Objective To estimate the dose–response associations between non-occupational physical activity and several chronic disease and mortality outcomes in the general adult population. Design Systematic review and cohort-level dose-response meta-analysis. Data sources PubMed, Scopus, Web of Science and reference lists of published studies. Eligibility criteria Prospective cohort studies with (1) general population samples >10 000 adults, (2) ≥3 physical activity categories, and (3) risk measures and CIs for all-cause mortality or incident total cardiovascular disease, coronary heart disease, stroke, heart failure, total cancer and site-specific cancers (head and neck, myeloid leukaemia, myeloma, gastric cardia, lung, liver, endometrium, colon, breast, bladder, rectum, oesophagus, prostate, kidney). Results 196 articles were included, covering 94 cohorts with >30 million participants. The evidence base was largest for all-cause mortality (50 separate results; 163 415 543 person-years, 811 616 events), and incidence of cardiovascular disease (37 results; 28 884 209 person-years, 74 757 events) and cancer (31 results; 35 500 867 person-years, 185 870 events). In general, higher activity levels were associated with lower risk of all outcomes. Differences in risk were greater between 0 and 8.75 marginal metabolic equivalent of task-hours per week (mMET-hours/week) (equivalent to the recommended 150 min/week of moderate-to-vigorous aerobic physical activity), with smaller marginal differences in risk above this level to 17.5 mMET-hours/week, beyond which additional differences were small and uncertain. Associations were stronger for all-cause (relative risk (RR) at 8.75 mMET-hours/week: 0.69, 95% CI 0.65 to 0.73) and cardiovascular disease (RR at 8.75 mMET-hours/week: 0.71, 95% CI 0.66 to 0.77) mortality than for cancer mortality (RR at 8.75 mMET-hours/week: 0.85, 95% CI 0.81 to 0.89). If all insufficiently active individuals had achieved 8.75 mMET-hours/week, 15.7% (95% CI 13.1 to 18.2) of all premature deaths would have been averted. Conclusions Inverse non-linear dose–response associations suggest substantial protection against a range of chronic disease outcomes from small increases in non-occupational physical activity in inactive adults. PROSPERO registration number CRD42018095481.
Obesity develops when energy intake continuously exceeds energy expenditure, causing a fundamental chronic energy imbalance. Societal and behavioural changes over the last decades are held responsible for the considerable increase in sedentary lifestyles and inappropriate dietary patterns. The role of dietary fat and other dietary factors in the aetiology and maintenance of excess weight is controversial. The purposes of the present study were to investigate the dietary factors associated with body mass index (BMI) and waist circumference (WC), and to analyse whether dietary intake varies between subjects with different levels of sports participation. Data for this cross-sectional study, including anthropometric measurements, 3-day diet diary and physical activity questionnaire, were collected by the Flemish Policy Research Centre Sport, Physical Activity and Health (SPAH) between October 2002 and April 2004. Results of 485 adult men and 362 women with plausible dietary records were analysed. Analyses of covariance were performed to determine the differences in dietary intake between normal weight, overweight and obese subjects, and between subjects with different levels of sports participation. Total energy intake, protein and fat intake (kcal/day) were significantly higher in obese subjects compared to their lean counterparts in both genders. Percentage of energy intake from fat was significantly higher in obese men compared to men with normal weight or WC. Energy percentages from carbohydrates and fibres were negatively related to BMI and WC in men, whereas in women a higher carbohydrate and fibre intake was positively associated with obesity. Alcohol intake was positively associated with WC in men. Subjects participating in health related sports reported higher intake of carbohydrates, but lower intake of fat compared to subjects not participating in sports. This study supports the evidence that carbohydrate, fat, protein and fibre intake are closely related to BMI and WC. The sex differences for dietary intake between obese men and women might reflect the generally higher health consciousness of women. Alcohol intake was only associated with WC, emphasizing the importance of WC as an additional indicator in epidemiological studies. Besides enhancing sports and physical activity, it is necessary to improve the knowledge about nutrition and to promote the well-balanced consumption of wholesome food.
