Abstract
BackgroundMost studies of physical activity (PA) epidemiology use behaviour measured at a single time-point. We examined whether ‘PA patterns’ (consistently low, consistently high or inconsistent PA levels over time) showed different epidemiological relationships for anthropometric and mortality outcomes, compared to single time-point measure of PA.MethodsData were the Danish MONICA (MONItoring Trends and Determinants in CArdiovascular Disease) study over three waves 1982–3 (time 1), 1987–8 (time 2) and 1993–4 (time 3). Associations between leisure time single time-point PA levels at time 1 and time 3, and sport and active travel at times 1 and 2 with BMI, waist, hip circumference and mortality (death from coronary heart disease (CHD) and cardiovascular disease (CVD)) were compared to ‘PA patterns’ spanning multiple time points. PA pattern classified participants’ PA as either 1) inactive or low PA at both time points; 2) moderate level PA at time 1 and high activity at time 3; or 3) a ‘mixed PA pattern’ indicating a varying levels of activity over time. Similarly, sport and active travel were also classified as indicating stable low, stable high and mixed patterns.ResultsThe moderately and highly active groups for PA at times 1 and 3 had up to 1.7 cm lower increase in waist circumference compared with the inactive/low active group. Across ‘PA patterns’, ‘active maintainers’ had a 2.0 cm lower waist circumference than ‘inactive/low maintainers’. Waist circumference was inversely related to sport but not active travel. CHD risk did not vary by activity levels at time 1, but was reduced significantly by 43% for high PA at time 3 (vs ‘inactive’ group) and among ‘active maintainers’ (vs ‘inactive/low maintainers’) by 62%. ‘Sport pattern’ showed stronger reductions in mortality for cardiovascular disease and CHD deaths among sport maintainers, than the single time point measures.ConclusionsPA patterns demonstrated a stronger association with a number of anthropometric and mortality outcomes than the single time-point measures. Operationalising PA as a sustained behavioural pattern may address some of the known under-estimation of risk for poor health in PA self-report measurements and better reflect exposure for epidemiological analysis of risk of health outcomes.
Highlights
Most studies of physical activity (PA) epidemiology use behaviour measured at a single time-point
These data were from the matched sample, but did not differ on the prevalence of PA levels, weight or age/gender or education from the full baseline sample in 1982
Risk of all-cause mortality wcat time 3 and the ‘PA pattern’ exposure, (‘active maintainers’ showed a 59% reduction (HR 0.41; 95% Confidence interval (CI) 0.28–0.59))
Summary
Most studies of physical activity (PA) epidemiology use behaviour measured at a single time-point. We examined whether ‘PA patterns’ (consistently low, consistently high or inconsistent PA levels over time) showed different epidemiological relationships for anthropometric and mortality outcomes, compared to single time-point measure of PA. Six decades of epidemiological studies have identified the health consequences of physical inactivity, with clear and consistent evidence for a relationship with all-cause mortality and cardiovascular disease (CVD) but more inconsistently with weight gain and fat distribution [1]. The average meta-analytic risk reduces by 33% for all-cause mortality for the regularly active compared to the inactive [3], with slightly smaller estimates from more recent meta-analyses [4]. Meta-analytic reviews suggest a 25–30% risk reduction of fatal outcomes in those who are physically active compared to the inactive
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