Albert Clará1, Georgina Berenguer2, Silvia Pérez-Fernández3, Helmut Schröder4, Rafel Ramos5, María Grau4, Irene R Dégano6, Alba Fernández-Sanlés7, Jaume Marrugat3, Roberto Elosua8. 1. Servicio de Angiología y Cirugía Vascular, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; CIBER Enfermedades Cardiovasculares, Barcelona, Spain; Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain. 2. Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain. 3. Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; CIBER Enfermedades Cardiovasculares, Barcelona, Spain. 4. Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; CIBER Epidemiología y Salud Pública, Barcelona, Spain. 5. Instituto Universitario de Investigación en Atención Primaria Jordi Gol (IDIAP Jordi Gol), Unidad de Apoyo a la Investigación de Girona, Girona, Spain; Instituto de Investigación Biomédica de Girona (IdIBGi), Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain. 6. Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; CIBER Enfermedades Cardiovasculares, Barcelona, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Vic-Central de Cataluña, Vic, Barcelona, Spain. 7. Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain. 8. Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; CIBER Enfermedades Cardiovasculares, Barcelona, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Vic-Central de Cataluña, Vic, Barcelona, Spain. Electronic address: relosua@imim.es.
Abstract
INTRODUCTION AND OBJECTIVES: Regular leisure-time physical activity (LTPA) has been consistently recognized as a protective factor for cardiovascular diseases (CVD) and all-cause mortality. However, the pattern of this relationship is still not clear. The aim of this study was to assess the relationship of LTPA with incident CVD and mortality in a Spanish population. METHODS: A prospective population-based cohort of 11 158 randomly selected inhabitants from the general population. LTPA was assessed by a validated questionnaire. Mortality and CVD outcomes were registered during the follow-up (median: 7.24 years). The association between LTPA and outcomes of interest (all-cause mortality and cardiovascular disease) was explored using a generalized additive model with penalized smoothing splines and multivariate Cox proportional hazard models. RESULTS: We observed a significant nonlinear association between LTPA and all-cause and CVD mortality, and fatal and nonfatal CVD. Moderate-vigorous intensity LTPA, but not light-intensity LTPA, were associated with beneficial effects. The smoothing splines identified a cutoff at 400 MET-min/d. Below this threshold, each increase of 100 MET-min/d in moderate-vigorous LTPA contributed with a 16% risk reduction in all-cause mortality (HR, 0.84; 95%CI, 0.77-0.91), a 27% risk reduction in CVD mortality (HR, 0.73; 95%CI, 0.61-0.87), and a 12% risk reduction in incident CVD (HR, 0.88; 95%CI, 0.79-0.99). No further benefits were observed beyond 400 MET-min/d. CONCLUSIONS: Our results support a nonlinear inverse relationship between moderate-vigorous LTPA and CVD and mortality. Benefits of PA are already observed with low levels of activity, with a maximum benefit around 3 to 5 times the current recommendations.
INTRODUCTION AND OBJECTIVES: Regular leisure-time physical activity (LTPA) has been consistently recognized as a protective factor for cardiovascular diseases (CVD) and all-cause mortality. However, the pattern of this relationship is still not clear. The aim of this study was to assess the relationship of LTPA with incident CVD and mortality in a Spanish population. METHODS: A prospective population-based cohort of 11 158 randomly selected inhabitants from the general population. LTPA was assessed by a validated questionnaire. Mortality and CVD outcomes were registered during the follow-up (median: 7.24 years). The association between LTPA and outcomes of interest (all-cause mortality and cardiovascular disease) was explored using a generalized additive model with penalized smoothing splines and multivariate Cox proportional hazard models. RESULTS: We observed a significant nonlinear association between LTPA and all-cause and CVDmortality, and fatal and nonfatal CVD. Moderate-vigorous intensity LTPA, but not light-intensity LTPA, were associated with beneficial effects. The smoothing splines identified a cutoff at 400 MET-min/d. Below this threshold, each increase of 100 MET-min/d in moderate-vigorous LTPA contributed with a 16% risk reduction in all-cause mortality (HR, 0.84; 95%CI, 0.77-0.91), a 27% risk reduction in CVDmortality (HR, 0.73; 95%CI, 0.61-0.87), and a 12% risk reduction in incident CVD (HR, 0.88; 95%CI, 0.79-0.99). No further benefits were observed beyond 400 MET-min/d. CONCLUSIONS: Our results support a nonlinear inverse relationship between moderate-vigorous LTPA and CVD and mortality. Benefits of PA are already observed with low levels of activity, with a maximum benefit around 3 to 5 times the current recommendations.