Physical activity in the Japan population: association with blood lipid levels and effects in reducing cardiovascular and all-cause mortality

Morning physical activity may be more beneficial for blood lipids than afternoon physical activity in older adults: a cross-sectional study

BACKGROUND

The effect of differences in daily physical activity patterns on blood lipids has not been determined. This study examines the effects of the differences in free-living daily physical activity patterns (amount and intensity) on blood lipid levels in older adults.

METHODS

This cross-sectional study included 51 older participants (71.8 ± 0.6 years, men = 8, women = 43). A triaxial accelerometer was used to assess physical activity patterns. The time from awakening to bedtime for each participant was used for group classification based on the amount (number of steps) and intensity (moderate-to-vigorous physical activity, MVPA) of physical activity. The morning step group (M Step) was defined as those who took more steps in the morning, and the afternoon step group (A Step) was defined as those who took more steps in the afternoon. The same method was used for MVPA (morning MVPA: M MVPA; afternoon MVPA: A MVPA). Blood samples were collected at the start of the study to determine blood lipid levels.

RESULTS

Number of steps taken showed a trend toward lower low-density lipoprotein cholesterol (LDL-C) levels in the M Step group compared with the A Step group. The LDL/high-density lipoprotein (HDL) ratio was significantly lower in the M Step group than the A Step group (p < 0.05). The M MVPA group also had higher HDL-C levels and significantly lower LDL/HDL ratios than the A MVPA group (p < 0.05).

CONCLUSIONS

These results suggest that compared with afternoon physical activity, daily morning physical activity (amount and intensity) is more effective in improving blood lipid levels.

Step count and multiple health outcomes: An umbrella review

OBJECTIVE

This study aimed to quantify the association between step count and multiple health outcomes in a healthy population.

METHODS

PubMed, Embase, Web of Science, and The Cochrane Library were systematically searched for systematic reviews and meta-analyses from inception to April 1, 2022. Literature screening, data extraction, and data analysis were performed in this umbrella review. The intervention factor was daily step counts measured based on devices. Multiple health outcomes included metabolic diseases, cardiovascular diseases, all-cause mortality, and other outcomes in the healthy population.

RESULTS

Twenty studies with 94 outcomes were identified in this umbrella review. The increase in daily step count contributed to a range of human health outcomes. Furthermore, the special population, different age groups, countries, and cohorts should be carefully considered. Negative correlation between step counts and the following outcomes: metabolic outcomes, cardiovascular diseases, all-cause mortality, postural balance, cognitive function, and mental health. However, there was no association between participation in the outdoor walking group and the improvement of systolic blood pressure and diastolic blood pressure. Analysis of the dose-response association between increasing daily step count and the risk of cardiovascular disease events and all-cause mortality showed a substantially linear relationship.

CONCLUSION

A wide range of health outcomes can benefit from the right number of steps.

Preliminary Efficacy, Feasibility, and Perceived Usefulness of a Smartphone-Based Self-Management System with Personalized Goal Setting and Feedback to Increase Step Count among Workers with High Blood Pressure: Before-After Study (Preprint)

BACKGROUND

High blood pressure (BP) and physical inactivity are the major risk factors for cardiovascular diseases. Mobile health is expected to support patients' self-management for improving cardiovascular health; the development of fully automated systems is necessary to minimize the workloads of health care providers.

OBJECTIVE

The objective of our study was to evaluate the preliminary efficacy, feasibility, and perceived usefulness of an intervention using a novel smartphone-based self-management system (DialBetes Step) in increasing steps per day among workers with high BP.

METHODS

On the basis of the Social Cognitive Theory, we developed personalized goal-setting and feedback functions and information delivery functions for increasing step count. Personalized goal setting and feedback consist of 4 components to support users' self-regulation and enhance their self-efficacy: goal setting for daily steps, positive feedback, action planning, and barrier identification and problem-solving. In the goal-setting component, users set their own step goals weekly in gradual increments based on the system's suggestion. We added these fully automated functions to an extant system with the function of self-monitoring daily step count, BP, body weight, blood glucose, exercise, and diet. We conducted a single-arm before-and-after study of workers with high BP who were willing to increase their physical activity. After an educational group session, participants used only the self-monitoring function for 2 weeks (baseline) and all functions of DialBetes Step for 24 weeks. We evaluated changes in steps per day, self-reported frequencies of self-regulation and self-management behavior, self-efficacy, and biomedical characteristics (home BP, BMI, visceral fat area, and glucose and lipid parameters) around week 6 (P1) of using the new functions and at the end of the intervention (P2). Participants rated the usefulness of the system using a paper-based questionnaire.

RESULTS

We analyzed 30 participants (n=19, 63% male; mean age 52.9, SD 5.3 years); 1 (3%) participant dropped out of the intervention. The median percentage of step measurement was 97%. Compared with baseline (median 10,084 steps per day), steps per day significantly increased at P1 (median +1493 steps per day; P<.001), but the increase attenuated at P2 (median +1056 steps per day; P=.04). Frequencies of self-regulation and self-management behavior increased at P1 and P2. Goal-related self-efficacy tended to increase at P2 (median +5%; P=.05). Home BP substantially decreased only at P2. Of the other biomedical characteristics, BMI decreased significantly at P1 (P<.001) and P2 (P=.001), and high-density lipoprotein cholesterol increased significantly only at P1 (P<.001). DialBetes Step was rated as useful or moderately useful by 97% (28/29) of the participants.

CONCLUSIONS

DialBetes Step intervention might be a feasible and useful way of increasing workers' step count for a short period and, consequently, improving their BP and BMI; self-efficacy-enhancing techniques of the system should be improved.

Associations of specific types of physical activities with 10-year risk of cardiovascular disease among adults: Data from the national health and nutrition examination survey 1999–2006

Background

Physical activity plays a key role in the prevention of cardiovascular disease (CVD). However, previous studies focused predominantly on the associations of the total amount of physical activity with CVD. There were few evidences on the associations of specific sport disciplines with CVD. Furthermore, little was known on the interactions between the different types of sports on CVD risk. Therefore, this study aimed to examine the independent associations of specific types of physical activities with the 10-year risk of CVD, and further evaluate the interactions between specific types of physical activities on the 10-year risk of CVD in US adults.