To develop healthy ageing interventions, longitudinal associations between objectively assessed physical behaviours and physical function need to be better understood. We assessed associations between accelerometer-assessed total physical activity (PA), moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary time and prolonged sedentary bout time, and clinically assessed physical function (grip strength, usual walking speed (UWS), chair stand speed) at two time-points in 3188 participants (≥ 60 years) of the EPIC-Norfolk study. Bidirectional associations were assessed using multivariable linear regression. Over an average of 6.1 years, baseline physical behaviours (greater total PA, MVPA and LPA, and less sedentary time) were associated with better subsequent walking and chair stand speed. Better baseline physical function was associated with better follow-up physical behaviours. There were no bidirectional associations between changes in physical behaviours and grip strength. Improvements in UWS were associated with improvements in all physical behaviours. Improvements in chair stand speed were associated with improvements in total PA, MVPA, and sedentary bout time. Improvements in physical behaviours were associated with improvements in UWS (3.1 cm/s/yr per 100 cpm/yr total PA, 3.6 cm/s/yr per hr/day/yr MVPA, 2.5 cm/s/yr per hr/day/yr LPA, - 2.9 cm/s/yr per hour/day/yr sedentary time, and - 1.6 cm/s/yr per hr/day/yr prolonged sedentary bout time). Only improvements in total PA, MVPA and sedentary bout time were associated with improvements in chair stand speed. In conclusion, we found bidirectional associations between changes in some physical behaviours and physical function and between baseline physical behaviours and subsequent physical function, highlighting the importance of considering the full range of physical behaviours to promote healthy ageing.The online version contains supplementary material available at 10.1007/s10433-022-00733-y.
<p> </p> <p><u>Objective</u></p> <p>To investigate the association between accelerometer-derived physical activity energy expenditure (PAEE) and incident type 2 diabetes (T2D) in a cohort of middle-aged adults and within subgroups.</p> <p><u>Research Design and Methods</u></p> <p>Data were from 90,096 UK Biobank participants without prevalent diabetes (mean age 62 years, 57% women) who wore a wrist accelerometer for 7 days. PAEE was derived from wrist acceleration using a population-specific method validated against doubly-labelled water. Logistic regressions were used to assess associations between PAEE, its underlying intensity, and incident T2D, ascertained using hospital episode and mortality data up to November 2020. Models were progressively adjusted for demographic, lifestyle factors, and body mass index (BMI). </p> <p><u>Results</u></p> <p>The association between PAEE and T2D was approximately linear (n=2018 events). We observed 19% (95% confidence interval 17-21%) lower odds of T2D per 5 kJ.kg-1.d-1 in PAEE without adjustment for BMI, and 11% (9-13%) with BMI adjustment. The association was stronger in men than women, and weaker in those with obesity and higher genetic susceptibility to obesity. There was no evidence of effect modification by genetic susceptibility to T2D or insulin resistance. For a given level of PAEE, odds of T2D were lower amongst those engaging in more moderate-to-vigorous activity.</p> <p><u>Conclusions</u></p> <p>There was a strong linear relationship between PAEE and incident T2D. A difference in PAEE equivalent to an additional daily 20-minute brisk walk was associated with 19% lower odds of T2D. The association was broadly similar across population subgroups, supporting physical activity for diabetes prevention in the whole population. </p>
Abstract Aims The interplay between physical activity (PA) volume and intensity is poorly understood in relation to cardiovascular disease (CVD) risk. This study aimed to investigate the role of PA intensity, over and above volume, in relation to incident CVD. Methods and results Data were from 88 412 UK Biobank middle-aged adults (58% women) without prevalent CVD who wore accelerometers on their dominant wrist for 7 days, from which we estimated total PA energy expenditure (PAEE) using population-specific validation. Cox proportional hazards regressions modelled associations between PAEE (kJ/kg/day) and PA intensity (%MVPA; the fraction of PAEE accumulated from moderate-to-vigorous-intensity PA) with incident CVD (ischaemic heart disease or cerebrovascular disease), adjusted for potential confounders. There were 4068 CVD events during 584 568 person-years of follow-up (median 6.8 years). Higher PAEE and higher %MVPA (adjusted for PAEE) were associated with lower rates of incident CVD. In interaction analyses, CVD rates were 14% (95% confidence interval: 5–23%) lower when MVPA accounted for 20% rather than 10% of 15 kJ/kg/d PAEE; equivalent to converting a 14 min stroll into a brisk 7 min walk. CVD rates did not differ significantly between values of PAEE when the %MVPA was fixed at 10%. However, the lowest CVD rates were observed for combinations of both higher PAEE and %MVPA. Conclusion Reductions in CVD risk may be achievable through higher PA volume and intensity, with the role of moderately intense PA appearing particularly important. This supports multiple approaches or strategies to PA participation, some of which may be more practical or appealing to different individuals.
We aimed to quantify the associations between change in objectively measured sedentary and moderate-to-vigorous physical activity (MVPA) times and self-reported television viewing over 6 years and change in a clustered cardiometabolic risk score (CCMR), including and excluding waist circumference (CCMR without adiposity component, CCMR no adip ), and its individual components, among the adult children of people with type 2 diabetes.
