Table 11.
Publication Country Study Design Quality Score | Objective | Population | Methods | Outcome | Comments and Conclusions |
---|---|---|---|---|---|
Blair et al 1989 [7] | To study physical fitness (PF) and risk of all-cause mortality in men and women. | • n = 13,344 (10,224 men; 3,120 women) | Baseline and 8 year follow-up | • 283 deaths | Low levels of PF increase the risk for premature mortality. |
• Sex: Men and women | Adjusted risk ratio (RR), 95% confidence interval (CI) | ||||
USA | • Age: 20->60 years (yr) | PF assessment: Maximal treadmill exercise test. | |||
Prospective cohort | • Characteristics: Participants were given a preventative Medicine examination including maximal treadmill exercise test | Fitness categorized into quintiles: | Men | ||
D & B score = 12 | Q1 = least fit | • Q1 = 3.44 (2.05-5.77) | |||
Q2 | • Q2 = 1.37 (0.76-2.50) | ||||
Q3 | • Q3 = 1.46 (0.81-2.63) | ||||
Q4 | • Q4 = 1.17 (0.63-2.17) | ||||
Q5 = most fit | • Q5 = 1.00 (referent) | ||||
Women | |||||
• Q1 = 4.65 (2.22-9.75) | |||||
• Q2 = 2.42 (1.09-5.37) | |||||
• Q3 = 1.43 (0.60-3.44) | |||||
• Q4 = 0.76 (0.27-2.11) | |||||
• Q5 = 1.00 (referent) | |||||
Myers et al 2004 [32] | To determine the effects of PF and physical activity (PA) on all-cause mortality. | • n = 6,213 | Baseline and mean 5.5 ± 2.0 year follow-Up | • 1,256 deaths | Being fit or active is associated with >50% reductions in mortality risk. |
• Sex: Men | |||||
USA | • Age: Mean 59.0 ± 11.2 yr | PF Level hazard ratio (HR) (95% CI) | |||
• Characteristics: Men referred for exercise testing | PF assessment: Treadmill test to measure VO2 peak | • G1 = 1.00 (referent) | PF predicted mortality more strongly than PA. | ||
Prospective cohort | • G2 = 0.59 (0.52-0.68) | ||||
• G3 = 0.46 (0.39-0.55) | |||||
• G4 = 0.28 (0.23-0.34) | Increasing PA (by 1000 kcal/wk or 1 MET) confers a mortality benefit of 20%. | ||||
D & B score = 12 | PA assessment: Self reported PA divided into 4 groups | ||||
PA Level HR (95% CI) | |||||
G1 = Lowest level | • G1 = 1.00 (referent) | ||||
G2 | • G2 = 0.63 (0.36-1.10) | ||||
G3 | • G3 = 0.42 (0.23-0.78) | ||||
G4 = Highest level | • G4 = 0.38 (0.19-0.73) | ||||
Blair et al 1995 [36] | To evaluate the relationship between changes in PF and risk of mortality in men. | • n = 9,777 | 4.9 year mean follow-up | • 223 deaths | Men who maintained or increased adequate PF had a reduced risk for all-cause mortality than individuals who were consistently unfit. |
• Sex: Men | |||||
• Age: 20-82 yr | RR (95% CI) | ||||
USA | • Characteristics: Participants were given a preventative medicine examination including maximal treadmill exercise test | PF assessment: Maximal exercise test at baseline and follow-up | • G1 = 1.00 (referent) | ||
Prospective cohort | • G2 = 0.56 (0.41-0.75) | ||||
• G3 = 0.52 (0.38-0.70) | |||||
• G4 = 0.33 (0.23-0.47) | |||||
D & B score = 13 | Groups based on changes in PF | ||||
G1 = unfit to unfit | |||||
G2 = unfit to fit | |||||
G3 = fit to unfit | |||||
G4 = fit to fit | |||||
Bijnen et al 1999 [37] | To examine the association of PA at baseline and 5 years | • n = 472 | 1985 and 1990 | • 118 deaths | Recent levels of PA were more important for mortality risk than PA 5 years previously. |
• Sex: Men | |||||
• Age: >65 yr | PA assessment: Questionnaire, divided into tertiles: Lowest Middle Highest | Multivariate adjusted RR (95% CI) | |||
Netherlands | previously with all- cause mortality risk in a cohort of elderly Dutch men. | • Characteristics: Mostly independently living elders (~95%) | PA in 1985: Lowest tertile = 1.00 (referent) Middle tertile | ||
Retrospective cohort | • Zutphen Elderly Study | • Total activity = 1.25 (0.79- 1.99) | Becoming or remaining sedentary increased the mortality risk. | ||
D & B score = 12 | • Walking = 0.97 (0.60-1.57) | ||||
• Bike = 0.97 (0.59-1.57) | |||||
• Gardening = 0.66 (0.39-1.10) | |||||
• Other = 1.08 (0.66-1.78) | |||||
• Heavy activity = 0.73 (0.45-1.17) | |||||
• Non heavy activity = 0.89 (0.57-1.40) | |||||
Highest tertile | |||||
• Total activity = 1.25 (0.73-2.12) | |||||
• Walking = 0.94 (0.58-1.55) | |||||
• Bike = 1.07 (0.61-1.88) | |||||
• Gardening = 0.77 (0.42-1.39) | |||||
• Other = 1.24 (0.74-2.07) | |||||
• Heavy activity = 0.76 (0.44-1.32) | |||||
• Non heavy activity = 0.94 (0.58-1.53) | |||||
PA in 1990: | |||||
Lowest tertile = 1.00 (referent) | |||||
Middle tertile | |||||
• Total activity = 0.56 (0.35-0.89) | |||||
• Walking = 0.82 (0.51-1.32) | |||||
• Bike = 0.49 (0.29-0.82) | |||||
• Gardening = 1.67 (1.00-2.79) | |||||
• Other = 0.93 (0.53-1.65) | |||||
• Heavy activity = 1.19 (0.73-1.92) | |||||
• Non heavy activity = 0.61 (0.38-0.99) | |||||
Highest tertile | |||||
• Total activity = 0.44 (0.25-0.80) | |||||
• Walking = 1.17 (0.70-1.96) | |||||
• Bike = 0.43 (0.23-0.80) | |||||
• Gardening = 1.03 (0.55-1.94) | |||||
• Other = 0.74 (0.44-1.23) | |||||
• Heavy activity = 0.72 (0.40-1.31) | |||||
• Non heavy activity = 0.65 (0.40-1.05) | |||||
Gregg et al 2003 [39] | To examine the relationship of changes in PA and mortality among older women. | • n = 9,518 | Baseline (1986-1988) and median 10.6 year follow-up (1992-1994) | • 2,218 deaths | Increasing and maintaining PA levels could lengthen life for older women but appears to provide less benefit for women aged at least 75 years and those with poor health status. |
• Sex: Women | PA Assessment: Questionnaire, divided into quintiles of PA (kcal/wk) | ||||
• Age: ≥ 65 yr | Multivariate adjusted HRR | ||||
USA | • Characteristics: White community dwelling participants from 4 US research centres | (95% CI): Quintiles of total | |||
Q1= <163 | PA | ||||
Prospective cohort | Q2 = 163-503 | • Q1 = 1.00 (referent) | |||
Q3 = 504-1045 | • Q2 = 0.73 (0.64-0.82) | ||||
Q4 = 1046-1906 | • Q3 = 0.77 (0.68-0.87) | ||||
D & B score = 13 | Q5 = ≥ 1907 | • Q4 = 0.62 (0.54-0.71) | |||
• Q5 = 0.68 (0.59-0.78) | |||||
Walking HRR (95% CI) | |||||
• Q1 = 1.00 (referent) | |||||
Quintiles of walking(kcal/wk) | • Q2 = 0.91 (0.81-1.02) | ||||
Q1 = <70 | • Q3 = 0.78 (0.68-0.88) | ||||
Q2 = 70-186 | • Q4 = 0.71 (0.63-0.82) | ||||
Q3 = 187-419 | • Q5 = 0.71 (0.62-0.82) | ||||
Q4 = 420-897 | |||||
Q5 = 898 | |||||
Multivariate adjusted HRR (95% CI) | |||||
Change in activity level: Sedentary at baseline | |||||
• Staying sedentary = 1.00 (referent) | |||||
• Became active = 0.52 (0.40-0.69) | |||||
Mod / high active at baseline | |||||
• Became sedentary = 0.92 (0.77-1.09) | |||||
• Stayed active = 0.68 (0.56-0.82) | |||||
Wannamethee et al 1998 [40] | To study the relationship between heart rate, PA and all- cause mortality. | • n = 5,934 | Baseline (1978-1980) and 12-14 year follow-up | • 219 deaths | Maintaining or taking up light or moderate PA reduces mortality in older men. |
• Sex: Men | |||||
• Age: Mean 63 yr | Multivariate adjusted RR (95% CI), | ||||
UK | • Characteristics: Healthy, sedentary(4,311 were considered "healthy" in 1992) | PA assessment: Questionnaire, split into groups | PA | ||
Prospective cohort | • The British Regional Heart Study | • G1 = 1.00 (referent) | |||
• G2 = 0.61 (0.43-0.86) | |||||
• G3 = 0.50 (0.31-0.79) | |||||
D & B score = 12 | PA score | • G4 = 0.65 (0.45-0.94) | |||
G1 = | |||||
Inactive/occasional | Regular walking | ||||
G2 = Light | • G1 = 1.00 (referent) | ||||
G3 = Moderate | • G2 = 1.15 (0.73-1.79) | ||||
G4 = Moderately | • G3 = 1.06 (0.75-1.50) | ||||
vigorous/Vigorous | • G4 = 0.97 (0.65-1.46) | ||||
Regular walking (min/d) | • G5 = 0.62 (0.37-1.05) | ||||
G1 = 0 | Recreational activity | ||||
G2 = <20 | • G1 = 1.00 (referent) | ||||
G3 = 21-40 | • G2 = 0.95 (0.43-1.07) | ||||
G4 = 41-60 | • G3 = 0.68 (0.43-1.07) | ||||
G5 = ≥ 60 | • G4 = 0.34 (0.35-1.00) | ||||
Recreational activity, 4 groups | Sporting activity | ||||
G1 = Inactive/fairly Inactive | • G1 = 1.00 (referent) | ||||
G2 = Average 4 hr/weekend | • G2 = 0.50 (0.25-1.03) | ||||
G3 = Fairly active >4 h/weekend | • G3 = 0.88 (0.64-1.23) | ||||
G4 = Very active | |||||
Sporting activity, 3 Groups | |||||
G1 = None | |||||
G2 = Occasional | |||||
G3 = >1 time/month | |||||
Paffenbarger et al 1986 [63] | To examine the PA and life-style characteristics of Harvard alumni for the relationship with all-cause mortality. | • n = 16,936 | 12-16 year follow-up (1962 to 1978) | • 1,413 deaths | The findings suggest a protective effect of exercise against all-cause mortality. |
• Sex: Men | Age adjusted RR (95% CI): | ||||
• Age: 35-74 | |||||
USA | • Characteristics: Harvard alumni | Records of freshman year physical examinations and records of intercollegiate sport | Those who walked | ||
Prospective cohort | • G1 = 1.00 (referent) | ||||
• G2 = 0.85 | |||||
• G3 = 0.79 | |||||
D & B score = 14 | Trend p = 0.0009 | ||||
PA assessment: Mailed questionnaires surveying post college | Physical Activity Index (95% CI): | ||||
PA | • G1 = 1.00 (referent) | ||||
• G2 = 0.78 | |||||
• G3 = 0.73 | |||||
• G4 = 0.63 | |||||
Exercise reported: Walking (miles/wk) 3 | • G5 = 0.62 | ||||
groups | • G6 = 0.52 | ||||
G1 = <3 | • G7 = 0.46 | ||||
G2 = 3-8 | • G8 = 0.62 | ||||
G3 = ≥ 9 | |||||
Trend p = <0.0001 | |||||
PA index (kcal/wk) 3 groups: | |||||
G1 = <500 | |||||
G2 = 500-999 | |||||
G3 = 1000-1499 | |||||
G4 = 1500-1999 | |||||
G5 = 2000-2499 | |||||
G6 = 2500-2999 | |||||
G7 = 3000-3499 | |||||
G8 = >3500 | |||||
Cox proportional hazard models | |||||
Schnohr et al 2007 [64] | To determine the impact of walking duration and intensity on all-cause mortality. | • n = 7,308 (3,204 male; 4,104 female) | Baseline and an average of 12 year | • 1,391 deaths | The findings indicate that the relative intensity and not duration of walking is the most important in relation to all-cause mortality. |
Denmark | • Sex: Male and female | follow-up | Multivariate adjusted HR (95% CI): | ||
• Age: 20-93 yr | PA assessment: Questionnaire, 4 durations and 3 intensities | ||||
Prospective cohort | • Characteristics: Participants with no history of CHD, stroke or cancer and who had no difficulty in walking | Men | |||
D & B score = 12 | • The Copenhagen City Heart Study | • G1 = 1.00 (referent) | |||
• G2 = 0.38 (0.25-0.58) | |||||
• G3 = 0.38 (0.18-0.79) | |||||
Duration (hours/day) | • G4 = 0.69 (0.44-1.07) | ||||
1 = <0.5 | • G5 = 0.37 (0.26-0.54) | ||||
2 = 0.5-1 | • G6 = 0.33 (0.18-0.61) | ||||
3 = 1-2 | • G7 = 0.78 (0.50-1.23) | ||||
4 = >2 | • G8 = 0.41 (0.29-0.59) | ||||
• G9 = 0.33 (0.20-0.54) | |||||
Intensity | • G10 = 0.43 (0.22-0.82) | ||||
Slow intensity (SI) | • G11 = 0.42 (0.29-0.60) | ||||
