Baseline Leisure-time Physical Activity Research Articles

Does pain tolerance mediate the effect of physical activity on chronic pain in the general population? The Tromsø Study.

Knowledge is needed regarding mechanisms acting between physical activity (PA) and chronic pain. We investigated whether cold pain tolerance mediates an effect of leisure-time physical activity on the risk of chronic pain 7 to 8 years later using consecutive surveys of the population-based Tromsø Study. We included participants with information on baseline leisure-time PA (LTPA) and the level of cold pressor-assessed cold pain tolerance, who reported chronic pain status at follow-up as any of the following: chronic pain for ≥3 months, widespread chronic pain, moderate-to-severe chronic pain, or widespread moderate-to-severe chronic pain. We included 6834 participants (52% women; mean age, 55 years) in counterfactual mediation analyses. Prevalence decreased with severity, for example, 60% for chronic pain vs 5% for widespread moderate-to-severe chronic pain. People with one level higher LTPA rating (light to moderate or moderate to vigorous) at baseline had lower relative risk (RR) of 4 chronic pain states 7 to 8 years later. Total RR effect of a 1-level LTPA increase was 0.95 (0.91-1.00), that is, -5% decreased risk. Total effect RR for widespread chronic pain was 0.84 (0.73-0.97). Indirect effect for moderate-to-severe chronic pain was statistically significant at RR 0.993 (0.988-0.999); total effect RR was 0.91 (0.83-0.98). Statistically significantly mediated RR for widespread moderate-to-severe chronic pain was 0.988 (0.977-0.999); total effect RR was 0.77 (0.64-0.94). This shows small mediation of the effect of LTPA through pain tolerance on 2 moderate-to-severe chronic pain types. This suggests pain tolerance to be one possible mechanism through which PA modifies the risk of moderate-to-severe chronic pain types with and without widespread pain.

Occupational physical activity, all-cause, cardiovascular disease, and cancer mortality in 349,248 adults: Prospective and longitudinal analyses of the MJ Cohort

BackgroundEvidence on the health benefits of occupational physical activity (OPA) is inconclusive. We examined the associations of baseline OPA and OPA changes with all-cause, cardiovascular disease (CVD), and cancer mortality and survival times. MethodsThis study included prospective and longitudinal data from the MJ Cohort, comprising adults over 18 years recruited in 1998–2016, 349,248 adults (177,314 women) with baseline OPA, of whom 105,715 (52,503 women) had 2 OPA measures at 6.3 ± 4.2 years (mean ± SD) apart. Exposures were baseline OPA, OPA changes, and baseline leisure-time physical activity. ResultsOver a mean mortality follow-up of 16.2 ± 5.5 years for men and 16.4 ± 5.4 years for women, 11,696 deaths (2033 of CVD and 4631 of cancer causes) in men and 8980 deaths (1475 of CVD and 3689 of cancer causes) in women occurred. Combined moderately heavy/heavy baseline OPA was beneficially associated with all-cause mortality in men (multivariable-adjusted hazard ratio (HR) = 0.93, 95% confidence interval (95%CI): 0.89–0.98 compared to light OPA) and women (HR = 0.86, 95%CI: 0.79–0.93). Over a mean mortality follow-up of 12.5 ± 4.6 years for men and 12.6 ± 4.6 years for women, OPA decreases in men were detrimentally associated (HR = 1.16, 95%CI: 1.01–1.33) with all-cause mortality, while OPA increases in women were beneficially (HR = 0.83, 95%CI: 0.70–0.97) associated with the same outcome. Baseline or changes in OPA showed no associations with CVD or cancer mortality. ConclusionHigher baseline OPA was beneficially associated with all-cause mortality risk in both men and women. Our longitudinal OPA analyses partly confirmed the prospective findings, with some discordance between sex groups.

