Harvard Alumni Health Study Research Articles

Associations of self-reported stair climbing with all-cause and cardiovascular mortality: The Harvard Alumni Health Study

To evaluate the association between numbers of floors climbed (per week) and all-cause and cardiovascular (CVD) mortality in men. A prospective study was conducted in 8874 men (Median [interquartile range] age: 65 years [60–71.6 years]) from the Harvard Alumni Health Study. Participants reported the number of floors habitually climbed, physical activity in their leisure time, other health related behaviours and any physician diagnosed disease in 1988. Men were followed for mortality through December 2008. Multivariate Cox hazard models to examine the association between weekly number of floors climbed and all-cause and CVD mortality adjusted for participation in total physical activity and other confounders.During a median follow-up of 12.4 years, 4063 men died (1195 from CVD). After adjusting for confounders (age, walking, sports/recreation, body mass index, alcohol intake, and smoking, diagnoses of hypertension or diabetes or high cholesterol) number of stairs habitually climbed was inversely associated with all-cause mortality (p trend <0.001). Compared with the group who climbed <10 floors/week, the hazard ratio (HR) for the ≥35 floors/week group was 0.84 95% confidence interval (CI) (0.78–0.91). In contrast, we found no evidence for an association between stair climbing and CVD mortality risk (p trend = 0.38), in the ≥35 floors/week group: HR = 0.94 95%CI (0.81–1.09). In this cohort of older men, stair climbing was associated with a lower risk of mortality from any causes. Further insights may be gained from future observational studies utilizing emerging pattern recognition of stair climbing from objective measurements of physical activity.

Abstract P271: Diet in Association with Weight Change and the Development of Overweight and Obesity - A Prospective Study of Men

Background: Obesity has become an epidemic affecting all age and socioeconomic groups worldwide with tremendous health consequences. Research is needed to determine modifiable lifestyle factors, including dietary factors, to prevent adults from becoming overweight or obese. Hypothesis: Diet is associated with weight change and overweight and obesity development. Methods: The Harvard Alumni Health Study is a prospective cohort study of men who matriculated at Harvard University from 1916-1950, and who have been followed by periodic questionnaires since 1962. We studied 6614 men free of cancer, cardiovascular disease, and diabetes (mean age, 65.5 years) who were nonobese (body mass index (BMI) &lt;30 kg/m 2 ) based on a 1988 questionnaire that also inquired about lifestyle, clinical, and dietary factors (23-item food frequency questionnaire). We considered individual dietary factors and a derived Dietary Approaches to Stop Hypertension (DASH) score of 6 dietary components: high intake of fruits, vegetables, fish, and low-fat dairy products, and low intake of sweets and red/processed meats). Men reported body weight on follow-up questionnaires in 1993 and 1998; 5- and 10-year body weight changes were computed along with the odds ratios (ORs) (95% confidence intervals (CIs)) of becoming overweight or obese, adjusting for various lifestyle and clinical factors as well as baseline BMI. Results: Over a 10-year period, 631 of 3906 initially normal weight (BMI≤25 kg/m 2 ) men became overweight or obese, and 230 of 6614 men initially nonobese (BMI≤30 kg/m 2 ) became obese. The multivariable-adjusted 5-year mean changes in body weight (standard deviation) were 0.03 (0.12), -0.12 (0.07), and -0.36 (0.09) kg, among men consuming total dairy products ≤6 times/week, 1-2 times/day, and ≥3 times/day (P-trend: 0.009), respectively, primarily driven by high-fat dairy intake (P, trend = 0.02). These associations weakened for 10-year weight changes. Higher tea consumption was inversely associated with greater 10-year (P-trend = 0.04), but not 5-year, weight loss. Among initially normal weight men, alcohol intake was inversely associated with a lower odds of becoming overweight or obese (OR (95% CI) for ≥168 versus 0 grams/week, 0.69 (0.49, 0.98); P, trend = 0.08). Other individual dietary factors were not associated with the odds of becoming overweight or obese. When investigating a combination of 6 beneficial dietary factors derived from the DASH score, an inverse linear association was observed with a lower OR of becoming obese (P-trend = 0.048), but not for becoming overweight or obese. Conclusion: In this prospective study of older men, selected individual dietary factors as well as a broader score reflecting a beneficial diet was related to less weight gain and lower odds of becoming overweight or obese.