Average intensity (AI) | • G12 = 0.28 (0.16-0.48) | ||||
Fast intensity (FI) | |||||
Women | |||||
12 groups | • G1 = 1.00 (referent) | ||||
G1 = 1 and SI | • G2 = 0.82 (0.52-1.29) | ||||
G2 = 1 and AI | • G3 = 0.78 (0.27-2.21) | ||||
G3 = 1 and FI | • G4 = 1.22 (0.82-1.81) | ||||
G4 = 2 and SI | • G5 = 0.74 (0.52-1.05) | ||||
G5 = 2 and AI | • G6 = 0.56 (0.33-0.96) | ||||
G6 = 2 and FI | • G7 = 0.94 (0.60-1.47) | ||||
G7 = 3 and SI | • G8 = 0.87 (0.61-1.23) | ||||
G8 = 3 and AI | • G9 = 0.48 (0.28-0.83) | ||||
G9 = 3 and FI | • G10 = 0.88 (0.40-1.88) | ||||
G10 = 4 and SI | • G11 = 0.64 (0.44-0.95) | ||||
G11 = 4 and AI | • G12 = 0.38 (0.21-0.69) | ||||
G12 = 4 and FI | |||||
Kushi et al 1997 [65] | To evaluate the association between PA and all-cause mortality in postmenopausal women. | • n = 40,417 | 7 year follow-up | • 2,260 deaths | The results demonstrate a graded inverse association between PA and all-cause mortality in postmenopausal women. |
• Sex: Women | |||||
• Age: 55-69 yr | PA assessment: Questionnaire for frequency of moderate and vigorous LTPA | Multivariate adjusted Frequency of moderate PA per week RR (95% CI): | |||
USA | • Characteristics: Postmenopausal Iowa women | ||||
Prospective cohort | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.71 (0.63-0.79) | |||||
D & B score = 13 | Divided by frequency/week | • G3 = 0.63 (0.56-0.71) | |||
• G4 = 0.59 (0.51-0.67) | |||||
G1 = Rarely/never | Trend p = <0.001 | ||||
G2 = 1 time/week to a few times/month | |||||
Frequency of vigorous PA per week | |||||
G3 = 2-4 times/week | |||||
G4 = >4 times/week | • G1 = 1.00 (referent) | ||||
• G2 = 0.83 (0.69-0.99) | |||||
• G3 = 0.74 (0.59-0.93) | |||||
Activity index | • G4 = 0.62 (0.42-0.90) | ||||
G1 = Low | Trend p = 0.009 | ||||
G2 = Medium | |||||
G3 = High | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.77 (0.69-0.86) | |||||
• G3 = 0.68 (0.60-0.77) | |||||
Trend p = <0.001 | |||||
Paffenbarger et al 1993 [67] | To analyze changes in the lifestyles of Harvard College alumni and the association of these changes with mortality. | • n = 10,269 | Baseline (1977) and 8 year follow-up (1985) | • 476 deaths | Beginning moderately vigorous sports activity was associated with lower rates of death from all causes among middle aged and older men. |
• Sex: Men | |||||
• Age: 45-84 yr (in 1977) | Beginning moderate sports activity was associated with 23% lower risk of death (95% CI 4%-42%, p = 0.015) than those not taking up moderate activity | ||||
USA | • Characteristics: Participants with no reported life- threatening disease | PA Assessment: Questionnaire -- blocks walked daily, stairs climbed daily and type, frequency and duration of weekly sports and recreational activities | |||
Prospective cohort | |||||
D & B score = 13 | |||||
Physical activity index (kcal/wk) | |||||
Sports and recreational activities | |||||
Light <4.5 METs | |||||
Moderate >4.5 METs | |||||
Weekly lists of deaths were obtained from the Harvard college alumni office | |||||
Proportional hazard models with Poisson regression methods | |||||
Katzmarzyk and Craig 2002 [154] | To quantify the relationship between musculoskeletal fitness and all-cause mortality. | • n = 8,116 (3,933 male; 4,183 female) | Baseline (1981) and | • 238 deaths | Some components of musculoskeletal fitness are predictive of mortality. |
13 year follow-up | |||||
• Sex: Men and women | RR (95% CI) adjusted for age, smoking status, body mass and VO2max | ||||
Canada | Musculoskeletal fitness (sit ups, push ups, grip strength, sit and reach) measures divided into quartiles | ||||
• Age: 20-69 yr | Q1 = lowest | Sit ups | |||
Prospective cohort | • Characteristics: Participants who had musculoskeletal fitness measurements taken | Q2 | Men | ||
Q3 | • Q1 = 2.72 (1.56-4.64) | ||||
Q4 = highest | • Q2 = 1.32 (0.73-2.41) | ||||
D & B score = 11 | • Q3 = 1.61 (0.90-2.87) | ||||
• Q4 = 1.00 (referent) | |||||
• Canadian Fitness Survey | |||||
Cox proportional hazard ratio model | Women | ||||
• Q1 = 2.26 (1.15-4.43) | |||||
• Q2 = 2.24 (1.07-4.67) | |||||
• Q3 = 1.27 (0.59-2.72) | |||||
• Q4 = 1.00 (referent) | |||||
Push-ups | |||||
Men | |||||
• Q1 = 1.25 (0.77-2.05) | |||||
• Q2 = 1.17 (0.71-1.90) | |||||
• Q3 = 0.94 (0.55-1.62) | |||||
• Q4 = 1.00 (referent) | |||||
Women | |||||
• Q1 = 0.61 (0.32-1.17) | |||||
• Q2 = 0.81 (0.45-1.47) | |||||
• Q3 = 0.87 (0.48-1.58) | |||||
• Q4 = 1.00 (referent) | |||||
Grip strength (kg) | |||||
Men | |||||
• Q1 = 1.49 (0.86-2.59) | |||||
• Q2 = 1.42 (0.82-2.45) | |||||
• Q3 = 1.59 (0.95-2.68) | |||||
• Q4 = 1.00 (referent) | |||||
Women | |||||
• Q1 = 1.08 (0.58-1.99) | |||||
• Q2 = 0.62 (0.44-1.56) | |||||
• Q3 = 1.25 (0.70-2.23) | |||||
• Q4 = 1.00 (referent) | |||||
Sit and reach (cm) | |||||
Men | |||||
• Q1 = 1.06 (0.64-1.74) | |||||
• Q2 = 1.01 (0.61-1.66) | |||||
• Q3 = 1.20 (0.74-1.95) | |||||
• Q4 = 1.00 (referent) | |||||
Women | |||||
• Q1 = 1.18 (0.66-2.10) | |||||
• Q2 = 1.07 (0.60-1.91) | |||||
• Q3 = 0.77 (0.44-1.46) | |||||
• Q4 = 1.00 (referent) | |||||
Andersen et al 2000 [163] | To evaluate the relationship between levels of OPA, LTPA, cycling to work and sports participation and all-cause mortality. | • n = 30,640 (17,265 men; 13,375 women) | 14.5 year follow-up | • 8,549 deaths | LTPA was inversely associated with all-cause mortality in both men and women in all age groups. |
PA assessment: Questionnaire for LTPA, divided into: | Incidence of all-cause mortality and PA | ||||
Denmark | • Sex: Men and women | ||||
Prospective cohort | • Age: 20-93 years (yr) | Multivariate adjusted RR (95% CI) | |||
G1 = Low | |||||
• Characteristics: Participants of the Copenhagen City Heart Study, Glostrup Population Study and Copenhagen Male Study | G2 = Moderate | ||||
D & B score = 13 | G3 = High | Age 20-44 yr | |||
Men | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.73 (0.56-0.96) | |||||
• G3 = 0.74 (0.55-1.01) | |||||
Women | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.75 (0.54-1.04) | |||||
• G3 = 0.66 (0.42-1.05) | |||||
Age 45-64 yr | |||||
Men | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.75 (0.67-0.84) | |||||
• G3 = 0.75 (0.67-0.85) | |||||
Women | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.73 (0.65-0.83) | |||||
• G3 = 0.66 (0.56-0.77) | |||||
Age >65 yr | |||||
Men | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.62 (0.53-0.73) | |||||
• G3 = 0.60 (0.50-0.72) | |||||
Women | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.52 (0.45-0.61) | |||||
• G3 = 0.49 (0.39-0.61) | |||||
All age groups | |||||
Men | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.72 (0.66-0.78) | |||||
• G3 = 0.71 (0.65-0.78) | |||||
Women | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.65 (0.60-0.71) | |||||
• G3 = 0.59 (0.52-0.67) | |||||
Barengo et al 2004 [164] | To investigate whether moderate or high LTPA are associated with reduced CVD and all-cause mortality, independent of CVD risk factors and other forms of PA in men and women. | • n = 31,677 (15,853 men; 16,824 women) | 20 year follow-up | HRR (95% CI) | Moderate and high levels of LTPA and OPA are associated with reduced premature all-cause mortality. |
• Sex: Men and women | PA assessment: Questionnaire self administered to measure OPA, LTPA and commuting activity | LTPA | |||
Finland | • Age: 30-59 yr | • 1.00 (referent) = low | |||
• Characteristics: Participants from eastern and south-western Finland | • 0.91 (0.84-0.98) = mod, Men | ||||
Prospective cohort | |||||
• 0.79 (0.70-0.90) = high, Men | |||||
D & B score = 14 | • 0.89 (0.81-0.98) = mod, women | ||||
• 0.98 (0.83-1.16) = high, women | |||||
OPA | |||||
• 1.00 (referent) = low | |||||
• 0.75 (0.68-0.83) = mod, men | |||||
• 0.77 (0.71-0.84) = active, men | |||||
• 0.79 (0.70-0.89) = mod, women | |||||
• 0.78 (0.70-0.87) = active, women | |||||
Bath 2003 [165] | To examine differences between older men and women on the self-rated health mortality relationship. | • n = 1,042 (406 men; 636 women at baseline) | Baseline, 4 and 12 years post | Number of deaths: At 4 years 242 (106 men; 136 women) | The self-rated health-mortality relationship can be explained by health and related factors among older men and women. |
UK | • Sex: Men and women | • At 12 years 665 (287 men; 378 women) | |||
Prospective cohort | • Age: >65 yr | ||||
• Characteristics: Community-dwelling Elderly | General physical health 14-item health index (Ebrahin et al 1987) scoring from 0-14 (no health problems -- multiple health problems) |
Multivariate adjusted HR (95% CI) | |||
D & B score = 11 | |||||
• The Nottingham Longitudinal Study of Activity and Ageing | |||||
Men after 4 years | |||||
• High = 1.00 (referent) | |||||
• Med = 1.19 (0.61-2.33) | |||||
PA assessment: Self-rated health surveys, divided into 3 levels of PA: | • Low = 1.51 (0.75-3.03) | ||||
High | Women after 4 years | ||||
Medium | • High = 1.00 (referent) | ||||
Low | • Med = 1.03 (0.58-1.82) | ||||
• Low = 1.51 (0.86-2.67) | |||||
Men after 12 years | |||||
Cox proportional hazards regression Models | • High = 1.00 (referent) | ||||
• Med = 1.28 (0.94-1.74) | |||||
• Low = 1.13 (0.82-1.55) | |||||
Women after 12 years | |||||
• High = 1.00 (referent) | |||||
• Med = 1.20 (0.90-1.61) | |||||
• Low = 1.23 (0.93-1.62) | |||||
Bijnen et al 1998 [166] | To describe the association between PA and mortality (CVD, stroke, all-cause) in elderly men. | • n = 802 | 10 year follow-up | • 373 deaths | PA may protect against all- cause mortality in elderly men |
• Sex: Men | |||||
• Age: 64-84 yr | PA assessment: Questionnaire, divided into groups: | Multivariate adjusted RR (95% CI) | |||
Netherlands | • Characteristics: Retired Dutch men | ||||
• G1 = 1.00 (referent) | |||||
Prospective cohort | G1 = Lowest | • G2 = 0.80 (0.63-1.02) | |||
G2 = Middle | • G3 = 0.77 (0.59-1.00) | ||||
G3 = Highest | p = 0.04 | ||||
D & B score = 12 | |||||
Blair et al 1993 [167] | To evaluate the relationship of sedentary living habits to all-cause mortality in women. | • n = 3,120 | Baseline and 8 year follow-up | • 43 deaths | There is a graded inverse relationship between PF and all-cause mortality in women. |
• Sex: Women | |||||
• Age: Not available | Age adjusted death rates (per 10,000 person years) by fitness | ||||
USA | • Characteristics: Participants were given a preventative medicine examination | PF assessment: PF measured via maximal treadmill exercise test; | |||
Prospective | • Low Fitness = 40 | The lack of relationship between PA and death rate was believed to be due to an inadequate assessment of PA. | |||
