Intensity versus duration of physical activity: implications for the metabolic syndrome. A prospective cohort study

Leisure time physical activity is associated with improved diastolic heart function and is partly mediated by unsupervised quantified metabolic health

Objectives

To investigate the association between leisure time physical activity (LTPA) and MRI-based diastolic function and the mediating role of metabolic health.

Methods

This cross-sectional analysis comprised 901 participants (46% women, mean age (SD): 56 (6) years (The Netherlands, 2008-2012)). LTPA was assessed via questionnaire, quantified in metabolic equivalent of tasks (METs)-minutes per week and participants underwent abdominal and cardiovascular MRI. Confirmatory factor analysis was used to construct the metabolic load factor. Piecewise structural equation model with adjustments for confounders was used to determine associations between LTPA and diastolic function and the mediating effect of metabolic load.

Results

Significant differences in mitral early/late peak filling rate (E/A) ratio per SD of LTPA (men=1999, women=1870 MET-min/week) of 0.18, (95% CI= 0.03 to 0.33, p=0.021) were observed in men, but not in women: -0.01 (-0.01 to 0.34, p=0.058). Difference in deceleration time of mitral early filling (E-DT) was 0.13 (0.01 to 0.24, p=0.030) in men and 0.17 (0.05 to 0.28, p=0.005) in women. Metabolic load, including MRI-based visceral and subcutaneous adipose tissue, fasting glucose, high-density lipoprotein cholesterol and triglycerides, mediated these associations as follows: E/A-ratio of 0.030 (0.000 to 0.067, 19% mediated, p=0.047) in men but not in women: 0.058 (0.027 to 0.089, p<0.001) and E-DT not in men 0.004 (-0.012 to 0.021, p=0.602) but did in women 0.044 (0.013 to 0.057, 27% mediated, p=0.006).

Conclusions

A larger amount of LTPA was associated with improved diastolic function where confirmatory factor analysis-based metabolic load partly mediated this effect. Future studies should assess whether improving indicators of metabolic load alongside LTPA will benefit healthy diastolic function even more.

Impact of the metabolic syndrome on cardiopulmonary morbidity and mortality in individuals with lung function impairment: a prospective cohort study of the Danish general population

Background

Whether the metabolic syndrome plays a role for the prognosis of individuals with lung function impairment (preserved ratio impaired spirometry (PRISm) or airflow limitation) is unclear. We hypothesised that the metabolic syndrome in individuals with lung function impairment is associated with increased cardiopulmonary morbidity and mortality.

Methods

The Copenhagen General Population Study was initiated in 2003 based on a random sample of white men and women aged 20-100 years drawn from the Danish general population. The risk of ischemic heart disease/heart failure, respiratory disease, and all-cause mortality was analysed with Cox models adjusted for age, sex, current smoking, and asthma during 15 years of follow-up.

Findings

Among 106,845 adults, 86,159 had normal lung function, 6126 had PRISm, and 14,560 had airflow limitation. We observed 10,448 hospital admissions for ischemic heart disease/heart failure, 21,140 for respiratory disease, and 11,125 deaths. Individuals with versus individuals without the metabolic syndrome generally had higher 5-year absolute risk of all outcomes, including within those with normal lung function, mild-moderate-severe PRISm, and very mild-mild-moderate-severe airflow limitation alike. Compared to individuals without the metabolic syndrome and with normal lung function, those with both the metabolic syndrome and severe PRISm had hazard ratios of 3.74 (95% CI: 2.53-5.55; p < 0.0001) for ischemic heart disease/heart failure, 5.02 (3.85-6.55; p < 0.0001) for respiratory disease, and 5.32 (3.76-7.54; p < 0.0001) for all-cause mortality. Corresponding hazard ratios in those with both the metabolic syndrome and severe airflow limitation were 2.89 (2.34-3.58; p < 0.0001) for ischemic heart disease/heart failure, 5.98 (5.28-6.78; p < 0.0001) for respiratory disease, and 4.16 (3.50-4.95; p < 0.0001) for all-cause mortality, respectively. The metabolic syndrome explained 13% and 27% of the influence of PRISm or airflow limitation on ischemic heart disease/heart failure and all-cause mortality.

Interpretation

The metabolic syndrome conferred increased risk of cardiopulmonary morbidity and mortality at all levels of lung function impairment.

Funding

Danish Lung Foundation, Danish Heart Foundation, Capital Region of Copenhagen, and Boehringer Ingelheim. JV is supported by the NIHR Manchester BRC.

Reducing Sedentary Time and Whole-Body Insulin Sensitivity in Metabolic Syndrome: A 6-Month Randomized Controlled Trial

PURPOSE

This study aimed to investigate whether a reduction in daily sedentary behavior (SB) improves insulin sensitivity in adults with metabolic syndrome in 6 months, without adding intentional exercise training.

METHODS

Sixty-four sedentary inactive middle-age adults with overweight and metabolic syndrome (mean (SD) age, 58 (7) yr; mean (SD) body mass index, 31.6 (4.3) kg·m -2 ; 27 men) were randomized into intervention and control groups. The 6-month individualized behavioral intervention supported by an interactive accelerometer and a mobile application aimed at reducing daily SB by 1 h compared with baseline. Insulin sensitivity by hyperinsulinemic euglycemic clamp, body composition by air displacement plethysmography, and fasting blood samples were analyzed before and after the intervention. SB and physical activity were measured with hip-worn accelerometers throughout the intervention.

