Original ReportSeven-Year Changes in Physical Fitness, Physical Activity, and Lipid Profile in the CARDIA Study
Introduction
A large body of evidence indicates that higher levels of physical fitness and physical activity are causally linked to decreased incidence of and mortality from coronary heart disease (CHD) 1, 2, 3. This relationship may be mediated, in part, through a favorable influence of activity and fitness on plasma concentrations of lipids and lipoproteins. Cross-sectional analyses consistently find that more active, more fit individuals have higher high density lipoprotein-cholesterol (HDL-C) 4, 5, 6, 7, 8, 9, 10, 11, 12, HDL2 subfraction 11, 12, 13, 14 and apoprotein A-1 13, 15, all of which are negatively correlated with CHD risk (16). In addition, active individuals tend to have lower triglyceride levels (TG) than inactive people (17), and endurance-trained athletes tend to have lower low density lipoprotein-cholesterol (LDL-C) levels compared with sedentary controls (16); however, this is an inconsistent finding 13, 17. Body fat, which is often associated with a more atherogenic lipid profile (18), and lower levels of activity and fitness (19), explains some 11, 20, 21 but not all 7, 12 of these relationships.
Intervention studies, that examine change in lipid levels over time in relationship to change in fitness or activity, show that the effects of exercise training on plasma lipids and lipoproteins depend on a number of intervening variables, including changes in body weight, amount and type of exercise, and gender (17). Increases in HDL-C following endurance training, for example, seem to require a threshold level in terms of duration of training and absolute amount of exercise (22). Decreases in LDL-C are observed rarely (4) and usually in association with substantial decreases in body weight while decreases in triglycerides are usually seen only if the levels are elevated initially (23).
Few observational cohort studies have examined the relationship between change in fitness or activity and change in the lipid profile. The little evidence that exists is generally in agreement with the cross-sectional findings 24, 25, 26, 27.
In the Coronary Artery Risk Development in Young Adults (CARDIA) study, a longitudinal cohort study comparing the relationships of lifestyle and physiological variables to the development of coronary heart disease risk factors in black and white young adults, substantial decreases in physical activity and physical fitness and substantial increases in weight have occurred over a seven year period 28, 29, 30. Despite those changes, LDL-C decreased in the women and incresed only slightly in the men (31). The purpose of this investigation was to examine specifically how change in physical fitness and physical activity related to change in lipids and lipoproteins, and to explore the influence of change in body weight on those relationships.
Section snippets
Study Population
The subjects for this study were 320 black men (BM), 494 white men (WM), 510 black women (BW), and 453 white women (WW) from Birmingham, AL, Chicago, IL, and Oakland, CA, who are part of the CARDIA cohort. Included in this analysis are those participants who terminated a symptom-limited graded treadmill test due to fatigue, shortness of breath or completion of the protocol, and who had an overnight fasting blood draw at both the Baseline (1985–86) and Year 7 (1992–93) exams. Because
Results
As shown in Table 1, there were substantial decreases in both fitness and activity in all race/gender groups. The greatest mean decline in treadmill duration, observed in BM, exceeded 1.5 minutes while the greatest mean decreases in activity were observed in white men and women. All race/gender groups also experienced large increases in weight, ranging from 11 pounds in WW to 19 pounds in BW. In the men, the lipid profile changed in a generally unfavorable direction, including small increases
Discussion
This study examined the relationships between change in fitness, activity, and lipids and lipoproteins that occurred over a seven year period during young adulthood and the influence of weight change on those relationships. In this cohort of black and white men and women, decreased fitness was generally related to increases in total cholesterol, LDL-C, and triglycerides and decreases in HDL-C. Most of these relationships were explained by change in body weight. However, change in HDL-C appeared
Acknowledgements
This research was supported by NHLBI contracts NO1-HC-84047 through NO1-HC-84050.