• Mod Fitness = 16 | |||||
D & B score = 14 | • High Fitness = 7 | ||||
PA assessment: Questionnaire | |||||
No difference between levels of PA | |||||
Blair et al 1996 [168] | To review the association of PF to all-cause and CVD mortality. | • n = 32,421 (25,341 men; 7,080 women) | Baseline and average 8 year follow-up (range 0.1-19.1 years) | • 601 deaths in men | The study observed a steep inverse gradient of death rates across low, moderate and high PF levels. The association was strong and remained after adjustment for potential confounding factors. |
• 89 deaths in women | |||||
• Sex: Men and women | |||||
USA | • Age: 20-80 yr (mean 43 yr) | RR (95% CI) in low PF vs. | |||
PF assessment: Treadmill test; duration was used to assign participants to sex specific groups: | high PF | ||||
Prospective cohort | • Characteristics: Participants were excluded if they did not reach 85% of their age predicted maximal heart rate on the maximal exercise treadmill test | Men | |||
• 1.52 (1.28-1.82) | |||||
Women | |||||
D & B score = 14 | • 2.10 (1.36-3.26) | ||||
Low (least fit 20%) | Adjusted deaths per 10,000 person years according to PF | ||||
Moderate (next 40%) | |||||
High (most fit 40%) | Men | ||||
• Aerobics Center Longitudinal Study | Proportional hazard modeling | • Low = 49 | |||
• Med = 27 | |||||
• High = 23 | |||||
Women | |||||
• Low = 29 | |||||
• Med = 13 | |||||
• High = 14 | |||||
Boyle et al 2007 [169] | To examine the association between PA and the risk of incident disability, including impairment in activities of daily living and instrumental activities of daily living in community based older persons free from dementia. | • n = 1,020 | 2.6 year follow-up | • 156 deaths | The risk of death decreased 11% with each hour of PA/wk. |
• Sex: Men and women | |||||
• Age: 54-100 yr | PA assessment: Questionnaire, hr/wk of PA Incidence of all-cause mortality | HR for all-cause mortality | |||
USA | • Characteristics: Participants from 40 retirement communities across Chicago | The risk of death was 11% lower for each hr/wk of PA | |||
Prospective cohort | |||||
D & B score = 13 | • Rush Memory and Aging Project | ||||
Bucksch et al 2005 [170] | To examine the effect of moderately intense PA on all-cause mortality. | • n = 7,187 (3,742 men; 3,445 women) | Baseline (1984-1986) and 12-14 yr follow-up (1998) | • 943 deaths | Participants who achieved recommended amounts of MPA or VPA were at a significantly lower risk of death than their sedentary counterparts. |
• Sex: Men and women | RR (95% CI) for achieving recommended PA vs. not achieving recommendation | ||||
Germany | • Age: 30-69 yr | ||||
Prospective cohort | • Characteristics: Participants were healthy and physically active during leisure time | PA assessment: Questionnaire (Minnesota Leisure Time Physical Activity questionnaire) divided into groups based on: Achieving recommended amount of MPA (30 min, 5 d/wk (≥2.5 h/wk)) | |||
Women | |||||
• MPA = 0.65 (0.51-0.82) | |||||
D & B score = 13 | • VPA = 0.78 (0.57-1.08) | ||||
• MPA or VPA = 0.60 (0.47-0.75) | |||||
Men | |||||
• MPA = 0.90 (0.77-1.01) | |||||
• VPA = 0.74 (0.61-0.90) | |||||
• MPA or VPA = 0.80 (0.68-0.94) | |||||
Achieving recommended amount of VPA (20 min, 3 d/wk (≥ 1 h/wk)) | |||||
RR (95% CI) for volume of lifestyle activities (kcal/kg/wk) | |||||
Volume of lifestyle activities (kcal/kg/wk) | Women | ||||
G1 = 0 | • G1 = 1.00 (referent) | ||||
G2 = <14 | • G2 = 0.79 (0.57-1.08) | ||||
G3 = 14-33.5 | • G3 = 0.68 (0.50-0.94) | ||||
G4 = ≥ 33.5 | • G4 = 0.57 (0.41-0.79) | ||||
p < 0.001 | |||||
Men | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.98 (0.76-1.17) | |||||
• G3 = 0.80 (0.63-1.00) | |||||
• G4 = 0.91 (0.74-1.13) | |||||
p = 0.20 | |||||
Adjusted for age, other recommendation, social class, smoking, BMI, cardio risk factor index, alcohol intake, chronic disease index and dietary factors | |||||
Bucksch and Helmert 2004 [171] | To examine LTPA and premature death in the general population of former West Germany. | • n = 7,187 (3,742 men; 3,445 women) | Baseline (1984-1986) and 12-14 year follow-up (1998) | • 943 deaths | LTPA is inversely associated with all-cause mortality in men and women. |
• Sex: Men and women | RR (95% CI) | ||||
• Age: 30-69 yr | Men, LTPA | ||||
Germany | • Characteristics: Participants were selected on the basis of the German Cardiovascular Prevention Study | PA assessment: Questionnaire (Minnesota Leisure Time Physical Activity questionnaire) divided into groups based on: LTSA (h/wk) | • G1 = 1.00 (referent) | ||
• G2 = 0.85 (0.78-0.93) | |||||
Prospective cohort | • G3 = 0.64 (0.50-0.82) | ||||
• G4 = 0.70 (0.54-0.91) | |||||
p < 0.001 | |||||
D & B score = 14 | • The National Health Survey of the German Federal Institute of Population Research (1984-1998) | Men, LTPA index | |||
G1 = 0 | • G1 = 1.00 (referent) | ||||
G2 = <1 | • G2 = 0.92 (0.70-1.23) | ||||
G3 = 1-2 | • G3 = 0.89 (0.69-1.17) | ||||
G4 = >2 | • G4 = 0.61 (0.44-0.84) | ||||
p <0.01 | |||||
The LTSA-index (kcal/kg/wk) | |||||
G1 = 0 | Women, LTPA | ||||
G2 = 1-10 | • G1 = 1.00 (referent) | ||||
G3 = 10-25 | • G2 = 0.93 (0.82-1.04) | ||||
G4 = >25 | • G3 = 0.69 (0.48-0.98) | ||||
• G4 = 0.57 (0.35-0.94) | |||||
Mortality -- Records from the mandatory population registries | p < 0.01 | ||||
Women, LTPA index | |||||
• G1 = 1.00 (referent) | |||||
Cox proportional hazard regression model | • G2 = 0.68 (0.45-1.01) | ||||
• G3 = 0.79 (0.51-1.21) | |||||
• G4 = 0.46 (0.25-0.85) | |||||
p < 0.01 | |||||
Adjusted for age, social class, smoking, BMI, cardio risk factor index, alcohol intake, chronic disease index and dietary factors | |||||
Carlsson et al 2006 [172] | To investigate the association between PA and mortality in post-menopausal women. | • n = 27,734 | Baseline (1997) and 2-7 year follow-up (1999-2004) | • 1,232 deaths | The study indicates that even fairly small amounts of activity will reduce mortality in older women. |
• Sex: Women | |||||
• Age: 51-83 yr | RR (95% CI) adjusted for lifestyle and medical problems | ||||
Sweden | • Characteristics: Women who participated in a population based Screening programme in 1987 | ||||
Prospective cohort | PA assessment: Questionnaires for: METs/day, different PA (walking/biking), LTPA, OPA, household PA, TV watching and reading | ||||
PA (METs/day) | |||||
• >50 = 1.00 (referent) | |||||
D & B score = 12 | • 45-50 = 1.05 (0.77-1.42) | ||||
• The Swedish Mammography Cohort | • 40-45 s = 1.09 (0.81-1.46) | ||||
• 45-40 = 1.26 (0.94-1.70) | |||||
• <35 = 2.56 (1.85-3.53) | |||||
Mortality -- Records from the National Population Register | |||||
Different PA | |||||
Walking/biking (min/d) | |||||
• > 90 = 1.00 (referent) | |||||
• 60-90 = 1.01 (0.76-1.34) | |||||
• 40-60 = 0.92 (0.70-1.20) | |||||
• 20-40 = 0.96 (0.75-1.23) | |||||
• <20 = 1.16 (0.90-1.50) | |||||
• Almost never = 1.94 (1.51-2.50) | |||||
LTPA (hr/wk) | |||||
• >5 = 1.00 (referent) | |||||
• 4-5 = 0.95 (0.74-1.22) | |||||
• 2-3 = 1.02 (0.83-1.26) | |||||
• 1 = 1.09 (0.88-1.36) | |||||
• <1 = 1.91 (1.56-2.35) | |||||
OPA | |||||
• Heavy manual labour = 1.00 (referent) | |||||
• Walking/lifting/ a lot carrying = 0.96 (0.55-1.70) | |||||
• Walking/lifting/ not a lot carrying = 1.00 (0.60-1.68) | |||||
• Mostly standing = 0.91 (0.52-1.61) | |||||
• Seated 50% of time = 0.97 (0.58-1.62) | |||||
• Mostly sedentary = 1.93 (1.15-3.25) | |||||
Household work (hr/d) | |||||
• >8 h/d = 1.00 (referent) | |||||
• 7-8 = 0.68 (0.49-0.93) | |||||
• 5-6 = 0.66 (0.51-0.87) | |||||
• 3-4 = 0.83 (0.64-1.06) | |||||
• 1-2 = 0.89 (0.69-1.15) | |||||
• <1 = 1.73 (1.30-2.32) | |||||
Adjusted for age | |||||
Crespo et al 2002 [173] | To study the relationship between PA and obesity with all- cause mortality in Puerto Rican men. | • n = 9,136 (1962-1965) | Baseline and 12 year follow-up | • 1,445 deaths | Some PA is better than none in protecting against all-cause mortality. The benefits are independent of body weight. |
Puerto Rico | • Sex: Men | PA assessment: Questionnaire, divided into 4 groups based on METs | Multivariate OR (95% CI) adjusted for age | ||
G1 = low | |||||
G2 | |||||
G3 | |||||
G4 = high | |||||
Prospective cohort | • Age: 35-79 yr | Multivariate logistic function model | • C1 = 1.00 (referent) | ||
D & B score = 12 | • Characteristics: Participants with no known coronary heart disease | • C2 = 0.67 (0.57-0.78) | |||
• The Puerto Rico Heart Health Program | • C3 = 0.63 (0.54-0.74) | ||||
• C4 = 0.54 (0.46-0.64) | |||||
p < 0.0001 | |||||
Multivariate adjusted OR (95% CI) | |||||
• C1 = 1.00 (referent) | |||||
• C2 = 0.68 (0.58-0.79) | |||||
• C3 = 0.63 (0.54-0.75) | |||||
• C4 = 0.55 (0.46-0.65) | |||||
p < 0.0001 | |||||
Davey Smith et al 2000 [174] |
To examine the relationship of PA and various causes of death. | • n = 6,702 (at baseline) | Baseline (1969-1970) and 25 year follow-up | • 926 deaths | In the study, an inverse association of both LTPA and walking pace with mortality from all-causes was seen. |
UK | • Sex: Men | PA assessment: Questionnaire with 3 groups for walking pace (Slower, same, faster) and 3 groups for LTPA (inactive, moderately active, active) | Age adjusted RR (95% CI) for walking pace | ||
Prospective cohort | • Age: 40-64 yr | • Slower = 2.47 (2.2-2.8) | |||
D & B score = 13 | • Characteristics: Participants from rural northern Japan | • Same = 1.35 (1.2-1.5) | |||
• Whitehall study | • Faster = 1.00 (referent) p < 0.001 |
||||
Fully adjusted RR (95% CI) for walking pace | |||||
• Slower = 1.87 (1.6-2.1) | |||||
• Same = 1.21 (1.1-1.3) | |||||
• Faster = 1.00 (referent) p < 0.001 |
|||||
Age adjusted RR (95% CI) for LTPA | |||||
• Inactive = 1.44 (1.3-1.6) | |||||
• Mod = 1.13 (1.0-1.2) | |||||
• Active = 1.00 (referent) p < 0.001 |
|||||
Fully adjusted RR (95% CI) for LTPA | |||||
• Inactive = 1.20 (1.1-1.3) | |||||
• Mod = 1.07 (1.0-1.2) | |||||
• Active = 1.00 (referent) p < 0.001 |
|||||
Eaton et al 1995 [175] | To determine whether self-reported PA predicts a decreased rate of CHD and all- cause mortality in middle aged men. | • n = 8,463 | 21 year follow-up | • 2,593 deaths | Baseline levels of self- reported LTPA predicted a decreased rate of CHD and all-cause mortality. |
Europe, Israel, mid eastern Asia, Northern Africa | • Sex: Men | PA assessment: Questionnaire for LTPA | Age adjusted RR (95% CI) LTPA | ||
Prospective cohort | • Age: ≥40 yr | G1 = Sedentary | • G1 = 1.00 (referent) | ||
D & B score = 12 | • Characteristics: Government employees without known CVD | G2 = Light | • G2 = 0.84 (0.74-0.94) | ||
