode, road traffic injury (RTI) and assaults]. Qualitative component: interviews analysed using both deductive and inductive methods. Economic evaluation: cost–benefit analysis (CBA).Data sourcesLondon Area Transport Survey (LATS) and London Travel Demand Survey (LTDS) (travel mode); STATS19 Road Accident data set (RTI); Hospital Episode Statistics (HES) (assaults); interviews with young people and older citizens; and cost data from providers and literature reviews.ResultsThe introduction of free bus travel for young people was associated with higher use of bus travel by adults and young people [31% increase, 95% confidence interval (CI) 19% to 42%; and 26% increase, 95% CI 13% to 41%, respectively], especially for short journeys, and lower car distances relative to adults (relative change 0.73, 95% CI 0.55 to 0.94); no significant overall reduction in ‘active travel’ [reduction in number of walking trips but no evidence of change in distance walked (relative change 0.99, 95% CI 0.92 to 1.07)]; significant reduction in cycling relative to adults (but from a very low base); a reduction in road traffic injuries for car occupants (relative change 0.89, 95% CI 0.84 to 0.95) and cyclists (relative change 0.60, 95% CI 0.55 to 0.66), but not pedestrians; an overall modest increase in journeys to work or school (relative change 1.09, 95% CI 1.06 to 1.14); equivocal evidence of impact on socioeconomic gradients in travel behaviour and no evidence of adverse impact on travel of older people aged > 60 years. An increase in assaults largely preceded the scheme. Qualitative data suggested that the scheme increased opportunities for independent travel, social inclusion, and a sense of belonging and that it ‘normalised’ bus travel. The monetised benefits of the scheme substantially outweighed the costs, providing what the Department for Transport (DfT) considers ‘high’ value for money.ConclusionThe free bus travel scheme for young people appears to have encouraged their greater use of bus transport for short trips without significant impact on their overall active travel. There was qualitative evidence for benefits on social determinants of health, such as normalisation of bus travel, greater social inclusion and opportunities for independent travel. In the context of a good bus service, universal free bus travel for young people appears to be a cost-effective contributor to social inclusion and, potentially, to increasing sustainable transport in the long term. Further research is needed on the effects of both active and other travel modes on the determinants of health; the factors that influence maintenance of travel mode change; travel as ‘social practice’; the impact of driving license changes on injury rates for young adults and the value of a statistical life for young people.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Judith Green
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Steinbach
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Alasdair Jones
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Methodology, London School of Economics and Political Science, London, UK
| | - Phil Edwards
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Charlotte Kelly
- Institute for Transport Studies, University of Leeds, Leeds, UK
| | - John Nellthorp
- Institute for Transport Studies, University of Leeds, Leeds, UK
| | - Anna Goodman
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Roberts
- General and Adolescent Paediatrics Unit, University College London Institute of Child Health, London, UK
| | - Mark Petticrew
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Wilkinson
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Lamb MJE, Halbesma N, Wild SH. Cycling as a mode of transport: a possible solution for the increasing burden of type 2 diabetes? PRACTICAL DIABETES 2013. [DOI: 10.1002/pdi.1793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hoevenaar-Blom MP, Spijkerman AMW, Kromhout D, Verschuren WMM. Sufficient sleep duration contributes to lower cardiovascular disease risk in addition to four traditional lifestyle factors: the MORGEN study. Eur J Prev Cardiol 2013; 21:1367-75. [PMID: 23823570 DOI: 10.1177/2047487313493057] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The contribution of sufficient sleep duration to lower CVD risk in addition to sufficient physical activity, a healthy diet, (moderate) alcohol consumption, and non-smoking has not been investigated yet. DESIGN The MORGEN study is a prospective cohort study including 8128 men and 9759 women aged 20-65 years, free of CVD at baseline. METHODS Sufficient physical activity (≥3.5 h/week cycling or sports), a healthy diet (Mediterranean Diet Score ≥5), (moderate) alcohol consumption (≥1 beverage/month), non-smoking, and sufficient sleep duration (≥7 hours) were assessed by self-administered questionnaires between 1994 and 1997. Cardiovascular morbidity and mortality were ascertained through linkage with national registers. Hazard ratios and preventable proportions were calculated adjusted for age, sex, and educational level. RESULTS During 10-14 years of follow up, 607 composite CVD events (fatal CVD, nonfatal myocardial infarction and stroke) occurred, of which 129 were fatal. Those with the four traditional healthy lifestyle factors had a 57% lower risk of composite CVD (HR 0.43, 95% CI 0.31-0.59) and a 67% lower risk of fatal CVD (HR 0.33, 95% CI 0.16-0.68) compared with those with none or one healthy lifestyle factor. Sleeping sufficiently in addition to the four traditional lifestyle factors resulted in a 65% lower risk of composite CVD (HR 0.35, 95% CI 0.23-0.52), and an 83% lower risk of fatal CVD (HR 0.17, 95% CI 0.07-0.43). CONCLUSIONS Sufficient sleep and adherence to all four traditional healthy lifestyle factors was associated with lower CVD risk. When sufficient sleep duration was added to the traditional lifestyle factors, the risk of CVD was further reduced.