Leisure-time physical activity and all-cause mortality and cardiovascular disease in adults with type 2 diabetes: Cross-country comparison of cohort studies

PurposeThis study aimed to quantify the dose–response association and the minimal effective dose of leisure-time physical activity (PA) to prevent mortality and cardiovascular disease in adults with type 2 diabetes. MethodsCross-country comparison of 2 prospective cohort studies including 14,913 and 17,457 population-based adults with type 2 diabetes from the UK and China. Baseline leisure-time PA was self-reported and categorized by metabolic equivalent hours per week (MET-h/week) according to World Health Organization recommendations: none, below recommendation (>0–7.49 MET-h/week); at recommended level (7.5–14.9 MET-h/week); above recommendation (≥15 MET-h/week). Mortality and cardiovascular disease data were obtained from national registries. ResultsDuring a median follow-up of 12.4 and 9.7 years, in the UK and China cohorts, repectively, higher levels of leisure-time PA were inversely associated with all-cause (1571 and 2351 events) and cardiovascular mortality (392 and 1060 events), mostly consistent with a linear dose–response relationship. PA below, at, and above recommendations, compared with no activity, yielded all-cause mortality hazard ratios of 0.94 (95% confidence interval (95%CI): 0.79–1.12), 0.90 (95%CI: 0.74–1.10), and 0.85 (95%CI: 0.70–1.02) in British adults and 0.87 (95%CI: 0.68–1.10), 0.88 (95%CI: 0.74–1.03), and 0.77 (95%CI: 0.70–0.85) in Chinese adults. Associations with cardiovascular mortality were more pronounced in British adults (0.80 (95%CI: 0.58–1.11), 0.75 (95%CI: 0.52–1.09), and 0.69 (95%CI: 0.48–0.97)) but less pronounced in Chinese adults (1.06 (95%CI: 0.76–1.47), 1.01 (95%CI: 0.80–1.28), and 0.79 (95%CI: 0.69–0.92)). PA at recommended levels was not associated with lower rates of major adverse cardiovascular events (2345 and 4458 events). ConclusionLeisure-time PA at the recommended levels was not convincingly associated with lower mortality and had no association with risk of major adverse cardiovascular events in British or Chinese adults with type 2 diabetes. Leisure-time PA above current recommendations may be needed to prevent cardiovascular disease and premature mortality in adults with type 2 diabetes.

Association of Leisure-Time Physical Activity and Mortality Risk in High Cardiovascular Risk Population with and without Left Ventricular Hypertrophy.

Increased leisure-time physical activity (LTPA) is linked with decreased mortality risk, while also with increased left ventricular mass, which may induce left ventricular hypertrophy (LVH). We investigated whether LVH modifies the association between higher LTPA and lower mortality risk in population at high cardiovascular risk. In a prospective national cohort, we used the left ventricular mass/body surface area (LVM/BSA) method to define LVH. Baseline LTPA was self-reported and divided into: low ( 500 metabolic equivalent of task [MET]) min/week), moderate (500-1999 MET min/week) and high ( 2000 MET-min/week). Analyses of the dose-response relationship between LTPA and left ventricular mass were performed using restricted cubic spline regression. A multivariate adjusted Cox proportional hazards regression analysis was used to estimate hazard ratios (HRs). A total of 163,006 participants (55.3% females, mean [standard deviation] age, 62.4 [7.4] years) were included. During a median of 4.8 years of follow-up, 6586 (4.0%) died from all causes and 3024 (1.9%) from cardiovascular causes. Multivariate adjusted Cox proportional hazards regression analyses revealed that moderate and high LTPA were linked with less cardiovascular and all-cause mortality risk than low LTPA in the absence of LVH. In those with LVH, the association of high (0.83, 0.69-0.99) or moderate (0.72, 0.56-0.91) LTPA with cardiovascular mortality risk persisted. For all-cause mortality risk, this association was only significant in high LTPA (0.73, 0.61-0.86), while marginal in moderate LTPA (0.96, 0.84 to 1.08). Overall, the correlation patterns between LTPA and mortality risk appears distinct between those with LVH and those without LVH; the modification of LVH was not significant regarding mortality risk among the high cardiovascular risk population (all-cause: p-value for interaction = 0.074; cardiovascular cause: p-value for interaction = 0.581), except in females regarding all-cause mortality risk (p-value for interaction = 0.006). The association between higher LTPA and lower mortality risk was not modified by LVH in high cardiovascular risk population. However, the presence of LVH altered this association in females regarding the all-cause mortality risk.