G3 = Light daily | • G3 = 0.81 (0.73-0.90) | ||||
G4 = Heavy | • G4 = 0.84 (0.72-0.98) | ||||
OPA | |||||
Questionnaire for OPA | • G1 = 1.00 (referent) | ||||
G1 = Sitting | • G2 = 0.99 (0.88-1.12) | ||||
G2 = Standing | • G3 = 1.09 (0.99-1.20) | ||||
G3 = Walking | • G4 = 1.16 (1.03-1.30) | ||||
G4 = Physical labour | |||||
Fang et al 2005 [176] | To assess the association of exercise and CVD outcome among persons with different blood pressure status. | • n = 9,791 (3,819 men; 5,972 women) | 17 year follow-up | Incidence of all-cause mortality and PA | A significant effect of exercise on mortality in normotensive subjects was not found. |
USA | • Sex: Men and women | PA assessment: Questionnaire with 3 groups | Multivariate adjusted HR (95% CI) | ||
Prospective cohort | • Age:25-74 yr | G1 = Least exercise | • G1 = 1.00 (referent) | ||
D & B score = 12 | • Characteristics: Non- institutionalized participants | G2 = Moderate exercise | • G2 = 0.75 (0.53-1.05) | ||
G3 = Most exercise | • G3 = 0.71 (0.45-1.12) | ||||
Fried et al 1998 [177] | To determine the disease, functional and personal characteristics that jointly predict mortality. | • n = 5,886 | 5 year follow-up | • 646 deaths | PA was a predictor of 5-year mortality. |
USA | • Sex: Men and women | PA assessment: Self reported exercise (5 groups) | Incidence of all-cause mortality and PA | ||
Prospective cohort | • Age: ≥65 yr | MPA or VPA (kJ/wk) | Multivariate adjusted RR (95% CI) | ||
D & B score = 11 | • Characteristics: Community dwelling elders | G1 = ≤282 | • G1 = 1.00 (referent) | ||
G2 = 283-1789 | • G2 = 0.78 (0.60-1.00) | ||||
G3 = 1790-4100 | • G3 = 0.81 (0.63-1.05) | ||||
G4 = 4101-7908 | • G4 = 0.72 (0.55-0.93) | ||||
G5 = >7908 | • G5 = 0.56 (0.43-0.74) p < 0.005 |
||||
Fujita et al 2004 [178] | To examine the relationship between walking duration and all-cause mortality in a Japanese cohort. | • n = 41,163 (20,004 men; 21,159 women) | Baseline (1990) and 11 year follow-up (2001) | • 1,879 deaths | Time spent walking was associated with a reduced risk for all-cause mortality. |
Japan | • Sex: Men and women | PA assessment: Questionnaire Walking, 3 levels: | Age and sex adjusted RR (95% CI) for time spent walking (hr/d) | ||
G1 = ≤30 min | |||||
G2 = 30 min to 1 hr | |||||
G3 = ≥1 hr | |||||
Prospective cohort | • Age: 40-64 yr | Cox proportional hazard model | Whole group | ||
D & B score = 13 | • Characteristics: Healthy, sedentary | • G1 = 1.22 (1.09-1.35) | |||
• G2 = 1.09 (0.95-1.22) | |||||
• G3 = 1.00 (referent) p < 0.001 |
|||||
Men only | |||||
• G1 = 1.14 (1.00-1.30) | |||||
• G2 = 1.03 (0.90-1.19) | |||||
• G3 = 1.00 (referent p = 0.061 | |||||
Women only | |||||
• G1 = 1.40 (1.16-1.68) | |||||
• G2 = 1.23 (1.01-1.49) | |||||
• G3 = 1.00 (referent) p < 0.001 |
|||||
RR (95% CI) for time spent walking (hr/d) (adjusted for age, education, marital status, past history of diseases, smoking, drinking, BMI and dietary variables) | |||||
Whole group | |||||
• G1 = 1.17 (1.04-1.31) | |||||
• G2 = 1.06 (0.93-1.20) | |||||
• G3 = 1.00 (referent) p = 0.011 |
|||||
Men | |||||
• G1 = 1.08 (0.94-1.25) | |||||
• G2 = 0.98 (0.84-1.14) | |||||
• G3 = 1.00 (referent) p = 0.318 |
|||||
Women | |||||
• G1 = 1.38 (1.12-1.70) | |||||
• G2 = 1.24 (1.00-1.54) | |||||
• G3 = 1.00 (referent) p < 0.001 |
|||||
Glass et al 1999 [179] | To examine any association between social activity, productive activity and PA and mortality in older people. | • n = 2,761 (1,169 men; 1,143 women) | 13 year follow-up | Incidence of all-cause mortality by fitness activity quartile | More active elderly people were less likely to die than those who were less active. |
USA | • Sex: Men and women | PA assessment: Interview, Amount of activity | 13 yr mortality by amount of activity | ||
Prospective cohort | • Age: ≥ 65 yr | G1 = Low | • G1 = 74.0 | ||
D & B score = 12 | • Characteristics: Healthy elders | G2 = Low-medium | • G2 = 69.8 | ||
G3 = Medium-high | • G3 = 62.4 | ||||
G4 = High | • G4 = 55.2 | ||||
Gulati et al 2003 [180] | To determine whether exercise capacity is a predictor for all-cause mortality in asymptomatic women. | • n = 5,721 | Baseline (1992) and 8 year follow-up (2000) | • 180 deaths | This study confirmed that exercise capacity is an independent predictor of death in asymptomatic women, greater than what has been previously established among men. |
USA | • Sex: Women | PF Assessment: Treadmill stress test Exercise capacity (METs) G1 = <5 G2 = 5-8 G3 = >8 |
For every 1 MET increase there was a reduced death risk of 17% (p < 0.001) | ||
Prospective cohort | • Age: Mean 52 ± 11 yr | Age-adjusted RR | |||
D & B score = 11 | • Characteristics: Asymptomatic women | • G1 = 2.0 (1.3-3.2) | |||
• St James Women Take Heart Project | • G2 = 1.6 (1.1-2.4) | ||||
• G3 = 1.00 (referent) | |||||
Adjusted for Framingham Risk Score |
|||||
• G1 = 3.1 (2.1-4.8) | |||||
• G2 = 1.9 (1.3-2.9) | |||||
• G3 = 1.00 (referent) | |||||
Haapanen et al 1996 [181] | To examine the association between LTPA and all-cause mortality. | • n = 1,072 | Baseline and a 10 yr 10 month follow-up |
• 168 deaths | Low PA is a risk factor for all-cause mortality. |
Finland | • Sex: Men | PA assessment: Self-reported LTPA, divided into 4 groups by EE (kJ/wk) G1 = 0-3349 G2 = 3350-6279 G3 = 6280-8791 G4 = >8791 |
RR (95% CI) according to EE group | ||
Prospective cohort | • Age: 35-63 yr | Mortality--National Death Index search |
• G1 = 2.74 (1.46-5.14) | ||
D & B score = 14 | • Characteristics: Healthy, sedentary | Cox proportional HR | • G2 = 1.10 (0.55-2.21) | ||
• G3 = 1.74 (0.87-3.50) | |||||
• G4 = 1.00 (referent) | |||||
Hakim et al 1998 [182] | To examine the association between walking and mortality in retired men. | • n = 707 | Baseline and 12 yr follow-up | • 208 deaths | The findings in older physically capable men indicate that regular walking is associated with a lower overall mortality rate. |
USA | • Sex: Men | RR (95% CI) according to distance walked | |||
Prospective cohort | • Age: 61-81 yr | Adjusted for age | |||
D & B score = 12 | • Characteristics: Retired non-smoking men who were physically capable of participating in low intensity activities on a daily basis | PA assessment: Questionnaire Distance walked (miles/day) | • G1 vs. G3 = 1.9 (1.3-2.9) | ||
G1 = 0.0-0.9 | • G1 vs. G3 = 1.6 (1.2-2.2) | ||||
G2 = 1.0-2.0 | • G2 vs. G3 = 1.2 (0.8-1.7) | ||||
G3 = 2.1-8.0 | Trend p = 0.002 | ||||
• Honolulu Heart Program | |||||
Adjusted for risk factors | |||||
• G1 vs. G3 = 1.8 (1.2-2.7) | |||||
• G1 vs. G2 = 1.5 (1.1-2.1) | |||||
• G2 vs. G3 = 1.1 (0.8-1.7) | |||||
Trend p = 0.01 | |||||
Hillsdon et al 2004 [183] | To examine whether VPA is associated with all-cause mortality. | • n = 10,522 (4,929 men; 5,593 women) | >10 year follow-up | • 825 deaths | Questionnaire respondents who reported engaging in VPA less than twice a week experienced a 37% reduced risk of all-cause mortality compared with respondents who reported a lower frequency of VPA. |
• Sex: Men and women | PA assessment: Questionnaire for frequency of VPA | Age and sex adjusted RR (95% CI) | |||
UK | • Age: 35-64 yr | G1 = Never, <1 time/month | |||
• Characteristics: Healthy, sedentary | G2 = <2 times/wk | • G1 = 1.00 (referent) | |||
Prospective Cohort | • OXCHECK study | G3 = >2 times/wk | • G2 = 0.57 (0.42-0.79) | ||
• G3 = 0.72 (0.54-0.95) | |||||
D & B score = 11 | Fully adjusted RR (95% CI) | ||||
• G1 = 1.00 (referent) | |||||
Mortality -- Recorded from the Office of National Statistics | • G2 = 0.63 (0.45-0.89) | ||||
• G3 = 0.81 (0.60-1.09) | |||||
Cox proportional HR | |||||
Hu et al 2005 [184] | To examine the association of PA and BMI and their combined effect with the risk of total, CVD and cancer mortality. | • n = 47,212 (22,528 men; 24,684 women) | 17.7 year follow-up | • 7,394 deaths | Regular PA is an important indicator for decreased risk of all-cause mortality. PA has a strong independent effect on mortality. |
• Sex: Men and women | |||||
Finland | • Age:25-64 yr | PA assessment: Questionnaire for PA level, divided into 3 groups | Adjusted HR (95% CI) | ||
• Characteristics: Participants from eastern Finland | Men | ||||
Prospective cohort | • G1 = 1.00 (referent) | ||||
• G2 = 0.74 (0.68-0.81) | |||||
G1 = Low | • G3 = 0.63 (0.58-0.70) | ||||
D & B score = 12 | G2 = Moderate | Trend p = <0.001 | |||
G3 = High | |||||
Women | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.64 (0.58-0.70) | |||||
• G3 = 0.58 (0.52-0.64) | |||||
Trend p = <0.001 | |||||
Hu et al 2004 [185] | To examine the association of BMI and PA with death. | • n = 116,564 | Baseline (1976) and | • 10,282 deaths | Reduced PA is a strong and independent predictor of death. |
• Sex: Women | 24 year follow-up | ||||
• Age: 30-55 yr | Multivariate RR (95% CI) by PA (hr/wk) | ||||
USA | • Characteristics: Females free of known CVD and cancer | PA assessment: Questionnaire for PA level, divided into 3 groups (hr/week) | • G1 = 1.00 (referent) | ||
G1 = ≥ 3.5 | • G2 = 1.18 (1.10-1.26) | ||||
Prospective cohort | G2 = 1.0-3.4 | • G3 = 1.52 (1.41-1.63) | |||
D & B score = 11 | G3 = <1.0 | Multivariate RR (95% CI) by PA adjusted for BMI | |||
• G1 = 1.00 (referent) | |||||
BMI (kg/m2) | • G2 = 1.14 (1.06-1.22) | ||||
G1 = <25 | • G3 = 1.44 (1.34-1.55) | ||||
G2 = 25-29 | |||||
G3 = 30 | |||||
Cox proportional HR | |||||
Kampert et al 1996 [186] | To examine PF and PA in relation to all-cause and cancer mortality. | • n = 32,421 (25,341 men; 7,080 women) | Baseline (1970) and ~8 year follow-up (1989) | • 690 deaths | The data support the hypothesis that an active and fit way of life delays death. |
• Sex: Men and women | Adjusted RR (95% CI) by quintiles of activity | ||||
USA | • Age: 20-88 yr (mean ~43) | ||||
Prospective cohort | • Characteristics: Predominantly white and from the middle and upper socioeconomic strata | PA assessment: Questionnaire, divided into quintiles of activity (min/wk) | Men | ||
• Sedentary = 1.00 (referent) | |||||
• C1-2 = 0.71 (0.58-0.97) | |||||
D & B score = 13 | • C3 = 0.83 (0.59-1.16) | ||||
Male activity categories | • C4 = 0.57 (0.30-1.08) | ||||
• C5 = 0.92 (0.29-2.88) | |||||
Sedentary = 855 | Trend p = 0.011 | ||||
C1-2 = 1,072 | |||||
C3 = 1,292 | Women | ||||
C4 = 1,453 | • Sedentary = 1.00 (referent) | ||||
C5 = 1,601 | • C1-2 = 0.68 (0.39-1.17) | ||||
• C3 = 0.39 (0.09-1.65) | |||||
Females activity categories | • C4-5 = 1.14 (0.27-4.80) | ||||
Sedentary = 605 | Trend p = 0.217 | ||||
C1-2 = 792 | |||||
C3 = 979 | |||||
C4-5 = 1,158 | |||||
Cox proportional HR | |||||