Methods

This study used the data of the National Health and Nutrition Examination Survey (NHANES) 1999-2006. Participants aged ≥ 30 years and with free of CVD were eligible. The physical activity questionnaire is used to collect general information on leisure-time activities in the past 30 days, including the frequency, duration, and intensity of participation in each activity. The exposures of interest included cycling, swimming, aerobics, running, American Football, basketball, and racquet sports. The Framingham risk score algorithm was used to assess 10-year CVD risk based on age, high density lipoprotein, total cholesterol, systolic blood pressure, smoking status, and diabetes. A higher total score reflects a greater risk of CVD.

Results

This study included 10829 participants. Compared to no participation, participation in cycling (β = −0.890, 95% CI:−1.278,−0.502, P < 0.001), running (β = −1.466, 95% CI:−1.837,−1.095, P < 0.001), American Football (β = −2.934, 95% CI:−3.750,−2.119, P < 0.001), basketball (β = −1.968, 95% CI:−2.645,−1.291, P < 0.001), and aerobics (β = −0.980, 95% CI:−1.352,−0.608, P < 0.001) was associated with a lower CVD risk. Furthermore, cycling was antagonistic with basketball and racquet sports in the associations with CVD risk. An antagonistic action between swimming and aerobics was also observed. Nevertheless, running was synergistic with cycling, aerobics, and racquet sports in the associations with CVD risk.

Conclusions

There were inverse associations of specific types of physical activities with CVD risk. Furthermore, there might be synergistic and antagonistic associations of multiple types of physical activities with CVD risk.

Trends of Dietary Intakes and Metabolic Diseases in Japanese Adults: Assessment of National Health Promotion Policy and National Health and Nutrition Survey 1995–2019

Health Japan 21 is Japan’s premier health promotion policy encompassing preventive community health measures for lifestyle-related diseases. In this repeated cross-sectional survey, we report 24-year trends of type 2 diabetes mellitus (T2DM), obesity, hypertension, and their association with dietary intakes to evaluate Health Japan 21’s impact and identify gaps for future policy implementation. We analyzed data from 217,519 and 232,821 adults participating in the physical examination and dietary intake assessment, respectively, of the National Health and Nutrition Survey 1995–2019. Average HbA1c and BMI have significantly increased along with the prevalence of T2DM and overweight/obesity among males. Despite a significant decrease in daily salt intake, the decline in the combined prevalence of Grades 1–3 hypertension was non-significant. Seafood and meat intakes showed strong opposing trends during the study period, indicating a dietary shift in the Japanese population. Neither salt nor vegetable/fruit intake reached the target set by Health Japan 21. Metabolic disease trend differences between males and females highlight the need for a gender-specific health promotion policy. Future Health Japan 21 implementation must also consider locally emerging dietary trends.

Relationship of leisure-time and household physical activity level and type with cardiovascular disease: secondary analysis of the Takashima Study data

Background

High levels of participation in leisure-time and household physical activity lower the risk of cardiovascular disease (CVD), although it is unclear whether the number of activity types is related to new-onset CVD. We aimed to evaluate the effect of the amount of leisure-time physical activity and the number of types of leisure-time physical activities on the risk of CVD incidence.

Methods

From 2002 to 2003, 3,741 participants without any history of CVD participated in the Takashima Study. Data on the amount of leisure-time and household physical activity and the types of leisure-time and household physical activity were obtained from a self-administered questionnaire. Hazard ratios for CVD (acute myocardial infarction and stroke) incidence (follow-up data from 2002 to 2013), according to the participation level and number of activity types, were calculated using Cox proportional hazards models.

Results

The mean age of the subjects was 58.7 ± 13.1 years. During the mean follow-up period of 8.0 ± 1.1 years, 92 participants developed CVD. An inverse dose–response relationship was noted between the amount of leisure-time and household physical activity and CVD events. After adjusting for baseline characteristics, lifestyle-related diseases, and the amount of physical activity other than leisure-time and household, the risk of CVD onset was compared by dividing the participants into two groups by the level of participation; the highest activity group had an adjusted hazard ratio (95% confidence interval) of 0.40 (0.20–0.82) compared to the lowest activity group. Compared to participants who engaged in 0–1 type of activity, participants who engaged in two or more types of activities had a multivariable-adjusted hazard ratio (95% confidence interval) of 0.31 (0.12–0.79).

Conclusion

Increasing the amount of leisure-time and household physical activity and promoting engagement in two or more types of such activities may reduce the rate of CVD incidence in the Japanese general population.

Changes in the Frequency of Moderate-to-Vigorous Physical Activity and Subsequent Risk of All-Cause and Cardiovascular Disease Mortality

We investigated the association of changes in the frequency of moderate-to-vigorous physical activity (MVPA) and the risks of all-cause and cardiovascular disease (CVD) mortality. This study used the nationally representative National Health Insurance Service-National Sample Cohort database. We included 286,402 individuals aged ≥20 years and estimated changes in the frequency of MVPA over a two-year period. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard regression models. The HRs (95% CIs) for the risk of all-cause and CVD mortality for an increased frequency of MVPA from physical inactivity compared with continual physical inactivity were 0.82 and 0.68 (0.73–0.92 and 0.51–0.91) for 1–2, 0.72 and 0.48 (0.62–0.84 and 0.31–0.74) for 3–4, and 0.73 and 0.70 (0.63–0.85 and 0.50–0.98) for ≥5 sessions of MVPA/week. The HRs (95% CIs) for the risk of all-cause and CVD mortality were 1.28 and 1.58 (1.07–1.53 and 1.01–2.46), 1.25 and 2.17 (1.01–1.57 and 1.14–4.12), and 1.43 and 1.44 (1.15–1.77 and 0.84–2.47) for changes from 1–2, 3–4, and ≥5 sessions of MVPA/week to physical inactivity, respectively. This study showed the beneficial effect of increasing physical activity, particularly for those who were physically inactive at baseline, as well as the increased risk of all-cause and CVD mortality after adapting a physically inactive lifestyle regardless of their baseline physical activity status.

