Physical activity protects against coronary death and deaths from all causes in middle-aged men: Evidence from a 20-year follow-up of the primary prevention study in Göteborg

doi:10.1016/S1047-2797(96)00106-8

Annals of Epidemiology

Volume 7, Issue 1, January 1997, Pages 69-75

https://doi.org/10.1016/S1047-2797(96)00106-8 Get rights and content

Abstract

We set out to examine the long-term effect of work-related and leisure time physical activity on risk of death from coronary heart disease (CHD) and other causes. Data were obtained from a large prospective population study of 7142 participant men aged 47 to 55 years at baseline in 1970–1973 and without symptomatic CHD. Data on physical activity at work and at leisure were assessed by way of a questionnaire. After 20 years follow-up men with physically demanding work had a slightly higher mortality from all causes, but not from CHD. The association with all-cause mortality disappeared after controlling for smoking, occupational class, and alcohol abuse. Men who were physically active during leisure time had a lower risk of death from CHD, cancer, and all causes. After controlling for smoking, diastolic blood pressure, serum cholesterol, body mass index, diabetes, alcohol abuse, and low occupational class, the most active men had a relative risk (RR) of dying from CHD of 0.72 (0.56–0.92 95% CI) and of all causes of 0.70 (0.61–0.80 95% CI). The adjusted relative risk for cancer death was of borderline significance. Noncardiovascular deaths other than cancer showed a strong relationship with low physical activity in the present study that remained after controlling for smoking, alcohol abuse, and other factors (adjusted RR 0.55 (0.42–0.73 95% CI)). The protective effect on CHD and on mortality was present after excluding the first 8 years of follow-up, and at all levels of other risk factors, such as smoking, diastolic blood pressure, serum cholesterol, and body mass index. In conclusion, this long-term study demonstrates the protective effect of leisure time physical activity on CHD death, cancer death, and on death from all causes. The effect on coronary death and on death from all causes was independent of other risk factors.

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Cited by (195)