Kaplan et al 1996 [187] | To assess LTPA and its association with all cause mortality. | • n = 6,131 (3298 men; 2833 women) | 28 year follow-up | • 1,226 deaths | The data provide further support for the importance of PA and indicate that the protective effect of PA is a robust one. |
• Sex: Men and women | PA assessment: Three questions about PA, with scores 0 (never), 2 (sometimes) or 4 (often). | Incidence of all-cause mortality and PA | |||
USA | • Age: 16-94 yr | ||||
• Characteristics: Northern Californian adults | |||||
Prospective cohort | Death rates/1000 person years | ||||
Men | |||||
D & B score = 13 | • T1 = 24.68 | ||||
Tertiles of PA score | • T2 = 11.37 | ||||
T1 = 0-2 | • T3 = 7.59 | ||||
T2 = 4-6 | Women | ||||
T3 = 8-12 | • T1 = 18.03 | ||||
• T2 = 7.66 | |||||
• T3 = 3.88 | |||||
Khaw et al 2006 [188] | To examine the relationship between PA patterns over 1 year and total mortality. | • n = 22,191 (9,984 men; 12,207 women) | 8 year follow-up | • 1,553 deaths | Even very moderate levels of usual PA are associated with reductions in mortality. |
• Sex: Men and women | PA assessment: Questionnaire, divided into 4 groups of PA | Incidence of all-cause mortality and PA | |||
UK | • Age: 45-79 yr | Adjusted RR (95% CI) | |||
• Characteristics: Community living participants | All | ||||
Prospective cohort | G1 = Inactive | • G1 = 1.00 (referent) | |||
G2 = Moderately inactive | • G2 = 0.83 (0.73-0.95) | ||||
D & B score = 13 | • G3 = 0.68 (0.58-0.80) | ||||
G3 = Moderately active | • G4 = 0.68 (0.57-0.81) | ||||
G4 = Active | Age <65 | ||||
• G1 = 1.00 (referent) | |||||
• G2 = 1.01 (0.78-1.31) | |||||
• G3 = 0.81 (0.62-1.07) | |||||
• G4 = 0.82 (0.62-1.09) | |||||
Age >65 | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.77 (0.66-0.91) | |||||
• G3 = 0.65 (0.53-0.79) | |||||
• G4 = 0.64 (0.50-0.80) | |||||
Kohl et al 1996 [189] | To determine the association of maximal exercise hemodynamic responses with risk of all-cause mortality. | • n = 26,621 (20,387 men; 6,234 women) | Average 8.1 year follow-up | • 348 deaths in men and 66 in women | The results suggest an exaggerated SBP or an attenuated heart rate response to maximal exercise may indicate an elevated risk for mortality. |
• Sex: Men and women | |||||
USA | • Age: Male mean 42.2 yr; female mean 41.9 Yr | Adjusted RH (95% CI) by maximal exercise test HR | |||
Prospective cohort | Men | ||||
• Characteristics: Apparently healthy patients of a preventive medicine centre | PF assessment: Maximal exercise test HR (bpm), divided into 4 Groups: | • Q1 = 1.00 (referent) | |||
G1 = <171 | • Q2 = 0.61 (0.44-0.85) | ||||
D & B score = 12 | G2 = 171-178 | • Q3 = 0.69 (0.51-0.93) | |||
G3 = 179-188 | • Q4 = 0.60 (0.41-0.87) | ||||
G4 = >188 | Trend p<0.05 | ||||
Women | |||||
• Q1 = 1.00 (referent) | |||||
• Q2 = 1.23 (0.65-2.32) | |||||
• Q3 = 0.69 (0.30-1.63) | |||||
• Q4 = 0.71 (0.22-2.24) | |||||
Trend p>0.05 | |||||
Kujala et al 1998 [190] | To investigate LTPA and mortality in a cohort of twins. | • n = 15,902 (7,925 men; 7,977 women) | Baseline 1975 and death outcome from 1977-1994 | • 1,253 deaths | LTPA is associated with reduced mortality, even after genetic and other familial factors are taken into account. |
• Sex: Men and women | HR (95% CI) | ||||
Finland | • Age: 25-64 yr | ||||
• Characteristics: Healthy, Finnish same sex twins | PA assessment: Questionnaire, quintiles of fitness in MET hours/day | Adjusted for age and sex | |||
Prospective cohort | • Sedentary = 1.00 (referent) | ||||
• OE = 0.71 (0.62-0.81) | |||||
• The Finnish Twin Cohort | • CE = 0.57 (0.45-0.74) | ||||
D & B score = 13 | Q1 = <58 | Trend p = 0.001 | |||
Q2 = 59-1.29 | |||||
Q3 = 1.30-2.49 | Adjusted for age, sex, smoking | ||||
Q4 = 2.50-4.49 | |||||
Q5 = >4.50 | • Sedentary = 1.00 (referent) | ||||
• OE = 0.76 (0.67-0.87) | |||||
Categorized into: | • CE = 0.68 (0.53-0.88) | ||||
-Sedentary | |||||
-Occasional exerciser (OE) | Trend p = 0.001 | ||||
-Conditioning exerciser (CE) | Adjusted for age, sex, smoking, occupational group, alcohol | ||||
• Sedentary = 1.00 (referent) | |||||
• OE = 0.80 (0.69-0.91) | |||||
• CE = 0.76 (0.59-0.98) | |||||
Trend p = 0.002 | |||||
HR (95% CI) among 434 same sex twin pairs compared with sedentary category in 1975 | |||||
• Sedentary = 1.00 (referent) | |||||
• OE = 0.66 (0.46-0.94) | |||||
• CE = 0.44 (0.23-0.83) | |||||
Trend p = 0.005 | |||||
Adjusted for smoking | |||||
• Sedentary = 1.00 (referent) | |||||
• OE = 0.70 (0.48-1.01) | |||||
• CE = 0.56 (0.29-1.09) | |||||
Trend p = 0.04 | |||||
Adjusted for smoking, occupational group, alcohol | |||||
• Sedentary = 1.00 (referent) | |||||
• OE = 0.73 (0.50-1.07) | |||||
• CE = 0.56 (0.29-1.11) | |||||
Trend p = 0.06 | |||||
OR (95% CI) in quintiles among 434 same sex twin pairs compared with sedentary category in 1975 | |||||
• Q1 = 1.00 (referent) | |||||
• Q2 = 0.85 | |||||
• Q3 = 0.72 | |||||
• Q4 = 0.68 | |||||
• Q5 = 0.60 | |||||
LaCroix et al 1996 [191] | To determine whether walking is associated with a reduced risk of CVD hospitalization and death in older adults. | • n = 1,645 (615 men; 1030 women) | 4.2 year follow-up | RR (95% CI) by category of walking | Walking more than 4 hr/wk was associated with a reduced risk of mortality from all-causes. |
• Sex: Men and women | PA assessment: Questionnaire for walking h/wk, divided into 3 groups | ||||
USA | • Age: ≥65 yr | G1 = <1 hr/week | Men | ||
Characteristics: Participants from a group health co-operative | G2 = 1-4 hr/week | • G1 = 1.00 (referent) | |||
Prospective cohort | G3 = >4 hr/week | • G2 = 0.78 (0.43-1.45) | |||
• G3 = 0.89 (0.49-1.62) | |||||
D & B score = 12 | Women | ||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.50 (0.28-0.90) | |||||
• G3 = 0.48 (0.25-0.83) | |||||
Age 65-74 yr | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.81 (0.40-1.61) | |||||
• G3 = 1.13 (0.60-2.15) | |||||
Age ≥75 yr | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.63 (0.37-1.08) | |||||
• G3 = 0.46 (0.25-0.84) | |||||
High functioning | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.73 (0.38-1.41) | |||||
• G3 = 0.89 (0.48-1.65) | |||||
Limited functioning | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.60 (0.34-1.05) | |||||
• G3 = 0.51 (0.28-0.92) | |||||
Lam et al 2004 [192] | To investigate the relationship LTPA and mortality in Hong Kong. | • n = 24,079 cases (13,778 men; 10,301 women); | 10 years prior | Multivariate adjusted OR (95% CI) by LTPA | The data confirm and extend previous findings in Caucasian populations on the association between LTPA and longevity. |
PA assessment: | Men | ||||
Hong Kong | • n = 13,054 controls (3,918 men; 9,136 women) | Questionnaire for LTPA, divided into 3 groups | • G1 = 1.00 (referent) | ||
• G2 = 0.60 (0.54-0.67) | |||||
Case-Control | • G3 = 0.66 (0.60-0.73) | ||||
• Sex: Men and women | G1 = <1 times per month | ||||
D & B score = 12 | • Age: ≥35 yr | Women | |||
• Characteristics: All ethnic Chinese | G2 = 1-3 times per month | • G1 = 1.00 (referent) | |||
• G2 = 0.81 (0.74-0.88) | |||||
G3 = ≥4 times per month | • G3 = 0.71 (0.66-.077) | ||||
Lan et al 2006 [193] | To investigate the relationship between exercise and all-cause mortality. | • n = 2,113 (1,081 men; 1,032 women) | Baseline and 2 year follow-up | • 197 deaths | Older persons are recommended to expend at least 1000 kcal/wk through regular exercise for mortality reduction. |
• Sex: Men and women | HR (95% CI) by LTPA frequency | ||||
Taiwan | • Age: ≥65 yr | PA assessment: Questionnaire for LTPA (frequency/wk) | |||
Prospective cohort | • Characteristics: Non-institutionalized elders | Adjusted for age and sex | Protection of exercise against death also increases with the number of activities. | ||
G1 = Sedentary | • G1 = 1.00 (referent) | ||||
• Taiwan National Health Interview Survey | G2 = 1 time/wk | • G2 = 0.49 (0.36-0.67) | |||
D & B score = 13 | G3 = ≥2 times/wk | • G3 = 0.20 (0.09-0.46) | |||
Trend p = <0.001 | |||||
Questionnaire for EE (kcal/wk), divided into 5 groups: | Multivariate adjusted | ||||
• G1 = 1.00 (referent) | |||||
G1 = Sedentary | • G2 = 0.70 (0.50-0.98) | ||||
G2 = <500 | • G3 = 0.35 (0.15-0.82) | ||||
G3 = 500-999 | Trend p = 0.014 | ||||
G4 = 1000-1999 | |||||
G5 = ≥2000 | |||||
HR (95% CI) by EE | |||||
Adjusted for age and sex | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.64 (0.41-1.01) | |||||
• G3 = 0.55 (0.35-0.85) | |||||
• G4 = 0.30 (0.17-0.53) | |||||
• G5 = 0.24 (0.12-0.48) | |||||
Trend p <0.001 | |||||
Multivariate adjusted | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.80 (0.49-1.30) | |||||
• G3 = 0.74 (0.46-1.17) | |||||
• G4 = 0.50 (0.27-0.90) | |||||
• G5 = 0.43 (0.21-0.87) | |||||
Trend p = 0.043 | |||||
Laukkanen et al 2001 [194] | To examine the relationship between maximal oxygen uptake and overall mortality. | • n = 1,294 | Baseline and 10.7 year follow-up | • 124 deaths | PF has a strong, graded, inverse association with overall mortality. |
• Sex: Men | Adjusted RR (95% CI) by quartile | ||||
Finland | • Age: 42.0-61.3 yr (mean 52.1) | ||||
• Characteristics: Men free from CVD, COPD, and cancer at baseline | PF assessment: Exercise tolerance test, 4 groups by maximal oxygen uptake (ml/kg/min) | ||||
Prospective cohort | Maximal oxygen uptake | ||||
• G1 = 1.00 (referent) | |||||
• G2 = 1.47 (0.71-3.01) | |||||
D & B score = 14 | • G3 = 2.79 (1.44-5.39) | ||||
G1 = >37.1 | • G4 = 3.85 (2.02-7.32) | ||||
G2 = 32.3-37.1 | Linear trend p = <0.001 | ||||
G3 = 27.6-32.2 | |||||
G4 = <27.6 | Test duration | ||||
• G1 = 1.00 (referent) | |||||
Test duration (min) | • G2 = 2.22 (1.08-4.55) | ||||
G1 = >11.2 | • G3 = 2.23 (1.11-4.49) | ||||
G2 = 9.6-11.2 | • G4 = 3.94 (2.01-7.74) | ||||
G3 = 8.2-9.5 | Linear trend p<0.001 | ||||
G4 = <8.2 | |||||
Lee and Paffenbarger 2000 [195] | To compare various levels of PA with mortality. | • n = 13,485 | Baseline and 15 year follow-up | • 2,539 deaths | The study provides some support for recommendations that emphasize MPA. A benefit of VPA is also evident. |
• Sex: Men | |||||
• Age: Mean 57.5 yr | RR (95% CI) | ||||
• Characteristics: Men who matriculated as undergraduates in 1916-1950 | PA assessment: | • G1 = 1.00 (referent) | |||
USA | Questionnaires for LTPA index (including walking, stair climbing, sports and recreational activity), | • G2 = 0.80 (0.72-0.88) | |||
• G3 = 0.74 (0.65-0.83) | |||||
Prospective cohort | • G4 = 0.80 (0.69-0.93) | ||||
• The Harvard Alumni Health Study | • G5 = 0.73 (0.64-0.84) | ||||
Trend p = <0.001 | |||||
D & B score = 12 | 5 groups (kJ/wk) | ||||