Impact of Ergonomics on Cardiometabolic Risk in Office Workers: Transition to Activity-Based Working With Height-Adjustable Desk

OBJECTIVE

Ergonomic office redesigning possibly improves physical activity (PA) and sedentary behavior (SB); however, its impact on cardiometabolic risk has not yet been determined. This study aimed to examine the effect of office relocation on cardiometabolic risk factors.

METHODS

Annual health check-up data of 95 office workers from four offices in Tokyo, Japan, who relocated to an office with activity-based working (ABW) and height-adjustable desk (HAD) and a propensity-score matched control-cohort were analyzed. PA and SB on weekdays were measured only in the relocation group before and 10 months after relocation.

RESULTS

Significant interactions were observed for waist circumference, high-density lipoprotein cholesterol, and glycosylated hemoglobin (HbA1c). HbA1c changes showed a significant negative association with moderate-to-vigorous-intensity PA.

CONCLUSION

An ABW office with HAD improves cardiometabolic risk factors in office workers, possibly through changes in PA and SB.

Effects of a health education program to promote healthy lifestyle and glycemic control in patients with type 2 diabetes: A randomized controlled trial

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a common chronic disease with an increase in prevalence within developing countries. The aim of this study was to determine the efficacy of a structured educational program for improving lifestyle and health-related measures in Iranians with T2DM.

METHODS

A randomized controlled trial was conducted in 80 participants with T2DM who were randomly assigned to either the intervention or a control group. A demographic questionnaire along with the Health Promoting Lifestyle Profile-II and related laboratory tests were used to assess the efficacy of the program. The intervention consisted of six educational sessions held over 45 days. The control group received routine diabetic care at the clinic. Three months after the intervention, participants completed the measures again. Within-group and between-group comparisons were then made.

RESULTS

All subscales of lifestyle measure improved in the intervention group, whereas only the nutrition domain improved in the control group. After adjusting for baseline differences, physical activity and nutrition domains showed the greatest improvement in the intervention group compared to controls. All clinical measures were also significantly improved within intervention group from baseline to follow-up (p < 0.001), whereas HbA1c, fasting blood glucose, HDL, triglyceride, cholesterol, and weight also changed significantly in the control group. The frequency of HbA1c < 7% was increased from 27.5% at baseline to 37.5% at follow-up (10%) in the intervention group compared to only a 5% increase in the control group.

CONCLUSION

This educational health program significantly improved lifestyle changes and health-related clinical characteristics in persons with T2DM, compared to routine diabetic care in Iran. Further research is needed to better understand the usefulness of such programs in diabetics and other medical conditions among those in different cultural settings.

Evaluation of the Cancer Transition Theory in the US, Select European Nations, and Japan by Investigating Mortality of Infectious- and Noninfectious-Related Cancers, 1950-2018

IMPORTANCE

Despite cancer being a leading cause of death worldwide, scant research has been carried out on the validity of the cancer transition theory, the idea that as nations develop, they move from a situation where infectious-related cancers are prominent to one where noninfectious-related cancers dominate.

OBJECTIVE

To examine whether cancer transitions exist in the US, select European countries, and Japan.

DESIGN, SETTING, AND PARTICIPANTS

In this cross-sectional study, annual cause-of-death data from the 1950s to 2018 for the US, England and Wales, France, Sweden, Norway, and Japan were extracted from the Human Mortality Database and the World Health Organization (WHO). Statistical analysis was performed from April 2020 to February 2021.

MAIN OUTCOMES AND MEASURES

Age-standardized death rates for all ages and both sexes combined were estimated for cancers of the stomach, cervix, liver, lung, pancreas, esophagus, colorectum, breast, and prostate.

RESULTS

The results of the analysis show that for all countries in this study except for Japan, mortality from infectious-related cancers has declined steadily throughout the period, so that by the end of the period, for Norway, England and Wales, Sweden, and the US, rates were approximately 20 deaths per 100 000 population. Regarding noninfectious-related cancers, at the beginning of the period, all countries exhibited an increasing trend in rates, with England and Wales having the greatest peak of 215.1 deaths per 100 000 population (95% CI 213.7-216.6 deaths per 100 000 population) in 1985 followed by a decline, with most of the other countries reaching a peak around 1990 and declining thereafter. Furthermore, there is a visible crossover in the trends for infectious-related and noninfectious-related cancers in Japan and Norway. This crossover occurred in 1988 in Japan, when the rates for both types of cancers stood at 116 per 100 000 population (95% CI, 115.0-116.5 per 100 000 population), and in 1955 in Norway, when they passed each other at 100 per 100 000 population (95% CI, 96.4-105.3 per 100 000 population).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, the findings suggest that cancer mortality patterns parallel the epidemiological transition, which states that as nations develop, they move from a stage where infectious diseases are prominent to one where noninfectious diseases dominate. An implication is that the epidemiological transition theory as originally formulated continues to be relevant, despite some researchers arguing that there should be additional stages beyond the original 3.

Fermented and nonfermented soy foods and the risk of breast cancer in a Japanese population-based cohort study

Background

Although preclinical studies suggest that fermented soy foods may have a protective effect against breast cancer, no prospective cohort studies have examined this association.

Objective

Our study examined the association between fermented and nonfermented soy food intake and breast cancer risk using a population‐based prospective cohort study in Japan.

Methods

We included a total of 47,614 women aged 45–74 years in an analysis of the Japan Public Health Center‐based Prospective Study (JPHC Study). A validated food frequency questionnaire (FFQ) was used for the assessment of dietary intake. Breast cancer incidence was analyzed by multivariate Cox proportional hazards regression models.

Results

During an average of 15.5 years of follow‐up, 825 breast cancer cases were newly identified. We found no association of intake of soy foods with breast cancer risk, regardless of fermentation, with multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for the highest quartiles of fermented and nonfermented soy food intake of 0.94 (0.67, 1.32) and 1.15 (0.85, 1.57) compared with the lowest quartile (p for trend = 0.305 and 0.393). Unlike nonfermented soy, higher intake of fermented soy foods was associated with a significant decrease in the risk of nonlocalized breast cancer. The HR and 95% CI in the highest compared to lowest intake category of fermented soy foods was 0.53 (0.28, 0.99) versus nonfermented soy foods 0.85 (0.51, 1.42) (p for trend = 0.026 and 0.797).