RESULTS

SB decreased by 40 (95% confidence interval, 17-65) min·d -1 , and moderate-to-vigorous physical activity increased by 20 (95% confidence interval, 11-28) min·d -1 on average in the intervention group with no significant changes in these outcomes in the control group. After 6 months, fasting plasma insulin decreased (~1 mU·L -1 ) in the intervention group compared with the control group (time-group, P = 0.0081), but insulin sensitivity did not change in either group. The changes in body mass or adiposity did not differ between groups. Among all participants, the changes in SB and body mass correlated inversely with the change in insulin sensitivity ( r = -0.31, -0.44; P = 0.025, 0.0005, respectively).

CONCLUSIONS

An intervention aimed at reducing daily SB resulted in slightly decreased fasting insulin, but had no effects on insulin sensitivity or body adiposity. However, as the change in insulin sensitivity associated with the changes in SB and body mass, multifaceted interventions targeting to weight loss are likely to be beneficial in improving whole-body insulin sensitivity.

Longitudinal association between physical activity and the risk of incident metabolic syndrome in middle-aged adults in Germany

We examined the longitudinal association between physical activity (PA) and the risk of incident metabolic syndrome (MetS) among middle-aged, community-dwelling adults, including 591 individuals (314 females; mean (SD) age, 43.8 (8.5) years) who were free of MetS at baseline. Habitual and sports-related PA was assessed by a self-reported questionnaire. MetS was defined based on HDL-cholesterols, triglycerides, glucose or HbA1c, blood pressure, and waist circumference. We calculated Cox proportional hazard ratios (HR) and 95% confidence intervals (CI) using regression analyses. Over a mean follow-up of 12.5 years, 205 participants developed incident MetS. Four different sports-related PA measures were associated with a decreased risk of incident MetS: (1) Engaging in ≥ 75 min/week (HR 0.71, 95% CI 0.53-0.94), (2) maintaining a continuously high amount from baseline to follow-up of ≥ 75 min/week (HR 0.66, 95% CI 0.46-0.94), (3) starting from < 150 min/week at baseline to ≥ 150 min/week at follow-up (HR 0.65, 95% CI 0.45-0.94), and (4) increasing from < 16.6 MET-hours/week at baseline to ≥ 16.6 MET-hours/week at follow-up (HR 0.47, 95% CI 0.31-0.71). Thus, maintaining, starting or increasing sports-related PA is associated with a lower risk of incident MetS.

Desk based prompts to replace workplace sitting with stair climbing; a pilot study of acceptability, effects on behaviour and disease risk factors

Background

Prolonged sitting is associated with increased risk of obesity, type 2 diabetes and cardiovascular disease. Occupational sitting accounts for up to 50 h/week for employees. This pilot study assessed the acceptability of stair climbing as an interruption to sitting throughout working hours, and provided preliminary data of the effects on glucose and lipid profiles.

Methods

A quasi-experimental design was conducted involving 16 sedentary office workers (five females and 11 males) for intervention (n = 8) and control groups (n = 8) with mean age of 36.38 (5.58). For the eight-week intervention, a continuous four-floor stair climb and descent was performed eight times/day spread evenly over the working day. A prompt to climb was presented on the participant’s computer eight times/day. Participants in the experimental group recorded daily floors climbed and steps (measured using pedometers) in a weekly log sheet. Blood samples were collected pre and post intervention to test effects on fasting glucose and 2 h plasma glucose, triglycerides, and total (TC), LDL and HDL cholesterol. Experimental participants were interviewed at the end of the study. The Wilcoxon signed rank test was used to compare the median changes (pre-post) of the dependent variables.

Results

On average, the experimental group climbed 121 floors/week when prompted. There were significant reductions in fasting blood glucose, TC and LDL, as well as the derived measures of ‘bad’ cholesterol and the TC/HDL ratio in the experimental group. Post-experimental interviews indicated that the interruption to sitting was well tolerated.

Conclusion

Prompted stair climbing activity had impacts on health outcomes and was found acceptable to employees at work.

Trial registration

Ethics for this study was approved by Science, Technology, Engineering and Mathematics Ethical Review Committee, University of Birmingham with ethics reference number ERN_15_0491.

Supplementary information

The online version contains supplementary material available at 10.1186/s12889-022-14393-1.

Population analysis of mortality risk: Predictive models from passive monitors using motion sensors for 100,000 UK Biobank participants