G1 = <4200 | |||||
G2 = 4200-8399 | |||||
G3 = 8400-12599 | |||||
G4 = 12600-16799 | |||||
G5 = ≥ 16800 | |||||
Lee et al 1995 [196] | To examine the independent association of vigorous and non-vigorous PA with longevity. | • n = 17,321 | Follow-up 22-26 years | • 3,728 deaths | There is a graded inverse relationship between PA and mortality. Vigorous, but not non-vigorous activities are associated with longevity. |
• Sex: Men | |||||
• Age: Mean 46 yr | PA assessment: Questionnaires for EE (kJ/wk), quintiles | RR (95% CI) by EE (kJ/wk) | |||
USA | • Characteristics: Harvard University alumni, without self-reported physician diagnosed cardiovascular disease, cancer or chronic obstructive pulmonary disease | Q1= 1.00 (referent) | |||
• Q2 = 0.94 (0.86--1.04) | |||||
Prospective cohort | Q1 = ≤ 630 | • Q3 = 0.95 (0.86--1.05) | |||
Q2 = 630-1680 | • Q4 = 0.91 (0.83 - 1.01) | ||||
Q3 = 1680-3150 | • Q5 = 0.91 (0.82-1.00) | ||||
D & B score = 12 | Q4 = 3150-6300 | ||||
Q5 = >6300 | RR (95% CI) by EE (Vigorous activity, kJ/wk) | ||||
• Q1 = 1.00 (referent) | |||||
• The Harvard Alumni Health Study | • Q2 = 0.88 (0.82-0.96) | ||||
• Q3 = 0.92 (0.82-1.02) | |||||
• Q4 = 0.87 (0.77-0.99) | |||||
• Q5 = 0.87 (0.78-0.97) | |||||
Lee et al 2004 [197] | To investigate the effect of various PA patterns on all-cause mortality. | • n = 8,421 | Baseline 1988 and follow-up 1993 | • 1,234 deaths | The results suggest that regular PA generating 1000 kcal/wk or more should be recommended for lowering mortality rates. Among those with no major risk factors, even 1-2 episodes per week generating 1000 kcal or more can postpone mortality. |
• Sex: Men | |||||
• Age: Mean 66 yr | Age adjusted RR (95% CI) by PA pattern | ||||
USA | • Characteristics: Participants free of major chronic disease | PA assessment: Questionnaire for PA (kcal/wk), 4 groups | |||
• G1 = 1.00 (referent) | |||||
Prospective cohort | • G2 = 0.75 (0.63-0.90) | ||||
G1 = <500 | • G3 = 0.82 (0.63-1.07) | ||||
• The Harvard Alumni Health Study | (Sedentary) | • G4 = 0.61 (0.53-0.69) | |||
D & B score = 11 | G2 = 500-999 | ||||
(Insufficiently active) | Multivariate adjusted | ||||
G3 = ≥ 1000 | |||||
(Weekend warrior) | • G1 = 1.00 (referent) | ||||
G4 = Regularly active | • G2 = 0.75 (0.62-0.91) | ||||
• G3 = 0.85 (0.65-1.11) | |||||
• G4 = 0.64 (0.55-0.73) | |||||
Leitzmann et al 2007 [198] | To examine PA guidelines in relation to mortality. | • n = 252,925 (142,828 male; 110,097 women) | Baseline and 6 month follow-up | • 7,900 deaths | Following PA guidelines is associated with lower risk of death. Mortality benefit may also be achieved by engaging in less than recommended activity levels. |
USA | • Sex: Men and women | PA assessment: Questionnaire for MPA and VPA, 5 groups each MPA (h/wk) | Multivariate adjusted RR (95% CI) according to activity | ||
• Age: 50-71 yr | MPA | ||||
Prospective cohort | • Characteristics: Participants free of CVD, cancer or emphysema | • G1 = 1.00 (referent) | |||
• The National Institute of Health-American Association of Retired Persons | • G2 = 0.85 (0.79-0.93) | ||||
• G3 = 0.79 (0.74-0.85) | |||||
D & B score = 13 | G1 = sedentary | • G4 = 0.76 (0.71-0.82) | |||
G2 = <1 | • G5 = 0.68 (0.63-0.74) | ||||
G3 = 1-3 | Trend p = <0.001 | ||||
G4 = 4-7 | VPA | ||||
G5 = >7 | |||||
VPA (frequency/wk) | • G1 = 1.00 (referent) | ||||
G1 = inactive | • G2 = 0.77(0.71-0.83) | ||||
G2 = <1 | • G3 = 0.77 (0.72-0.82) | ||||
G3 = 1-2 | • G4 = 0.68 (0.63-0.73) | ||||
G4 = 3-4 | • G5 = 0.71 (0.66-0.77) | ||||
G5 = ≥ 5 | Trend p = <0.001 | ||||
Cox proportional HR | |||||
Leon et al 1997 [199] | To examine the long-term association of LTPA and risk of death from coronary heart disease and all-causes. | • n = 12,138 | 16 year follow-up | • 1,904 deaths | The data suggest that a relatively small amount of daily moderate intensity LTPA can reduce premature mortality in middle-aged and older men at high risk for CHD. |
• Sex: Men | |||||
• Age: 35-57 yr | PA assessment: Minnesota LTPA questionnaire, categorized by frequency/month and average duration, deciles (min/d) | Multivariate adjusted RR (95% CI) by deciles of LTPA | |||
USA | • Characteristics: Men who at entry to the study were free of clinical evidence of CHD or other serious medical problems but were at the upper 10%-15% of a CHD probability score distribution derived from the FHS data | ||||
Prospective cohort | • D1 = 1.00 (referent) | ||||
• D2-4 = 0.85 (0.73-0.99) | |||||
• D5-7 = 0.87 (0.75-1.02) | |||||
D & B score = 12 | • D8-10 = 0.83 (0.71-0.97) | ||||
D1 = 4.9 | |||||
D2-4 = 22.7 | |||||
D5-7 = 53.9 | |||||
D8-10 = 140.4 | |||||
• Multiple Risk Factor Intervention Trial | Cox proportional HR | ||||
Lissner et al 1996 [200] | To examine the relationship of OPA and LTPA on all-cause mortality in women. | • n = 1,405 | Baseline and 20 year follow-up | • 277 deaths | Decreases in PA as well as low initial levels are strong risk factors for mortality. |
• Sex: Women | |||||
• Age: 38-60 yr | RR (95% CI) by LTPA | ||||
Sweden | • Characteristics: Free from major disease at baseline | PA assessment: Questionnaire for OPA and LTPA, 3 groups | |||
20 year follow-up | |||||
Prospective cohort | LTPA during age 20-38 years | ||||
• The Gothenburg Prospective Study of Women | • Low = 1.00 (referent) | ||||
G1 = Low | • Med = 0.66 (0.34-1.26) | ||||
D & B score = 10 | G2 = Medium | • High = 0.46 (0.21-1.01) | |||
G3 = High | |||||
LTPA during age 39-60 years | |||||
Proportional hazard regression | • Low = 1.00 (referent) | ||||
• Med = 0.56 (0.35-0.90) | |||||
• High = 0.44 (0.22-0.91) | |||||
LTPA during the past 12 months | |||||
• Low = 1.00 (referent) | |||||
• Med = 0.56 (0.39-0.82) | |||||
• High = 0.45 (0.24-0.86) | |||||
20 year follow-up | |||||
OPA during age 20-38 years | |||||
• Low = 1.00 (referent) | |||||
• Med = 0.59 (0.18-1.87) | |||||
• High = 0.50 (0.16-1.58) | |||||
OPA during age 39-60 years | |||||
• Low = 1.00 (referent) | |||||
• Med = 0.66 (0.21-2.08) | |||||
• High = 0.47 (0.14-1.52) | |||||
OPA during the past 12 months | |||||
• Low = 1.00 (referent) | |||||
• Med = 0.28 (0.17-0.46) | |||||
• High = 0.24 (0.14-0.43) | |||||
Manini et al 2006 [201] | To determine whether energy expenditure is associated with all-cause mortality in older adults. | • n = 302 (150 men; 152 women) | Mean follow-up of 6.15 years | • 55 deaths | Free-living activity EE was strongly associated with lower risk of mortality. |
• Sex: Men and women | HR (95% CI) by tertiles of PA EE | ||||
USA | • Age: 70-82 yr | PA assessment: Questionnaire, divided into tertiles of PA EE (kcal/d) | |||
Prospective cohort | • Characteristics: High-functioning community dwelling elders | Adjusted for age, sex, race and study site | |||
T1 = <521 | • T1 = 1.00 (referent) | ||||
D & B score = 13 | T2 = 521-770 | • T2 = 0.63 (0.29-1.18) | |||
T3 = >770 | • T3 = 0.37 (0.15-0.76) | ||||
Trend p = 0.009 | |||||
Adjusted for age, sex, race, study site, weight, height, percent body fat and sleep duration | |||||
• T1 = 1.00 (referent) | |||||
• T2 = 0.57 (0.30-1.09) | |||||
• T3 = 0.31 (0.14-0.69) | |||||
Trend p = 0.004 | |||||
Adjusted for age, sex, race, study site, self rated health, education, smoking, CVD, lung disease, diabetes, hip or knee osteoarthritis, osteoporosis, cancer and depression | |||||
• T1 = 1.00 (referent) | |||||
• T2 = 0.65 (0.33-1.28) | |||||
• T3 = 0.33 (0.15-0.74) | |||||
Trend p = 0.007 | |||||
Matthews et al 2007 [202] | To determine the effects of exercise and non-exercise PA on mortality. | • n = 67,143 | Baseline and an average of 5.7 year follow-up | • 1,091 deaths | Overall PA levels are an important determinant of longevity. |
• Sex: Women | |||||
• Age: 40-70 yr | RR (95% CI) | ||||
China | • Characteristics: Women without heart disease, stroke or cancer | ||||
PA assessment: Interview to report (MET h/d), 4 groups Overall activity | Multivariate adjustment | ||||
Prospective cohort | Overall activity (MET hr/d) | ||||
• G1 = 1.00 (referent) | |||||
• The Shanghai Women's Health Study | • G2 = 0.81 (0.69-0.96) | ||||
D & B score = 12 | G1 = ≤ 9.9 | • G3 = 0.67 (0.57-0.80) | |||
G2 = 10.0-13.6 | • G4 = 0.61 (0.51-0.73) | ||||
G3 = 13.7-18.0 | Trend p = 0.000 | ||||
G4 = ≥ 18.1 | |||||
Adult exercise (MET hr/d) | |||||
Adult exercise | • G1 = 1.00 (referent) | ||||
G1 = 0 | • G2 = 0.84 (0.74-0.96) | ||||
G2 = 0.1-3.4 | • G3 = 0.77 (0.59-0.99) | ||||
G3 = 3.5-7.0 | • G4 = 0.64 (0.36-1.14) | ||||
G4 = ≥ 7.1 | Trend p = 0.008 | ||||
Cox proportional hazard models | |||||
Menotti and Seccareccia 1985 [203] | To investigate the relationship between OPA and all-cause mortality. | • n = 99,029 | Baseline and 5 year follow-up | • 2,661 deaths | The results suggest that PA may play a role in the prediction of fatal events. |
• Sex: Men | |||||
• Age: 40-59 yr | |||||
• Characteristics: Men employed on the Italian railway system | PA assessment: Questionnaire Men at risk classified by 3 levels of PA and 3 levels of job responsibility, combined to create 8 groups of PA-job responsibility | Age adjusted death rates per 1000 over 5 years classified by PA only | |||
Italy | • Sedentary = 26.20 | ||||
Prospective cohort | • Moderate = 27.05 | ||||
• Heavy = 27.35 | |||||
D & B score = 12 | Age adjusted death rates per 1,000 over 5 years classified by PA and job responsibility | ||||
G1 = sedentary -- low | • G1 = 30.00 | ||||
G2 = sedentary -- med | • G2 = 25.20 | ||||
G3 = sedentary -- high | • G3 = 25.80 | ||||
G4 = moderate -- low | • G4 = 26.30 | ||||
G5 = moderate -- med | • G5 = 28.50 | ||||
G6 = moderate -- high | • G6 = 25.80 | ||||
G7 = heavy -- low | • G7 = 26.90 | ||||
G8 = heavy -- med | • G8 = 30.80 | ||||
Mensink et al 1996 [204] | To compare various indices for PA and their association with cardiovascular risk factors as well as total and CVD mortality. | • n = 15,436 (7,689 men; 7797 women) | 5-8 year follow-up | Incidence of all-cause mortality and PA | An inverse relation of PA and total mortality. |
Germany | • Sex: Men and women | PA assessment: Questionnaire Total activity, 3 groups | Adjusted RR (95% CI) | ||
• Age: 25-69 yr | |||||
Prospective cohort | • Characteristics: Participants from communities in Western Germany | Total activity, men | |||
G1 = Low | • G1 = 1.00 (referent) | ||||
G2 = Moderate | • G2 = 0.56 (0.30-1.04) | ||||
D & B score = 12 | G3 = High | • G3 = 0.78 (0.42-1.44) | |||
Total activity, women | |||||
LTPA, 3 groups | • G1 = 1.00 (referent) | ||||
G1 = Low | • G2 = 1.24 (0.60-2.58) | ||||
G2 = Moderate | • G3 = 1.29 (0.58-2.85) | ||||