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Cholesterol transport in blood, lipoproteins, and cholesterol metabolism
2022, Cholesterol: From Chemistry and Biophysics to the ClinicAge-related change in peak oxygen uptake and change of cardiovascular risk factors. The HUNT Study
2020, Progress in Cardiovascular DiseasesCitation Excerpt :However, the 2478 participants were all relatively young (<30 years), and CRF was estimated by maximal treadmill time, which may explain some of the discrepancy to our study. Few other studies have examined the concurrent change of CRF and CVD risk factors, but another investigation from the CARDIA study showed how change in CRF was associated with change in HDL-, LDL- and total-cholesterol, and triglycerides, while only the association with HDL-cholesterol was significant after adjustment for weight change.23 These findings are similar to ours.
Impact of Changes in Cardiorespiratory Fitness on Hypertension, Dyslipidemia and Survival: An Overview of the Epidemiological Evidence
2017, Progress in Cardiovascular DiseasesCitation Excerpt :The longitudinal epidemiological studies related to CRF change over time and lipid abnormalities are limited, with most studies focusing on individual components of the lipid profile18,47,54,59–61 and only one recent study examining the development of atherogenic dyslipidemia, the lipid triad that consists of a combination of elevated LDL-C, reduced HDL-C, and elevated TGs27 (Table 3). Three reports from the CARDIA study showed some inconsistencies,18,47,60 with two of them finding no association between CRF change and incident low HDL-C, high TG, or high LDL-C.18,47 However, another study from Sternfeld et al. followed a group of 1777 Black and White men and women, aged 18–30, for 7 years. They found that 7-year change in CRF was directly and positively related to change in HDL-C after controlling for change in body weight, while an inverse association between changes in CRF and changes in LDL-C and TGs was apparently mediated by changes in body weight.60
The Impact of Cardiorespiratory Fitness Levels on the Risk of Developing Atherogenic Dyslipidemia
2016, American Journal of MedicineCitation Excerpt :Similar results were observed in another subsample of the ACLS, in which fitness changes were inversely associated with changes in TGs as well as with changes in total cholesterol.18 Another observational study conducted within the Coronary Artery Risk Development in Young Adults (CARDIA) cohort also observed a significant negative correlation in men and white women only, but this became nonsignificant after accounting for weight changes over a 7-year period.40 Additionally, within the ACLS population, fitness changes were positively associated with changes in HDL-C even after adjusting for covariates, which was similarly observed in the CARDIA cohort.17,40
Association of Fitness With Incident Dyslipidemias Over 25 Years in the Coronary Artery Risk Development in Young Adults Study
2015, American Journal of Preventive MedicineCitation Excerpt :However, only a few longitudinal population studies have documented the influence of changes in fitness over time on changes in the lipid profile7,12,19,20 or on the risk of developing dyslipidemias. In a previous investigation of the Coronary Artery Risk Development in Young Adults Study (CARDIA) cohort, 7-year change in fitness was directly related to change in HDL-C, independent of change in body weight, whereas inverse associations between changes in fitness and changes in LDL-C and TGs appeared to be mediated by changes in body weight.21 CARDIA includes objective measurements of fitness at baseline and Year 20, along with lipid variables measured at eight different examinations across a period of 25 years, thus providing a unique opportunity to examine the association of fitness and dyslipidemia during the transition from young adulthood to middle age.
Physical (in)activity over 20y in adulthood: Associations with adult lipid levels in the 1958 British birth cohort
2011, AtherosclerosisCitation Excerpt :Many early observational studies of activity and lipids were cross-sectional [12,13] with small samples, sometimes with narrowly targeted groups [11,12] rather than general population samples. These limitations are to some extent overcome in recent longitudinal studies in large general population samples [6,8,21–23] with some reporting that changes in (in)activity predict lipid levels over the period of follow-up [6,21–24]. Given that evidence is scarce on long-term associations of (in)activity with lipid levels further longitudinal studies are needed to clarify whether effects of (in)activity are cumulative.