Conclusions

Our analyses showed that fermented soy foods had no association with overall breast cancer but may be associated with decreased risk of nonlocalized breast cancer.

Pubertal maturation and weight status are associated with dyslipidemia among children and adolescents in Northwest China

Dyslipidemia is one of major risk factors for cardiovascular disease. The early detection and treatment of dyslipidemia can reduce cardiovascular disease risk. A cross-sectional study was carried out in Ningxia, China to determine the prevalence of dyslipidemia and its association with body mass index (BMI) and pubertal stage. A total of 1783 students were selected from middle schools and high schools in September 2014 using stratified random cluster sampling. Serum triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured by using MOL-300 automatic biochemical analyzer with associated kits. The prevalence of adolescents with one abnormal serum lipid component was 43.2% and was significantly different across three pubertal stages (p < 0.0001). The abnormal rates of HDL-C and TG increased as the students maturated through the early, middle, and late stages of puberty (all p < 0.0001). Similar results were obtained when separate analyses were performed for boys and girls. In linear regression analysis, BMI was positively associated with serum levels of TC, LDL-C, and TG, but inversely associated with serum levels of HDL-C after the adjustment for age, sex, and race. In multivariable logistic regression analysis, obesity was associated with an increased risk of developing high TC, while pubertal maturation was associated with an elevated risk of experiencing low HDL-C and high TG (all p < 0.05). In conclusions, dyslipidemia is common in an adolescent population of Northwest China and its prevalence rates substantially vary with weight status and pubertal stage.

Tailored feedback reduced prolonged sitting time and improved the health of housewives: a single-blind randomized controlled pilot study

Reducing sitting time, independent of physical activity, is important for health. However, few reports have been published regarding physical activity of housewives compared to that of employed women. We examined strategies to shorten housewives' sitting time using a single-blind randomized controlled trial. Forty-eight housewives (38.0 ± 4.5 years old) were randomly assigned to one of three groups: pamphlet, self-feedback, and tailored feedback groups. All participants received a pamphlet describing the risks of prolonged sitting. The self-feedback and tailored feedback groups were also given feedback on sitting time by a smartphone application. The tailored feedback group received individual suggestions regarding lifestyle to shorten sitting time. We measured physical activity using an accelerometer and health-related quality of life using the Short-Form 8. The longest prolonged sitting time significantly decreased over time, a significant reduction was observed after the intervention only in the tailored feedback group. Vitality, mental health, and role emotional components of health-related quality of life showed a significant improvement with time but no significant differences were observed among the study groups. We suggested an easy approach to shortening prolonged sitting time in housewives using a pamphlet and feedback by smartphone. However, tailored consulting was necessary to yield a more effective result.

Impact of Physical Activity on Coronary Plaque Volume and Components in Acute Coronary Syndrome Patients After Early Phase II Cardiac Rehabilitation

BACKGROUND

Cardiac rehabilitation (CR) is an established multidisciplinary secondary preventive program. We investigated the effects of CR involving intensive physical activity (PA) on coronary plaque volume and components in patients with acute coronary syndrome (ACS).Methods and Results:We enrolled 32 consecutive patients with ACS in early phase II CR and randomly assigned them to an intensive CR group (n=18; CR participation ≥twice/week, daily PA ≥9,000 steps) or a standard CR group (n=14; CR participation ≥once/2weeks, daily PA ≥6,000 steps). Serial integrated backscatter intravascular ultrasound was performed for non-culprit lesions at baseline and after 8 months. Baseline clinical data were identical between the 2 groups. Unexpectedly, CR participation and PA did not differ significantly between the 2 groups, and there was no significant difference in plaque volume (PV) or components between the 2 groups. Subsequently, we classified the patients into 2 groups according to median PA (7,000 steps). There were significant differences in percent change of PV and of lipid volume between these 2 groups. In addition, these changes were negatively and independently correlated with PA.

CONCLUSIONS

No significant difference was observed in PV or components between the intensive CR and the standard CR groups. Intensive PA, however, may retard coronary PV and ameliorate lipid component in patients with ACS participating in late phase II CR.

Adherence to the Healthy Nordic Food Index and the incidence of acute myocardial infarction and mortality among patients with stable angina pectoris

BACKGROUND

The Healthy Nordic Food Index (HNFI) has been associated with beneficial effects on markers of cardiovascular disease (CVD). Whether such effects are present among patients with established coronary heart disease is unknown. In the present study, we investigated the association between adherence to the HNFI and the risk of acute myocardial infarction (AMI) (fatal or nonfatal) and death among patients with stable angina pectoris.

METHODS

In the Western Norway B-vitamin Intervention Trial, participants completed a 169-item semi-quantitative food frequency questionnaire. The HNFI was calculated from six food groups (fish, cabbage, apples/pears, root vegetables, whole grain bread and oatmeal), scoring 0-6. Three adherence groups were defined: 0-1 points (low), 2-3 points (medium) or 4-6 points (high). Cox regression analyses investigated associations between adherence to the HNFI and outcomes.

RESULTS

Among 2019 men (79.7%) and women with mean age of 61.7 years, 307 patients experienced an AMI event during a median (25th and 75th percentiles) follow-up of 7.5 (6.3 and 8.7) years. Median follow-up for total mortality was 10.5 (9.3 and 11.7) years; 171 patients died from CVD and 380 from any cause. No association between HNFI and the risk of AMI was detected. However, the HNFI was associated with a reduced risk of all-cause death, both by linear estimates [hazard ratio (95% confidence interval = 0.91 (0.84-0.98)] and by comparison of the highest with the lowest adherence group [hazard ratio (95% confidence interval = 0.70 (0.52-0.95)].

CONCLUSIONS

The results of the present study suggest that a Healthy Nordic diet may reduce mortality in patients with established CVD.

Cardiovascular disease mortality in relation to physical activity during adolescence and adulthood in Japan: Does school-based sport club participation matter?