ABSTRACT Importance The association of cardiorespiratory fitness with cancer risk is not clear. Objective To investigate whether fitness is associated with the risk of diagnosis of common cancers. Design, setting, and participants In observational analyses, we used multivariable-adjusted Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of cancer in a subset of UK Biobank participants who completed a submaximal fitness test in 2009-12 ( N =72,572). In secondary analyses, we used a two-sample Mendelian randomization (MR) framework, with genetically predicted fitness as an instrumental variable derived from UK Biobank study participants and genetic cancer data from international consortia. Odds ratios (ORs) were estimated using the inverse-variance weighted method. Relationships between fitness and cancer may be partially mediated by adiposity, and therefore associations were estimated with and without adjustment for adiposity. Exposures Estimated maximal cardiorespiratory fitness (ml O 2 ⋅min -1 ⋅kg -1 total-body mass and ml O 2 ⋅min -1 ⋅kg -1 fat-free mass). Main outcomes and measures Diagnosis of lung, colon, rectal, endometrial, female breast, and prostate cancer. MR analyses additionally included pancreatic and renal cancers. Results After a median of 11 years of follow-up, 4,290 cancers of interest were diagnosed. A 3.5 ml O 2 ⋅min - 1 ⋅kg - 1 total-body mass increase in fitness (approximately 0.5 standard deviation (SD)) was associated with lower risks of endometrial (HR=0.81, 95% CI 0.73-0.89), colorectal (0.94, 0.90-0.99), and breast cancer (0.96, 0.92-0.99). In MR analyses, higher levels of genetically predicted fitness were associated with a lower risk of breast cancer (OR per genetically predicted 0.5 SD increase in ml O 2 ⋅min - 1 ⋅kg - 1 fat-free mass=0.92, 95% CI 0.86-0.98), including estrogen receptor (ER)+ (0.91, 0.84-0.99) and ER-(0.88, 0.80-0.97) subtypes. After adjusting for body fat, both the observational and genetic associations were attenuated. Conclusions and relevance Higher fitness levels may reduce risks of endometrial, colorectal, and breast cancer, though relationships with adiposity are complex and may mediate these relationships. Aiming to increase fitness, including via changes in body composition, may be an effective strategy for cancer prevention. KEY POINTS Question: Is cardiorespiratory fitness associated with subsequent risk of cancer diagnosis? Findings: In a prospective cohort study of 73,000 cancer-free participants who completed a submaximal fitness test, we report that higher fitness levels were associated with lower risks of endometrial, colorectal, and breast cancer. Using two-sample Mendelian randomization methods we also found an inverse association with breast cancer. Associations were attenuated following adjustment for adiposity. Meaning: Higher fitness may be associated with reduced risk of certain cancer sites. Aiming to increase fitness, including via changes in body composition, may be an effective strategy for cancer prevention. The role of adiposity in mediating the relationship between fitness and cancer risk is not fully understood, and further research is needed to explore this complex relationship.
PURPOSE Overweight is an epidemic problem in the United States but also in Europe there has been a very rapid increase in the prevalence of overweight in the last decade. The aim of this study was to describe the prevalence of overweight and obesity in Flemish adults. METHODS Data are from the research project “Investigation of the current quantitative and qualitative pattern of physical activity, sport participation, physical fitness and general health of the Flemish population” as part of the Policy Research Centre Sport, Physical Activity and Health. In total, 3978 men and 3596 women were measured for different anthropometrical indicators of overweight: body weight, BMI, waist circumference, sum of 4 skinfolds (biceps, triceps, suprailiac and subscapular) and body fat percentage (Durnin-Womersley). Men and women were analysed separately and divided in eleven five-year interval groups: 18–24, 25–29, ???,70–74 years. The international BMI cutoff scores were used for the classification in overweight (BMI>25kg/m2) and obese adults (BMI>30kg/m2). RESULTS In general, the anthropometrical indicators of overweight increase with age in both sexes. There was a small decrease in the oldest age group for men in all measurements. About 1 out of 7 men and 1 out of 8 women in the 18–24 age group are overweight. There is a strong increase in the prevalence of overweight with age, especially between the age of 18 and 34 in men (from 14 to 45%) and between the age of 18 and 29 in women (from 13 to 29%). The overall prevalence of overweight is higher for men than for women. In the age group 35–39, 49% of men and 28% of women are overweight. In the oldest age group about 7 out of 10 are overweight in both sexes. The prevalence of obesity in the youngest group is only 1.06% in women and 2.87% in men, with increasing prevalence of obesity with age. In the age group 45–49 the prevalence of obesity reaches about 10% in both sexes. Highest prevalence of obesity is seen in the 65–69 age group in men (18.56%) and in the 55–59 age group in women (19.62%). CONCLUSIONS The prevalence of overweight and obesity among Flemish adults is normal in the youngest age group but increases dramatically in the older age groups in both sexes. The prevalence of overweight is lower among Flemish compared to US Caucasian adults but is similar for the adults above 60 years of age (NHANES 1999–2000). Compared with the US, the overall prevalence of obesity is lower for Flemish adults in all age groups. Our data suggest that preventive action by the Flemish government is necessary for Flemish adults. This project is supported by the Flemish Government.
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