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    Minimizing Risk Associated With Sedentary Behavior: Should We Focus on Physical Activity, Sitting, or Both? Matthews Charles E Journal of the American College of Cardiology 10.1016/j.jacc.2019.02.030
    Sitting Time, Physical Activity, and Risk of Mortality in Adults. Stamatakis Emmanuel,Gale Joanne,Bauman Adrian,Ekelund Ulf,Hamer Mark,Ding Ding Journal of the American College of Cardiology BACKGROUND:It is unclear what level of moderate to vigorous intensity physical activity (MVPA) offsets the health risks of sitting. OBJECTIVES:The purpose of this study was to examine the joint and stratified associations of sitting and MVPA with all-cause and cardiovascular disease (CVD) mortality, and to estimate the theoretical effect of replacing sitting time with physical activity, standing, and sleep. METHODS:A longitudinal analysis of the 45 and Up Study calculated the multivariable-adjusted hazard ratios (HRs) of sitting for each sitting-MVPA combination group and within MVPA strata. Isotemporal substitution modeling estimated the per-hour HR effects of replacing sitting. RESULTS:A total of 8,689 deaths (1,644 due to CVD) occurred among 149,077 participants over an 8.9-year (median) follow-up. There was a statistically significant interaction between sitting and MVPA only for all-cause mortality. Sitting time was associated with both mortality outcomes in a nearly dose-response manner in the least active groups reporting <150 MVPA min/week. For example, among those reporting no MVPA, the all-cause mortality HR comparing the most sedentary (>8 h/day) to the least sedentary (<4 h/day) groups was 1.52 (95% confidence interval: 1.13 to 2.03). There was inconsistent and weak evidence for elevated CVD and all-cause mortality risks with more sitting among those meeting the lower (150 to 299 MVPA min/week) or upper (≥300 MVPA min/week) limits of the MVPA recommendation. Replacing sitting with walking and MVPA showed stronger associations among high sitters (>6 sitting h/day) where, for example, the per-hour CVD mortality HR for sitting replaced with vigorous activity was 0.36 (95% confidence interval: 0.17 to 0.74). CONCLUSIONS:Sitting is associated with all-cause and CVD mortality risk among the least physically active adults; moderate-to-vigorous physical activity doses equivalent to meeting the current recommendations attenuate or effectively eliminate such associations. 10.1016/j.jacc.2019.02.031
    Physical activity, CVD, and older adults. Ferraro Richard A,Pallazola Vincent A,Michos Erin D Aging 10.18632/aging.101942
    Aerobic Fitness and Adherence to Guideline-Recommended Minimum Physical Activity Among Ambulatory Patients With Type 2 Diabetes Mellitus. Jarvie Jennifer L,Pandey Ambarish,Ayers Colby R,McGavock Jonathan M,Sénéchal Martin,Berry Jarett D,Patel Kershaw V,McGuire Darren K Diabetes care OBJECTIVE:Lifestyle intervention remains the cornerstone of management of type 2 diabetes mellitus (T2DM). However, adherence to physical activity (PA) recommendations and the impact of that adherence on cardiorespiratory fitness in this population have been poorly described. We sought to investigate adherence to PA recommendations and its association with cardiorespiratory fitness in a population of patients with T2DM. RESEARCH DESIGN AND METHODS:A cross-sectional analysis of baseline data from a randomized clinical trial (NCT00424762) was performed. A total of 150 individuals with medically treated T2DM and atherosclerotic cardiovascular disease (ASCVD) or risk factors for ASCVD were recruited from outpatient clinics at a single academic medical center. All individuals underwent a graded maximal exercise treadmill test to exhaustion with breath-by-breath gas exchange analysis to determine VO. PA was estimated using a structured 7-Day Physical Activity Recall interview. RESULTS:Participants had a mean ± SD age of 54.9 ± 9.0 years; 41% were women, 40% were black, and 21% were Hispanic. The mean HbA was 7.7 ± 1.8% and the mean BMI, 34.5 ± 7.2 kg/m. A total of 72% had hypertension, 73% had hyperlipidemia, and 35% had prevalent ASCVD. The mean ± SD reported daily PA was 34.3 ± 4 kcal/kg, only 7% above a sedentary state; 47% of the cohort failed to achieve the minimum recommended PA. Mean ± SD VO was 27.4 ± 6.5 mL/kg fat-free mass/min (18.8 ± 5.0 mL/kg/min). CONCLUSIONS:On average, patients with T2DM who have or are at risk for ASCVD report low levels of PA and have low measured cardiopulmonary fitness. This underscores the importance of continued efforts to close this therapeutic gap. 10.2337/dc18-2634
    Physical Activity and Mortality in Cancer Survivors: A Systematic Review and Meta-Analysis. Friedenreich Christine M,Stone Chelsea R,Cheung Winson Y,Hayes Sandra C JNCI cancer spectrum Background:Recommendations for improved survival after cancer through physical activity (PA) exist, although the evidence is still emerging. Our primary objective was to conduct a systematic review and meta-analysis of the association between prediagnosis and postdiagnosis PA and survival (cancer-specific, all-cause, and cardiovascular disease mortality) for all cancers and by tumor site. Secondary objectives were to examine the associations within population subgroups, by PA domain, and to determine the optimal dose of PA related to survival. Methods:PubMed, EMBASE, and SportsDiscus databases were searched from inception to November 1, 2018. DerSimonian-Laird random-effects models were used to estimate the summary hazard ratios (HRs) and 95% confidence intervals (CI) for primary and secondary analyses and to conduct dose-response analyses. Results:Evidence from 136 studies showed improved survival outcomes with highest vs lowest levels of prediagnosis or postdiagnosis total or recreational PA for all-cancers combined (cancer specific mortality: HR = 0.82, 95% CI = 0.79 to 0.86, and HR = 0.63, 95% CI = 0.53 to 0.75, respectively) as well as for 11 specific cancer sites. For breast and colorectal cancers, greater reductions were observed for postdiagnosis PA (HR = 0.58-0.63) compared with prediagnosis PA (HR = 0.80-0.86) for cancer-specific and all-cause mortality. Survival benefits through PA were observed in most subgroups (within sex, body mass index, menopausal status, colorectal subtypes, and PA domain) examined. Inverse dose-response relationships between PA and breast cancer-specific and all-cause mortality were observed, with steep reductions in hazards to 10-15 metabolic equivalent hours per week. Conclusion:Higher prediagnosis and postdiagnosis levels of PA were associated with improved survival outcomes for at least 11 cancer types, providing support for global promotion of PA guidelines following cancer. 10.1093/jncics/pkz080
    Dose-Response Association Between Level of Physical Activity and Mortality in Normal, Elevated, and High Blood Pressure. Joseph Gowsini,Marott Jacob Louis,Torp-Pedersen Christian,Biering-Sørensen Tor,Nielsen Gitte,Christensen Ann-Eva,Johansen Martin Berg,Schnohr Peter,Sogaard Peter,Mogelvang Rasmus Hypertension (Dallas, Tex. : 1979) It has been a challenge to verify the dose of exercise that will produce the maximum health benefits in hypertension. This study aimed to explore the association between level of daily physical activity, all-cause mortality and cardiovascular outcome at different blood pressure levels. A random sample of 18 974 white men and women aged 20 to 98 years were examined in a prospective cardiovascular population study. Self-reported activity level in leisure-time was drawn from the Physical Activity Questionnaire (level I: inactivity; II: light activity; and III: moderate/high-level activity). Blood pressure was defined as normal blood pressure: <120/<80 mm Hg; Prehypertension: 120-139/80-89 mm Hg; Stage I hypertension: 140-159/90-99 mm Hg; Stage II hypertension ≥160/≥100 mm Hg. The mean follow-up time was 23.4±11.7 years. At all levels of blood pressure, higher levels of physical activity were associated with lower all-cause mortality in a dose-response pattern. The pattern remained unchanged after adjustment for following confounders: sex, age, smoking status, education, diabetes mellitus, previous cardiovascular disease, body mass index, and calendar time. Compared with inactivity, following hazard ratios were found for stage I hypertension: light activity, hazard ratio 0.78 (0.72-0.84; <0.001), moderate/high-level activity, hazard ratio 0.69 (0.63-0.75; <0.001). At all levels of blood pressure, the risk of cardiovascular events was significantly reduced independent of the level of physical activity. In conclusion, the association between physical activity and all-cause mortality was present in an inverse dose-response pattern at all levels of blood pressure. Physical activity was associated with reduction in cardiovascular events independent of the level of physical activity. 10.1161/HYPERTENSIONAHA.119.13786