Many studies have utilized physical activity for predicting mortality risk, using measures such as participant walk tests and self-reported walking pace. The rise of passive monitors to measure participant activity without requiring specific actions opens the possibility for population level analysis. We have developed novel technology for this predictive health monitoring, using limited sensor inputs. In previous studies, we validated these models in clinical experiments with carried smartphones, using only their embedded accelerometers as motion sensors. Using smartphones as passive monitors for population measurement is critically important for health equity, since they are already ubiquitous in high-income countries and increasingly common in low-income countries. Our current study simulates smartphone data by extracting walking window inputs from wrist worn sensors. To analyze a population at national scale, we studied 100,000 participants in the UK Biobank who wore activity monitors with motion sensors for 1 week. This national cohort is demographically representative of the UK population, and this dataset represents the largest such available sensor record. We characterized participant motion during normal activities, including daily living equivalent of timed walk tests. We then compute walking intensity from sensor data, as input to survival analysis. Simulating passive smartphone monitoring, we validated predictive models using only sensors and demographics. This resulted in C-index of 0.76 for 1-year risk decreasing to 0.73 for 5-year. A minimum set of sensor features achieves C-index of 0.72 for 5-year risk, which is similar accuracy to other studies using methods not achievable with smartphone sensors. The smallest minimum model uses average acceleration, which has predictive value independent of demographics of age and sex, similar to physical measures of gait speed. Our results show passive measures with motion sensors can achieve similar accuracy to active measures of gait speed and walk pace, which utilize physical walk tests and self-reported questionnaires.

Daily stair climbing is associated with decreased risk for the metabolic syndrome

BACKGROUND

Stair climbing can be a vigorous lifestyle physical activity, and is associated with healthier lipoprotein profiles, lower body weight and blood pressure, as well as higher aerobic fitness. The present analysis of data from a cohort of late middle-aged men and women examined the association between daily stair climbing and the metabolic syndrome.

METHODS

Data from 782 (423 women) participants (mean (SD) age 58.3 (0.95) years in the Dutch Famine Birth Cohort Study (2002-2004) were used to examine the cross-sectional association between self-reported daily stair climbing and the metabolic syndrome. Stair climbing was assessed by the question 'Do you climb stairs daily?' and the metabolic syndrome was defined using the established five components relating to lipid fractions, blood glucose levels, blood pressure and abdominal obesity.

RESULTS

Not climbing stairs daily was associated with an increased incidence of the metabolic syndrome (OR = 1.90, 95% CI = 1.23, 2.92, p = 0.004) and a greater number of its components (F_1,780 = 8.48, p = 0.004): these associations were still evident after adjusting for a variety of potential confounders.

CONCLUSIONS

The most likely explanation for the current findings is that daily stair climbing may be protective against the metabolic syndrome. This result reinforces public health recommendations for increased stair climbing with evidence from physiological outcomes.

Association of fatal myocardial infarction with past level of physical activity: a pooled analysis of cohort studies

AIMS

To assess the association between past level of physical activity (PA) and risk for death during the acute phase of myocardial infarction (MI) in a pooled analysis of cohort studies.

METHODS AND RESULTS

European cohorts including participants with a baseline assessment of PA, conventional cardiovascular (CV) risk factors, and available follow-up on MI and death were eligible. Patients with an incident MI were included. Leisure-time PA was grouped as sedentary (<7 MET-hours), low (7-16 MET-hours), moderate (16.1-32 MET-hours), or high (>32 MET-hours) based on calculated net weekly energy expenditure. The main outcome measures were instant and 28-day case fatality of MI. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using multivariate random-effects models. Adjustments for age, sex, CV risk factors, alcohol consumption, and socioeconomic status were made. From 10 cohorts including a total of 1 495 254 participants, 28 140 patients with an incident MI comprised the study population. A total of 4976 (17.7%) died within 28 days-of these 3101 (62.3%) were classified as instant fatal MI. Compared with sedentary individuals, those with a higher level of PA had lower adjusted odds of instant fatal MI: low PA [OR, 0.79 (95% CI, 0.60-1.04)], moderate PA [0.67 (0.51-0.89)], and high PA [0.55 (0.40-0.76)]. Similar results were found for 28-day fatal MI: low PA [0.85 (0.71-1.03)], moderate PA [0.64 (0.51-0.80)], and high PA [0.72 (0.51-1.00)]. A low-to-moderate degree of heterogeneity was detected in the analysis of instant fatal MI (I2 = 47.3%), but not in that of 28-day fatal MI (I2 = 0.0%).

CONCLUSION

A moderate-to-high level of PA was associated with a lower risk of instant and 28-day death in relation to a MI.

Home-Based Stair Climbing as an Intervention for Disease Risk in Adult Females; A Controlled Study

Cardiovascular disease and the metabolic syndrome are major contributors to health care expenditure. Increased physical activity reduces disease risk. The study compared effects of walking up and down stairs at home with continuous, gym-based stair climbing on the disease risk factors of aerobic fitness, serum lipids, body composition, fasting blood glucose, and resting cardiovascular variables. Sedentary women (31.7 ± 1.4 years) were randomly assigned to home-based (n = 26) or gym-based (n = 24) climbing for five days.week⁻¹ over an eight-week period. Each ascent required a 32.8-m climb, with home-based climbing matching the vertical displacement in the gym. Participants progressed from two ascents.day⁻¹ to five ascents.day⁻¹ in weeks 7 and 8. Relative to controls, stair climbing improved aerobic fitness (V˙O₂max +1.63 mL.min⁻¹.kg⁻¹, 95% CI = 1.21–2.05), body composition (weight −0.99 kg, 95% CI = 1.38–0.60), and serum lipids (LDL cholesterol −0.20 mmol.L⁻¹, 95% CI = 0.09–0.31; triglycerides −0.21 mmol.L⁻¹, 95% CI = 0.15–0.27), with similar risk reductions for home and gym-based groups. Only the home-based protocol reduced fasting blood glucose. Discussion focuses on stair climbing bouts as time-efficient exercise and the potential benefits of a home-based intervention. Stair use at home offers a low-cost intervention for disease risk reduction to public health.