G3 = High | |||||
Conditioning activity, 3 groups | LTPA, men | ||||
• G1 = 1.00 (referent) | |||||
G1 = No activity | • G2 = 0.61 (0.35-1.05) | ||||
G2 = Moderate | • G3 = 0.79 (0.48-1.31) | ||||
G3 = High | LTPA, women | ||||
• G1 = 1.00 (referent) | |||||
Sports activity, 4 groups | • G2 = 0.94 (0.51-1.75) | ||||
• G3 = 0.81 (0.44-1.49) | |||||
G1 = no sports | |||||
G2 = <1 hour | Conditioning activity, men | ||||
G3 = 1-2 hours | • G1 = 1.00 (referent) | ||||
G4 = >2 hours | • G2 = 0.76 (0.44-1.34) | ||||
• G3 = 0.67 (0.36-1.25) | |||||
Conditioning activity, women | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.38 (0.13-1.06) | |||||
• G3 = 0.80 (0.42-1.54) | |||||
Sports Activity, men | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.49 (0.26-0.95) | |||||
• G3 = 0.57 (0.30-1.09) | |||||
• G4 = 0.36 (0.16-0.79) | |||||
Sports activity, women | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.38 (0.12-1.23) | |||||
• G3 = 0.52 (0.23-1.17) | |||||
• G4 = 0.28 (0.07-1.17) | |||||
Morgan and Clarke 1997 [205] | To assess the value of broadly based customary PA scores in predicting 10-year mortality in elderly people. | • n = 1,042 (407 men; 635 women) | 10 year follow-up | Incidence of all-cause mortality and PA | A wide range of customary or habitual PA, can provide indices showing both cross sectional and predictive validity for 10 year mortality. |
• Sex: Men and women | PA assessment: Questionnaire for PA, 3 groups | ||||
UK | • Age: ≥65 yr | HR (95% CI) | |||
• Characteristics: British elders | Men | ||||
Prospective cohort | G1 = Low | • G1 = 1.59 (1.12-2.25) | |||
• Nottingham Longitudinal Study of Activity and Aging | G2 = Intermediate | • G2 = 1.35 (0.96-1.89) | |||
G3 = High | • G3 = 1.00 (referent) | ||||
D & B score = 12 | Women | ||||
• G1 = 2.07 (1.53-2.79) | |||||
• G2 = 1.53 (1.12-2.09) | |||||
• G3 = 1.00 (referent) | |||||
Myers et al 2002 [206] | To compare PF and PA levels with all-cause mortality. | • n = 6,213 | Baseline and mean 6.2 ± 3.7 year follow-up | • 1,256 deaths | Exercise capacity is a more powerful predictor of mortality among men than other established risk factors for CVD. |
• Sex: Men | |||||
• Age: Mean 59 ± 11 yr | Age adjusted RR (95% CI) by quintile | ||||
USA | • Characteristics: Participants with a normal exercise test result (n = 2,534) and participants with an abnormal exercise test or CVD or both (n = 3,679) | ||||
PF assessment: Treadmill test for VO2 peak, divided into quintiles (METs) | • Q1 = 4.5 (3.0-6.8) | ||||
Prospective cohort | • Q2 = 2.4 (1.5-3.8) | ||||
• Q3 = 1.7 (1.1-2.8) | |||||
• Q4 = 1.3 (0.7-2.2) | |||||
D & B score = 12 | Q1 = Lowest level | • Q5 = 1.00 (referent) | |||
1.0-5.9 | |||||
Q2 | |||||
Q3 | |||||
Q4 | |||||
Q5 = Highest level | |||||
≥13.0 | |||||
Ostbye et al 2002 [207] | To analyze the effect of smoking and other modifiable risk factors on ill health, defined in a multidimensional fashion. | • n = 12,956 | 6 year follow-up | • 782 deaths | Quitting smoking and increasing exercise levels are the lifestyle interventions most likely to improve overall health. |
• Sex: Men and women | |||||
• Age: 50-60 yr | PA assessment: Questionnaire for PA, 4 groups | Incidence of all-cause mortality and PA | |||
USA | • Characteristics: Participants from the Health and Retirement Study (HRS) only | ||||
Prospective cohort | G1 = Sedentary | Death rates (95% CI) per 1000 population/yr | |||
G2 = Light | |||||
G3 = Moderate | • G1 = 20.6 (17.8-24.0) | ||||
D & B score = 13 | G4 = Heavy | • G2 = 9.1 (8.1-9.5) | |||
• G3 = 8.3 (7.5-9.2) | |||||
• G4 = 4.4 (3.5-5.6) | |||||
Paffenbarger et al 1994 [208] | To study the adoption or maintenance of PA and other optional lifestyle patterns for their influence on mortality rates of Harvard College alumni. | • n = 14,786 | Follow-up between | • 2,343 deaths | Adopting a physically active lifeway delays mortality and extends longevity. |
• Sex: Men | 1977 and 1988 | ||||
• Age: 45-84 yr (in 1977) | RR (95% CI) of mortality according to PA | ||||
USA | PA assessment: Questionnaire for blocks walked daily, stairs climbed daily and type, frequency and duration of weekly sports and recreational activities | ||||
Characteristics: Harvard College alumni | |||||
Prospective cohort | Physical activity index (kcal/wk) | ||||
• G1 = 1.00 (referent) | |||||
D & B score = 14 | • G2 = 1.13 (1.01-1.26) | ||||
• G3 = 0.72 (0.64-0.82) | |||||
• G4 = 0.77 (0.69-0.85) | |||||
Physical activity index (kcal/wk) Sports and recreational activities were scored according to intensity and duration | Walking (km/wk) | ||||
• G1 = 1.00 (referent) | |||||
• G2 = 1.21 (1.08-1.35) | |||||
• G3 = 0.94 (0.83-1.07) | |||||
• G4 = 0.89 (0.78-1.01) | |||||
Moderately vigorous sports play (METs) | |||||
Light < 4.5 METs | |||||
Moderate ≥ 4.5 METs | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 1.11 (0.93-1.33) | |||||
• G3 = 0.73 (0.65-0.81) | |||||
• G4 = 0.72 (0.64-0.80) | |||||
Adjusted for potential confounding influences | |||||
Richardson et al 2004 [209] | To investigate the impact of a sedentary lifestyle on all-cause mortality. | • n = 9,611 (4,642 men; 4,969 women) | Baseline (1992) and 8 year follow-up | • 810 deaths | A sedentary lifestyle is associated with a higher risk of death in pre- retirement aged adults. |
• Sex: Men and women | OR (95% CI) | ||||
USA | • Age: 51-61 yr | PA assessment: Questionnaire for PA, 3 groups: | • G1 = 1.00 (referent) | ||
Prospective cohort | • Characteristics: Participants born between 1931-1941 and who not institutionalized in 1992 | • G2 = 0.64 (0.52-0.81) | |||
G1 = Sedentary | • G3 = 0.62 (0.44-0.85) | ||||
G2 = occasional or light | p = 0.01 | ||||
D & B score = 13 | G3 = Regular MVPA | ||||
• Health and Retirement Study | |||||
Rockhill et al 2001 [210] | To determine the association between recreational PA and mortality in women. | • n = 80,348 | Baseline (1980) and follow-up between 1982-1996 | • 4,871 deaths | People who are more physically active are at reduced mortality risk relative to those who are less active. |
• Sex: Women | |||||
• Age: 30-55 yr | Multivariate adjusted RR (95% CI) by (hr/wk) | ||||
USA | • Characteristics: Free from CVD or cancer at baseline | ||||
• Nurses Health Study | PA assessment: Questionnaire in 1980 and up-dated every 2- 4 years, 5 groups of PA (hr/wk) | • G1 = 1.00 (referent) | |||
Prospective cohort | • G2 = 0.82 (0.76-0.89) | ||||
• G3 = 0.75 (0.69-0.81) | |||||
• G4 = 0.74 (0.68-0.81) | |||||
D & B score = 11 | • G5 = 0.71 (0.61-0.82) | ||||
p<0.001 | |||||
G1 = <1 | |||||
G2 = 1-1.9 | |||||
G3 = 2-3.9 | |||||
G4 = 4-6.9 | |||||
G5 = ≥7 | |||||
Rosengren and Wilhelmsen 1997 [211] | To investigate the effect of OPA and LTPA on risk of death. | • n = 7,142 | Baseline (1970-1973) and 20 year follow-up | • 2,182 deaths | The study demonstrates the protective effect of LTPA on mortality. |
• Sex: Men | |||||
• Age: 47-55 yr | Unadjusted RR (95% CI) | ||||
• Characteristics: Without symptomatic CHD | PA assessment: Postal questionnaires, 3 groups: | • G1 = 1.00 (referent) | |||
Sweden | • G2 = 0.74 (0.68-0.82) | ||||
• G3 = 0.73 (0.68-0.79) | |||||
Prospective cohort | G1 = Sedentary | ||||
G2 = Moderately active | Multivariate adjustment | ||||
G3 = Regular exercise | • G1 = 1.00 (referent) | ||||
D & B score = 13 | • G2 = 0.84 (0.77-0.93) | ||||
• G3 = 0.83 (0.77-0.90) | |||||
Schnohr et al 2003 [212] | To assess the associations of regular LTPA and changes in LTPA with risk of death. | • n = 7,023 (4,471 men; 5,676 women) | 18 year follow-up | • 2,725 deaths | Maintaining or adopting a moderate or high degree of PA was associated with lower risk of death. |
• Sex: Men and women | PA assessment: Questionnaire, 9 groups | Incidence of all-cause mortality and PA and changes in PA | |||
Denmark | • Age: 20-79 yr | ||||
• Characteristics: Participants from the Copenhagen City Heart Registered Population | |||||
Prospective cohort | G1 = Low--low | ||||
G2 = Low--moderate | Adjusted RR (95% CI) | ||||
G3 = Low--high | Men | ||||
D & B score = 12 | G4 = Moderate- low | • G1 = 1.00 (referent) | |||
G5 = Moderate-Moderate | • G2 = 0.64 (0.49-0.83) | ||||
• G3 = 0.64 (0.47-0.87) | |||||
G6 = Moderate-high | • G4 = 0.73 (0.56-0.96) | ||||
G7 = High-low | • G5 = 0.71 (0.57-0.88) | ||||
G8 = High-moderate | • G6 = 0.64 (0.51-0.81) | ||||
G9 = High-high | • G7 = 1.11 (0.76-1.62) | ||||
• G8 = 0.66 (0.51-0.85) | |||||
• G9 = 0.61 (0.48-0.76) | |||||
Women | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.75 (0.57-0.97) | |||||
• G3 = 0.72 (0.50-1.05) | |||||
• G4 = 0.70 (0.54-0.91) | |||||
• G5 = 0.64 (0.52-0.79) | |||||
• G6 = 0.58 (0.45-0.73) | |||||
• G7 = 0.72 (0.48-1.07) | |||||
• G8 = 0.61 (0.47-0.80) | |||||
• G9 = 0.66 (0.51-0.85) | |||||
Schnohr et al 2004 [213] | To examine whether the relationship between established risk factors and mortality differs with socioeconomic status as measured by level of education. | • n = 30,635 (16,236 men; 14,399 women) | 16 year follow-up | • 10,952 deaths | The study shows the strong predictive effect of PA on mortality is independent of education level. |
• Sex: Men and women | Socioeconomic status assessment: level of education | Incidence of all-cause mortality and PA stratified by years of education | |||
Denmark | • Age: 20-93 yr | ||||
• Characteristics: Participants from the Copenhagen City Heart Registered Population | |||||
Prospective cohort | PA assessment: Questionnaire | Deaths <8 years of education | |||
D & B score = 12 | Men | ||||
4 groups of PA | G1 = 916 | ||||
G1 = none or very little | G2 = 1693 | ||||
G2 = 2-4 h/wk of LPA | G3 = 1012 | ||||
G3 = >4 h/wk of LPA or 2-4 h/wk of high level activity | G4 = 67 | ||||
G4 = Competition level or >4 h/wk of hard level activity | Women | ||||
• G1 = 872 | |||||
• G2 = 1298 | |||||
• G3 = 346 | |||||
• G4 = 10 | |||||
8-11 years of education | |||||
Men | |||||
• G1 = 432 | |||||
• G2 = 1040 | |||||
• G3 = 616 | |||||
• G4 = 33 | |||||
Women | |||||
• G1 = 363 | |||||
• G2 = 852 | |||||
• G3 = 268 | |||||
• G4 = 10 | |||||
>11 years of education | |||||
Men | |||||
• G1 = 104 | |||||
• G2 = 302 | |||||
• G3 = 182 | |||||
• G4 = 11 | |||||
Women | |||||
• G1 = 48 | |||||
• G2 = 129 | |||||
• G3 = 61 | |||||
• G4 = 3 | |||||
Schnohr et al 2006 [214] | To investigate the association between LTPA and mortality. | • n = 4,894 (2,136 men; 2,758 women) | Baseline (1976) and start of follow-up in 1981-1983 (to 2000) | • 1,787 deaths | Long-term moderate or high PA was associated with significantly lower mortality in men and women. |