We examined potential associations of sport club participation during adolescence and sports-related physical activity during adulthood with mortality from cardiovascular diseases (CVD) in a Japanese population. Between 1988 and 1990, 29,526 men and 41,043 women aged 40-79 years responded to a questionnaire including questions about the frequency of sports participation at baseline and sport club participation during junior/senior high school. Subjects were followed-up until the end of 2009, and 4230 cardiovascular deaths (870 CHD, 1859 stroke) were identified. Cox proportional-hazard regression models were used to estimate hazard ratios (HR). During the first-two thirds of the follow-up - where the proportional hazards assumption was met - the multivariate-adjusted HR (95% confidence interval) for total CVD mortality was 0.77 (0.61-0.98) among men and 0.82 (0.61-1.10) among women who were physically active at baseline (≥5 h/week versus 1-2 h/week). The corresponding HRs for coronary heart disease (CHD) mortality were 0.65 (0.39-1.07) and 0.40 (0.17-0.91), respectively. The combined associations of sports participation during adulthood and adolescence were also examined. Among men who participated in sports for ≥5 h/week at baseline, the multivariate-adjusted HR for those who also engaged in sport club activities during adolescence was 0.89 (0.61-1.30) for total CVD mortality and 0.24 (0.08-0.71) for CHD mortality when compared to non-participants. Among women, no statistically significant differences were found between sport club participants and non-participants. In conclusion, participating in sport clubs during adolescence might lead to a more pronounced risk-reduction for CHD mortality among men who also participate in sport activities during adulthood.

The joint impact of habitual exercise and glycemic control on the incidence of chronic kidney disease (CKD) in middle-aged and older males

Background

This retrospective study evaluated the influence of the joint impact of habitual exercise and glycemic control on the incidence of chronic kidney disease (CKD) during a 6-year follow-up period in middle-aged and older males.

Methods

The study population included 303 males without a history of cardiovascular disease, stroke, renal dysfunction, or dialysis treatment. Their lifestyle behaviors regarding exercise and physical activity were evaluated using a standardized self-administered questionnaire. The participants were divided into four categories according to the performance or non-performance of habitual exercise and the presence or absence of hyperglycemia.

Results

After 6 years, 32 subjects (10.6%) developed CKD (estimated glomerular filtration rate < 60 ml/min/1.73 m² and/or proteinuria). The cumulative incidence of CKD was significantly higher among subjects who did not perform habitual exercise and hyperglycemic subjects (log-rank test: p < 0.05, respectively). According to a Cox proportional hazards model, the hazard ratio (HR) for the incidence of CKD in subjects with a normal glucose tolerance (NGT) who did not perform habitual exercise (HR = 2.82, 95% confidence of interval (CI) = 1.07–7.36, p = 0.034) and that in hyperglycemic subjects who did not perform habitual exercise (HR = 5.89, 95% CI = 1.87–16.63, p = 0.003) were significantly higher in comparison to the subjects with a NGT who performed habitual exercise.

Conclusions

These results suggest that the habitual exercise and good glycemic control and their combination were associated with the incidence of CKD.

The increased risk of sarcopenia in patients with cardiovascular risk factors in Suburb-Dwelling older Chinese using the AWGS definition

The aim of the present study is to investigate the relationship between sarcopenia and cardiovascular risk factors (CVRF) in the Chinese elderly. A total of 1611 elderly individuals aged ≥60 years were enrolled in this study. The well-established CVRF of diabetes, hypertensions, and dyslipidemia were assessed. Sarcopenia was defined according to the recommended algorithm of the Asian Working Group for Sarcopenia (AWGS). Multiple logistic regression analyses and the linear regressions were used to evaluate the components of CVRF and the number of CVRF of elderly patients with sarcopenia. After adjusting for potential confounders, CVRF was associated with a high prevalence of sarcopenia in elderly Chinese populations. Furthermore, diabetes and hypertension, but not dyslipidemia, were found to be significantly associated with sarcopenia. The OR and 95% CI for sarcopenia of the participants with 1, 2, and 3 features of CVRF were 2.27(1.14-4.48), 4.13(1.80-9.46), and 4.90(1.01-23.81), respectively. A linear increase in the prevalence of sarcopenia was found to be associated with the number of CVRF components in the elderly population (P values for the trends < 0.001). Knowledge of known CVRF, particularly diabetes and hypertension, may help predict the risk for sarcopenia in the elderly.

Clinical importance of change in physical activity after endovascular treatment combined with exercise training in patients with peripheral arterial disease

We aimed to investigate the characteristics of changes in amount of physical activity of patients with peripheral arterial disease (PAD) before/after endovascular treatment (EVT) combined with exercise training. Twenty-two patients with peripheral arterial disease at stage-II of the Fontaine classification who received EVT combined with exercise training were included in this study. A tri-axial accelerometer was used to record physical activity every day from the day before surgery to 3 months after discharge from hospital. The mean number of walking steps before surgery was 2664 steps (611 steps-5404 steps), whereas those after surgery was 3393 (567 steps-7578 steps). Ankle Brachial Index (from 0.69 to 1.03; p < 0.001), maximum walking distance (from 728.2 to 1271.8 m; p < 0.05) and Vascu-QOL (from 98.9 to 137.9; p < 0.01) showed improvement between before and after surgery. Physical activity of patients with PAD was still low at 3 months after surgery even though walking ability, QOL, and self-efficacy were improved after EVT combined with exercise training. Among the 22 patients, the number of walking steps increased in 17 of them and decreased in 5 of them. Compared with the patients in the increased-steps group, those in the decreased-steps group were significantly older (p < 0.05), and had a significantly higher cardiovascular event rate within the first 3 months after surgery (p < 0.05). These results suggested that, not only the improvement of walking ability, but increase in physical activity after EVT combined with exercise training is also important for short-term prognosis.

A U-shaped relationship between alcohol consumption and cardiometabolic index in middle-aged men

BACKGROUND

Cardiometabolic index (CMI) is a new index for discriminating diabetes. The purpose of this study was to determine whether CMI is affected by habitual alcohol drinking.