DAily time use, Physical Activity, quality of care and interpersonal relationships in patients with Schizophrenia spectrum disorders (DiAPASon): an Italian multicentre study

BACKGROUND

Schizophrenia spectrum disorders (SSD) are ranked among the leading causes of disabilities worldwide. Many people with SSD spend most of their daily time being inactive, and this is related to the severity of negative symptoms. Here, we present the 3-year DiAPAson project aimed at (1) evaluating the daily time use among patients with SSD living in Residential Facilities (RFs) compared to outpatients with SSD and to the general population (Study 1); (2) evaluating the quality of staff-patient relationships, its association with specific patient outcomes and the quality of care provided in RFs (Study 2); and (3) assessing daily activity patterns in residential patients, outpatients with SSD and healthy controls using real-time methodologies (Study 3).

METHODS

Study 1 will include 300 patients with SSD living in RFs and 300 outpatients; data obtained in these clinical populations will be compared with normative data obtained by the National Institute of Statistics (ISTAT) in the national survey on daily time use. Time use assessments will consist of daily diaries asking participants to retrospectively report time spent in different activities. In Study 2, a series of questionnaires will be administered to 300 residential patients (recruited for Study 1) to evaluate the quality of care and staff-patient relationships, level of well-being and burnout of RFs' staff, and quality of RFs using a European standardized questionnaire (QuIRC-SA). In Study 3, the daily time use will be evaluated in a subgroup of 50 residential patients, 50 outpatients and 50 healthy controls using the Experience Sampling Method approach (participants will complete a brief questionnaire -about time use, mood and perceived energy- on a smartphone 8 times a day for 1 week) to compare retrospective and real-time reports. Moreover, their level of physical activity, sleep patterns, and energy expenditure will be monitored through a multi-sensor device.

DISCUSSION

This project is highly innovative because it combines different types of assessments (i.e., retrospective and real-time reports; multi-sensor monitoring) to trace an accurate picture of daily time use and levels of physical activity that will help identify the best therapeutic options promoting daily activities and physical exercise in patients with SSD.

TRIAL REGISTRATION

ISRCTN registry ID ISRCTN21141466.

Volume and Intensity of Stepping Activity and Cardiometabolic Risk Factors in a Multi-ethnic Asian Population

The health benefits of objectively measured physical activity volume versus intensity have rarely been studied, particularly in non-western populations. The aim of this study was to investigate the association between cardiometabolic risk factors and stepping activity including; volume (step count), intensity (cadence) or inactivity (zero-steps/minute/day), in a multi-ethnic Asian population. Participants clinical data was collected at baseline and their physical activity was monitored for seven days, using an accelerometer (Actigraph GT3X+) in 2016. Tertiles (low, moderate, high) of the mean daily step count, peak one-minute, 30-min, 60-min cadences and time/day spent at zero-steps/minute were calculated. Adjusted linear regressions explored the association between stepping activity tertiles and cardiometabolic risk factors. A total of 635 participants (41% male, 67% Chinese, mean age 48.4 years) were included in the analyses. The mean daily step count was 7605 (median daily step count 7310) and 7.8 h of awake time per day were spent inactive (zero-steps/minute). A greater number of associations were found for step intensity than volume. Higher step intensity was associated with reduced body mass index (BMI), waist circumference, blood pressures and higher high-density lipoprotein (HDL). Future health promotion initiatives should consider the greater role of step intensity to reduce cardiometabolic risk.

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

Introduction

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

Methods

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

Results

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

Conclusions

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

Associations Between Unhealthy Lifestyle Behaviors and Metabolic Syndrome by Gender in Young Adults

OBJECTIVE

Unhealthy lifestyle behaviors, such as smoking, drinking, betel-quid chewing, insufficient exercise, and inadequate sleep are significantly correlated with metabolic syndrome (MetS). To further understand this relationship, this study examined the main effect of unhealthy lifestyle behaviors and their interaction on MetS by gender in young adults.

METHOD

A cross-sectional study involving 694 young adults from a national survey was performed in which demographic characteristics, unhealthy lifestyle behaviors, anthropometric measurements, and blood chemistry panels were collected during face-to-face interviews.

RESULTS

The prevalence of MetS among young adults was 17.4% and was greater in males than females (19.0% vs. 7.8%). The unhealthy lifestyle-behavior risk factors associated with MetS included smoking (odds ratio [ OR] = 4.53) and physical activity ( OR = 0.51) among males and betel-quid chewing ( OR = 8.90) and less sleep ( OR = 0.08) among females. Significant interaction effects were observed between the abovementioned behaviors and gender for the risk of developing MetS.

CONCLUSION

These results can guide health-care providers in reducing MetS risk by encouraging young adult males to reduce or quit cigarette smoking and maintain optimum levels of physical activity and young adult females to quit chewing betel quid and obtain appropriate amounts of sleep.