    The effectiveness of eHealth interventions on physical activity and measures of obesity among working-age women: a systematic review and meta-analysis. Cotie L M,Prince S A,Elliott C G,Ziss M C,McDonnell L A,Mullen K A,Hiremath S,Pipe A L,Reid R D,Reed J L Obesity reviews : an official journal of the International Association for the Study of Obesity Physical inactivity and obesity are modifiable risk factors for cardiovascular disease, particularly in women. eHealth interventions may increase physical activity and improve obesity-related outcomes among women. The objective of this study was to review the evidence of the effectiveness of eHealth interventions to increase moderate-to-vigorous physical activity among working-age women. The secondary objective was to examine their effectiveness on improving obesity-related outcomes. A comprehensive search strategy was developed for eight electronic databases; through July 2016. All studies consisting of >80% women of working-age (18-65 years) in high income countries were included. Multiple unblinded reviewers determined study eligibility and extracted data. Risk of bias was evaluated using the Cochrane Risk of Bias Tool and data quality using the Grading of Recommendations Assessment, Development and Evaluation approach. Data were pooled using a random-effects model. Sixty studies were included in the review of which 20 were in the meta-analysis. The meta-analysis demonstrated eHealth interventions improved moderate-to-vigorous physical activity (standard mean difference = 1.13, 95% confidence interval: 0.58, 1.68, P < 0.0001); an increase of ~25 min week . No changes were observed in obesity-related outcomes; waist circumference (P = 0.06), body mass (P = 0.05) and body mass index (P = 0.35). eHealth interventions are effective at increasing min week of moderate-to-vigorous physical activity among working-age women from high income countries. 10.1111/obr.12700
    Physical Activity, Cardiorespiratory Fitness, and Incident Glaucoma. Meier Nathan F,Lee Duck-Chul,Sui Xuemei,Blair Steven N Medicine and science in sports and exercise PURPOSE:This study aimed to examine the associations of physical activity and cardiorespiratory fitness (hereafter fitness) with incident glaucoma in a prospective observational study. METHODS:Physical activity was measured by self-reported leisure-time activities, and fitness was measured by maximal treadmill test. Incident glaucoma was defined based on physician diagnosis. Participants were 9519 men and women between the ages of 40 and 81 yr old (mean age 50 yr) who were enrolled in the Aerobics Center Longitudinal Study. Hazard ratios (HR) were estimated using Cox proportional hazard regression after adjusting for age, sex, race, examination year, smoking status, heavy alcohol drinking, hypertension, hypercholesterolemia, abnormal ECG, diabetes, cardiovascular disease, and cancer. RESULTS:A total of 128 cases of incident glaucoma were reported during a mean follow-up of 5.7 yr. A significantly lower risk of incident glaucoma (HR = 0.53, 95% confidence interval [95% CI] = 0.35-0.79) was found in individuals who met the physical activity guidelines of ≥500 MET·min·wk compared with inactive individuals (0 MET·min·wk). Compared with low fitness (lower third), individuals with high fitness (upper third) also had a significantly lower risk of incident glaucoma (HR = 0.60, 95% CI = 0.38-0.95). A joint analysis of physical activity and fitness showed that meeting physical activity guidelines and being in the high fitness category was associated with the lowest risk for developing glaucoma (HR = 0.49, 95% CI = 0.31-0.79). CONCLUSION:These data provide epidemiological evidence that meeting physical activity guidelines or being fit reduces the risk of developing glaucoma. 10.1249/MSS.0000000000001692
    Frequency, Type, and Volume of Leisure-Time Physical Activity and Risk of Coronary Heart Disease in Young Women. Chomistek Andrea K,Henschel Beate,Eliassen A Heather,Mukamal Kenneth J,Rimm Eric B Circulation BACKGROUND:The inverse association between physical activity and coronary heart disease (CHD) risk has primarily been shown in studies of middle-aged and older adults. Evidence for the benefits of frequency, type, and volume of leisure-time physical activity in young women is limited. METHODS:We conducted a prospective analysis among 97 230 women aged 27 to 44 years at baseline in 1991. Leisure-time physical activity was assessed biennially by questionnaire. Cox proportional hazards models were used to examine the associations between physical activity frequency, type, and volume, and CHD risk. RESULTS:During 20 years of follow-up, we documented 544 incident CHD cases. In multivariable-adjusted models, the hazard ratio (95% confidence interval) of CHD comparing ≥30 with <1 metabolic equivalent of task-hours/wk of physical activity was 0.75 (0.57-0.99) (P, trend=0.01). Brisk walking alone was also associated with significantly lower CHD risk. Physical activity frequency was not associated with CHD risk when models also included overall activity volume. Finally, the association was not modified by body mass index (kg/m(2)) (P, interaction=0.70). Active women (≥30 metabolic equivalent of task-hours/wk) with body mass index<25 kg/m(2) had 0.52 (95% confidence interval, 0.35-0.78) times the rate of CHD in comparison with women who were obese (body mass index≥30 kg/m(2)) and inactive (physical activity <1 metabolic equivalent of task-hours/wk). CONCLUSIONS:These prospective data suggest that total volume of leisure-time physical activity is associated with lower risk of incident CHD among young women. In addition, this association was not modified by weight, emphasizing that it is important for normal weight, overweight, and obese women to be physically active. 10.1161/CIRCULATIONAHA.116.021516
    Physical activity, resting heart rate, and atrial fibrillation: the Tromsø Study. Morseth Bente,Graff-Iversen Sidsel,Jacobsen Bjarne K,Jørgensen Lone,Nyrnes Audhild,Thelle Dag S,Vestergaard Peter,Løchen Maja-Lisa European heart journal AIMS:The objective was to examine the association of physical activity and resting heart rate (RHR) with hospital-diagnosed atrial fibrillation (AF) in a Norwegian cohort. METHODS AND RESULTS:This prospective study included 20 484 adults (50.3% men) who participated in the third Tromsø Study survey in 1986-87. At baseline, physical activity was assessed by a validated questionnaire, and RHR was objectively measured. Participants were followed from baseline through 2010 with respect to incident cases of hospital-diagnosed AF documented on an electrocardiogram. During a mean follow-up period of 20 years (409 045 person-years), 750 participants (70.5% men) were diagnosed with AF. Compared with the low physical activity group, moderately active individuals had a 19% lower risk of any AF [adjusted hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.68-0.97], whereas highly active had similar risk of AF. Vigorously active individuals showed a non-significantly higher risk of AF (adjusted HR 1.37, 95% CI 0.77-2.43). Risk of AF increased with decreasing RHR (adjusted HR 0.92, 95% CI 0.86-0.98 for each 10 b.p.m. increase in RHR), and RHR < 50 b.p.m. was a risk factor for AF (P < 0.05). CONCLUSION:In this prospective cohort study, leisure time physical activity was associated with AF in a J-shaped pattern. Moderate physical activity was associated with a reduced risk of AF, whereas higher activity levels attenuated the benefits of moderate activity. Low RHR was a risk factor for AF. Our results support the hypothesis that moderate and vigorous physical activity may affect AF risk via different pathophysiological mechanisms. 10.1093/eurheartj/ehw059