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Affiliation(s)
- Marieke P Hoevenaar-Blom
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands Wageningen University, Wageningen, The Netherlands
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Active transport and health outcomes: findings from a population study in Jiangsu, China. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2013; 2013:624194. [PMID: 23690804 PMCID: PMC3649642 DOI: 10.1155/2013/624194] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 03/12/2013] [Accepted: 03/17/2013] [Indexed: 11/26/2022]
Abstract
To investigate the prevalence of active transport (AT, defined as walking or bicycling for transport) and to explore the association between AT and health outcomes, we conducted a population-based cross-sectional study in Jiangsu, China, where walking and bicycling are still the main modes of transport. In this study, 8400 community residents aged 18 or above were interviewed following a multistage random sampling method (100% response rate). Face-to-face questionnaire survey data, anthropometric measurements, and biochemical data from blood tests were collected. Results show that 49.6% of the subjects, as part of daily transport, actively traveled on average 5.3 days per week, 53.5 minutes per day, and 300.3 minutes per week. There was an inverse correlation between AT and some health outcomes: AT respondents had a higher prevalence of cholesterol disorder; AT respondents who actively travelled every day had a higher risk of diabetes, whilst AT respondents with shorter daily or weekly duration had a lower risk of obesity, central obesity, and cholesterol disorder. Moreover, AT influences more health aspects among urban residents than among rural residents. Findings of this study do not support the notion that AT is beneficial to population health. Further research is needed in determining the negative side effects of AT.
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Katchunga P, Masumbuko B, Belma M, Kashongwe Munogolo Z, Hermans MP, M’Buyamba-Kabangu JR. Age and living in an urban environment are major determinants of diabetes among South Kivu Congolese adults. DIABETES & METABOLISM 2012; 38:324-31. [DOI: 10.1016/j.diabet.2012.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 02/22/2012] [Accepted: 02/22/2012] [Indexed: 12/30/2022]
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Over EA, Wendel-Vos GW, van den Berg M, Reenen HHHV, Tariq L, Hoogenveen RT, van Baal PH. Cost-effectiveness of counseling and pedometer use to increase physical activity in the Netherlands: a modeling study. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2012; 10:13. [PMID: 23006466 PMCID: PMC3495195 DOI: 10.1186/1478-7547-10-13] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 09/19/2012] [Indexed: 11/22/2022] Open
Abstract
Background Counseling in combination with pedometer use has proven to be effective in increasing physical activity and improving health outcomes. We investigated the cost-effectiveness of this intervention targeted at one million insufficiently active adults who visit their general practitioner in the Netherlands. Methods We used the RIVM chronic disease model to estimate the long-term effects of increased physical activity on the future health care costs and quality adjusted life years (QALY) gained, from a health care perspective. Results The intervention resulted in almost 6000 people shifting to more favorable physical-activity levels, and in 5100 life years and 6100 QALYs gained, at an additional total cost of EUR 67.6 million. The incremental cost-effectiveness ratio (ICER) was EUR 13,200 per life year gained and EUR 11,100 per QALY gained. The intervention has a probability of 0.66 to be cost-effective if a QALY gained is valued at the Dutch informal threshold for cost-effectiveness of preventive intervention of EUR 20,000. A sensitivity analysis showed substantial uncertainty of ICER values. Conclusion Counseling in combination with pedometer use aiming to increase physical activity may be a cost-effective intervention. However, the intervention only yields relatively small health benefits in the Netherlands.