Asociación de la actividad física con la funcionalidad de las lipoproteínas de alta densidad en una cohorte de base poblacional: el estudio REGICOR

Introduction and objectivesTo determine the dose-response association between current and past leisure-time physical activity (LTPA), total and at different intensities, and high-density lipoprotein (HDL) functionality parameters. MethodsStudy participants (n=642) were randomly drawn from a large population-based survey. Mean age of the participants was 63.2 years and 51.1% were women. The analysis included data from a baseline and a follow-up visit (median follow-up, 4 years). LTPA was assessed using validated questionnaires at both visits. Two main HDL functions were assessed: cholesterol efflux capacity and HDL antioxidant capacity, at the follow-up visit. Linear regression and linear additive models were used to assess the linear and nonlinear association between LTPA and HDL functionality. ResultsTotal LTPA at follow-up showed an inverse and linear relationship between 0 and 400 METs x min/d with HDL antioxidant capacity (regression coefficient [beta]: −0.022; 95%CI, −0.030, −0.013), with a plateau above this threshold. The results were similar for moderate (beta: −0.028; 95%CI, −0.049, −0.007) and vigorous (beta: −0.025; 95%CI, −0.043, −0.007), but not for light-intensity LTPA. LTPA at follow-up was not associated with cholesterol efflux capacity. Baseline LTPA was not associated with any of the HDL functionality parameters analyzed. ConclusionsCurrent moderate and vigorous LTPA showed a nonlinear association with higher HDL antioxidant capacity. Maximal benefit was observed with low-intermediate doses of total LTPA (up to 400 METs x min/d). Our results agree with current recommendations for moderate-vigorous LTPA practice and suggest an association between PA and HDL functionality in the general population.Full English text available from:www.revespcardiol.org/en

Association of socioeconomic status measures with physical activity and subsequent frailty in older adults

BackgroundDespite increased recognition, frailty remains a significant public health challenge. Objectivewe aimed to assess the role of education and income, as well as neighborhood socioeconomic status, on physical activity and subsequent frailty in older adults. MethodsUsing a population-based cohort of older adults, this study examined the relationship between socioeconomic status (SES) factors, physical activity and frailty. The study included 1,799 participants (mean [SD], 74.6 (6.2), 53.3% female) from the "National Health and Nutrition Survey of Older Adults Aged 65 and Over in Israel", conducted in 2005–2006. A follow-up interview was performed 12–14 years later in a subgroup of 601 subjects (mean [SD], age 84[4]; 56% women). Self-reported leisure-time physical activity (LTPA) was measured at both baseline and follow-up. SES measures were assessed at baseline. Frailty was measured at follow-up, using the Fried's Phenotype Model.ResultsAll SES measures were strongly and positively associated with LTPA (all p < 0.001). Eighty-two participants (14%) were classified as frail at follow-up. After age and sex adjustment and accounting for attrition bias using inverse probability weighting, baseline LTPA (OR = 2.77, 95% CI: 1.57–4.90, for inactivity; OR = 1.41, 95% CI: 0.75–2.68, for insufficient activity, compared with sufficient activity, Ptrend < 0.001) was inversely associated with incident frailty. The association persisted after further adjustment for SES and comorbidity.ConclusionAmong older individuals, multiple SES measures were positively associated with LTPA, which was a strong predictor of lower subsequent frailty risk.

Association of physical activity with high-density lipoprotein functionality in a population-based cohort: the REGICOR study

Introduction and objectivesTo determine the dose-response association between current and past leisure-time physical activity (LTPA), total and at different intensities, and high-density lipoprotein (HDL) functionality parameters. MethodsStudy participants (n=642) were randomly drawn from a large population-based survey. Mean age of the participants was 63.2 years and 51.1% were women. The analysis included data from a baseline and a follow-up visit (median follow-up, 4 years). LTPA was assessed using validated questionnaires at both visits. Two main HDL functions were assessed: cholesterol efflux capacity and HDL antioxidant capacity, at the follow-up visit. Linear regression and linear additive models were used to assess the linear and nonlinear association between LTPA and HDL functionality. ResultsTotal LTPA at follow-up showed an inverse and linear relationship between 0 and 400 METs x min/d with HDL antioxidant capacity (regression coefficient [beta]: −0.022; 95%CI, −0.030, −0.013), with a plateau above this threshold. The results were similar for moderate (beta: −0.028; 95%CI, −0.049, −0.007) and vigorous (beta: −0.025; 95%CI, −0.043, −0.007), but not for light-intensity LTPA. LTPA at follow-up was not associated with cholesterol efflux capacity. Baseline LTPA was not associated with any of the HDL functionality parameters analyzed. ConclusionsCurrent moderate and vigorous LTPA showed a nonlinear association with higher HDL antioxidant capacity. Maximal benefit was observed with low-intermediate doses of total LTPA (up to 400 METs x min/d). Our results agree with current recommendations for moderate-vigorous LTPA practice and suggest an association between PA and HDL functionality in the general population.