Relationship Between Sitting Time, Physical Activity, and Metabolic Syndrome Among Adults Depending on Body Mass Index (BMI)

Background

The aim of this study was to assess the possible relationship between sitting time and physical activity and the risk of occurrence of metabolic syndrome and its components. Analyses were conducted in the whole sample, and with stratification according to BMI. We have formulated a hypothesis that individuals with different BMIs have different responses to metabolic health modifiers such as physical activity and sitting time.

Material/Methods

Altogether, the data from 10 367 participants from urban and rural areas, aged 37–66 years were used in the study (7479 of whom were overweight or obese). The definition of metabolic syndrome devised by the IDF Joint Interim Statement criteria using an ethnic-specific cut-off point for waist circumference as the central obesity criterion was used.

Results

In all analyzed BMI groups, longer sitting time was only associated with abdominal obesity (all p for trend <0.05). In participants declaring low physical activity levels, the risk of metabolic syndrome and abnormal triglycerides concentration was higher compared to those declaring high physical activity, regardless of BMI (all p for trend <0.05). In the group with overweight or obesity, low physical activity was associated with a higher risk of abdominal obesity (p for trend <0.05), increased glucose concentration (p for trend <0.05), and elevated blood pressure (p for trend <0.05). In participants with a normal BMI, these associations did not occur.

Conclusions

Our data suggest that physical activity helps preventive metabolic syndrome and its abnormal components, especially in participants who are overweight or obese.

Association between Exercise and Metabolic Syndrome in Koreans

Background

The favorable role of exercise on metabolic syndrome is well established; however, there is a lack of consistent epidemiological data. Thus, we analyzed the association between exercise intensity and metabolic syndrome using data from the Fourth Korea National Health and Nutrition Examination Survey (2007–2009).

Methods

A total of 10,533 Korean individuals were screened. Exercise amount and intensity were assessed from questionnaire responses. Subjects were divided into three groups according to exercise intensity: no activity (n=607), walking only without intense exercise (n=2,336), and moderate to vigorous activity with or without walking (n=3,855). Logistic regression analyses were used to evaluate the associations between exercise intensity and metabolic syndrome.

Results

The overall prevalence of metabolic syndrome was 22.3% (total n=6,798). The prevalence of metabolic syndrome was 20.4% for the intense exercise group, 24.0% for the walking only group, and 29.9% for the no activity group (P<0.001). The intense exercise group had a significantly lower odds ratio for the prevalence of metabolic syndrome and its components, especially abdominal obesity and hypertriglyceridemia, but not for blood pressure. Interestingly, there were no negative associations identified within the walking only group, other than prevalence of metabolic syndrome itself. The risk of hyperglycemia was slightly lower in the walking group compared to the no activity group but disappeared after multiple adjustments.

Conclusion

A strong inverse relationship between metabolic syndrome and moderate to vigorous intensity exercise was identified, which may reflect a protective effect of intense exercise, but not walking, on metabolic syndrome. Further prospective studies are needed to consolidate our findings.

Leisure-time physical activity and incident metabolic syndrome: a systematic review and dose-response meta-analysis of cohort studies

BACKGROUND

Leisure-time physical activity (LTPA) has been suggested to reduce risk of metabolic syndrome (MetS). However, a quantitative comprehensive assessment of the dose-response association between LTPA and incident MetS has not been reported. We performed a meta-analysis of studies assessing the risk of MetS with LTPA.

METHOD

MEDLINE via PubMed and EMBase databases were searched for relevant articles published up to March 13, 2017. Random-effects models were used to estimate the summary relative risk (RR) of MetS with LTPA. Restricted cubic splines were used to model the dose-response association.

RESULTS

We identified 16 articles (18 studies including 76,699 participants and 13,871 cases of MetS). We found a negative linear association between LTPA and incident MetS, with a reduction of 8% in MetS risk per 10 metabolic equivalent of task (MET) h/week increment. According to the restricted cubic splines model, risk of MetS was reduced 10% with LTPA performed according to the basic guideline-recommended level of 150min of moderate PA (MPA) per week (10METh/week) versus inactivity (RR=0.90, 95% CI 0.86-0.94). It was reduced 20% and 53% with LTPA at twice (20METh/week) and seven times (70METh/week) the basic recommended level (RR=0.80, 95% CI 0.74-0.88 and 0.47, 95% CI 0.34-0.64, respectively).

CONCLUSION

Our findings provide quantitative data suggesting that any amount of LTPA is better than none and that LTPA substantially exceeding the current LTPA guidelines is associated with an additional reduction in MetS risk.

Exercise Intensity and Incidence of Metabolic Syndrome: The SUN Project

INTRODUCTION

Emerging evidence suggests that vigorous physical activity may be associated with higher cardioprotective benefits than moderate physical activity. This study aimed to assess the long-term relationship between the intensity of leisure time physical activity (LTPA) and the risk of developing metabolic syndrome (MS) in a prospective cohort study.

METHODS

The Seguimiento Universidad de Navarra (SUN) Project comprises Spanish university graduates. Participants (n=10,145) initially free of MS were followed for a minimum of 6 years (2008-2014). Analysis was conducted in 2015. Physical activity was assessed though a validated questionnaire. The intensity of each physical activity was measured in METs. The intensity of LTPA was estimated by the ratio between total METs/week and total hours of LTPA/week, obtaining the mean METs/hour of LTPA. MS was defined according to the harmonizing definition. The association between the intensity of LTPA (METs/hour) and MS was assessed with logistic regression models adjusting for potential confounders.