    Pedro Hallal: putting physical activity at the heart of better health. Lane Richard Lancet (London, England) 10.1016/S0140-6736(16)31148-5
    International Mobile-Health Intervention on Physical Activity, Sitting, and Weight: The Stepathlon Cardiovascular Health Study. Ganesan Anand N,Louise Jennie,Horsfall Matthew,Bilsborough Shane A,Hendriks Jeroen,McGavigan Andrew D,Selvanayagam Joseph B,Chew Derek P Journal of the American College of Cardiology BACKGROUND:Although proof-of-concept for mobile health (mHealth) life-style programs targeting physical inactivity and overweight/obesity has been established in randomized trials, the feasibility and effect of a globally distributed, large-scale, mass-participation mHealth implementation has not been investigated. OBJECTIVES:The purpose of this study was to determine the effect of Stepathlon, an international, low-cost, mass-participation mHealth intervention, on physical activity, sitting, and weight. METHODS:We prospectively collected cohort data from participants completing Stepathlon, an annual 100-day global event in 2012, 2013, and 2014. Participants were organized in worksite-based teams, issued pedometers, and encouraged to increase daily steps and physical activity as part of the team-based race. The program was conducted via an interactive multiplatform application available on mobile devices and the Internet. Analysis was performed according to a pre-specified plan. RESULTS:A total of 69,219 subjects participated (481 employers, 1,481 cities, 64 countries, all populated continents, age 36 ± 9 years, 23.9% female, 8.0% high-income countries, and 92.0% lower-middle income countries). After Stepathlon completion, participants recorded improved step count (+3,519 steps/day; 95% confidence interval [CI]: 3,484 to 3,553 steps/day; p < 0.0001), exercise days (+0.89 days; 95% CI: 0.87 to 0.92 days; p < 0.0001), sitting duration (-0.74 h; 95% CI: -0.78 to -0.71 h; p < 0.0001) and weight (-1.45 kg; 95% CI: -1.53 to -1.38 kg; p < 0.0001). Improvements occurred in women and men, in all geographic regions, and in both high and lower-middle income countries, and the results were reproduced in 2012, 2013, and 2014 cohorts. Predictors of weight loss included step increase, sitting duration decrease, and increase in exercise days (all p < 0.0001). CONCLUSIONS:Distributed mHealth implementation of a low-cost life-style intervention is associated with short-term, reproducible, large-scale improvements in physical activity, sitting, and weight. (Effect of the Stepathlon Pedometer Program on Physical Activity, Weight and Well-Being; ACTRN12615001310550). 10.1016/j.jacc.2016.03.472
    Leisure Time Physical Activity Reduces the Risk for Stroke in Adults: A Reanalysis of a Meta-Analysis Using the Inverse-Heterogeneity Model. Kelley George A,Kelley Kristi S Stroke research and treatment Objective:Apply more robust and additional analyses to a previous meta-analysis that reported statistically significant associations between leisure time physical activity (LTPA) and stroke. Methods:A reanalysis of a previous meta-analysis that included nine prospective cohort studies representing 269,594 men and women 25-84 years of age and in which the association between LTPA and incident stroke was examined. Follow-up periods ranged from 7.7 to 32.0 years. Relative risks (RR) from each study were pooled using the inverse-heterogeneity model. Heterogeneity was examined using the Q statistic, inconsistency using , and small-study effects using Doi plots and the LFK index. Influence and cumulative meta-analysis were also conducted. Results:Using low LTPA as the reference, moderate LTPA was associated with a statistically significant reduction in the risk for stroke in men (RR = 0.79, 95% CI = 0.65 to 0.95) and a trend in women (RR = 0.88, 95% CI = 0.78 to 1.0). High LTPA was associated with a statistically significant reduction in the risk for stroke in both men (RR = 0.72, 95% CI = 0.60 to 0.86) and women (RR = 0.78, 95% CI = 0.66 to 0.92). No statistically significant heterogeneity was observed and inconsistency was low. However, potential small-study effects were observed. With each study deleted once, results remained statistically significant. Cumulative meta-analysis demonstrated stability in results since at least 2005. Conclusions:Leisure time physical activity is associated with a reduced risk of stroke in both men and women. However, the small-study effects observed suggest the possibility that results may be exaggerated. 10.1155/2019/8264502
    Physical Activity and Mortality in Patients With Stable Coronary Heart Disease. Stewart Ralph A H,Held Claes,Hadziosmanovic Nermin,Armstrong Paul W,Cannon Christopher P,Granger Christopher B,Hagström Emil,Hochman Judith S,Koenig Wolfgang,Lonn Eva,Nicolau José C,Steg Philippe Gabriel,Vedin Ola,Wallentin Lars,White Harvey D, Journal of the American College of Cardiology BACKGROUND:Recommendations for physical activity in patients with stable coronary heart disease (CHD) are based on modest evidence. OBJECTIVES:The authors analyzed the association between self-reported exercise and mortality in patients with stable CHD. METHODS:A total of 15,486 patients from 39 countries with stable CHD who participated in the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) study completed questions at baseline on hours spent each week taking mild, moderate, and vigorous exercise. Associations between the volume of habitual exercise in metabolic equivalents of task hours/week and adverse outcomes during a median follow-up of 3.7 years were evaluated. RESULTS:A graded decrease in mortality occurred with increased habitual exercise that was steeper at lower compared with higher exercise levels. Doubling exercise volume was associated with lower all-cause mortality (unadjusted hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.79 to 0.85; adjusting for covariates, HR: 0.90; 95% CI: 0.87 to 0.93). These associations were similar for cardiovascular mortality (unadjusted HR: 0.83; 95% CI: 0.80 to 0.87; adjusted HR: 0.92; 95% CI: 0.88 to 0.96), but myocardial infarction and stroke were not associated with exercise volume after adjusting for covariates. The association between decrease in mortality and greater physical activity was stronger in the subgroup of patients at higher risk estimated by the ABC-CHD (Age, Biomarkers, Clinical-Coronary Heart Disease) risk score (p for interaction = 0.0007). CONCLUSIONS:In patients with stable CHD, more physical activity was associated with lower mortality. The largest benefits occurred between sedentary patient groups and between those with the highest mortality risk. 10.1016/j.jacc.2017.08.017
    Sustained Physical Activity, Not Weight Loss, Associated With Improved Survival in Coronary Heart Disease. Moholdt Trine,Lavie Carl J,Nauman Javaid Journal of the American College of Cardiology BACKGROUND:Individuals with coronary heart disease (CHD) are recommended to be physically active and to maintain a healthy weight. There is a lack of data on how long-term changes in body mass index (BMI) and physical activity (PA) relate to mortality in this population. OBJECTIVES:This study sought to determine the associations among changes in BMI, PA, and mortality in individuals with CHD. METHODS:The authors studied 3,307 individuals (1,038 women) with CHD from the HUNT (Nord-Trøndelag Health Study) with examinations in 1985, 1996, and 2007, followed until the end of 2014. They calculated the hazard ratio (HR) for all-cause and cardiovascular disease (CVD) mortality according to changes in BMI and PA, and estimated using Cox proportional hazards regression models adjusted for age, smoking, blood pressure, diabetes, alcohol, and self-reported health. RESULTS:There were 1,493 deaths during 30 years of follow-up (55% from CVD, median 15.7 years). Weight loss, classified as change in BMI <-0.10 kg/m/year, associated with increased all-cause mortality (adjusted HR: 1.30; 95% confidence interval [CI]: 1.12 to 1.50). Weight gain, classified as change in BMI ≥0.10 kg/m/year, was not associated with increased mortality (adjusted HR: 0.97; 95% CI: 0.87 to 1.09). Weight loss only associated with increased risk in those who were normal weight at baseline (adjusted HR: 1.38; 95% CI: 1.11 to 1.72). There was a lower risk for all-cause mortality in participants who maintained low PA (adjusted HR: 0.81; 95% CI: 0.67 to 0.97) or high PA (adjusted HR: 0.64; 95% CI: 0.50 to 0.83), compared with participants who were inactive over time. CVD mortality associations were similar as for all-cause mortality. CONCLUSIONS:The study observed no mortality risk reductions associated with weight loss in individuals with CHD, and reduced mortality risk associated with weight gain in individuals who were normal weight at baseline. Sustained PA, however, was associated with substantial risk reduction. 10.1016/j.jacc.2018.01.011