Association of socioeconomic status measures with physical activity and subsequent frailty in older adults

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite increased recognition, frailty remains a significant public health challenge. Methods Using a population-based cohort of older adults, this study examined the relationship between socioeconomic status (SES) factors, physical activity and frailty. The study included 1,799 participants (mean [SD], age 75[6]; 53% women) from the "National Health and Nutrition Survey of Older Adults Aged 65 and Over in Israel", conducted in 2005-2006. A follow-up interview was performed 12-14 years later in a subgroup of 601 subjects (mean [SD], age 84[4]; 56% women). Extensive data including self-reported leisure time physical activity (LTPA) and SES measures were assessed at baseline. Frailty was measured at follow-up. Results All SES measures were strongly and positively associated with LTPA (all p&amp;lt;0.001). Eighty-two participants (14%) were classified as frail at follow-up. After age and sex adjustment and accounting for attrition bias using inverse probability weighting, baseline LTPA (OR=2.77, 95% CI: 1.57-4.90, for inactivity; OR=1.41, 95% CI: 0.75-2.68, for insufficient activity, compared with sufficient activity, Ptrend&amp;lt;0.001) was inversely associated with incident frailty. The association persisted after further adjustment for SES and comorbidity. Conclusion Among older individuals, multiple SES measures were positively associated with LTPA, which was a strong predictor of lower subsequent frailty risk.

Prospective Associations of Leisure-Time Physical Activity With Psychological Distress and Well-Being: A 12-Year Cohort Study.

This study aimed to investigate the associations of leisure-time physical activity with psychological distress and well-being, and potential mediators. We used data from the 1970 British Cohort Study (n = 5197; 2688 men), including waves 34y (2004), 42y (2012), and 46y (2016). Participants reported leisure-time physical activity frequency and intensity (exposure) at age 34 years (baseline); cognition (vocabulary test), body mass index, disability, mobility and pain perception (potential mediators) at age 42 years; and psychological distress (Malaise Inventory) and well-being (Warwick-Edinburgh scale) at age 46 years. Baseline confounders included sex, country, education, employment status, alcohol use, tobacco smoking, and psychological distress. Main analyses included logistic regression and mediation models. Higher leisure-time physical activity intensity at baseline was associated with lower psychological distress at 46y (β = -0.038 [95% confidence interval {CI} =-0.069 to -0.007]), but not leisure-time physical activity frequency. Baseline leisure-time physical activity frequency and intensity were associated with higher psychological well-being at 46y (frequency: β = 0.089 [95% CI = 0.002 to 0.176]; intensity: β = 0.262 [95% CI = 0.123 to 0.401]); and total: β = 0.041 [95% CI = 0.013 to 0.069]). Only body mass index at 42y partially mediated the association between leisure-time physical activity frequency (15.7%) and total leisure-time physical activity (6.2%) at 34y, with psychological well-being at 46y. Our findings highlight the role of leisure-time physical activity in psychological distress and well-being, with greater effect sizes associated with higher frequency and intensity of leisure-time physical activity. Future interventions should consider examining potential mediators of the association of leisure-time physical activity with psychological well-being, such as body mass index.

Physical Activity Among Preadolescents Modifies the Long-Term Association Between Sedentary Time Spent Using Digital Media and the Increased Risk of Being Overweight.