• Sex: Men and women | RR (95% CI) | ||||
Denmark | • Age: 20-79 yr | ||||
• Characteristics: Healthy males and women | Unadjusted | ||||
Prospective cohort | PA assessment: Survey for LTPA, 3 groups: | • G1 = 1.00 (referent) | |||
• G2 = 0.64 (0.56-0.73) | |||||
• The Copenhagen City Heart Study | • G3 = 0.56 (0.48-0.65) | ||||
D & B score = 13 | G1 = Low | Trend p < 0.001 | |||
G2 = Mod | |||||
G3 = High | Multivariate adjustment | ||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.78 (0.68-0.89) | |||||
• G3 = 0.75 (0.64-0.87) | |||||
Trend p = 0.001 | |||||
Schooling et al 2006 [215] | To examine how a Comprehensive assessment of baseline health status affects the relationship between obesity or PA and mortality. | • n = 54,088 (17,849 men; 36,239 women) | 4.1 year follow-up | • 3,819 deaths | PA, which normally has a negative relationship with adiposity, had the largest impact on survival for the health states, with the strongest inverse relationship between BMI and mortality. |
• Sex: Men and women | PA assessment: Interview for PA min/d, 3 groups | Incidence of all-cause mortality and PA | |||
Hong Kong | • Age: ≥ 65 yr | ||||
Prospective cohort | • Characteristics: Chinese elders | G1 = None | Adjusted HR (95% CI) | ||
G2 = ≤ 30 min/d | • G1 = 1.00 (referent) | ||||
G3 = ≥ 30 min/d | • G2 = 0.83 (0.76-0.91) | ||||
D & B score = 13 | • G3 = 0.73 (0.67-0.80) | ||||
Trend p<0.001 | |||||
Sundquist et al 2004 [216] | To study the association between varying levels of PA and all-cause mortality in the elderly. | • n = 3,206 (1,414 men; 1,792 women) | Baseline (1988-1989) and follow-up in 2000 | • 1,806 deaths | Even occasional PA decreases the risk of mortality among elderly people. |
• Sex: Men and women | PA assessment: Questionnaire for PA, 5 groups | Age-adjusted HR (95% CI) | |||
Sweden | • Age: ≥65 yr | Men | |||
• Characteristics: Non-institutionalized elders | • G1 = 1.00 (referent) | ||||
Prospective cohort | • G2 = 0.74 (0.62-0.87) | ||||
G1 = none | • G3 = 0.57 (0.44-0.73) | ||||
The Swedish Annual Level-of-Living Survey (Statistics Sweden) | G2 = occasionally | • G4 = 0.51 (0.41-0.64) | |||
D & B score = 12 | G3 = once per week | • G5 = 0.60 (0.44-0.82) | |||
G4 = twice per week | Women | ||||
G5 = vigorously at least twice per week | • G1 = 1.00 (referent) | ||||
• G2 = 0.70 (0.59-0.82) | |||||
• G3 = 0.59 (0.46-0.77) | |||||
Cox proportional HR | • G4 = 0.47 (0.35-0.62) | ||||
• G5 = 0.54 (0.31-0.94) | |||||
Men and women | |||||
Multivariate adjustment | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.72 (0.64-0.81) | |||||
• G3 = 0.60 (0.50-0.71) | |||||
• G4 = 0.50 (0.42-0.59) | |||||
• G5 = 0.60 (0.46-0.79) | |||||
Talbot et al 2007 [217] | To investigate how changes in LTPA affect all-cause mortality. | • n = 2,092 (1,316 men; 776 women) | Baseline in 1958 for males and in 1978 for females and an average follow-up of 21.2 ± 9.4 years for men and 10.2 ± 5.6 years for women | • 628 deaths (538 male; 90 female) | Greater declines in total and high-intensity LTPA are independent predictors of all-cause mortality. |
• Sex: Men and women | |||||
USA | • Age: 19-<90 yr | RR (95% CI) for standard deviation of rate of change in LTPA | |||
Prospective cohort | • Characteristics: Community residents, generally with above average income, high education and with good or excellent self related health | (If RR is <1 then a SD increase is associated with decrease mortality. If RR is >1, then a SD increase is associated with increase in mortality) | |||
D & B score = 13 | PA assessment: Questionnaire for LTPA (METs min/24 h), 3 groups | ||||
The Baltimore Longitudinal Study of Aging | G1 = low | ||||
G2 = medium | Multivariate adjustment | ||||
G3 = high | Men <70 years | ||||
Rate of change (ROC) | • G1 = 0.96 (0.84-1.08) | ||||
• G2 = 0.91 (0.79-1.04) | |||||
• G3 = 0.42 (0.33-0.53) | |||||
• ROC low = 0.90 (0.80-1.01) | |||||
• ROC med = 1.01 (0.90-1.14) | |||||
• ROC high = 0.78 (0.65-0.94) | |||||
Men >70 years | |||||
• G1 = 0.95 (0.82-1.10) | |||||
• G2 = 0.89 (0.76-1.05) | |||||
• G3 = 0.78 (0.62-0.97) | |||||
• ROC low = 1.07 (0.93-1.24) | |||||
• ROC med = 1.13 (1.00-1.27) | |||||
• ROC high = 0.91 (0.75-1.12) | |||||
Women <70 years | |||||
• G1 = 0.75 (0.53-1.07) | |||||
• G2 = 0.61 (0.36-1.03) | |||||
• G3 = 0.80 (0.50-1.30) | |||||
• ROC low = 1.02 (0.74-1.40) | |||||
• ROC med = 1.38 (0.86-2.28) | |||||
• ROC high = 0.90 (0.63-1.27) | |||||
Women >70 years | |||||
• G1 = 0.85 (0.63-1.15) | |||||
• G2 = 0.78 (0.39-1.59) | |||||
• G3 = 0.62 (0.32-1.22) | |||||
• ROC low = 1.10 (0.85-1.42) | |||||
• ROC med = 0.96 (0.46-2.03) | |||||
• ROC high = 0.70 (0.40-1.22) | |||||
Trolle-Lagerros et al 2005 [218] | To quantify the effect of PA on overall mortality in younger women and to assess the effect of past versus current activity. | • n = 99,099 | 11.4 year follow-up | • 1,313 deaths | Current PA substantially reduces mortality among women. The association is observed even with low levels of PA and is accentuated with increased PA. |
• Sex: Women | |||||
• Age: 30-49 yr | PA assessment: Questionnaire using a 5 point scale, 5 groups | Incidence of all-cause mortality and PA past and current | |||
Sweden and Norway | • Characteristics: Participants from Norway and one region of Sweden | ||||
Retrospective cohort | G1 = Sedentary | Adjusted HR (95% CI) | |||
G2 = Low | PA at enrolment | ||||
G3 = Moderate | • G1 = 1.00 (referent) | ||||
D & B score = 13 | G4 = High | • G2 = 0.78 (0.61-1.00) | |||
G5 = Vigorous | • G3 = 0.62 (0.49-0.78) | ||||
• G4 = 0.58 (0.44-0.75) | |||||
• G5 = 0.46 (0.33-0.65) | |||||
Trend p<0.0001 | |||||
PA at age 30 yr | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.79 (0.55-1.15) | |||||
• G3 = 0.90 (0.64-1.28) | |||||
• G4 = 0.98 (0.68-1.42) | |||||
• G5 = 0.96 (0.65-1.44) | |||||
Trend p = 0.22 | |||||
PA at age 14 yr | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.95 (0.66-1.38) | |||||
• G3 = 0.96 (0.69-1.34) | |||||
• G4 = 0.88 (0.62-1.25) | |||||
• G5 = 1.06 (0.75-1.51) | |||||
Trend p = 0.62 | |||||
Villeneuve et al 1998 [219] | To examine the relationship between PF, PA and all-cause mortality. | • n = 14,442 (6,246 men; 8,196 women) | Baseline (1981) and 7 year follow-up | RR (95% CI) by EE, multivariate adjustment | There was a reduction in mortality risk associated with even modest participation in activities of low intensity. |
• Sex: Men and women | |||||
Canada | • Age: 20-69 yr | PA assessment: Questionnaire for EE (kcal/kg/day), 5 groups | LTPA, men | ||
• Characteristics: Asymptomatic for CVD | • G1 = 1.00 (referent) | ||||
Prospective cohort | • G2 = 0.81 (0.59-1.11) | ||||
• G3 = 0.79 (0.54-1.13) | |||||
Canadian Fitness Survey | G1 = 0-<0.5 | • G4 = 0.86 (0.61-1.22) | |||
D & B score = 11 | G2 = 0.5-<1.5 | • G5 = 0.82 (0.65-1.04)* | |||
G3 = 1.5-<3.0 | |||||
G4 = ≥ 3.0 | Non vigorous LTPA, men | ||||
G5 = ≥ 0.5 | • G1 = 1.00 (referent) | ||||
PF levels: | • G2 = 0.81 (0.56-1.17) | ||||
Recommended | • G3 = 0.70 (0.44-1.13) | ||||
Minimum | • G4 = 0.82 (0.53-1.27) | ||||
• G5 = 0.78 (0.59-1.04)* | |||||
Undesirable Refusal | |||||
LTPA, women | |||||
Multivariate Poisson regression analysis | • G1 = 1.00 (referent) | ||||
• G2 = 0.94 (0.69-1.30) | |||||
• G3 = 0.92 (0.64-1.34) | |||||
• G4 = 0.71 (0.45-1.11) | |||||
• G5 = 0.88 (0.68-1.04)* | |||||
Non vigorous LTPA, women | |||||
• G1 = 1.00 (referent) | |||||
• G2 = 0.97 (0.69-1.36) | |||||
• G3 = 0.87 (0.57-1.33) | |||||
• G4 = 0.72 (0.43-1.21) | |||||
• G5 = 0.89 (0.67-1.17)* | |||||
RR (95% CI) by fitness levels, adjusted for age, sex and smoking Recommended = 1.00 (referent) | |||||
• Minimum = 1.02 (0.69-1.51) | |||||
• Undesirable = 1.52 (0.72-3.18) | |||||
• Refusal = 1.04 (0.45-2.39) | |||||
Weller and Corey 1998 [220] | To study the relationship between PA and mortality in women. | • n = 6,620 | Baseline and 7 year follow-up | • 449 deaths | PA is inversely associated with risk of death in women. |
• Sex: Women | |||||
• Age: ≥;30 yr | OR (95% CI) | ||||
Canada | • Characteristics: Without known heart disease | PA assessment: Questionnaires for: EE (kcal/kg/d), quartiles | |||
• Canadian Fitness Survey | EE (kcal/kg/d) | ||||
Prospective cohort | • Q1 = 1.00 (referent) | ||||
• Q2 = 0.91 (0.66-1.25) | |||||
Q1 = lowest | • Q3 = 0.94 (0.72-1.23) | ||||
D & B score = 11 | Q2 = | • Q4 = 0.89 (0.67-1.17) | |||
Q3 = | |||||
Q4 = highest | LTPA levels | ||||
LTPA, 3 groups | • G1 = 1.00 (referent) | ||||
G1 = Sedentary | • G2 = 0.63 (0.46-0.86) | ||||
G2 = Mod | • G3 = 0.76 (0.59-0.98) | ||||
G3 = High | |||||
Walking | |||||
Walking, 3 groups | • G1 = 1.00 (referent) | ||||
G1 = < half the time | • G2 = 0.64 (0.49-0.82) | ||||
G2 = half the time | • G3 = 0.64 (0.47-0.86) | ||||
G3 = > half the time | |||||
Yu et al 2003 [221] | To examine the relationship between LTPA and all-cause mortality. | • n = 1,975 | Baseline and 10 year follow-up | • 252 deaths | The study found a strong inverse association between heavy LTPA and all-cause mortality. |
UK | • Sex: Men | ||||
• Age: 49-64 yr | Age adjusted HR (95% CI) | ||||
• Characteristics: Without a history of CHD at baseline | PA assessment: Questionnaire (Minnesota LTPA index, kcal/d), 3 group | • G1 = 1.00 (referent) | |||
• G2 = 0.73 (0.54-0.99) | |||||
Prospective cohort | • G3 = 0.74 (0.55-1.04) | ||||
Trend p = 0.046 | |||||
D & B score = 11 | G1 = Light to no activity | Multivariate adjusted | |||
G2 = Moderate activity | • G1 = 1.00 (referent) | ||||
G3 = Heavy activity | • G2 = 0.79 (0.58-1.08) | ||||
• G3 = 0.76 (0.56-1.04) | |||||
Trend p = 0.083 |
D & B score, Downs and Black quality score; PF, physical fitness; YR, years; RR, risk ratio; 95% CI, 95% confidence interval; PA, physical activity; VO2 peak, peak oxygen consumption; HR, hazard ratio; min/d, minutes per day; kcal/wk, kilocalories per week; LTPA, leisure-time physical activity; MET, metabolic equivalent; VO2 max, maximal oxygen consumption; OPA, occupational physical activity; CVD, cardiovascular disease; hr/wk, hours per week; MPA, moderate physical activity; kcal/kg/wk, kilocalories per kilogram per week; kJ/wk, kilojoules per week; EE, energy expenditure; G, groups; EE, energy expenditure; BMI, body mass index; C, class; kg/m2, kilogram by meters squared; HR, heart rate; BPM, beats per minute; MVPA, moderate to vigorous physical activity; OR, odds ratio; Q, quartile or quintile; RCT, randomized clinical trial; T, tertiles; TPA, total physical activity; VPA, vigorous physical activity; mL/kg/min, milliliters per kilogram per minute.