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Affiliation(s)
- Eelco Ab Over
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, P,O, Box 1, 3720, BA, Bilthoven, The Netherlands.
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de Goede J, Verschuren WMM, Boer JMA, Kromhout D, Geleijnse JM. Gender-specific associations of marine n-3 fatty acids and fish consumption with 10-year incidence of stroke. PLoS One 2012; 7:e33866. [PMID: 22496770 PMCID: PMC3322144 DOI: 10.1371/journal.pone.0033866] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 02/21/2012] [Indexed: 01/10/2023] Open
Abstract
Background There is some evidence that the association of fish and marine fatty acids with stroke risk differs between men and women. We investigated the gender-specific associations of habitual intake of the marine fatty acids eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) and fish on incident stroke in a population-based study in the Netherlands. Methods We prospectively followed 20,069 men and women, aged 20–65 years, without cardiovascular diseases at baseline. Habitual diet was assessed with a validated 178-item food frequency questionnaire. Incidence of stroke was assessed through linkage with mortality and morbidity registers. Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (95%CI). Results During 8–13 years of follow-up, 221 strokes occurred. In women, an inverse dose-response relation (P-trend = 0.02) was observed between EPA-DHA intake and incident stroke, with an HR of 0.49 (95% CI: 0.27–0.91) in the top quartile of EPA-DHA (median 225 mg/d) as compared to the bottom quartile (median 36 mg/d). In men, the HR (95%CI) for the top quartile of EPA-DHA intake was 0.87 (0.51–1.48) (P-trend = 0.36). Similar results were observed for fish consumption and stroke incidence. Conclusion A higher EPA-DHA and fish intake is related to a lower stroke risk in women, while for men an inverse association could not be demonstrated.
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Affiliation(s)
- Janette de Goede
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | | | - Jolanda M. A. Boer
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Daan Kromhout
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Johanna M. Geleijnse
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
- * E-mail:
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van Dis I, Kromhout D, Boer JMA, Geleijnse JM, Verschuren WMM. Paternal and maternal history of myocardial infarction and cardiovascular diseases incidence in a Dutch cohort of middle-aged persons. PLoS One 2011; 6:e28697. [PMID: 22194890 PMCID: PMC3241680 DOI: 10.1371/journal.pone.0028697] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 11/14/2011] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A positive parental history of myocardial infarction (MI) is an independent risk factor for cardiovascular diseases (CVD). However, different definitions of parental history have been used. We evaluated the impact of parental gender and age of onset of MI on CVD incidence. METHODS Baseline data were collected between 1993 and 1997 in 10,524 respondents aged 40-65 years. CVD events were obtained from the National Hospital Discharge Register and Statistics Netherlands. We used proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for CVD incidence and adjusted for lifestyle and biological risk factors. RESULTS At baseline, 36% had a parental history of MI. During 10-year follow-up, 914 CVD events occurred. The age and gender adjusted HR was 1.3 (95% CI 1.1-1.5) for those with a paternal MI, 1.5 (1.2-1.8) for those with a maternal MI and 1.6 (1.2-2.2) for those with both parents with an MI. With decreasing parental age of MI, HR increased from 1.2 (1.0-1.6) for age ≥70 years to 1.5 (1.2-1.8) for age <60 years for a paternal MI and from 1.1 (0.9-1.5) to 2.2 (1.6-3.0) for a maternal MI. The impact of having a mother with MI before age 60 significantly differed in women [(2.9 (1.8-4.6)] and men [1.5 (0.9-2.6)]. Adjustment only slightly influenced HRs for maternal MI. CONCLUSIONS Respondents with a parental history of MI have an increased CVD incidence, in particular with parental onset of MI before age 70. A maternal history of MI before age 60 was the strongest predictor of CVD incidence.
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Affiliation(s)
- Ineke van Dis
- Netherlands Heart Foundation, The Hague, The Netherlands.