This study aimed to examine whether sedentary digital media use in preadolescence increases the risk of being overweight 3 years later, and whether this association differs based on preadolescents' leisure-time physical activity (LTPA) levels. The authors conducted a 3-year follow-up study among 4661 participants with a mean (SD) age of 11 (1)years at baseline and 14 (1)years at follow-up. A web-based questionnaire assessed sedentary digital media use and LTPA. The authors categorized baseline LTPA duration into 3 levels: 0 to 5 (low), 6 to 8 (moderate), and ≥9 (high) hours per week. In addition, the authors categorized adolescents as normal weight or overweight/obese at follow-up. Greater amounts of sedentary digital media use at baseline associated with an increased risk of being overweight 3 years later even after adjusting for confounders. This only held for preadolescents with low baseline LTPA (OR = 1.14; 95% confidence interval, 1.05-1.24), but not among those with moderate (OR = 1.02; 0.91-1.15) or high (OR = 0.96; 0.85-1.08) LTPA. Preadolescent LTPA modified the long-term association between sedentary digital media use and being overweight; specifically, 6hours per week or more of LTPA mitigated the increased risk of being overweight associated with higher amounts of digital media use.

Leisure-Time Physical Activity and Cardiovascular Disease Risk Among Hypertensive Patients: A Longitudinal Cohort Study.

Objective: Few studies estimated the effect of leisure-time physical activity (LTPA) on cardiovascular disease (CVD) risk among hypertensive patients in a longitudinal cohort. This study aims to evaluate the association between LTPA and CVD in a longitudinal management cohort of hypertensive patients.Methods: A total of 58,167 hypertensive patients without baseline CVD from a longitudinal cohort were included in this study. LTPA and other covariates were measured at the follow-up four times annually. The primary outcome was CVD events. The association between LTPA and CVD was assessed by the marginal structure model (MSM) and Cox model with adjustment for age, gender, body mass index (BMI), smoking, drinking, diabetes, hyperlipidemia, and antihypertensive medication. The restricted cubic spline and segmented regression were used to assess the dose–response relationship between LTPA and CVD.Results: We recorded 16,332 CVD events; crude incidence of CVD were 89.68, 80.39, 62.64, and 44.04 per 1,000 person-years for baseline 0, 1–150, 151–300, and >300 min/week LTPA, respectively. Compared with inactive LTPA, the adjusted hazard ratios (HRs) estimated by Cox model and MSM-Cox model for CVD associated with 1–150,151–300, and 300 min/week LTPA were 0.85 (95% CI, 0.83–0.88), 0.67 (95% CI, 0.64–0.71), 0.47 (95% CI, 0.44–0.51), and 0.83 (95% CI, 0.76–0.91), 0.58 (95% CI, 0.52–0.63), and 0.39 (95% CI, 0.35–0.44), respectively. Per 60 min/week increase in LTPA was associated with a 13% reduction in CVD risk. LTPA breakpoint was 417 min/week for CVD. Before and after the break-point, the slopes of the piecewise-linear relationship between LTPA and CVD risk were −0.0017 and −0.0003, respectively.Conclusion: LTPA was more strongly associated with the CVD risk than that estimated by conventional analyses based on baseline LTPA; 417 min/week is a breakpoint, after which the incremental health benefits on CVD prevention obtained from the increase in LTPA are much less than before.

Does baseline leisure-time physical activity level predict future depressive symptoms or physical activity among depressive patients? Findings from a Finnish five-year cohort study

Objectives The aims of this study were to investigate whether baseline leisure-time physical activity (LTPA) is associated with future recovery from depression among patients with a depression diagnosis and whether baseline LTPA is associated with total physical activity after five years of follow-up. Methods A total of 258 patients aged ≥35 years with clinically confirmed depression at baseline participated. The study was conducted between 2008 and 2016 in municipalities within the Central Finland Hospital District. Depressive symptoms (DS) were determined with the Beck Depression Inventory (BDI) with a cutoff score ≥10, and depression diagnoses were confirmed by the Mini-International Neuropsychiatric Interview (MINI). Blood pressure and anthropometric parameters were measured and blood samples for glucose and lipid determinations were drawn at baseline. LTPA, physical activity, and other social and clinical factors were captured by standard self-administered questionnaires at baseline and the five-year follow-up point. Results Of the 258 patients, 76 (29%) had DS at follow-up. Adjusted odds ratio (OR) for future DS was 1.43 (confidence interval [CI] 0.69–2.95) for participants with moderate LTPA and 0.92 (CI 0.42–2.00) for participants with high LTPA, compared with low LTPA at baseline. Higher baseline LTPA levels were associated with higher total physical activity in the future (β=0.14 [95% CI: 0.02–0.26] for linearity = 0.024). Conclusion Baseline LTPA did not affect the five-year prognosis of depression among depressed patients in a Finnish adult population. Because the baseline LTPA level predicted the future total physical activity, it could be included as a part of the overall health management and treatment of depression in clinical practices.