METHODS

The subjects were 21572 men (35-60 years) receiving annual health checkups. They were divided by average daily ethanol consumption into non-, light (< 22 g), moderate (≥ 22 and < 44 g), heavy (≥ 44 and < 66 g) and very heavy (≥ 66 g) drinkers. Relationship between alcohol intake and CMI was investigated with adjustment for age and histories of smoking and regular exercise.

RESULTS

Log-transformed CMI was significantly lower in light, moderate and heavy drinkers than in nondrinkers and was lowest in light drinkers, while there was no significant difference in log-transformed CMI of nondrinkers and very heavy drinkers. Odds ratio vs. nondrinkers for high CMI was significantly lower than the reference level of 1.00 in light, moderate and heavy drinkers and was lowest in light drinkers but was not significantly different from the reference level in very heavy drinkers. Odds ratio of subjects with vs. those without high CMI for hyperglycemia was significantly higher than the reference level in all of the alcohol groups and was significantly lower in moderate drinkers but was not significantly different in the other drinker groups when compared with the nondrinker group.

CONCLUSION

There is a U-shaped relationship between alcohol consumption and CMI, and moderate drinking but not excessive drinking attenuates the association between CMI and hyperglycemia.

Beneficial Effects of Exercise-Based Cardiac Rehabilitation on High-Density Lipoprotein-Mediated Cholesterol Efflux Capacity in Patients with Acute Coronary Syndrome

AIM

Recent studies reported that low high-density lipoprotein (HDL)-mediated cholesterol efflux capacity rather than low HDL cholesterol (HDL-C) is strongly associated with the increased risk for coronary artery disease. It remains unclear whether exercised-based cardiac rehabilitation (CR) can increase HDL cholesterol efflux capacity.

METHOD

This study is a retrospective analysis of stored serum from patients with acute coronary syndrome (ACS) who participated in outpatient CR program following successful percutaneous coronary intervention. We employed a cell-based cholesterol efflux system including the incubation of (3)H-cholesterol labeled macrophages with apolipoprotein B-depleted serum at the onset or early phase of ACS and at 6-month follow-up periods in 57 male and 11 female patients with ACS. Cardiopulmonary exercise tests were performed at the beginning and end of CR program.

RESULT

Fifty-seven patients completed the CR program. Compared with patients who dropped out from CR program (non-CR group), CR participants showed marked amelioration in serum lipid levels, increased efflux capacity, and improved exercise capacity. Spearman's rank correlation coefficient analysis revealed that the percent increases of efflux capacity were significantly associated with the percent increases in HDL-C (ρ=0.598, p＜0.0001) and apolipoprotein A1 (ρ=0.508, p＜0.0001), whereas no association between increases in efflux capacity and increases in cardiopulmonary fitness was observed. Increases in cholesterol efflux capacity were not seen in patients who continued smoking and those who did not achieve all risk factor targets and higher exercise tolerance.

CONCLUSION

CR can markedly increase both HDL-C and HDL cholesterol efflux capacity. These results suggest that CR is a very useful therapy for reverse cholesterol transport and secondary prevention.

Body Mass Index Modifies an Association between Self-Reported Regular Exercise and Proteinuria

AIM

Regular exercise habits are well-known to exert a favorable effect on the metabolic syndrome, which may cause proteinuria and chronic kidney disease (CKD). However, it remains unknown if exercise exerts a favorable effect on proteinuria and kidney dysfunction. The aim of this study was to reveal the association between exercise and the prevalence of proteinuria and kidney dysfunction and the attenuation by obesity.

METHODS

This study was a cross-sectional cohort study that included 292,013 participants who underwent the Specific Health Check and Guidance in Japan. The exercise score (range 0-3) was based on the number of positive answers to three questions regarding exercise habits. The outcome was defined as urinary protein detected by a dipstick test and kidney dysfunction [estimated glomerular filtration rate (GFR) less than 45 ml/min/1.73 m(2)].

RESULTS

The exercise score was significantly associated with the prevalence of proteinuria in both males [vs. exercise score 0; exercise score 1, multivariate-adjusted odds ratio 0.86 (95% confidence interval 0.81-0.92), P<0.001; exercise score 2, 0.84 (0.79-0.90), P<0.001; exercise score 3, 0.77 (0.72-0.82), P<0.001] and females (same as in males). After the male subjects were divided into quintiles according to body mass index (BMI) in more than three groups (22.9<BMI<24.1), there was no significant association between the exercise score and the prevalence of proteinuria. In females, a higher exercise score was associated with a lower prevalence of proteinuria, regardless of BMI. The association between the exercise score and kidney dysfunction was as similar as that between the exercise score and proteinuria, except the attenuation of BMI.

CONCLUSION

Exercise may associate with a lower prevalence of proteinuria and kidney dysfunction, and a high BMI may attenuate this association between exercise and proteinuria in male subjects.

The effect of exercise on lipid profiles and inflammatory markers in lean male adolescents: a prospective interventional study

BACKGROUND

Physical activity improves body composition and inflammatory markers in obese individuals, but little is known about the nonobese population.

OBJECTIVE

The aim of this study was to investigate associations between exercise and inflammatory cytokines in lean male adolescents in Taiwan.

METHODS

This interventional study enrolled a total of 79 normal body weight male adolescents [mean age, 16.8 (1.0) years] from the Army Academy of Taiwan. Body composition and inflammatory markers were measured at baseline and upon completion of a 12-week exercise intervention program.

RESULTS

Subjects' postintervention anthropometric measures, including waist circumference [74.6 (5.2)→72.6 (5.2) cm], hip circumference [92.3 (4.1)→89.9 (5.0) cm], body fat mass [10.2 (3.2)→8.2 (3.2) kg], and body fat percentage [15.8% (4.2)→12.6 (4.5)%] declined significantly compared to preintervention (all P<0.001), as did systolic blood pressure (P=0.002) and mean blood pressure (P = 0.020). Postintervention body height and free fat mass increased significantly (both P<0.001). Subjects' postintervention lipids including total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides increased significantly (all P<0.001). Inflammatory markers including adiponectin [14.32 (6.68)→31.31 (30.53) μg/mL, P<0.001], interleukin 6 [2.15 (4.81)→2.86 (6.37) pg/mL, P=0.005], and C-reactive protein [1.00 (2.57)→2.30 (4.17) μg/mL, P<0.001] increased significantly postintervention, but not leptin.