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Hoevenaar-Blom MP, Spijkerman AMW, Kromhout D, van den Berg JF, Verschuren WMM. Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence: the MORGEN study. Sleep 2011; 34:1487-92. [PMID: 22043119 DOI: 10.5665/sleep.1382] [Citation(s) in RCA: 369] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
STUDY OBJECTIVES We studied sleep duration and sleep quality in relation to cardiovascular disease (CVD) incidence. DESIGN/SETTING Dutch population-based cohort study. PARTICIPANTS 20,432 men and women aged 20-65 and with no history of CVD. INTERVENTIONS N/A. MEASUREMENTS Sleep duration and sleep quality were assessed by a self-administered questionnaire. Morbidity data, vital status, and causes of death were obtained through linkage with several national registries. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated using Cox proportional hazards models. RESULTS During 10-15 years of follow-up, 1,486 CVD and 1,148 coronary heart disease (CHD) events occurred. Short sleepers (≤ 6 h) had a 15% higher risk of total CVD (HR: 1.15; 95%CI: 1.00-1.32) and a 23% higher risk of CHD (HR: 1.23 [1.04-1.45]) compared to normal sleepers (7 h) after adjustment for all confounders. Additional adjustment for intermediate biological risk factors attenuated these relative risks to 1.11 (0.97-1.27) for total CVD and to 1.19 (1.00-1.40) for CHD. Short sleepers with poor sleep quality had a 63% higher risk of CVD (HR: 1.63 [1.21-2.19]) and a 79% higher risk of CHD incidence (HR: 1.79 [1.24-2.58]) compared to normal sleepers with good sleep quality, after adjustments for all confounders. We observed no associations between long sleep duration (≥ 9 h) and CVD or CHD incidence. CONCLUSIONS Short sleepers, especially those with poor sleep quality, have an increased risk of total CVD and CHD incidence. Future investigations should not only focus on sleep duration, but should also take sleep quality into account.
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Affiliation(s)
- Marieke P Hoevenaar-Blom
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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Linoleic acid intake, plasma cholesterol and 10-year incidence of CHD in 20,000 middle-aged men and women in the Netherlands. Br J Nutr 2011; 107:1070-6. [PMID: 21816117 DOI: 10.1017/s0007114511003837] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We studied the associations of a difference in linoleic acid or carbohydrate intake with plasma cholesterol levels and risk of CHD in a prospective cohort study in the Netherlands. Data on diet (FFQ) and plasma total and HDL-cholesterol were available at baseline (1993-7) of 20,069 men and women, aged 20-65 years, who were initially free of CVD. Incidence of CHD was assessed through linkage with mortality and morbidity registers. During an average of 10 years of follow-up, 280 CHD events occurred. The intake of linoleic acid ranged from 3·6 to 8·0 % of energy (en%), whereas carbohydrate intake ranged from 47·6 to 42·5 en% across quintiles of linoleic acid intake. Linoleic acid intake was inversely associated with total cholesterol and HDL-cholesterol in women but not in men. Linoleic acid intake was not associated with the ratio of total to HDL-cholesterol. No association was observed between linoleic acid intake and CHD incidence, with hazard ratios varying between 0·83 and 1·00 (all P>0·05) compared to the bottom quintile. We conclude that a 4-5 en% difference in linoleic acid or carbohydrate intake did not translate into either a different ratio of total to HDL-cholesterol or a different CHD incidence.
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Abstract
The colours of the edible part of fruit and vegetables indicate the presence of specific micronutrients and phytochemicals. The extent to which fruit and vegetable colour groups contribute to CHD protection is unknown. We therefore examined the associations between fruit and vegetables of different colours and their subgroups and 10-year CHD incidence. We used data from a prospective population-based cohort including 20 069 men and women aged 20-65 years who were enrolled between 1993 and 1997. Participants were free of CVD at baseline and completed a validated 178-item FFQ. Hazard ratios (HR) for the association between green, orange/yellow, red/purple, white fruit and vegetables and their subgroups with CHD were calculated using multivariable Cox proportional hazards models. During 10 years of follow-up, 245 incident cases of CHD were documented. For each 25 g/d increase in the intake of the sum of all four colours of fruit and vegetables, a borderline significant association with incident CHD was found (HR 0·98; 95 % CI 0·97, 1·01). No clear associations were found for the colour groups separately. However, each 25 g/d increase in the intake of deep orange fruit and vegetables was inversely associated with CHD (HR 0·74; 95 % CI 0·55, 1·00). Carrots, their largest contributor (60 %), were associated with a 32 % lower risk of CHD (HR 0·68; 95 % CI 0·48, 0·98). In conclusion, though no clear associations were found for the four colour groups with CHD, a higher intake of deep orange fruit and vegetables and especially carrots may protect against CHD.