    Piezo1 channels sense whole body physical activity to reset cardiovascular homeostasis and enhance performance. Rode Baptiste,Shi Jian,Endesh Naima,Drinkhill Mark J,Webster Peter J,Lotteau Sabine J,Bailey Marc A,Yuldasheva Nadira Y,Ludlow Melanie J,Cubbon Richard M,Li Jing,Futers T Simon,Morley Lara,Gaunt Hannah J,Marszalek Katarzyna,Viswambharan Hema,Cuthbertson Kevin,Baxter Paul D,Foster Richard,Sukumar Piruthivi,Weightman Andrew,Calaghan Sarah C,Wheatcroft Stephen B,Kearney Mark T,Beech David J Nature communications Mammalian biology adapts to physical activity but the molecular mechanisms sensing the activity remain enigmatic. Recent studies have revealed how Piezo1 protein senses mechanical force to enable vascular development. Here, we address Piezo1 in adult endothelium, the major control site in physical activity. Mice without endothelial Piezo1 lack obvious phenotype but close inspection reveals a specific effect on endothelium-dependent relaxation in mesenteric resistance artery. Strikingly, the Piezo1 is required for elevated blood pressure during whole body physical activity but not blood pressure during inactivity. Piezo1 is responsible for flow-sensitive non-inactivating non-selective cationic channels which depolarize the membrane potential. As fluid flow increases, depolarization increases to activate voltage-gated Ca channels in the adjacent vascular smooth muscle cells, causing vasoconstriction. Physical performance is compromised in mice which lack endothelial Piezo1 and there is weight loss after sustained activity. The data suggest that Piezo1 channels sense physical activity to advantageously reset vascular control.The mechanisms that regulate the body's response to exercise are poorly understood. Here, Rode et al. show that the mechanically activated cation channel Piezo1 is a molecular sensor of physical exercise in the endothelium that triggers endothelial communication to mesenteric vessel muscle cells, leading to vasoconstriction. 10.1038/s41467-017-00429-3
    Leisure-time physical activity sustained since midlife and preservation of cognitive function: The Atherosclerosis Risk in Communities Study. Palta Priya,Sharrett A Richey,Deal Jennifer A,Evenson Kelly R,Gabriel Kelley Pettee,Folsom Aaron R,Gross Alden L,Windham B Gwen,Knopman David,Mosley Thomas H,Heiss Gerardo Alzheimer's & dementia : the journal of the Alzheimer's Association INTRODUCTION:We tested the hypotheses that higher levels of and persistence of midlife leisure-time physical activity (LTPA) are associated long-term with lower cognitive decline and less incident dementia. METHODS:A total of 10,705 participants (mean age: 60 years) had LTPA (no, low, middle, or high) measured in 1987-1989 and 1993-1995. LTPA was assessed in relation to incident dementia and 14-year change in general cognitive performance. RESULTS:Over a median follow-up of 17.4 years, 1063 dementia cases were observed. Compared with no LTPA, high LTPA in midlife was associated with lower incidence of dementia (hazard ratio [95% confidence interval], 0.71 [0.61, 0.86]) and lower declines in general cognitive performance (-0.07 standard deviation difference [-0.12 to -0.04]). These associations were stronger when measured against persistence of midlife LTPA over 6 years. DISCUSSION:LTPA is a readily modifiable factor associated inversely with long-term dementia incidence and cognitive decline. 10.1016/j.jalz.2018.08.008
    Correction: Physical activity, but not body mass index, predicts less disability before and after stroke. Neurology 10.1212/WNL.0000000000004320
    Physical Activity to Reduce Weight and Cardiovascular Events: A Wrong Focus Regarding a Shiver Contention. Leggio Massimo,D'Emidio Stefania,Fusco Augusto,Bendini Maria Grazia,Mazza Andrea Journal of the American College of Cardiology 10.1016/j.jacc.2018.03.543
    How does light-intensity physical activity associate with adult cardiometabolic health and mortality? Systematic review with meta-analysis of experimental and observational studies. Chastin Sebastien F M,De Craemer Marieke,De Cocker Katrien,Powell Lauren,Van Cauwenberg Jelle,Dall Philippa,Hamer Mark,Stamatakis Emmanuel British journal of sports medicine AIM:To assess the relationship between time spent in light physical activity and cardiometabolic health and mortality in adults. DESIGN:Systematic review and meta-analysis. DATA SOURCES:Searches in Medline, Embase, PsycInfo, CINAHL and three rounds of hand searches. ELIGIBILITY CRITERIA FOR SELECTING STUDIES:Experimental (including acute mechanistic studies and physical activity intervention programme) and observational studies (excluding case and case-control studies) conducted in adults (aged ≥18 years) published in English before February 2018 and reporting on the relationship between light physical activity (<3 metabolic equivalents) and cardiometabolic health outcomes or all-cause mortality. STUDY APPRAISAL AND SYNTHESIS:Study quality appraisal with QUALSYST tool and random effects inverse variance meta-analysis. RESULTS:Seventy-two studies were eligible including 27 experimental studies (and 45 observational studies). Mechanistic experimental studies showed that short but frequent bouts of light-intensity activity throughout the day reduced postprandial glucose (-17.5%; 95% CI -26.2 to -8.7) and insulin (-25.1%; 95% CI -31.8 to -18.3) levels compared with continuous sitting, but there was very limited evidence for it affecting other cardiometabolic markers. Three light physical activity programme intervention studies (n ranging from 12 to 58) reduced adiposity, improved blood pressure and lipidaemia; the programmes consisted of activity of >150 min/week for at least 12 weeks. Six out of eight prospective observational studies that were entered in the meta-analysis reported that more time spent in daily light activity reduced risk of all-cause mortality (pooled HR 0.71; 95% CI 0.62 to 0.83). CONCLUSIONS:Light-intensity physical activity could play a role in improving adult cardiometabolic health and reducing mortality risk. Frequent short bouts of light activity improve glycaemic control. Nevertheless, the modest volume of the prospective epidemiological evidence base and the moderate consistency between observational and laboratory evidence inhibits definitive conclusions. 10.1136/bjsports-2017-097563
    Reply: Exercise Capacity Characterization and Physical Activity Intensification Should Be Priorities in Heart Failure Patients. Taylor Rod S,Smart Neil A,Warren Fiona C,Dalal Hasnain M Journal of the American College of Cardiology 10.1016/j.jacc.2019.05.041
