Does total volume of physical activity matter more than pattern for onset of CVD? A prospective cohort study of older British men

Barbara J Jefferis,Tessa J Parsons,Claudio Sartini,Sarah Ash,Lucy T Lennon,Olia Papacosta,Richard W Morris,S Goya Wannamethee,I-Min Lee,Peter H Whincup

doi:10.1016/j.ijcard.2018.12.024

Abstract

AimsWith increasing age, physical inactivity and sedentary behaviour levels increase, as does cardiovascular disease (CVD) incidence. We investigate how device-measured sedentary behaviour and physical activity (PA) are related to CVD onset in men aged 70+; whether the total volume of activity is more important than pattern. Methods and resultsProspective population-based cohort study of men recruited from 24 UK General Practices in 1978–80. In 2010–12, 3137 survivors were invited to complete questionnaires and wear an Actigraph GT3x accelerometer for 7 days. PA intensity was categorised as sedentary, light and moderate to vigorous (MVPA). Men were followed up for Myocardial Infarction, stroke and heart failure (ICD9 410–414, 430–438 and 428) morbidity and mortality from 2010 to 12 to June 2016. Hazard Ratios (HRs) for incident Cardiovascular Disease (CVD) were estimated. 1528/3137 (49%) men had sufficient accelerometer data. 254 men with pre-existing CVD were excluded. Participants' mean age was 78.4 (range 71–92) years. After median 4.9 years follow-up, 122 first CVD events occurred in 1181 men (22.7/1000 person-years) with complete data. For each additional 30 min in sedentary behaviour, light PA,10 min in MVPA, or 1000 steps/day, HRs for CVD were 1.09(95%CI 1.00, 1.19), 0.94(0.85, 1.04), 0.88(0.81, 0.96) and 0.86(0.78 to 0.95) respectively, adjusted for measurement-related factors, socio-demographics, health behaviours and disability. HRs for accumulating 150 min/week MVPA in bouts ≥1 min and bouts ≥10 min were 0.47(0.32 to 0.69), and 0.49(0.25, 0.98). ConclusionsIn older men, high volume of steps or MVPA rather than MVPA bouts was associated with reduced CVD risk.

Highlights

Physical activity (PA) is a key preventive measure against cardiovascular disease (CVD): with 25–30% reductions in risk of CVD events in middle aged adults doing moderate compared to low PA [1]
Mean accelerometer wear time was 855 min/day, of which 616 min were in sedentary behaviour and 199 in LIPA and 40 in moderate to vigorous physical activity (MVPA)
Investigating the shape of associations between total minutes/day spent in MVPA and steps/day with CVD indicated that the lower CVD risks were gained across the spectrum of step counts and time in MVPA, not confined to a threshold duration

Summary

Introduction

Physical activity (PA) is a key preventive measure against cardiovascular disease (CVD): with 25–30% reductions in risk of CVD events in middle aged adults doing moderate compared to low PA [1]. Most evidence underpinning PA guidelines is derived from epidemiologic studies linking self-reported activity data to onset of CVD events and mortality [2]. Current guidelines [2,3] suggest accumulating moderate to vigorous physical activity (MVPA) in 10 min bouts, based on trial data for cardiometabolic risk factors only, not clinical end points [2]. The availability of body-worn sensors in large scale epidemiologic studies enables measurement of the pattern of accumulation of activities and the number of minutes per day spent in different intensities of activity. This includes light activity (the most common intensity), which can be hard to recall

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Discussion

Conclusion