CONCLUSIONS

Exercise training significantly improves body composition and anti-inflammatory adiponectin levels in lean male adolescents.

Dietary patterns and physical inactivity, two contributing factors to the double burden of malnutrition among adults in Burkina Faso, West Africa

A population-based cross-sectional study was carried out in the northern neighbourhoods of Ouagadougou (Burkina Faso), to examine the relationship of nutritional deficiencies and cardiometabolic risk factors (CMRF) with lifestyle in adults. We randomly selected 330 households stratified by income tertile. In each income stratum, 110 individuals aged 25-60 years and having lived in Ouagadougou for at least 6 months were randomly selected. We performed anthropometric, dietary intake and physical activity measurements, and blood sample collection. Cluster analysis of dietary intake identified two dietary patterns: 'urban' (29 % of subjects) and 'traditional' (71 %). The 'urban' cluster exhibited a higher intake of fat and sugar, whereas a higher intake of plant protein, complex carbohydrate and fibre was observed in the 'traditional' pattern. Female sex, low income and lack of education were associated with the 'traditional' cluster, as well as Fe and vitamin A deficiency. CMRF prevalence (abdominal obesity, hypertension, hyperglycaemia, dyslipidaemia) was similar in both clusters. Subjects in the 'traditional' cluster spent more time in physical activity and had less sedentary time than those in the 'urban' cluster. 'Traditional' dietary pattern, low income, female sex and sedentary time were significant contributing factors to the double burden of malnutrition. The rapid nutrition transition is reflected in this co-occurrence of CMRF and nutritional deficiencies. This stresses the need for prevention strategies addressing both ends of the nutrition spectrum.

Associations of self-reported physical activity types and levels with quality of life, depression symptoms, and mortality in hemodialysis patients: the DOPPS

BACKGROUND AND OBJECTIVES

Physical activity has been associated with better health status in diverse populations, but the association in patients on maintenance hemodialysis is less established. Patient-reported physical activities and associations with mortality, health-related quality of life, and depression symptoms in patients on maintenance hemodialysis in 12 countries were examined.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

In total, 5763 patients enrolled in phase 4 of the Dialysis Outcomes and Practice Patterns Study (2009-2011) were classified into five aerobic physical activity categories (never/rarely active to very active) and by muscle strength/flexibility activity using the Rapid Assessment of Physical Activity questionnaire. The Kidney Disease Quality of Life scale was used for health-related quality of life. The Center for Epidemiologic Studies Depression scale was used for depression symptoms. Linear regression was used for associations of physical activity with health-related quality of life and depression symptoms scores. Cox regression was used for association of physical activity with mortality.

RESULTS

The median (interquartile range) of follow-up was 1.6 (0.9-2.5) years; 29% of patients were classified as never/rarely active, 20% of patients were classified as very active, and 20.5% of patients reported strength/flexibility activities. Percentages of very active patients were greater in clinics offering exercise programs. Aerobic activity, but not strength/flexibility activity, was associated positively with health-related quality of life and inversely with depression symptoms and mortality (adjusted hazard ratio of death for very active versus never/rarely active, 0.60; 95% confidence interval, 0.47 to 0.77). Similar associations with aerobic activity were observed in strata of age, sex, time on dialysis, and diabetes status.

CONCLUSIONS

The findings are consistent with the health benefits of aerobic physical activity for patients on maintenance hemodialysis. Greater physical activity was observed in facilities providing exercise programs, suggesting a possible opportunity for improving patient outcomes.

Changes in body composition and use of blood cholesterol lowering drugs predict changes in blood lipids during 12 weeks of resistance exercise training in old adults

PURPOSE

Aging is associated with an impairment of blood lipids. The present study investigated the response of blood lipids to resistance exercise in old adults. The particular aim was to investigate whether the response of blood lipids is associated with changes in body composition of blood lipid medication.

METHODS

Subjects (N = 236, 73.7 ± 5.7 years, 58.2 % female) participated in a 12-week resistance exercise program (3 times/week; 3 sets, 6-8 repetitions at 75-80 % of the 1-repetition maximum), designed to increase strength and muscle mass of major muscle groups. Body composition, drug use, triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) were assessed at baseline and endpoint.

RESULTS

The concentrations of HDL (-6 mg/dl), LDL (-18 mg/dl), TC (-26 mg/dl) and TG (-12 mg/g) decreased significantly during the study period. A reduction in fat mass by 1 kg predicted a reduction in TG (5.0 mg/dl, P = 0.017) and a gain in lean body mass by 1 kg predicted also a reduction in TG (-4.5 mg/dl, P = 0.023). The use of blood cholesterol lowering drugs predicted greater reductions in TC (-16.9 mg/dl, P = 0.032) and LDL (-11.8 mg/dl, P = 0.038) during training.

CONCLUSIONS

TG, TC, LDL and HDL decreased significantly after 12 weeks of progressive resistance exercise in old adults. Changes in body composition, i.e., reduction in fat mass and gain in lean body mass improved the blood lipid profile. Use of blood lipid lowering drugs was associated with greater reductions in TC and LDL after the training.

Leisure-time aerobic physical activity, muscle-strengthening activity and mortality risks among US adults: the NHANES linked mortality study

BACKGROUND

Regular physical activity elicits multiple health benefits in the prevention and management of chronic diseases. We examined the mortality risks associated with levels of leisure-time aerobic physical activity and muscle-strengthening activity based on the 2008 Physical Activity Guidelines for Americans among US adults.

METHODS

We analysed data from the 1999 to 2004 National Health and Nutrition Examination Survey with linked mortality data obtained through 2006. Cox proportional HRs with 95% CIs were estimated to assess risks for all-causes and cardiovascular disease (CVD) mortality associated with aerobic physical activity and muscle-strengthening activity.