Practical Guide to Measuring Physical Activity

Research has demonstrated the benefits of physical activity and the negative consequences of sedentary behavior for physical and mental well-being. 1 Macfarlane D.J. Lee C.C. Ho E.Y. et al. Convergent validity of six methods to assess physical activity in daily life. J Appl Physiol. 2006; 101: 1328-1334 Crossref PubMed Scopus (0) Google Scholar , 2 Blair S.N. Haskell W.L. Ho P. et al. Assessment of habitual physical activity by a seven-day recall in a community survey and controlled experiments. Am J Epidemiol. 1985; 122: 794-804 Crossref PubMed Google Scholar , 3 Craig C.L. Marshall A.L. Sjostrom M. et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003; 35: 1381-1395 Crossref PubMed Scopus (9429) Google Scholar , 4 Lee I.M. Hsieh C.C. Paffenbarger Jr., R.S. Exercise intensity and longevity in men. The Harvard Alumni Health Study. JAMA. 1995; 273: 1179-1184 Crossref PubMed Google Scholar , 5 Reilly J.J. Penpraze V. Hislop J. et al. Objective measurement of physical activity and sedentary behaviour: Review with new data. Arch Dis Child. 2008; 93: 614-619 Crossref PubMed Scopus (371) Google Scholar Thus, physical activity has become increasingly prominent as an intervention tool; however, research is often hindered by the challenge of employing a valid, reliable measure that also adequately satisfies the research question or design. 1 Macfarlane D.J. Lee C.C. Ho E.Y. et al. Convergent validity of six methods to assess physical activity in daily life. J Appl Physiol. 2006; 101: 1328-1334 Crossref PubMed Scopus (0) Google Scholar , 4 Lee I.M. Hsieh C.C. Paffenbarger Jr., R.S. Exercise intensity and longevity in men. The Harvard Alumni Health Study. JAMA. 1995; 273: 1179-1184 Crossref PubMed Google Scholar , 5 Reilly J.J. Penpraze V. Hislop J. et al. Objective measurement of physical activity and sedentary behaviour: Review with new data. Arch Dis Child. 2008; 93: 614-619 Crossref PubMed Scopus (371) Google Scholar , 6 Dishman R.K. The measurement conundrum in exercise adherence research. Med Sci Sports Exerc. 1994; 26: 1382-1390 Crossref PubMed Google Scholar , 7 Welk G. Introduction to physical activity research. in: Welk G.J. Physical Activity Assessments for Health-Related Research. Human Kinetics Publishers, Champaign, IL2002: 4 Google Scholar The doubly labeled water method (DLW) remains the gold standard for assessing total energy expenditure; however, it is not often used for research studies because it is expensive, has high subject burden, is time-intensive, and cannot capture qualitative data. 8 Melanson Jr., E.L. Freedson P.S. Physical activity assessment: A review of methods. Crit Rev Food Sci Nutr. 1996; 36: 385-396 Crossref PubMed Google Scholar , 9 Westerterp K.R. Assessment of physical activity: A critical appraisal. Eur J Appl Physiol. 2009; 105: 823-828 Crossref PubMed Scopus (300) Google Scholar The aim of our commentary is to summarize the main methods of measuring physical activity as well as offer examples of their uses in research trials. 10 Janz K.F. Witt J. Mahoney L.T. The stability of children's physical activity as measured by accelerometry and self-report. Med Sci Sports Exerc. 1995; 27: 1326-1332 Crossref PubMed Google Scholar , 11 Sallis J.F. Self-report measures of children's physical activity. J Sch Health. 1991; 61: 215-219 Crossref PubMed Google Scholar , 12 Welk G.J. Corbin C.B. The validity of the Tritrac-R3D Activity Monitor for the assessment of physical activity in children. Res Q Exerc Sport. 1995; 66: 202-209 Crossref PubMed Google Scholar L. G. Sylvia is an assistant professor of psychology, Bipolar Clinic and Research Program, The Massachusetts General Hospital, Boston, MA. E. E. Bernstein is a clinical research coordinator, Bipolar Clinic and Research Program, The Massachusetts General Hospital, Boston, MA. J. L. Hubbard is a dietitian, Clinical Research Center, The Massachusetts General Hospital, Boston, MA. E. J. Anderson is director of metabolism & nutrition research, Clinical Research Center, The Massachusetts General Hospital, Boston, MA. L. Keating is a registered dietitian, Clinical Center for Investigation, Brigham & Women's Hospital, Boston, MA.