Physical Activity After Treatment for Symptomatic Peripheral Artery Disease
2021, American Journal of Cardiology
Citation Excerpt :
Grade 1 was defined as mainly sedentary, grade 2 as predominantly walking on one level, but no heavy lifting, grade 3 as mainly walking, including climbing stairs or walking uphill or lifting heavy objects, grade 4 as heavy physical labor, and grade 5 as do not work.10 Previous studies have demonstrated the prognostic significance of physical activity assessed by these questionnaires for predicting incident coronary artery disease and all-cause death.8,11 Treatment status was independently adjudicated by trained research personnel through a detailed review of each patient's chart.
The association of invasive versus noninvasive treatment and physical activity level in patients with claudication remains unclear. Participants with claudication were enrolled from US vascular clinics. Treatment was categorized as invasive (surgical or endovascular treatment <3 months of initial visit) versus noninvasive. Self-reported leisure time (LTPA) and work related physical activity (WRPA) (sedentary, mild, moderate/strenuous), and health status (peripheral artery questionnaire summary score [PAQ SS]) was measured at baseline and 12 months. Change in PA was also categorized as increased, decreased, persistent sedentary [reference] and persistent active based on activity status at baseline and 12 months. Multivariable logistic regression assessed the association of treatment with 12-month LTPA and WRPA. Multivariable linear regression examined the association between 12-month change in PA with a 12-month change in PAQ. A total of 196of 656 patients (29.9%) underwent invasive treatment. There was no association between treatment and 12-month LTPA (p = 0.77) or WRPA (p = 0.26). Compared with being persistently sedentary, increased LTPA was associated with increased PAQ SS (OR 11.1 95% CI [4.4 to 17.7], p <0.01). In conclusion, there was no association between invasive treatment and physical activity at follow up despite a greater health status change in the invasive group. As increased physical activity was associated with more health status gains than remaining sedentary, additional ways to improve physical activity levels could potentially improve PAD outcomes.
Physical Activity in Patients with Symptomatic Peripheral Artery Disease: Insights from the PORTRAIT Registry
2020, European Journal of Vascular and Endovascular Surgery
Citation Excerpt :
For this analysis, activity was dichotomised as sedentary (grade 1) or non-sedentary (≥ grade 2). Previous studies have shown that physical activity assessed by this questionnaire independently predicts all cause and cardiovascular death, and this questionnaire has been incorporated into the INTERHEART risk score.12,13 All study participants provided informed consent and institutional review board approval was obtained at each participating centre.
A physically active lifestyle reduces the risk of cardiovascular events and functional impairment in patients with peripheral artery disease (PAD). There are limited data on the patterns of physical activity in patients with PAD compared between countries.
Self reported physical activity (sedentary vs. not) was obtained at enrolment, 3, 6, and 12 months in the US and Netherlands' cohorts of the Patient-centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT) registry of patients with new or worsening claudication. Multivariable repeated measures using modified Poisson regression analysis compared the proportion of sedentary participants over time between countries to identify factors that attenuate intercountry differences.
Of 1 098 participants, 743 (67.7%) and 355 (32.3%) were recruited from the USA and the Netherlands respectively. Compared with the Netherlands, participants from the US were older (mean age 68.6 vs. 65.3 years; p < .001), more obese (41.3% vs. 20.5%; p < .001), and more likely to be female (41.3% vs. 31.4%; p = .002). There were fewer current smokers (30.1% vs. 52.8%; p < .001) and supervised exercise referrals (1.6% vs. 63.9%; p < .001) in the US compared with the Netherlands. US participants were more sedentary at baseline (43.7% vs. 34.1%; p < .001). Sedentary behaviour decreased after three months in both countries, then diverged with an increase in sedentary participants in the USA. Risk of sedentary behaviour was significantly greater in the USA compared with the Netherlands at 12 months, after adjustment of sociodemographic, lifestyle factors, and comorbidities (relative risk [RR] 1.56, 95% confidence interval [CI] 1.08–2.25; p = .020) but was attenuated after accounting for referral to supervised exercise (RR 1.20, 95% CI 0.67–2.16; p = .54).
Referral to supervised exercise was key in explaining the observed difference in the physical activity levels between patients with PAD in the USA and the Netherlands. Further promotion of supervised exercise for PAD may improve physical activity in patients with PAD and modify cultural norms of inactivity in the US.
Self-assessed preoperative level of habitual physical activity predicted postoperative complications after colorectal cancer surgery: A prospective observational cohort study
2019, European Journal of Surgical Oncology
There is a growing interest in physical activity in relation to recovery after surgery. One important aspect of measuring recovery after surgical procedures is postoperative complications. The aim of this study was to determine if there is an association between the preoperative level of habitual physical activity and postoperative complications in patients undergoing elective surgery for colorectal cancer.
115 patients scheduled for elective surgery due to colorectal cancer between February 2014 and September 2015 answered a questionnaire regarding physical activity and other baseline variables. Physical activity was assessed using the Saltin-Grimby physical activity level scale. Complications within 30 days after surgery were classified according to Clavien-Dindo, and the Comprehensive Complications Index (CCI) was calculated. Primary outcome was difference in CCI and key secondary outcome was risk for CCI ≥20.
Physically inactive individuals had a CCI that was 12 points higher than individuals with light activity (p = 0.002) and 17 points higher than regularly active individuals (p = 0.0004). Inactive individuals had a relative risk for a CCI ≥20 that was 65% higher than for individuals reporting light activity (95% confidence interval (CI) for relative risk (RR) = 1.1–2.5) and 338% higher than for regularly active individuals (95% CI for RR = 2.1–9.4).
Self-assessed level of habitual physical activity before colorectal cancer surgery was associated with fewer postoperative complications measured with CCI, in a dose-response relationship.
The preoperative level of physical activity is associated to the postoperative recovery after elective cholecystectomy - A cohort study
2015, International Journal of Surgery
There is an increasing interest in the role of preoperative physical activity for postoperative recovery. The effect of preoperative physical activity and recovery after cholecystectomy is unknown. The aim of this study was to evaluate the association of self-reported leisure-time preoperative physical activity with postoperative recovery and complications after elective cholecystectomy due to gallstone disease.
Prospective observational cohort study with 200 patients scheduled to undergo elective cholecystectomy. Level of self-assessed leisure-time physical activity was compared with recovery.
Regular physical activity was associated with a higher degree of return to work within three weeks post-operatively (relative chance (RC) 1.26, p = 0.040); with a higher chance of leaving hospital within one day post-op (RC 1.23, p = 0.001), as well as with better mental recovery (RC 1.18, p = 0.049), compared to physically inactive. No statistically significant association was seen with return to work within one week or with self-assessed physical recovery.
In clinical practice, evaluating the patients' level of physical activity is feasible, and may potentially be used to identify patients being more suitable for same-day surgery. Given the study design, the results from this study cannot prove causality.
The present study shows that the preoperative leisure-time physical activity-level, is positively associated with less sick leave, a shorter hospital stay and with better mental recovery, three weeks post-elective cholecystectomy. We recommend assessing the physical activity-level preoperatively for prognostic reasons. If preoperative/postoperative physical training will increase recovery remains to be shown in a randomized controlled study.
Exercise: Teaching myocytes new tricks
2017, Journal of Applied Physiology
Development and feasibility of a function-based preventive intervention for lifestyle-related disorders
2024, BMC Public Health

View all citing articles on Scopus

^☆: This study was supported by the Swedish Medical Research Council, the Swedish Labour Market Insurance Company, the Göteborg Medical Society, and the Knut and Alice Wallenberg Foundation.

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Original reportPhysical activity protects against coronary death and deaths from all causes in middle-aged men: Evidence from a 20-year follow-up of the primary prevention study in Göteborg☆

Abstract

Am J Cardiol

Am Heart J

J Chronic Dis

Physical activity as an index of heart attack risk in college alumni

Am J Epidemiol

Physical activity, all-cause mortality and longevity of college alumni

N Engl J Med

Leisure-time physical activity levels and risk of coronary heart disease and death. The multiple risk factor intervention trial

JAMA

Physical activity and the incidence of coronary heart disease

Ann Rev Public Health

Leisure time physical activity and coronary heart disease death. The U.S. Railroad study

Circulation

A meta-analysis of physical activity in the prevention of coronary heart disease

Am J Epidemiol

Exercise in leisure time: Coronary attack and death rates

Br Heart J

Physical activity and ischemic heart disease in middle-aged British men

Br Heart J

Physical activity and 10.5 year mortality in the multiple risk factor intervention trial (MRFIT)

Int J Epidemiol

Physical activity and risk of stroke in British middle aged men

BMJ

Increased physical activity: A protective factor against heart attacks in Puerto Rico

Am J Cardiol

Relation of physical activity and cardiovascular fitness to coronary heart disease, part I: A meta-analysis of the independent relation of physical activity and coronary heart disease

J Am Board Fam Pract

Heart rate, physical activity, and mortality from cancer and other non-cardiovascular diseases

Am J Epidemiol

Physical activity in older middle aged men and reduced risk of stroke: The Honolulu Heart Program

Am J Epidemiol

Original report
Physical activity protects against coronary death and deaths from all causes in middle-aged men: Evidence from a 20-year follow-up of the primary prevention study in Göteborg☆