RESULTS

Among 10,145 participants initially free of any MS criteria, 412 new MS cases were observed. Vigorous LTPA was associated with a 37% relatively lower risk (AOR=0.63, 95% CI=0.44, 0.89) compared with light LTPA. For a given total energy expenditure, independent of the time spent on it, participants who performed vigorous LTPA exhibited a higher reduction in the risk of MS than those who performed light to moderate LTPA.

CONCLUSIONS

Vigorous LTPA was significantly associated with lower risk of developing MS after a 6-year follow-up period.

Step-Based Physical Activity Metrics and Cardiometabolic Risk: NHANES 2005-2006

PURPOSE

This study aimed to catalog the relationships between step-based accelerometer metrics indicative of physical activity volume (steps per day, adjusted to a pedometer scale), intensity (mean steps per minute from the highest, not necessarily consecutive, minutes in a day; peak 30-min cadence), and sedentary behavior (percent time at zero cadence relative to wear time; %TZC) and cardiometabolic risk factors.

METHODS

We analyzed data from 3388 participants, 20+ yr old, in the 2005-2006 National Health and Nutrition Examination Survey with ≥1 valid day of accelerometer data and at least some data on weight, body mass index, waist circumference, systolic and diastolic blood pressure, glucose, insulin, HDL cholesterol, triglycerides, and/or glycohemoglobin. Linear trends were evaluated for cardiometabolic variables, adjusted for age and race, across quintiles of steps per day, peak 30-min cadence, and %TZC.

RESULTS

Median steps per day ranged from 2247 to 12,334 steps per day for men and from 1755 to 9824 steps per day for women, and median peak 30-min cadence ranged from 48.1 to 96.0 steps per minute for men and from 40.8 to 96.2 steps per minute for women for the first and fifth quintiles, respectively. Linear trends were statistically significant (all P < 0.001), with increasing quintiles of steps per day and peak 30-min cadence inversely associated with waist circumference, weight, body mass index, and insulin for both men and women. Median %TZC ranged from 17.6% to 51.0% for men and from 19.9% to 47.6% for women for the first and fifth quintiles, respectively. Linear trends were statistically significant (all P < 0.05), with increasing quintiles of %TZC associated with increased waist circumference, weight and insulin for men, and insulin for women.

CONCLUSIONS

This analysis identified strong linear relationships between step-based movement/nonmovement dimensions and cardiometabolic risk factors. These data offer a set of quantified access points for studying the potential dose-response effects of each of these dimensions separately or collectively in longitudinal observational or intervention study designs.

Leisure-time exercise, physical activity during work and commuting, and risk of metabolic syndrome

Data are limited regarding effect of intensity of leisure-time physical activity on metabolic syndrome. Furthermore, no prospective data are available regarding effect of occupational and commuting physical activity on metabolic syndrome. We compared metabolic syndrome risk by intensity level of leisure-time exercise and by occupational and commuting physical activity in Japanese workers. We followed 22,383 participants, aged 30-64 years, without metabolic syndrome until 2014 March (maximum, 5 years of follow-up). Physical activity was self-reported. Metabolic syndrome was defined by the Joint Statement criteria. We used Cox regression models to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of metabolic syndrome. During a mean follow-up of 4.1 years, 5361 workers developed metabolic syndrome. After adjustment for covariates, compared with engaging in no exercise, the HRs (95 % CIs) for <7.5, 7.5 to <16.5, and ≥16.5 metabolic equivalent hours of exercise per week were 0.99 (0.90, 1.08), 0.99 (0.90, 1.10), and 0.95 (0.83, 1.08), respectively, among individuals engaging in moderate-intensity exercise alone; 0.93 (0.75, 1.14), 0.81 (0.64, 1.02), and 0.84 (0.66, 1.06), among individuals engaging in vigorous-intensity exercise alone; and 0.90 (0.70, 1.17), 0.74 (0.62, 0.89), and 0.81 (0.69, 0.96) among individuals engaging in the two intensities. Higher occupational physical activity was weakly but significantly associated with lower risk of metabolic syndrome. Walking to and from work was not associated with metabolic syndrome. Vigorous-intensity exercise alone or vigorous-intensity combined with moderate-intensity exercise and worksite intervention for physical activity may help prevent metabolic syndrome for Japanese workers.

Dose-response association of physical activity with HbA1c: Intensity and bout length

OBJECTIVE

The aims of this study were to characterize the dose-response relationship between moderate-to-vigorous intensity physical activity (MVPA), and light-intensity activity with HbA1c in adults at low, moderate, and high risks of type 2 diabetes, and to compare the relationship of short (1 to 9min) versus long (10+min) bouts of MVPA with HbA1c.

METHODS

Data from 2707 participants from the 2003-2006 National Health And Nutrition Examination Survey were analyzed in 2014-2015. Type 2 diabetes risk was classified into three groups based upon age (<40years; ≥40years) and BMI (<30; ≥30). The relationship between HbA1c and accelerometer-based physical activity variables was assessed using multiple regression models.