Abstract MP026: Does the Replacement of Moderate-Intensity with Vigorous-Intensity Physical Activity Further Reduce All-Cause and Cardiovascular Mortality?

The 2008 US federal guidelines require a minimum of 150 minutes/week of moderate-intensity, or 75 minutes/week of vigorous-intensity physical activity, or an equivalent combination of the two, for health benefits. Thus, they assume a 2:1 equivalence between the two intensities of activity; i.e., 2 minutes of moderate-intensity activity is equivalent to 1 minute of vigorous-intensity activity. However, no studies have specifically examined whether this assumption is correct. Purpose: To examine the effect of replacing 150 minutes/week of moderate-intensity with 75 minutes/week of vigorous-intensity physical activity on all-cause and cardiovascular disease (CVD) mortality. Methods: 8,859 men (mean age, 66.4 yr) from the Harvard Alumni Health Study, free from CVD and cancer, were followed from 1988 to 2008. At baseline (1988) and in 1993, men reported physical activity (blocks walked, stairs climbed, and a listing of sports/recreational activities and participation time). Time spent per week in sports/recreational activities of moderate-intensity (3 to &lt;6 METs, or multiples of resting metabolic rate) was summed and expressed as units (or fraction of units) of 150 minutes/week. Similarly, time spent in vigorous-intensity (≥6 METs) sports/recreational activities was summed, expressed as units (or fraction of units) of 75 min/week. Total and cause-specific mortality was identified from the National Death Index. Cox proportional hazards models calculated the risks of all-cause and CVD mortality, examining the effect of replacing 150 minutes/week of moderate-intensity with 75 minutes/week of vigorous-intensity physical activity, controlling for the total amount of physical activity. Results: During follow-up, 4,064 men died, including 1,192 from CVD. In multivariate analyses, controlling for the total physical activity, age, smoking, intakes of alcohol, vegetable, fruit, and saturated fat, and total caloric intake, replacing 150 minutes/week of moderate-intensity with 75 minutes/week of vigorous-intensity physical activity was associated with an additional 2% reduction in all-cause mortality (Hazard Ratio (95% confidence interval) = 0.98 (0.96, 1.00); p = 0.05), and an additional 5% reduction in CVD mortality (0.95 (0.92, 0.99); p = 0.02). Conclusions: The assumption that 2 minutes of moderate-intensity activity is equivalent to 1 minute of vigorous-intensity activity under current federal guidelines is not strictly correct. Vigorous-intensity physical activity is associated with additional risk reduction for CVD mortality compared to moderate-intensity physical activity. Although there is an added, statistically significant benefit of vigorous-intensity over moderate-intensity physical activity, the magnitude of benefit is small.

Physical activity and weight gain prevention in older men

BackgroundPhysical activity and adiposity are important predictors of mortality, even in older individuals. However, it is unclear how much physical activity is needed to prevent weight gain in older persons.PurposeTo examine the associations of different amounts of physical activity with weight gain prevention in older men.Methods5,973 healthy men (mean age, 65.0 y) from the Harvard Alumni Health Study were followed from 1988 to 1998. At baseline (1988), in 1993, and 1998, men reported their recreational physical activity and body weight. Physical activity was categorized as: <7.5 MET-hr/week (7.5 MET-hr/week corresponds to the minimum required by the 2008 US federal guidelines), 7.5 to <21 MET-hr/week (21 MET-hr/week corresponds to the 2002 Institute of Medicine [IOM] guideline), and ≥21 MET-hr/week. Meaningful weight gain was defined as an increase of ≥3% of body weight.ResultsOverall, weight tended to be stable over any 5-year period; mean change, −0.08 (SD=4.44) kg. However, ~21% of men experienced meaningful weight gain over any 5-year period. In multivariate analyses, compared to men expending ≥21 MET-hr/week, those expending 7.5 to <21 MET-hr/week had an odds ratio (OR) of 1.35 (95% confidence interval: 1.03, 1.77) for meaningful weight gain, and men expending <7.5 MET-hr/week, an OR of 1.16 (1.01, 1.33) (p, trend = 0.09).ConclusionsAmong older men, those with lesser levels of physical activity were more likely to gain weight than men satisfying the 2002 IOM guidelines of ≥21 MET-hr/week (~60 minutes per day of moderate-intensity physical activity).

