Abstract
Objective
To determine the relationship between lifelong exercise dose and the prevalence of
cardiovascular morbidity.
Patients and Methods
From June 1, 2011, through December 31, 2014, 21,266 individuals completed an online
questionnaire regarding their lifelong exercise patterns and cardiovascular health
status. Cardiovascular disease (CVD) was defined as a diagnosis of myocardial infarction,
stroke, or heart failure, and cardiovascular risk factors (CVRFs) were defined as
hypertension, hypercholesterolemia, or type 2 diabetes. Lifelong exercise patterns
were measured over a median of 32 years for 405 patients with CVD, 1379 patients with
CVRFs, and 10,656 controls. Participants were categorized into nonexercisers and quintiles
(Q1–Q5) of exercise dose (metabolic equivalent task [MET] minutes per week).
Results
The CVD/CVRF prevalence was lower for each exercise quintile compared with nonexercisers
(CVD: nonexercisers, 9.6% vs Q1: 4.4%, Q2: 2.8%, Q3: 2.4%, Q4: 3.6%, Q5: 3.9%; P<.001; CVRF: nonexercisers, 24.6% vs Q1: 13.8%, Q2: 10.2%, Q3: 9.0%, Q4: 9.4%, Q5:
12.0%; P<.001). The lowest exercise dose (Q1) significantly reduced CVD and CVRF prevalence,
but the largest reductions were found at 764 to 1091 MET-min/wk for CVD (adjusted
odds ratio=0.31; 95% CI, 0.20-0.48) and CVRFs (adjusted odds ratio=0.36; 95% CI, 0.28-0.47).
The CVD/CVRF prevalence did not further decrease in higher exercise dose groups. Exercise
intensity did not influence the relationship between exercise patterns and CVD or
CVRFs.
Conclusion
These findings demonstrate a curvilinear relationship between lifelong exercise patterns
and cardiovascular morbidity. Low exercise doses can effectively reduce CVD/CVRF prevalence,
but engagement in exercise for 764 to 1091 MET-min/wk is associated with the lowest
CVD/CVRF prevalence. Higher exercise doses do not yield additional benefits.
Abbreviations and Acronyms:
CVD (cardiovascular disease), CVRF (cardiovascular risk factor), MET (metabolic equivalent of task), OR (odds ratio), Q (quintile)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study.Lancet. 2011; 378: 1244-1253
- Exercise is medicine: at any dose?.JAMA. 2015; 314: 1915-1916
- Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity).Circulation. 2003; 107: 3109-3116
- Statement on exercise: benefits and recommendations for physical activity programs for all Americans. a statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association.Circulation. 1996; 94: 857-862
- Reduced disability and mortality among aging runners: a 21-year longitudinal study.Arch Intern Med. 2008; 168: 1638-1646
- Increased life expectancy of world class male athletes.Med Sci Sports Exerc. 1993; 25: 237-244
- Mortality of French participants in the Tour de France (1947-2012).Eur Heart J. 2013; 34: 3145-3150
Centers for Disease Control and Prevention, US Department of Health and Human Services. 2008 Physical activity guidelines for Americans: fact sheet for health professionals on physical activity guidelines for adults. http://www.cdc.gov/physicalactivity/downloads/pa_fact_sheet_adults.pdf. Accessed March 30, 2015.
- 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2014; 63: 2960-2984
Global strategy on diet, physical activity and health: physical activity and adults. World Health Organization website. http://www.who.int/dietphysicalactivity/factsheet_adults/en. Accessed July 10, 2015.
- Dose of jogging and long-term mortality: the Copenhagen City Heart Study.J Am Coll Cardiol. 2015; 65: 411-419
- Frequent physical activity may not reduce vascular disease risk as much as moderate activity: large prospective study of women in the United Kingdom.Circulation. 2015; 131: 721-729
- 2011 Compendium of Physical Activities: a second update of codes and MET values.Med Sci Sports Exerc. 2011; 43: 1575-1581
- Dose response between physical activity and risk of coronary heart disease: a meta-analysis.Circulation. 2011; 124: 789-795
- Leisure-time running reduces all-cause and cardiovascular mortality risk.J Am Coll Cardiol. 2014; 64: 472-481
- Physical activity, all-cause mortality, and longevity of college alumni.N Engl J Med. 1986; 314: 605-613
- Minimal amount of exercise to prolong life: to walk, to run, or just mix it up?.J Am Coll Cardiol. 2014; 64: 482-484
- Physical activity for health: what kind? how much? how intense? on top of what?.Annu Rev Public Health. 2011; 32: 349-365
- Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship.JAMA Intern Med. 2015; 175: 959-967
- Sudden cardiac death in the older athlete.J Am Coll Cardiol. 2015; 65: 493-502
- Triggering of acute myocardial infarction by heavy physical exertion: protection against triggering by regular exertion: determinants of Myocardial Infarction Onset Study Investigators.N Engl J Med. 1993; 329: 1677-1683
- Are there deleterious cardiac effects of acute and chronic endurance exercise?.Physiol Rev. 2016; 96: 99-125
- Persistent and reversible cardiac dysfunction among amateur marathon runners.Eur Heart J. 2006; 27: 1079-1084
- Exercise and the heart: the good, the bad, and the ugly.Eur Heart J. 2015; 36: 1445-1453
- Can intensive exercise harm the heart? you can get too much of a good thing.Circulation. 2014; 130: 992-1002
- Longevity of endurance skiers.Med Sci Sports. 1974; 6: 49-51
- Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era.BMJ. 2012; 345: e8308
- Effect of moderate to vigorous physical activity on all-cause mortality in middle-aged and older Australians.JAMA Intern Med. 2015; 175: 970-977
- Dose of jogging: mortality versus longevity.J Am Coll Cardiol. 2015; 65: 2672-2673
- Observational research methods. research design II: cohort, cross sectional, and case-control studies.Emerg Med J. 2003; 20: 54-60
Article info
Publication history
Published online: April 29, 2016
Footnotes
Grant Support: The work of T.M.H.E. was supported by a European Commission Horizon 2020 grant (Marie Sklodowska-Curie Fellowship 655502).
Potential Competing Interests: Dr Thompson reports receiving research grants from the National Institutes of Health, Genomas, Aventis, Regeneron, and Sanofi; serving as a consultant for AstraZeneca, Regeneron, Merck, Genomas, Abbott, Sanofi, and Pfizer; receiving speaker honoraria from Merck and AstraZeneca; and owning stock in General Electric, JA Wiley Publishing, J&J, and Abbott.
Identification
Copyright
© 2016 Mayo Foundation for Medical Education and Research