    Relationship Between Physical Activity, Body Mass Index, and Risk of Heart Failure. Pandey Ambarish,LaMonte Michael,Klein Liviu,Ayers Colby,Psaty Bruce M,Eaton Charles B,Allen Norrina B,de Lemos James A,Carnethon Mercedes,Greenland Philip,Berry Jarett D Journal of the American College of Cardiology BACKGROUND:Lower leisure-time physical activity (LTPA) and higher body mass index (BMI) are independently associated with risk of heart failure (HF). However, it is unclear if this relationship is consistent for both heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). OBJECTIVES:This study sought to quantify dose-response associations between LTPA, BMI, and the risk of different HF subtypes. METHODS:Individual-level data from 3 cohort studies (WHI [Women's Health Initiative], MESA [Multi-Ethnic Study of Atherosclerosis], and CHS [Cardiovascular Health Study]) were pooled and participants were stratified into guideline-recommended categories of LTPA and BMI. Associations between LTPA, BMI, and risk of overall HF, HFpEF (ejection fraction ≥45%), and HFrEF (ejection fraction <45%) were assessed by using multivariable adjusted Cox models and restricted cubic splines. RESULTS:The study included 51,451 participants with 3,180 HF events (1,252 HFpEF, 914 HFrEF, and 1,014 unclassified HF). In the adjusted analysis, there was a dose-dependent association between higher LTPA levels, lower BMI, and overall HF risk. Among HF subtypes, LTPA in any dose range was not associated with HFrEF risk. In contrast, lower levels of LTPA (<500 MET-min/week) were not associated with HFpEF risk, and dose-dependent associations with lower HFpEF risk were observed at higher levels. Compared with no LTPA, higher than twice the guideline-recommended minimum LTPA levels (>1,000 MET-min/week) were associated with an 19% lower risk of HFpEF (hazard ratio: 0.81; 95% confidence interval: 0.68 to 0.97). The dose-response relationship for BMI with HFpEF risk was also more consistent than with HFrEF risk, such that increasing BMI above the normal range (≥25 kg/m) was associated with a greater increase in risk of HFpEF than HFrEF. CONCLUSIONS:Our study findings show strong, dose-dependent associations between LTPA levels, BMI, and risk of overall HF. Among HF subtypes, higher LTPA levels and lower BMI were more consistently associated with lower risk of HFpEF compared with HFrEF. 10.1016/j.jacc.2016.11.081
    Physical Activity and Prognosis in the TOPCAT Trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist). Hegde Sheila M,Claggett Brian,Shah Amil M,Lewis Eldrin F,Anand Inder,Shah Sanjiv J,Sweitzer Nancy K,Fang James C,Pitt Bertram,Pfeffer Marc A,Solomon Scott D Circulation BACKGROUND:Physical activity (PA) is inversely associated with adverse cardiovascular outcomes in healthy populations, but the impact of physical activity in patients with heart failure (HF) with preserved ejection fraction is less well characterized. METHODS:The baseline self-reported PA of 1751 subjects enrolled in the Americas region of the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) was categorized as poor, intermediate, or ideal PA with American Heart Association criteria. PA was related to the primary composite outcome (HF hospitalization, cardiovascular mortality, or aborted cardiac arrest), its components, and all-cause mortality with the use of multivariable Cox models. RESULTS:The mean age at enrollment was 68.6±9.6 years. Few patients met American Heart Association criteria for ideal activity (11% ideal, 14% intermediate, 75% poor). Over a median follow-up of 2.4 years, the primary composite outcome occurred in 519 patients (397 HF hospitalizations, 222 cardiovascular deaths, and 6 aborted cardiac arrests). Compared with those with ideal baseline PA, poor and intermediate baseline PA was associated with a greater risk of the primary outcome (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.28-3.28; HR, 1.95; 95% CI, 1.15-3.33, respectively), HF hospitalization (HR, 1.93; 95% CI, 1.16-3.22; HR, 1.84; 95% CI, 1.02-3.31), cardiovascular mortality (HR, 4.36; 95% CI, 1.37-13.83; HR, 4.05; 95% CI, 1.17-14.04), and all-cause mortality (HR, 2.95; 95% CI, 1.44-6.02; HR, 2.05; 95% CI, 0.90-4.67) after multivariable adjustment for potential confounders. CONCLUSIONS:In patients with HF with preserved ejection fraction, both poor and intermediate self-reported PA were associated with higher risk of HF hospitalization and mortality. CLINICAL TRIAL REGISTRATION:URL: https://clinicaltrials.gov. Unique identifier: NCT00094302. 10.1161/CIRCULATIONAHA.117.028002
    Six-Year Changes in Physical Activity and the Risk of Incident Heart Failure: ARIC Study. Florido Roberta,Kwak Lucia,Lazo Mariana,Nambi Vijay,Ahmed Haitham M,Hegde Sheila M,Gerstenblith Gary,Blumenthal Roger S,Ballantyne Christie M,Selvin Elizabeth,Folsom Aaron R,Coresh Josef,Ndumele Chiadi E Circulation BACKGROUND:Higher physical activity (PA) is associated with lower heart failure (HF) risk; however, the effect of changes in PA on HF risk is unknown. METHODS:We evaluated 11 351 ARIC study (Atherosclerosis Risk in Communities) participants (mean age 60 years) who attended visit 3 (1993-1995) and did not have a history of cardiovascular disease. Exercise PA was assessed using a modified Baecke questionnaire and categorized according to American Heart Association guidelines as recommended, intermediate, or poor. We used Cox regression models to characterize the association of 6-year changes in PA between the first (1987-1989) and third ARIC visits and HF risk. RESULTS:During a median of 19 years of follow-up, 1750 HF events occurred. Compared with those with poor activity at both visits, the lowest HF risk was seen for those with persistently recommended activity (hazard ratio, 0.69; 95% confidence interval, 0.60-0.80). However, those whose PA increased from poor to recommended also had reduced HF risk (hazard ratio, 0.77; 95% confidence interval 0.63-0.93). Among participants with poor baseline activity, each 1 SD higher PA at 6 years (512.5 METS*minutes/week, corresponding to ≈30 minutes of brisk walking 4 times per week) was associated with significantly lower future HF risk (hazard ratio, 0.89, 95% confidence interval, 0.82-0.96). CONCLUSIONS:Although maintaining recommended activity levels is associated with the lowest HF risk, initiating and increasing PA, even in late middle age, are also linked to lower HF risk. Augmenting PA may be an important component of strategies to prevent HF. 10.1161/CIRCULATIONAHA.117.030226
    Sedentary behavior and cardiovascular disease in older women: The Objective Physical Activity and Cardiovascular Health (OPACH) Study. Bellettiere John,LaMonte Michael J,Evenson Kelly R,Rillamas-Sun Eileen,Kerr Jacqueline,Lee I-Min,Di Chongzhi,Rosenberg Dori E,Stefanick Marcia,Buchner David M,Hovell Melbourne F,LaCroix Andrea Z Circulation Background:Evidence that higher sedentary time is associated with higher risk for cardiovascular disease (CVD) is based mainly on self-reported measures. Few studies have examined whether patterns of sedentary time are associated with higher risk for CVD. Methods:Women from the Objective Physical Activity and Cardiovascular Health (OPACH) Study (n=5638, aged 63-97, mean age=79±7) with no history of myocardial infarction (MI) or stroke wore accelerometers for 4-to-7 days and were followed for up to 4.9 years for CVD events. Average daily sedentary time and mean sedentary bout duration were the exposures of interest. Cox regression models estimated hazard ratios (HR) and 95% confidence intervals (CI) for CVD using models adjusted for covariates and subsequently adjusted for potential mediators (body mass index (BMI), diabetes, hypertension, and CVD-risk biomarkers [fasting glucose, high-density lipoprotein, triglycerides, and systolic blood pressure]). Restricted cubic spline regression characterized dose-response relationships. Results:There were 545 CVD events during 19,350 person-years. Adjusting for covariates, women in the highest (≥ ~11 hr/day) vs. the lowest (≤ ~9 hr/day) quartile of sedentary time had higher risk for CVD (HR=1.62; CI=1.21-2.17; p-trend <0.001). Further adjustment for potential mediators attenuated but did not eliminate significance of these associations (p-trend<.05, each). Longer vs. shorter mean bout duration was associated with higher risks for CVD (HR=1.54; CI=1.27-2.02; p-trend=0.003) after adjustment for covariates. Additional adjustment for CVD-risk biomarkers attenuated associations resulting in a quartile 4 vs. quartile 1 HR=1.36; CI=1.01-1.83; p-trend=0.10). Dose-response associations of sedentary time and bout duration with CVD were linear (P-nonlinear >0.05, each). Women jointly classified as having high sedentary time and long bout durations had significantly higher risk for CVD (HR=1.34; CI=1.08-1.65) than women with both low sedentary time and short bout duration. All analyses were repeated for incident coronary heart disease (MI or CVD death) and associations were similar with notably stronger hazard ratios. Conclusions:Both high sedentary time and long mean bout durations were associated in a dose-response manner with increased CVD risk in older women, suggesting that efforts to reduce CVD burden may benefit from addressing either or both component(s) of sedentary behavior. 10.1161/CIRCULATIONAHA.118.035312