Blood Pressure in Early Adulthood, Hypertension in Middle Age, and Future Cardiovascular Disease Mortality: HAHS (Harvard Alumni Health Study)

We sought to examine the association of early adulthood blood pressure with cardiovascular disease (CVD) mortality, while accounting for middle-age hypertension. Elevated blood pressure in middle age is an established CVD risk factor, but evidence for association with measurements earlier in life is sparse. The HAHS (Harvard Alumni Health Study) is a cohort study of 18,881 male university students who had their blood pressure measured at university entry (1914 to 1952; mean age 18.3 years) and who responded to a questionnaire mailed in either 1962 or 1966 (mean age 45.8 years) in which physician-diagnosed hypertension status was reported. Study members were subsequently followed for mortality until the end of 1998. Following adjustment for age, body mass index, smoking, and physical activity at college entry, compared with men who were normotensive according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure criteria (<120/<80 mm Hg), there was an elevated risk of coronary heart disease (CHD) mortality (1,917 deaths) in those who were pre-hypertensive (120 to 139/80 to 89 mm Hg) (hazard ratio [HR]: 1.21; 95% confidence interval [CI]: 1.07 to 1.36), stage 1 (140 to 159/90 to 99 mm Hg) (HR: 1.46; 95% CI: 1.25 to 1.70), and stage 2 hypertensive (≥160/≥100 mm Hg) (HR: 1.89; 95% CI: 1.46 to 2.45), incremental across categories (p(trend) < 0.001). After additionally accounting for middle-age hypertension, estimates were somewhat attenuated, but the pattern remained. Similar associations were apparent for total and CVD mortality, but not stroke mortality. Higher blood pressure in early adulthood was associated with elevated risk of all-cause mortality, CVD, and CHD, but not stroke, several decades later. Effects largely persisted after taking into account mediation by middle-age hypertension. Thus, the long-term benefits of blood pressure lowering in early adulthood are promising, but supporting trial data are required.

Fat or fit: what is more important?

The prevalence of obesity is increasing worldwide, and obesity represents one of the major health hazards (1). Obesity was shown to be linked to an increased mortality and morbidity. However, obesity is often associated with modifications of physical activity level. Physical activity level itself affects the health status of the individual and thus may be a confounding variable in the obesity-mortality/morbidity relationship. Understanding the role of physical activity in the development of obesity-associated health hazards appears crucial for effective treatment of obesity and prevention of its complications. A large number of prospective studies have paid attention to the relationship between adiposity (i.e., degree of overweight/obesity) and mortality or morbidity. In the classic Framingham Heart Study (2), the degree of obesity predicted the incidence of cardiovascular disease. In the Harvard Alumni Health Study (3), men with the highest BMI (>26.0 kg/m2) had the highest risk of mortality. The Nurses Health Study (4) shows the lowest all-cause mortality and morbidity rates in subjects with the lowest BMI. The British Regional Heart Study (5) found an elevated all-cause mortality in men with BMI 30 kg/m2. A German study in obese subjects did show an elevated risk of all-cause mortality in obese subjects when compared with individuals with the lowest BMI, but, interestingly, did not find a difference in mortality rates between grossly obese (32 < BMI < 40 kg/m2) and overweight/moderately obese (25 < BMI < 32 kg/m2) patients (6). Abdominal fat distribution characterized by a higher waist-to-hip and waist-to-thigh ratio increases the risk of mortality not only among obese (BMI ≥30.0 kg/m2), but also among normal-weight (BMI 18.5–24.9 kg/m2) young and middle-aged adults (7). Measures of abdominal adiposity strongly and positively predict mortality, independent of BMI, among both white and black adults (8 …

The Built Environment and Physical Activity Levels: The Harvard Alumni Health Study

Physical activity is associated with better health, but many individuals are insufficiently active. Modifying the built environment may be an approach capable of influencing population-wide levels of physical activity, but few data exist from longitudinal studies that can minimize bias from active people choosing activity-friendly neighborhoods. This study aims to examine cross-sectional and longitudinal associations between the built environment and physical activity on a large scale. This study examined cross-sectional associations between urban sprawl (mapping addresses to corresponding counties) and physical activity (self-reported) among men throughout the U.S. in 1993 and in 1988, and longitudinal associations between changes in exposure to urban sprawl for movers and physical activity, 1988-1993. Included were 4997 men (mean age, 70 years) in the 1993 cross-sectional study; 4918 men in the 1988 cross-sectional study; and 3448 men in the longitudinal study, 1988-1993. Data were collected prospectively in 1988 and 1993, and analyses were performed in 2007-2008. In cross-sectional analyses, less sprawl was significantly associated with more walking OR, comparing least with most sprawling areas, for meeting physical activity recommendations by walking=1.38 [95% CI=1.09, 1.76] in 1993 and 1.53 [1.19, 1.96] in 1988). Less sprawl also was associated with lower prevalence of overweight (corresponding OR=0.79 [0.64, 0.98] in 1993 and 0.81 [0.66, 1.00] in 1988). However, longitudinal analyses assessing change did not show that decreasing sprawl was associated with increased physical activity or decreased BMI. These findings suggest that the cross-sectional results may reflect self-selection, rather than indicating that the built environment--as measured by urban sprawl--increases physical activity. However, the longitudinal findings were limited by small numbers of men changing residence and associated sprawl levels.