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Alpha-linolenic acid intake and 10-year incidence of coronary heart disease and stroke in 20,000 middle-aged men and women in the Netherlands. PLoS One 2011; 6:e17967. [PMID: 21464993 PMCID: PMC3064584 DOI: 10.1371/journal.pone.0017967] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 02/17/2011] [Indexed: 01/10/2023] Open
Abstract
Background Whether intake of alpha-linolenic acid (ALA), the plant-derived n-3
polyunsaturated fatty acid (PUFA), could prevent cardiovascular diseases is
not yet clear. We examined the associations of ALA intake with 10-year
incidence of coronary heart disease (CHD) and stroke in the Netherlands. Methods Data were collected from a general population of 20,069 generally healthy men
and women, aged 20 to 65 years. Habitual diet was assessed at baseline
(1993–1997) with a validated 178-item food frequency questionnaire.
Incidences of CHD and stroke were assessed through linkage with mortality
and morbidity registers. Hazard ratios (HR) were calculated with
multivariable Cox proportional hazards models, adjusted for age, gender,
lifestyle, and dietary factors. Results During 8–13 years of follow-up, we observed 280 incident CHD events
(19% fatal) and 221 strokes (4% fatal). Intakes of
energy-adjusted ALA in quintiles ranged from less than 1.0 g/d in the bottom
quintile (Q1) to more than 1.9 g/d in the top quintile (Q5). ALA intake was
not associated with incident CHD, with HRs varying between 0.89 and 1.01
(all p>0.05) in Q2–Q5 compared with the bottom quintile of ALA
intake. For incident stroke, however, participants in Q2–Q5 had a
35–50% lower risk compared with the reference group. HRs were
0.65 (0.43–0.97), 0.49 (0.31–0.76), 0.53 (0.34–0.83), and
0.65 (0.41–1.04) for Q2–Q5 respectively. Conclusion In this general Dutch population, ALA intake was not associated with incident
CHD. The data suggested that a low intake of ALA may be a risk factor for
incident stroke. These results warrant confirmation in other
population-based studies and in trials.
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Raw and processed fruit and vegetable consumption and 10-year coronary heart disease incidence in a population-based cohort study in the Netherlands. PLoS One 2010; 5:e13609. [PMID: 21049053 PMCID: PMC2963618 DOI: 10.1371/journal.pone.0013609] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 09/21/2010] [Indexed: 02/07/2023] Open
Abstract
Background Prospective cohort studies have shown that high fruit and vegetable consumption is inversely associated with coronary heart disease (CHD). Whether food processing affects this association is unknown. Therefore, we quantified the association of fruit and vegetable consumption with 10-year CHD incidence in a population-based study in the Netherlands and the effect of processing on these associations. Methods Prospective population-based cohort study, including 20,069 men and women aged 20 to 65 years, enrolled between 1993 and 1997 and free of cardiovascular disease at baseline. Diet was assessed using a validated 178-item food frequency questionnaire. Hazard ratios (HR) were calculated for CHD incidence using multivariable Cox proportional hazards models. Results During a mean follow-up time of 10.5y, 245 incident cases of CHD were documented, which comprised 211 non-fatal acute myocardial infarctions and 34 fatal CHD events. The risk of CHD incidence was 34% lower for participants with a high intake of total fruit and vegetables (>475 g/d; HR: 0.66; 95% CI: 0.45–0.99) compared to participants with a low total fruit and vegetable consumption (≤241 g/d). Intake of raw fruit and vegetables (>262 g/d vs ≤92 g/d; HR: 0.70; 95% CI: 0.47–1.04) as well as processed fruit and vegetables (>234 g/d vs ≤113 g/d; HR: 0.79; 95% CI: 0.54–1.16) were inversely related with CHD incidence. Conclusion Higher consumption of fruit and vegetables, whether consumed raw or processed, may protect against CHD incidence.
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