    Do the associations of sedentary behaviour with cardiovascular disease mortality and cancer mortality differ by physical activity level? A systematic review and harmonised meta-analysis of data from 850 060 participants. Ekelund Ulf,Brown Wendy J,Steene-Johannessen Jostein,Fagerland Morten Wang,Owen Neville,Powell Kenneth E,Bauman Adrian E,Lee I-Min British journal of sports medicine OBJECTIVE:To examine whether the associations between sedentary behaviours (ie, daily sitting/TV-viewing time) and mortality from cardiovascular disease (CVD) and cancer differ by different levels of physical activity (PA). DESIGN:Harmonised meta-analysis of prospective cohort studies. Data on exposure variables were harmonised according to a predefined protocol and categorised into four groups for sedentary behaviours and into quartiles of PA (MET-hour/week). DATA SOURCES:PubMed, PsycINFO, Embase, Web of Science, Sport Discus and Scopus. ELIGIBILITY CRITERIA FOR SELECTING STUDIES:Individual level data on both sedentary behaviours and PA and reported effect estimates for CVD or cancer mortality. RESULTS:Nine studies (n=850 060; deaths=25 730) and eight studies (n=777 696; deaths=30 851) provided data on sitting time and CVD and cancer mortality, respectively. Five studies had data on TV-viewing time and CVD (n=458 127; deaths=13 230) and cancer (n=458 091; deaths=16 430) mortality. A dose-response association between sitting time (9%-32% higher risk; p for trend <0.001) and TV time (3%-59% higher risk; p for trend <0.001) with CVD mortality was observed in the 'inactive', lowest quartile of PA. Associations were less consistent in the second and third quartiles of PA, and there was no increased risk for CVD mortality with increasing sedentary behaviours in the most active quartile. Associations between sedentary behaviours and cancer mortality were generally weaker; 6%-21% higher risk with longer sitting time observed only in the lowest quartile of PA. CONCLUSION:PA modifies the associations between sedentary behaviours and CVD and cancer mortality. These findings emphasise the importance of higher volumes of moderate and vigorous activity to reduce, or even eliminate these risks, especially for those who sit a lot in their daily lives. 10.1136/bjsports-2017-098963
    Beneficial associations of low and large doses of leisure time physical activity with all-cause, cardiovascular disease and cancer mortality: a national cohort study of 88,140 US adults. Zhao Min,Veeranki Sreenivas P,Li Shengxu,Steffen Lyn M,Xi Bo British journal of sports medicine BACKGROUND:Evidence on the role of very low or very high volumes of leisure time physical activity (PA) on the risk of all-cause and cause-specific mortality is limited. We aimed to examine the associations of different levels of leisure time PA with the risk of all-cause, cardiovascular disease (CVD) and cancer-specific mortality. METHODS:Data were from 12 waves of the National Health Interview Surveys (1997-2008) linked to the National Death Index records through 31 December 2011. A total of 88 140 eligible participants aged 40-85 years were included. RESULTS:Compared with inactive individuals, those performing 10-59 min/week of PA had 18% lower risk of all-cause mortality (hazard ratio (HR): 0.82, 95% confidence interval (CI): 0.72-0.95). Those who reported 1-2 times (150-299 min/week) the recommended level of leisure time PA had 31% (HR: 0.69, 95%CI: 0.63-0.75) reduced risk of all-cause mortality. Importantly, the continued benefits were observed among those performing leisure time PA 10 or more times (≥1500 min/week) the recommended minimum level (HR: 0.54, 95% CI: 0.45-0.64). For 10-59, 150-299 and ≥1500 min/week of PA, the corresponding HRs (95% CIs) for CVD-specific mortality were 0.88 (0.67-1.17), 0.63 (0.52-0.78) and 0.67 (0.45-0.99), respectively: for cancer-specific mortality were 0.86 (0.66-1.11), 0.76 (0.64-0.89) and 0.53 (0.39-0.73), respectively. In addition, there was a larger reduction in all-cause and cause-specific mortality for vigorous vs. moderate intensity PA. CONCLUSIONS:We found that beneficial association between leisure time PA and mortality starts from a low dose. Doing more vigorous exercise could lead to additional health benefits. 10.1136/bjsports-2018-099254
    Mortality reduction with physical activity in patients with and without cardiovascular disease. Jeong Sang-Woo,Kim Sun-Hwa,Kang Si-Hyuck,Kim Hee-Jun,Yoon Chang-Hwan,Youn Tae-Jin,Chae In-Ho European heart journal AIMS:Physical activity has been shown to reduce mortality in a dose-response fashion. Current guidelines recommend 500-1000 metabolic equivalent task (MET)-min per week of regular physical activity. This study aimed to compare the impact of leisure-time physical activity on mortality in primary versus secondary cardiovascular prevention. METHODS AND RESULTS:This study included a total of 131 558 and 310 240 subjects with and without cardiovascular disease (CVD), respectively, from a population-based cohort. Leisure-time physical activity was measured by self-report questionnaires. The study subjects were followed-up for a median of 5.9 years, and the main study outcome was all-cause mortality. There was an inverse relationship between the physical activity level and the mortality risk in both groups. The benefit in the secondary prevention group was shown to be greater than that in the primary prevention group: every 500 MET-min/week increase in physical activity resulted in a 14% and 7% risk reduction in mortality in the secondary and primary prevention groups, respectively (interaction P < 0.001). In addition, while individuals without CVD benefited the most between 1 and 500 MET-min/week of physical activity, the benefit in those with CVD continued above 500 - 1000 MET-min/week. The adjusted mortality risk of individuals with CVD who performed a high level of physical activity (≥1000 MET-min/week) was shown to be comparable to or lower than that of their counterparts without CVD. CONCLUSION:Individuals with CVD may benefit from physical activity to a greater extent than do healthy subjects without CVD. 10.1093/eurheartj/ehz564
    Association of "Weekend Warrior" and Other Leisure Time Physical Activity Patterns With Risks for All-Cause, Cardiovascular Disease, and Cancer Mortality. O'Donovan Gary,Lee I-Min,Hamer Mark,Stamatakis Emmanuel JAMA internal medicine Importance:More research is required to clarify the association between physical activity and health in "weekend warriors" who perform all their exercise in 1 or 2 sessions per week. Objective:To investigate associations between the weekend warrior and other physical activity patterns and the risks for all-cause, cardiovascular disease (CVD), and cancer mortality. Design, Setting, and Participants:This pooled analysis of household-based surveillance studies included 11 cohorts of respondents to the Health Survey for England and Scottish Health Survey with prospective linkage to mortality records. Respondents 40 years or older were included in the analysis. Data were collected from 1994 to 2012 and analyzed in 2016. Exposures:Self-reported leisure time physical activity, with activity patterns defined as inactive (reporting no moderate- or vigorous-intensity activities), insufficiently active (reporting <150 min/wk in moderate-intensity and <75 min/wk in vigorous-intensity activities), weekend warrior (reporting ≥150 min/wk in moderate-intensity or ≥75 min/wk in vigorous-intensity activities from 1 or 2 sessions), and regularly active (reporting ≥150 min/wk in moderate-intensity or ≥75 min/wk in vigorous-intensity activities from ≥3 sessions). The insufficiently active participants were also characterized by physical activity frequency. Main Outcomes and Measures:All-cause, CVD, and cancer mortality ascertained from death certificates. Results:Among the 63 591 adult respondents (45.9% male; 44.1% female; mean [SD] age, 58.6 [11.9] years), 8802 deaths from all causes, 2780 deaths from CVD, and 2526 from cancer occurred during 561 159 person-years of follow-up. Compared with the inactive participants, the hazard ratio (HR) for all-cause mortality was 0.66 (95% CI, 0.62-0.72) in insufficiently active participants who reported 1 to 2 sessions per week, 0.70 (95% CI, 0.60-0.82) in weekend warrior participants, and 0.65 (95% CI, 0.58-0.73) in regularly active participants. Compared with the inactive participants, the HR for CVD mortality was 0.60 (95% CI, 0.52-0.69) in insufficiently active participants who reported 1 or 2 sessions per week, 0.60 (95% CI, 0.45-0.82) in weekend warrior participants, and 0.59 (95% CI, 0.48-0.73) in regularly active participants. Compared with the inactive participants, the HR for cancer mortality was 0.83 (95% CI, 0.73-0.94) in insufficiently active participants who reported 1 or 2 sessions per week, 0.82 (95% CI, 0.63-1.06) in weekend warrior participants, and 0.79 (95% CI, 0.66-0.94) in regularly active participants. Conclusions and Relevance:Weekend warrior and other leisure time physical activity patterns characterized by 1 or 2 sessions per week may be sufficient to reduce all-cause, CVD, and cancer mortality risks regardless of adherence to prevailing physical activity guidelines. 10.1001/jamainternmed.2016.8014
