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      Physical activity, obesity and mortality: does pattern of physical activity have stronger epidemiological associations?

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          Abstract

          Background

          Most studies of physical activity (PA) epidemiology use behaviour measured at a single time-point. We examined whether ‘PA patterns’ (consistently low, consistently high or inconsistent PA levels over time) showed different epidemiological relationships for anthropometric and mortality outcomes, compared to single time-point measure of PA.

          Methods

          Data were the Danish MONICA (MONItoring Trends and Determinants in CArdiovascular Disease) study over three waves 1982–3 (time 1), 1987–8 (time 2) and 1993–4 (time 3). Associations between leisure time single time-point PA levels at time 1 and time 3, and sport and active travel at times 1 and 2 with BMI, waist, hip circumference and mortality (death from coronary heart disease (CHD) and cardiovascular disease (CVD)) were compared to ‘PA patterns’ spanning multiple time points. PA pattern classified participants’ PA as either 1) inactive or low PA at both time points; 2) moderate level PA at time 1 and high activity at time 3; or 3) a ‘mixed PA pattern’ indicating a varying levels of activity over time. Similarly, sport and active travel were also classified as indicating stable low, stable high and mixed patterns.

          Results

          The moderately and highly active groups for PA at times 1 and 3 had up to 1.7 cm lower increase in waist circumference compared with the inactive/low active group. Across ‘PA patterns’, ‘active maintainers’ had a 2.0 cm lower waist circumference than ‘inactive/low maintainers’. Waist circumference was inversely related to sport but not active travel. CHD risk did not vary by activity levels at time 1, but was reduced significantly by 43% for high PA at time 3 (vs ‘inactive’ group) and among ‘active maintainers’ (vs ‘inactive/low maintainers’) by 62%. ‘Sport pattern’ showed stronger reductions in mortality for cardiovascular disease and CHD deaths among sport maintainers, than the single time point measures.

          Conclusions

          PA patterns demonstrated a stronger association with a number of anthropometric and mortality outcomes than the single time-point measures. Operationalising PA as a sustained behavioural pattern may address some of the known under-estimation of risk for poor health in PA self-report measurements and better reflect exposure for epidemiological analysis of risk of health outcomes.

          Electronic supplementary material

          The online version of this article (10.1186/s12889-017-4806-6) contains supplementary material, which is available to authorized users.

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          Most cited references34

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          Physical Activity and Risk of Cardiovascular Disease—A Meta-Analysis of Prospective Cohort Studies

          In order to update and improve available evidence on associations of physical activity (PA) with cardiovascular disease (CVD) by applying meta-analytic random effects modeling to data from prospective cohort studies, using high quality criteria of study selection, we searched the PubMed database from January 1980 to December 2010 for prospective cohort studies of PA and incident CVD, distinguishing occupational PA and leisure time PA, coronary heart disease (CHD) and stroke, respectively. Inclusion criteria were peer-reviewed English papers with original data, studies with large sample size (n ≥ 1,000) and substantial follow-up (≥5 years), available data on major confounders and on estimates of relative risk (RR) or hazard ratio (HR), with 95% confidence intervals (CI). We included 21 prospective studies in the overall analysis, with a sample size of more than 650,000 adults who were initially free from CVD, and with some 20,000 incident cases documented during follow-up. Among men, RR of overall CVD in the group with the high level of leisure time PA was 0.76 (95% CI 0.70–0.82, p < 0.001), compared to the reference group with low leisure time PA, with obvious dose-response relationship. A similar effect was observed among women (RR = 0.73, 95% CI 0.68–0.78, p < 0.001). A strong protective effect of occupational PA was observed for moderate level in both men (RR = 0.89, 95% CI 0.82–0.97, p = 0.008) and women (RR = 0.83, 95% CI 0.67–1.03, p = 0.089). No publication bias was observed. Our findings suggest that high level of leisure time PA and moderate level of occupational PA have a beneficial effect on cardiovascular health by reducing the overall risk of incident coronary heart disease and stroke among men and women by 20 to 30 percent and 10 to 20 percent, respectively. This evidence from high quality studies supports efforts of primary and secondary prevention of CVD in economically advanced as well as in rapidly developing countries.
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            Physiological analysis of middle-aged and old former athletes. Comparison with still active athletes of the same ages.

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              Non-vigorous physical activity and all-cause mortality: systematic review and meta-analysis of cohort studies.

              Although previous studies have found physical activity to be associated with lower mortality, the dose-response relationship remains unclear. In this systematic review and meta-analysis we quantify the dose-response relationship of non-vigorous physical activity and all-cause mortality. We aimed to include all cohort studies in adult populations with a sample size of more than 10 000 participants that estimated the effect of different levels of light or moderate physical activity on all-cause mortality. We searched Medline, Embase, Cochrane (DARE), Web of Science and Global Health (June 2009). We used dose-response meta-regression models to estimate the relation between non-vigorous physical activity and mortality. We identified 22 studies that met our inclusion criteria, containing 977 925 (334 738 men and 643 187 women) people. There was considerable variation between the studies in their categorization of physical activity and adjustment for potential confounders. We found that 2.5 h/week (equivalent to 30 min daily of moderate intensity activity on 5 days a week) compared with no activity was associated with a reduction in mortality risk of 19% [95% confidence interval (CI) 15-24], while 7 h/week of moderate activity compared with no activity reduced the mortality risk by 24% (95% CI 19-29). We found a smaller effect in studies that looked at walking alone. Being physically active reduces the risk of all-cause mortality. The largest benefit was found from moving from no activity to low levels of activity, but even at high levels of activity benefits accrue from additional activity.
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                Author and article information

                Contributors
                adrian.bauman@sydney.edu.au
                anne.grunseit@sydney.edu.au
                vegar.rangul@ntnu.no
                blh2111@gmail.com
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                5 October 2017
                5 October 2017
                2017
                : 17
                : 788
                Affiliations
                [1 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, Prevention Research Collaboration, School of Public Health, , University of Sydney, ; Level 6, Charles Perkins Centre, Johns Hopkins Drive, Sydney, NSW 2006 Australia
                [2 ]HUNT Research Centre, Faculty of Medicine, Department of Public health and General practice, NTNU – Norwegian University of Science and Technology, Levanger, Norway
                [3 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, , University of Sydney, ; Sydney, NSW 2006 Australia
                [4 ]ISNI 0000 0000 9350 8874, GRID grid.411702.1, Research Unit for Dietary Studies at the Parker Institute and Institute of Preventive Medicine, Frederiksberg and Bispebjerg Hospital, ; Copenhagen, Denmark
                [5 ]ISNI 0000 0001 0728 0170, GRID grid.10825.3e, Institute of Public Health, , University of Southern Denmark, ; Odense, Denmark
                [6 ]GRID grid.475435.4, Copenhagen Center for Preventive Medicine, Glostrup Hospital, ; Copenhagen Capital Region, Denmark
                Author information
                http://orcid.org/0000-0003-1250-3265
                Article
                4806
                10.1186/s12889-017-4806-6
                5629749
                28982371
                9251b3de-4243-4a2e-a727-eeb425d49b51
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 28 June 2017
                : 28 September 2017
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Public health
                waist circumference,hip circumference,cardiovascular disease
                Public health
                waist circumference, hip circumference, cardiovascular disease

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