RESULTS

Of 10 535 participants, 665 died (233 deaths from CVD) during an average of 4.8-year follow-up. Compared with participants who were physically inactive, the adjusted HR for all-cause mortality was 0.64 (95% CI 0.52 to 0.79) among those who were physically active (engaging in ≥150 min/week of the equivalent moderate-intensity physical activity) and 0.72 (95% CI 0.54 to 0.97) among those who were insufficiently active (engaging in >0 to <150 min/week of the equivalent moderate-intensity physical activity). The adjusted HR for CVD mortality was 0.57 (95% CI 0.34 to 0.97) among participants who were insufficiently active and 0.69 (95% CI 0.43 to 1.12) among those who were physically active. Among adults who were insufficiently active, the adjusted HR for all-cause mortality was 44% lower by engaging in muscle-strengthening activity ≥2 times/week.

CONCLUSIONS

Engaging in aerobic physical activity ranging from insufficient activity to meeting the 2008 Guidelines reduces the risk of premature mortality among US adults. Engaging in muscle-strengthening activity ≥2 times/week may provide additional benefits among insufficiently active adults.

Effects of a year-long pedometer-based walking program on cardiovascular disease risk factors in active older people

We assessed the relationship between the number of daily steps and changes in cardiovascular disease (CVD) risk factors in a year-long pedometer-based walking program for physically active older people. A total of 36 physically active older people (68.3 ± 5.8 years) completed this 59-week program. The CVD risk parameters were measured at baseline and at weeks 21 and 59. The mean number of steps increased by week 21 and was maintained at week 59 (approximately 10 000 steps, increase in 1500 steps from the baseline; P < .05). Following a significant reduction in body mass index at week 21, systolic blood pressure levels were significantly reduced, and high-density lipoprotein cholesterol levels were significantly increased at week 59 (P < .05). In summary, even active older people can achieve further protection against CVD risks by minor, but sustained, physical activity using pedometers for a period of more than 1 year.

The interplay between inflammation, physical activity and metabolic syndrome in a remote male geriatric community in Southern Taiwan: the Tianliao Old People (TOP) study 03

BACKGROUND

Both physical activity and inflammation are important in the pathophysiology of metabolic syndrome (MetS). Our study aim is to explore their associations in an elderly male (≥ 65 years old) cohort.

METHODS

We enrolled 309 elderly male residents (mean age: 74.4 ± 6.0 years) in a remote southern Taiwan community. The physical activity was recorded by a standard questionnaire. A high-sensitivity C-reactive protein (hsCRP) level > 3.0 mg/L indicated a high inflammatory status.

RESULTS

The total prevalence rate of MetS was 27.8% in this male geriatric cohort. Median hsCRP levels were significantly higher in the MetS group (1.60 ± 0.7 vs. 1.0 ± 0.3 mg/L, p < 0.01), and the risk of elevated hsCRP increased with escalating MetS components (p for trend < 0.001). The non-MetS group had higher amount of median weekly physical activity (183.1 ± 19.0 vs. 173.5 ± 10.6 MET-hr/week, p = 0.029), which was also higher among those with lower hsCRP levels (186.1 ± 14.1 vs. 167.8 ± 38.5 MET-hr/week, p = 0.013). Multivariate analysis showed that higher body mass index (ORs: 1.527, 95% CI: 1.319-1.768, p < 0.01) insulin (OR: 1.128, 95% CI: 1.045-1.218, p < 0.01) and physical activity (ORs: 0.997, 95% IC: 0.994-0.999, p < 0.05) were independent predictors of MetS, but not hsCRP level (p > 0.05).

CONCLUSIONS

Reduced physical activity was one major pathophysiological MetS factor in our Asian geriatric participants.

Treadmill Exercise Training Modulates Hepatic Cholesterol Metabolism and Circulating PCSK9 Concentration in High-Fat-Fed Mice

Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a novel biomarker of LDL clearance and a therapeutic target of cardiovascular disease. We examined the effects of aerobic exercise training in modulating PCSK9 abundance and hepatic sterol regulation in high-fat-fed C57BL/6 mice. Mice (n = 8) were assigned to a low-fat (LF), high-fat (HF), or an HF with exercise (HF + EX) group for 8 weeks. The HF + EX group was progressively trained 5 days/week on a motorized treadmill. The HF + EX group was protected against body weight (BW) gain and diet-induced dyslipidemia compared with the HF group. The HF + EX group demonstrated an increase in hepatic PCSK9 mRNA (1.9-fold of HF control, P < 0.05) and a reduction in plasma PCSK9 (14%) compared with the HF group. Compared with HF mice, HF + EX mice demonstrated reduced hepatic cholesterol (14%) and increased (P < 0.05) nuclear SREBP2 protein (1.8-fold of HF group) and LDLr mRNA (1.4-fold of HF group). Plasma PCSK9 concentrations correlated positively with plasma non-HDL-C (P = 0.01, r = 0.84). Results suggest that treadmill exercise reduces non-HDL cholesterol and differentially modulates hepatic and blood PCSK9 abundance in HF-fed C57BL/6 mice.

Physical activity and mortality among middle-aged and older adults in the United States

BACKGROUND

Physical activity (PA) has been routinely linked to lower all-cause mortality, yet extant research in the United States is primarily based on nonrepresentative samples. Evidence is scant on the relative and independent merits of leisure-time (LTPA) versus non-leisure-time (NLTPA) activities and how the PA-mortality link may vary across racial-ethnic-gender groups.

METHODS

Data were from Health and Retirement Study which began in 1992 collecting data on individuals aged 51-61 years who were subsequently surveyed once every 2 years. The current study assessed group-specific effects of LTPA and NLTPA measured in 1992 on mortality that occurred during the 1992-2008 follow-up period. Cox proportional hazard analyses were performed to examine the PA-mortality link.

RESULTS

Net of a wide range of controls, both LTPA and NLTPA showed a gradient negative relation with mortality. No gender-PA interaction effects were evident. Some interaction effects of PA with race-ethnicity were found but they were weak and inconsistent. The mortality reduction effects of PA seemed robust across racial-ethnic-gender groups.

CONCLUSIONS

Regardless of personal background, PA is a major health promoting factor and should be encouraged in aging populations. More research is needed to assess relative merits of different types and domains of PA.