    Daily Total Physical Activity and Incident Cardiovascular Disease in Japanese Men and Women: Japan Public Health Center-Based Prospective Study. Kubota Yasuhiko,Iso Hiroyasu,Yamagishi Kazumasa,Sawada Norie,Tsugane Shoichiro, Circulation 10.1161/CIRCULATIONAHA.116.026557
    Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Risk Factors: US Preventive Services Task Force Recommendation Statement. ,Grossman David C,Bibbins-Domingo Kirsten,Curry Susan J,Barry Michael J,Davidson Karina W,Doubeni Chyke A,Epling John W,Kemper Alex R,Krist Alex H,Kurth Ann E,Landefeld C Seth,Mangione Carol M,Phipps Maureen G,Silverstein Michael,Simon Melissa A,Tseng Chien-Wen JAMA Importance:Adults who adhere to national guidelines for a healthful diet and physical activity have lower rates of cardiovascular morbidity and mortality than those who do not. All persons, regardless of their risk status for cardiovascular disease (CVD), can gain health benefits from healthy eating behaviors and appropriate physical activity. Objective:To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention among adults without obesity who do not have cardiovascular risk factors (hypertension, dyslipidemia, abnormal blood glucose levels, or diabetes). Evidence Review:The USPSTF reviewed the evidence on whether primary care-relevant counseling interventions to promote a healthful diet, physical activity, or both improve health outcomes, intermediate outcomes associated with CVD, or dietary or physical activity behaviors in adults; interventions to reduce sedentary behaviors; and the harms of behavioral counseling interventions. Findings:Counseling interventions result in improvements in healthful behaviors and small but potentially important improvements in intermediate outcomes, including reductions in blood pressure and low-density lipoprotein cholesterol levels and improvements in measures of adiposity. The overall magnitude of benefit related to these interventions is positive but small. The potential harms are at most small, leading the USPSTF to conclude that these interventions have a small net benefit for adults without obesity who do not have CVD risk factors. Conclusions and Recommendation:The USPSTF recommends that primary care professionals individualize the decision to offer or refer adults without obesity who do not have hypertension, dyslipidemia, abnormal blood glucose levels, or diabetes to behavioral counseling to promote a healthful diet and physical activity. Existing evidence indicates a positive but small benefit of behavioral counseling for the prevention of CVD in this population. Persons who are interested and ready to make behavioral changes may be most likely to benefit from behavioral counseling. (C recommendation). 10.1001/jama.2017.7171
    Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Risk Factors: Is Behavioral Counselling Necessary? Capewell Simon,Dowrick Christopher JAMA internal medicine 10.1001/jamainternmed.2017.1979
    The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lear Scott A,Hu Weihong,Rangarajan Sumathy,Gasevic Danijela,Leong Darryl,Iqbal Romaina,Casanova Amparo,Swaminathan Sumathi,Anjana R M,Kumar Rajesh,Rosengren Annika,Wei Li,Yang Wang,Chuangshi Wang,Huaxing Liu,Nair Sanjeev,Diaz Rafael,Swidon Hany,Gupta Rajeev,Mohammadifard Noushin,Lopez-Jaramillo Patricio,Oguz Aytekin,Zatonska Katarzyna,Seron Pamela,Avezum Alvaro,Poirier Paul,Teo Koon,Yusuf Salim Lancet (London, England) BACKGROUND:Physical activity has a protective effect against cardiovascular disease (CVD) in high-income countries, where physical activity is mainly recreational, but it is not known if this is also observed in lower-income countries, where physical activity is mainly non-recreational. We examined whether different amounts and types of physical activity are associated with lower mortality and CVD in countries at different economic levels. METHODS:In this prospective cohort study, we recruited participants from 17 countries (Canada, Sweden, United Arab Emirates, Argentina, Brazil, Chile, Poland, Turkey, Malaysia, South Africa, China, Colombia, Iran, Bangladesh, India, Pakistan, and Zimbabwe). Within each country, urban and rural areas in and around selected cities and towns were identified to reflect the geographical diversity. Within these communities, we invited individuals aged between 35 and 70 years who intended to live at their current address for at least another 4 years. Total physical activity was assessed using the International Physical Activity Questionnaire (IPQA). Participants with pre-existing CVD were excluded from the analyses. Mortality and CVD were recorded during a mean of 6·9 years of follow-up. Primary clinical outcomes during follow-up were mortality plus major CVD (CVD mortality, incident myocardial infarction, stroke, or heart failure), either as a composite or separately. The effects of physical activity on mortality and CVD were adjusted for sociodemographic factors and other risk factors taking into account household, community, and country clustering. FINDINGS:Between Jan 1, 2003, and Dec 31, 2010, 168 916 participants were enrolled, of whom 141 945 completed the IPAQ. Analyses were limited to the 130 843 participants without pre-existing CVD. Compared with low physical activity (<600 metabolic equivalents [MET] × minutes per week or <150 minutes per week of moderate intensity physical activity), moderate (600-3000 MET × minutes or 150-750 minutes per week) and high physical activity (>3000 MET × minutes or >750 minutes per week) were associated with graded reduction in mortality (hazard ratio 0·80, 95% CI 0·74-0·87 and 0·65, 0·60-0·71; p<0·0001 for trend), and major CVD (0·86, 0·78-0·93; p<0·001 for trend). Higher physical activity was associated with lower risk of CVD and mortality in high-income, middle-income, and low-income countries. The adjusted population attributable fraction for not meeting the physical activity guidelines was 8·0% for mortality and 4·6% for major CVD, and for not meeting high physical activity was 13·0% for mortality and 9·5% for major CVD. Both recreational and non-recreational physical activity were associated with benefits. INTERPRETATION:Higher recreational and non-recreational physical activity was associated with a lower risk of mortality and CVD events in individuals from low-income, middle-income, and high-income countries. Increasing physical activity is a simple, widely applicable, low cost global strategy that could reduce deaths and CVD in middle age. FUNDING:Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Ontario SPOR Support Unit, Ontario Ministry of Health and Long-Term Care, AstraZeneca, Sanofi-Aventis, Boehringer Ingelheim, Servier, GSK, Novartis, King Pharma, and national and local organisations in participating countries that are listed at the end of the Article. 10.1016/S0140-6736(17)31634-3
    Physical Activity to Prevent Cardiovascular Disease: A Simple, Low-Cost, and Widely Applicable Approach for All Populations. Lear Scott A,Yusuf Salim JAMA cardiology 10.1001/jamacardio.2017.4070