Physical activity and risk of instant and 28-day case-fatality in myocardial infarction.

BackgroundWhile physical activity reduces risk of developing myocardial infarction (MI), it is unknown whether a history of physical activity is also protective of fatal arrhythmia and case-fatality in patients who have suffered an acute MI.Methods104,801 individuals included in 2003–2014 in the Copenhagen General Population Study (CGPS), a prospective population-based study with self-reported leisure time physical activity (LTPA) in three categories measured at baseline, were followed until 2014 through national registries. The 1,517 individuals who suffered a first time MI during follow-up constituted the study population. Outcomes were fatal MI, defined as date of death same as date of MI (including out-of-hospital deaths) and 28-day fatality. Through multivariable analyses the association between baseline LTPA and outcomes were assessed adjusted for CVD risk factors.ResultsOf 1,517 MI events, 117 (7.7%) were fatal and another 79 (5.6%) lead to death within 28 days. Median time from baseline to MI was 3.6 years (IQR 1.7–5.8). LTPA was associated with lower risk of fatal MI with odds ratios of 0.40 (95% CI: 0.22–0.73) for light and 0.41 (0.22–0.76) for moderate/high LTPA after multivariable adjustment with sedentary LTPA as reference. Age, alcohol-intake, education and smoking were identified as other predictors for fatal MI. We found no association between LTPA and 28-day case fatality.ConclusionsAmong individuals with MI, those that have engaged in any light or moderate physical activity were more likely to survive their MI. Results are consistent with effect of exercise preconditioning on risk of fatal arrhythmia.

Abstract 53: Changes in Physical Activity and Risk of Stroke in the California Teachers Study

Introduction: Leisure time physical activity (LTPA) has been consistently associated with a lower risk of stroke across several populations. Less is known however about how changes over the life-time in physical activity may influence the risk of stroke. We examined the association of changes in engaging in moderate and strenuous physical activity with risk of stroke in the California Teachers Study. Methods: The California Teachers Study is a prospective cohort study established in 1995. Baseline LTPA was obtained using a questionnaire outlining time spent in moderate (brisk walking for example) and strenuous (swimming and running for example); the same questionnaire was repeated in 2005-6. We defined the exposure as engaging in any activity for at least 15 minutes per week (any) in the second questionnaire when not engaging in any on the first questionnaire, with the reference being no change or a decline in activity between both. Multi-variable Cox models were constructed to examine the association of the change in LTPA with risk of stroke. Separate models were created for moderate and strenuous activity. Results: There were a total of 61,256 participants with two LTPA questionnaires available separated by 10 years. A total of 3,111 participants increased their level of moderate activity, 11,744 remained active in both, 2,760 declined from the first to the second questionnaire, while 2,508 reported no activity in both. There were 987 (709 ischemic, 221 hemorrhagic, 247 deaths) strokes after the second questionnaires (mean follow up 6.5 years). In multi-variable models increasing any moderate intensity from none from the two questionnaires, versus no change or decline in activity, was associated with a lower risk of all stroke (adjusted HR 0.83, 95% CI 0.72-0.95). We found no associations of changes in strenuous LTPA with risk of stroke (adjusted HR 0.99, 95% CI 0.83-1.17). The associations were statistically significant for ischemic stroke (adjusted HR 0.75, 95% CI 0.64-0.89) but not hemorrhagic stroke (adjusted HR 0.94, 95% CI 0.72-1.25). Conclusion: Improving or maintaining moderate intensity physical activity is associated with a lower risk of stroke, while changes in strenuous activity is not.

Leisure-Time Physical Activity Reduces Total and Cardiovascular Mortality and Cardiovascular Disease Incidence in Older Adults.