RESULTS

There was a curvilinear dose-response relationship between HbA1c with total activity and MVPA in adults at moderate or high risk for type 2 diabetes: higher amounts of physical activity were associated with lower HbA1c. The association of physical activity on HbA1c was stronger at lower levels of physical activity. There was no dose-response relationship in adults at low risk for type 2 diabetes. The relationship between short bouts with HbA1c was stronger than for bouts≥10min.

CONCLUSIONS

In adults at risk for type 2 diabetes, there is a dose-response relationship between physical activity and HbA1c levels such that the relationship: (1) is curvilinear; (2) is stronger when a higher percent of total activity comes from MVPA; and (3) is more potent with short bouts of MVPA. Fractionalized physical activity of at least moderate-intensity may contribute to long-term glucose control.

Effects of moderate and vigorous physical activity on fitness and body composition

Current physical activity (PA) guidelines indicate that moderate-intensity (MPA) and vigorous intensity (VPA) PA provide similar benefits when total volume is equal. The present study examined the associations of MPA and VPA with body composition and cardiorespiratory fitness in free-living young adults. A total of 197 young adults (52.8 % male) were followed over a period of 15 months. Body composition was assessed via dual X-ray absorptiometry and time spent in various PA intensities was determined with a multi-sensor device every 3 months. Cardiorespiratory fitness was assessed with a graded exercise test at baseline and 15-months follow-up. Change in VPA was positively associated with cardiorespiratory fitness while MPA had beneficial associations with percent body fat. In overweight/obese participants the association with VO2peak was similar for MVPA bouts and VPA. Even though MPA and VPA have positive associations with overall health, their associations on key health parameters differ.

Association of physical activity with risk of metabolic syndrome: findings from a cross-sectional study conducted in rural area, Nantong, China

The prevalence of metabolic syndrome increases rapidly worldwide, and its association with physical activity (PA) varies with race and lifestyles. Little is known about the association in rural China. The Nantong Metabolic Syndrome Study recruited 13,505 female and 6997 male participants in 2007 and 2008. Socio-demographic characteristics, and physiological and behavioural data were collected. Logistic regression model was applied to estimate associations of metabolic syndrome and its components with different PAs. The overall metabolic syndrome prevalence was 21.6% in current study. Increasing total PA or moderate-to-vigorous-intensity occupational PA was associated with decreasing 5%-60% risk of having metabolic syndrome and abnormal metabolic syndrome components in both genders. An association between leisure-time PA and blood pressure was found in men, but no associations between leisure-time PA and metabolic syndrome components were found in women. Commuting PA, such as walking and taking bus, by bicycle and walking only, was associated with decrease of 20%-45% risk of several abnormal metabolic syndrome components in women. This study provides information for future investigation into the nature of these associations so that recommendations can be developed to reduce the prevalence of metabolic syndrome and its components among rural population in China.

[Prevention of cardiovascular diseases through sport and physical activity: A question of intensity?]

Coronary artery disease is the leading cause of death worldwide. A sedentary lifestyle accounts for 9% of premature mortality and creates a substantial health economic burden. Measurement of physical activity in daily practice refers to metabolic equivalent tasks and assessment of cardiopulmonary fitness to measurements of peak oxygen uptake during ergometry, which can be used to classify an individual's physical activity and maximum exercise capacity. Physical activity is a multifunctional intervention tool in prevention, which exerts its effects on multiple biochemical pathways, in contrast to conventional drug therapy. These changes reduce cardiovascular morbidity and mortality. Moderate physical exercise reduces blood pressure, improves insulin sensitivity and dyslipidemia, improves body composition and enhances weight reduction. Exercise of higher intensity seems to have superior effects compared to moderate intensity training; however, the training volume also seems to be important, as negative effects of long-term intensive training have been reported, e.g. atrial fibrillation or coronary sclerosis. Overall, exercise training has a major role in primary prevention of cardiovascular disease but seems to have a maximum threshold for benefit, which may be exceeded by some individuals.

Reduced flexibility associated with metabolic syndrome in community-dwelling elders

BACKGROUND

The ageing process may lead to reductions in physical fitness, a known risk factor in the development of metabolic syndrome. The purpose of the current study was to evaluate cross-sectional and combined associations of metabolic syndrome with body composition and physical fitness in a community based geriatric population.

METHODS

A total of 628 community-dwelling elders attending a geriatric health examination were enrolled in the study. The diagnosis of metabolic syndrome was based on the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criterion with Asian cutoff of waist girth was adopted in this study. Body composition was obtained using bioimpedance analysis, and physical fitness was evaluated through the measurement of muscle strength (handgrip force), lower extremity muscle endurance (sit-to-stand test), flexibility (sit-and-reach test), and cardiorespiratory endurance (2-minute step test). Multivariable logistic regression and correlation analysis were performed to determine the association of metabolic syndrome with body composition and functionality variables.

RESULTS

Metabolic syndrome was associated with increased skeletal muscle index (SMI) (odds ratio (OR), 1.61, 95% confidence interval (CI), 1.25-2.07) and decreased flexibility (OR, 0.97, 95% CI, 0.95-0.99) compared with those without metabolic syndrome. When body mass index was accounted for in the analysis, the association of SMI with metabolic syndrome was reduced. Waist circumference was positively correlated with SMI but negatively correlated with flexibility, whereas high density lipoprotein was positively correlated with flexibility but negatively correlated with SMI.