    Physical Activity and Risk of Coronary Heart Disease and Stroke in Older Adults: The Cardiovascular Health Study. Soares-Miranda Luisa,Siscovick David S,Psaty Bruce M,Longstreth W T,Mozaffarian Dariush Circulation BACKGROUND:Although guidelines suggest that older adults engage in regular physical activity (PA) to reduce cardiovascular disease (CVD), surprisingly few studies have evaluated this relationship, especially in those >75 years. In addition, with advancing age the ability to perform some types of PA might decrease, making light-moderate exercise such as walking especially important to meet recommendations. METHODS AND RESULTS:Prospective cohort analysis among 4207 US men and women of a mean age of 73 years (standard deviation=6) who were free of CVD at baseline in the Cardiovascular Health Study were followed from 1989 to 1999. PA was assessed and cumulatively updated over time to minimize misclassification and assess the long-term effects of habitual activity. Walking (pace, blocks, combined walking score) was updated annually from baseline through 1999. Leisure-time activity and exercise intensity were updated at baseline, 1992, and 1996. Incident CVD (fatal or nonfatal myocardial infarction, coronary death, or stroke) was adjudicated using medical records. During 41,995 person-years of follow-up, 1182 CVD events occurred. After multivariable adjustment, greater PA was inversely associated with coronary heart disease, stroke (especially ischemic stroke), and total CVD, even in those ≥75 years. Walking pace, distance, and overall walking score, leisure-time activity, and exercise intensity were each associated with lower risk. For example, in comparison with a walking pace <2 mph, those that habitually walked at a pace >3 mph had a lower risk of coronary heart disease (0.50; confidence interval, 0.38-0.67), stroke (0.47; confidence interval, 033-0.66), and CVD (0.50; confidence interval, 0.40-0.62). CONCLUSIONS:These data provide empirical evidence supporting PA recommendations, in particular, walking, to reduce the incidence of CVD among older adults. 10.1161/CIRCULATIONAHA.115.018323
    Associations of Fitness, Physical Activity, Strength, and Genetic Risk With Cardiovascular Disease: Longitudinal Analyses in the UK Biobank Study. Tikkanen Emmi,Gustafsson Stefan,Ingelsson Erik Circulation BACKGROUND:Observational studies have shown inverse associations among fitness, physical activity, and cardiovascular disease. However, little is known about these associations in individuals with elevated genetic susceptibility for these diseases. METHODS:We estimated associations of grip strength, objective and subjective physical activity, and cardiorespiratory fitness with cardiovascular events and all-cause death in a large cohort of 502 635 individuals from the UK Biobank (median follow-up, 6.1 years; interquartile range, 5.4-6.8 years). Then we further examined these associations in individuals with different genetic burden by stratifying individuals based on their genetic risk scores for coronary heart disease and atrial fibrillation. We compared disease risk among individuals in different tertiles of fitness, physical activity, and genetic risk using lowest tertiles as reference. RESULTS:Grip strength, physical activity, and cardiorespiratory fitness showed inverse associations with incident cardiovascular events (coronary heart disease: hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.77-0.81; HR, 0.95; 95% CI, 0.93-0.97; and HR, 0.68; 95% CI, 0.63-0.74, per SD change, respectively; atrial fibrillation: HR, 0.75; 95% CI, 0.73-0.76; HR, 0.93; 95% CI, 0.91-0.95; and HR, 0.60; 95% CI, 0.56-0.65, per SD change, respectively). Higher grip strength and cardiorespiratory fitness were associated with lower risk of incident coronary heart disease and atrial fibrillation in each genetic risk score group ( <0.001 in each genetic risk category). In particular, high levels of cardiorespiratory fitness were associated with 49% lower risk for coronary heart disease (HR, 0.51; 95% CI, 0.38-0.69) and 60% lower risk for atrial fibrillation (HR, 0.40; 95%, CI 0.30-0.55) among individuals at high genetic risk for these diseases. CONCLUSIONS:Fitness and physical activity demonstrated inverse associations with incident cardiovascular disease in the general population, as well as in individuals with elevated genetic risk for these diseases. 10.1161/CIRCULATIONAHA.117.032432
    The Importance of Vigorous-Intensity Leisure-Time Physical Activity in Reducing Cardiovascular Disease Mortality Risk in the Obese. O'Donovan Gary,Stamatakis Emmanuel,Stensel David J,Hamer Mark Mayo Clinic proceedings OBJECTIVE:To investigate the role of vigorous-intensity leisure-time physical activity in reducing cardiovascular disease (CVD) mortality risk in the obese. PARTICIPANTS AND METHODS:Trained interviewers assessed physical activity and body mass index (BMI; calculated as the weight in kilograms divided by the height in meters squared) in 59,005 adult participants (mean ± SD age, 57±12 years; 46.5% male) in 2 household-based surveillance studies: Health Survey for England and Scottish Health Survey. Mortality was ascertained from death certificates. Data were collected from January 1, 1994, through March 31, 2011. Cox proportional hazards models were adjusted for age, sex, smoking habit, total physical activity, long-standing illness, prevalent CVD, and occupation. RESULTS:There were 2302 CVD deaths during 532,251 person-years of follow-up (mean ± SD, 9±4 years). A total of 15,002 (25%) participants were categorized as obese (BMI ≥30). Leisure-time physical activity was inversely associated and BMI was positively associated with CVD mortality. Compared with those who reported meeting physical activity guidelines including some vigorous-intensity physical activity and who had a normal BMI (18.5-24.9) (reference group), the CVD mortality hazard ratio was not significantly different in the obese who also reported meeting physical activity guidelines including some vigorous-intensity physical activities (1.25; 95% CI, 0.50-3.12). Compared with the reference group, the CVD mortality hazard ratio was more than 2-fold in the obese who reported meeting physical activity guidelines, including only moderate-intensity physical activities (2.52; 95% CI, 1.15-2.53). CONCLUSION:This large, statistically powerful study suggests that vigorous-intensity leisure-time physical activity is important in reducing CVD mortality risk in the obese. 10.1016/j.mayocp.2018.01.016
    Physical activity less than the recommended amount may prevent the onset of major biological risk factors for cardiovascular disease: a cohort study of 198 919 adults. Martinez-Gomez David,Esteban-Cornejo Irene,Lopez-Garcia Esther,García-Esquinas Esther,Sadarangani Kabir P,Veiga Oscar L,Rodriguez-Artalejo Fernando British journal of sports medicine OBJECTIVES:We examined the dose-response relationship between physical activity (PA) and incidence of cardiovascular disease (CVD) risk factors in adults in Taiwan. METHODS:This study included 1 98 919 participants, aged 18-97 years, free of CVD, cancer and diabetes at baseline (1997-2013), who were followed until 2016. At baseline, participants were classified into five PA levels: inactive' (0 metabolic equivalent of task (MET)-h/week), 'lower insufficiently active' (0.1-3.75 MET-h/week), 'upper insufficiently active' (3.75-7.49 MET-h/week), 'active' (7.5-14.99 MET-h/week) and 'highly active' (≥15 MET-h/week]. CVD risk factors were assessed at baseline and at follow-up by physical examination and laboratory tests. Analyses were performed with Cox regression and adjusted for the main confounders. RESULTS:During a mean follow-up of 6.0±4.5 years (range 0.5-19 years), 20 447 individuals developed obesity, 19 619 hypertension, 21 592 hypercholesterolaemia, 14 164 atherogenic dyslipidaemia, 24 275 metabolic syndrome and 8548 type 2 diabetes. Compared with inactive participants, those in the upper insufficiently active (but not active) category had a lower risk of obesity (HR 0.92; 95% CI 0.88 to 0.95), atherogenic dyslipidaemia (0.96; 0.90 to 0.99), metabolic syndrome (0.95; 0.92 to 0.99) and type 2 diabetes (0.91; 0.86 to 0.97). Only highly active individuals showed a lower incidence of CVD risk factors than their upper insufficiently active counterparts. CONCLUSION:Compared with being inactive, doing half the recommended amount of PA is associated with a lower incidence of several common biological CVD risk factors. Given these benefits, half the recommended amount of PA is an evidence based target for inactive adults. 10.1136/bjsports-2018-099740