To determine whether leisure-time physical activity (LTPA) is independently associated with all-cause and cardiovascular mortality and with incidence of cardiovascular disease (CVD) and stroke in older adults. Population-based cohort study (median follow-up 11.8years). Community, five Finnish provinces. Men and women aged 65 to 74 who participated in a baseline risk factor survey between 1997 and 2007 in Finland (N=2,456). The study protocol included a self-administered questionnaire, health examination at the study site, and blood sample for laboratory analysis. LTPA was classified into three levels: low, moderate, high. Mortality data were obtained from the National Causes of Death Register and data on incident CVD (coronary heart disease, stroke) events from the National Hospital Discharge Register. Multifactorial-adjusted (age, area, study year, sex, smoking, body mass index, systolic blood pressure, serum cholesterol, education, marital status) risks of total mortality (moderate: hazard ratio (HR)=0.61, 95% confidence interval (CI)=0.50-0.74; high: HR=0.47, 95% CI=0.34-0.63, P for trend <.001), CVD mortality (moderate: HR=0.46, 95% CI=0.33-0.64; high: HR=0.34, 95% CI=0.20-0.59, P for trend <.001), and an incident CVD event (moderate HR=0.69, 95% CI=0.54-0.88; high: HR=0.55, 95% CI=0.38-0.79, P for trend <.001) were lower for those with moderate or high LTPA levels than for those with low LTPA levels. Further adjustment for self-reported inability to perform LTPA did not change the associations remarkably. Baseline LTPA reduces the risk of total and CVD mortality and incident CVD events in older adults independently of the major known CVD risk factors. The protective effect of LTPA is dose dependent.

SCIPA Com: outcomes from the spinal cord injury and physical activity in the community intervention.

Quasi-experimental translational study with pre- and post-measures. To determine the effects of the Spinal Cord Injury and Physical Activity in the Community (SCIPA Com) intervention on leisure-time physical activity (LTPA) and associated outcomes among participants with spinal cord injury (SCI). Young Men's Christian Associations and community fitness centers, Australia and New Zealand. SCIPA Com consisted of three stages: (i) training exercise professionals via the Train the Trainers Spinal Cord Injury course; (ii) implementation of supervised physical activity programs twice a week for 30 to 60 min for 8 to 12 weeks; and (iii) follow-up assessments on health outcomes over 9 months. Participants with SCI were classified as active or inactive by baseline LTPA levels and linear mixed methods compared LTPA between groups over time. Sixty-four community-dwelling participants with SCI completed customized physical activity programs. Compared with baseline, there were significant improvements in LTPA (26 min per day, 95% confidence interval (CI): 16.6-35.4; P<0.001), functional goals (2, 95% CI: 1.72-2.37; P<0.001), self-esteem (1.5, 95% CI: 0.72-2.27; P<0.001) and overall quality of life (P<0.05). Over time, LTPA participation was greater among the active compared with the inactive group, although LTPA levels among the inactive improved compared with baseline. Significant improvements in LTPA participation and health outcomes were observed, especially among inactive individuals with SCI. SCIPA Com is an ecologically valid intervention based on training and support provided to community exercise professionals who, although new to adapted training, delivered effective physical activity programs for those at risk of inactivity. Transport Accident Commission (Project Number DP172) and the International Postgraduate Research Scholarship (IPRS), Curtin University.

Abstract MP73: Leisure Time Physical Activity and Cognitive Decline in the Northern Manhattan Study