CONCLUSION

Reduced flexibility was positively associated with metabolic syndrome independent of age, gender, body composition, and functionality measurements in a community based geriatric population. Significant associations between metabolic syndrome with muscle strength and cardiorespiratory fitness in the elderly were not observed. Furthermore, flexibility should be included in the complete evaluation for metabolic syndrome.

Association between leisure time physical activity and metabolic syndrome: a meta-analysis of prospective cohort studies

A great number of prospective studies have investigated the relationship between leisure time physical activity (LTPA) and metabolic syndrome (MetS) risk. However, the results have been inconsistent. The aim of this study was to clarify the relationship between LTPA and MetS risk. Literature databases were searched including PubMed and Embase up to June 2013. A total of 17 studies, including 64,353 participants and 11,271 incident cases, were included in the meta-analysis. A high level of LTPA was statistically associated with decreased risk of MetS [high vs. low: relative risk (RR) = 0.80, 95 % confidence interval (CI) 0.75-0.85], whereas a moderate level of LTPA was weakly associated with decreased risk of MetS (moderate vs. low: RR = 0.95, 95 % CI 0.91-1.00). Subgroup analyses indicated that the association between a moderate level of LTPA and decreased risk of MetS was only significant in men (moderate vs. low: RR = 0.88, 95 % CI 0.81-0.97) and in studies with more than a 10-year follow-up period (moderate vs. low: RR = 0.90, 95 % CI 0.84-0.97). A high level of LTPA was statistically associated with decreased risk of MetS in each subgroup. A higher level of LTPA is associated with a lower risk of MetS. These findings could have public health implications with regard to prevention of MetS through lifestyle interventions.

Association between leisure time physical activity and metabolic syndrome: a meta-analysis of prospective cohort studies

A great number of prospective studies have investigated the relationship between leisure time physical activity (LTPA) and metabolic syndrome (MetS) risk. However, the results have been inconsistent. The aim of this study was to clarify the relationship between LTPA and MetS risk. Literature databases were searched including PubMed and Embase up to June 2013. A total of 17 studies, including 64,353 participants and 11,271 incident cases, were included in the meta-analysis. A high level of LTPA was statistically associated with decreased risk of MetS [high vs. low: relative risk (RR) = 0.80, 95 % confidence interval (CI) 0.75-0.85], whereas a moderate level of LTPA was weakly associated with decreased risk of MetS (moderate vs. low: RR = 0.95, 95 % CI 0.91-1.00). Subgroup analyses indicated that the association between a moderate level of LTPA and decreased risk of MetS was only significant in men (moderate vs. low: RR = 0.88, 95 % CI 0.81-0.97) and in studies with more than a 10-year follow-up period (moderate vs. low: RR = 0.90, 95 % CI 0.84-0.97). A high level of LTPA was statistically associated with decreased risk of MetS in each subgroup. A higher level of LTPA is associated with a lower risk of MetS. These findings could have public health implications with regard to prevention of MetS through lifestyle interventions.

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

AIM

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

METHODS AND RESULTS

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

CONCLUSIONS

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

Long-term effect of different physical activity levels on subclinical atherosclerosis in middle-aged men: a 25-year prospective study

BACKGROUND

The purpose of the study was to investigate the influence of lifetime physical activity (PA) on selected indices of atherosclerosis in longitudinal observation of middle-aged men.

METHODS

The subject of the study was a cohort of 101 men (mean age 59,7 ± 9,0 years), free of cardiovascular symptoms and treatment, participating in follow-up examinations in the years 1985/90-2011/12. Self-report PA was assessed by interviewer-administered Seven-Day PA Recall and Historical PA questionnaire. Subclinical atherosclerosis was measured by assessing the coronary artery calcification (CAC) according to Agatston's method using multi-slice computed tomography; the carotid intima-media thickness (IMT) using high-resolution B-mode ultrasound; and the reactive hyperemia index (RHI) using peripheral arterial tonometry (EndoPAT2000). The participants were initially divided into three groups according to tertiles of exercise-related energy expenditure (EE) in kcal/week at baseline, i.e. <2050 (low-to-moderate; n = 33), 2050-3840 (high; n = 34), >3840 (very high; n = 34).

RESULTS

The low-to-moderate, high and very high PA groups were comparable in terms of age and atherosclerosis risk factors at baseline. No linear relationship was found between PA and CAC, IMT and RHI. Men who maintained low-to-moderate (n = 26), high (n = 21) and very high (n = 15) PA level had the mean CAC of 286.1 ± 361.9, 10.7 ± 28.9, and 106.1 ± 278.3 (p<0.001 for low-to moderate vs high; p<0.05 for low-to-moderate vs very high); the mean IMT of 0.751 ± 0.19 mm, 0,641 ± 0.26 mm, and 0.750 ± 0.60 mm (p>0.05); and the mean RHI of 1.69 ± 0.4, 2.00 ± 0.4, and 2.13 ± 0.5 (p for trend = 0.050), respectively. No cases of CAC>400, IMT ≥ 0.9 and RHI<1.67 were noted only among men with maintained high PA level. At final examination men with high and very high PA had more favorable cardiometabolic profile than men with lower PA.

CONCLUSIONS

Maintaining regular high PA level through young and middle adulthood may protect against atherosclerosis as measured by CAC, IMT and RHI.