Background: Leisure time physical activity (LTPA) has been associated with a lower risk of dementia, but whether the effects are specific to particular cognitive abilities or improvement in functional status remains unclear. We examined LTPA in relation to domain-specific neurocognitive (NC) performance and change over time in a diverse community sample. Methods: Data on LTPA was collected during enrollment (1993-2001) into the Northern Manhattan Study (NOMAS), a prospective cohort study of risk factors for stroke and cognitive decline, using a validated in-person questionnaire, and two waves of NC assessments were done on a subcohort of participants undergoing brain MRI an mean of six and 12 years later (NC1: 2003-2008; NC2: 2008-2014). Baseline LTPA was defined in two manners: (1) maximum intensity of all activities performed categorized as moderate-heavy, light, and none; (2) total summarized as a continuous variable with the metabolic equivalent (MET) score, a composite of total reported intensity and time. Factor analysis-derived construct-relevant cognitive domains, including memory (MEM), executive function (EXEC), processing speed (PS), and language ability (LA), were computed by averaging z-transformed NC test scores. We used multivariable linear regression to examine LTPA in relation to baseline domain-specific NC performance, and change in performance over time, adjusting for socio-demographics, vascular risk factors, and MRI markers of cerebrovascular injury (white matter hyperintensity volume and total cerebral volume, both adjusted for total intracranial volume, and silent brain infarcts). Results: There were 1236 participants (mean age=64 years, 61% women, 67% Latino, 18% black, 15% white) with LTPA and NC data, and 879 with a second NC assessment. Moderate-to-heavy activity was associated with higher baseline LA (p &lt;0.05) and PS (p &lt;0.05), and with a protective effect on change of MEM (p &lt;0.05) and PS (p &lt;0.05); these effects were not attenuated after adjustment for MRI variables. Total MET-score was not associated with baseline NC domain performance. However, participants with greater MET-scores had significantly less decline in processing speed adjusting for age and education. Inclusion of vascular risk factors and MRI markers each attenuated these associations though they remained statistically significant. Conclusions: Leisure time physical activity is independently protective against a decline in processing speed and memory, and was partly mediated by MRI markers. Leisure-time physical activity may protect against dementia through preventing cerebrovascular correlates of brain injury.

Association of physical workload and leisure time physical activity with incident mobility limitations: a follow-up study

ObjectivesTo examine individual as well as joint associations of physical workload and leisure time physical activity with incident mobility limitations in initially well-functioning middle-aged workers.MethodsThis study is based on 6-year...

Investigating intermediary variables in the physical activity and quality of life relationship in persons with spinal cord injury.

Leisure time physical activity (LTPA) has been consistently associated with quality of life (QOL) in people with spinal cord injury (SCI). However, recent research suggests that intermediary variables account for the LTPA-QOL relationship in other populations. Using a prospective design, this study examined potential intermediary constructs linking LTPA and QOL in people with SCI. Drawing from previous literature, a longitudinal structural equation model was developed and tested to determine if depression, functional independence, social integration/participation, and self-efficacy mediate the LTPA-QOL relationship. Participants (n = 395) were adults with SCI who reported engaging in at least some LTPA over an 18-month period. LTPA was assessed at baseline, the intermediary variables of depression, functional independence, social integration/participation and self-efficacy were measured at 6-months, and QOL was evaluated at 18-months. The structural model had minimally acceptable fit [χ²(395) = 803.16, p > .05; CFI = .90, RMSEA = .05 and SRMR = .06]. Baseline LTPA was related to functional independence (β = .20, p > .05), depression (β = -.32, p > .05) and self-efficacy (β = .60, p > .05) at 6 months. Six-month functional independence (β = .15, p > .05), social participation (β = .21, p > .05) and depression (β = -.34, p > .05) significantly predicted 18-month QOL. Only functional independence and depression were significant mediators. These results suggest that LTPA may improve QOL in adults with SCI through its influence on functional independence and depression.

Incidence of school failure according to baseline leisure-time physical activity practice: prospective study.

PurposeTo evaluate the prospective association between leisure-time physical activity practice at 11 years of age and incidence of school failure from 11 to 15 years of age.MethodsThe sample comprised >4,300 adolescents followed up from birth to 15 years of age participating in a birth cohort study in Pelotas, Brazil. The incidence of school failure from age 11 to 15 years was calculated by first excluding from the analyses all subjects who experienced a school failure before 11 years of age, and then categorizing as “positive” all those who reported repeating a grade at school from 11 to 15 years of age. Leisure-time physical activity was measured using a validated questionnaire.ResultsThe incidence of school failure was 47.9% among boys and 38.2% among girls. Adolescents in the top quartile of leisure-time physical activity practice at 11 years of age had a higher likelihood of school failure (OR: 1.36; 95% CI: 1.06, 1.75) compared with the least active adolescents. In adjusted analyses stratified by sex, boys in the top quartile of leisure-time physical activity practice at 11 years of age were also more likely to have failed at school from age 11 to 15 years (OR: 1.60; 95% CI: 1.09, 2.33).ConclusionsAdolescents allocating >1,000 min/wk to leisure-time physical activity were more likely to experience a school failure from 11 to 15 years of age. Although this finding does not advocate against physical activity promotion, it indicates that excess time allocated to physical activity may jeopardize school performance among adolescents.