Elevated body mass index in early adulthood as a predictor of later coronary heart disease mortality: up to 82 years follow-up in the Harvard Alumni Health Study

Few studies have examined the association between adiposity in early adulthood and later coronary heart disease (CHD). Further, whether the impact of early adiposity is mediated via adiposity in middle...

Elevated blood pressure in early adulthood as a predictor of later coronary heart disease mortality: up to 83 years follow-up in the Harvard Alumni Health Study

Elevated blood pressure in early adulthood as a predictor of later coronary heart disease mortality: up to 83 years follow-up in the Harvard Alumni Health Study

Correlates of clinically significant fatigue in women with newly diagnosed breast cancer

e20517 Background: Cancer related fatigue (CRF) is common in cancer survivors. CRF has been reported to be one of the most distressing symptoms associated with cancer and its treatment. Activity and biological profiles of those who suffer from CRF, have been poorly characterized. This IRB approved prospective, natural history study reports fatigue and associated findings in women newly diagnosed with breast cancer (BrCa), receiving standard treatment. Methods: All women were evaluated pre-operatively and at &gt;9 months after diagnosis. Variables measured: Age, height, marital status, presence of children, menopausal status, tumor size, node status, estrogen receptor (ER+), hemoglobin, white blood cell count, fasting blood glucose, and BMI. Patient reported outcomes included visual analog scale (VAS) of fatigue (F), SF-36 version2, Physical Activity Questionnaire (PAQ, Harvard Alumni Health Study) and Sleep Questionnaire. Some variables were dichotomized to maximize the statistical power for the relatively small sample size. Bivariate correlations, and logistic regression analyses were performed using two fatigue conditions: presence of any F, or presence of clinically significant fatigue (CSF) defined as &gt;=4 on the VAS. Results: 61 women, mean age of 51y, 39% had BMI &gt;=25, 85% had &gt;= 1 child, 52% were post-menopause, 92% ER+. Increased F at follow-up was statistically significant when compared to baseline (p=&lt;0.0001, using paired t-test). Significant correlations (p&lt;0.1) are reported between CSF and the following: node+, BMI&gt;=25; inverse correlations with amount of vigorous activity (PAQ), physical function and vitality on SF-36. Physical function (SF-36) had significant inverse correlations with: age, menopause, and BMI. Low vitality was associated with: large tumor size, high WBC, longer time sleeping. Node+, BMI&gt;=25, low physical function and vitality levels retained statistically significant relationships to CSF in the regression analyses. Conclusions: Node+ BrCa, BMI&gt;=25, low level of physical activity and vitality (SF-36) are correlated with CSF. Except node status, each is treatable and may reduce CSF No significant financial relationships to disclose.

Body Mass Index and Risk of Parkinson's Disease: A Prospective Cohort Study

High body mass index has been associated with increased risk of several chronic diseases, including cardiovascular disease, and, recently, Alzheimer's disease. There are few data on the association of body mass index with Parkinson's disease, and results have been inconsistent. The authors conducted a prospective study among 10,812 men in the Harvard Alumni Health Study, followed from 1988 to 1998 (mean age at baseline: 67.7 years), to test the hypothesis that body mass index is associated with Parkinson's disease risk. Among 106 incident cases of Parkinson's disease, body mass index at baseline was not associated with Parkinson's disease risk (for body mass index <22.5, 22.5-<24.9, and > or =25.0 kg/m2: multivariate relative risks = 1.51 (95% confidence interval: 0.95, 2.40), 1.00 (referent), and 0.86 (95% confidence interval: 0.53, 1.41)). The authors had information on body mass index during late adolescence, when men entered college; this was unrelated to Parkinson's disease risk as well. Subjects who lost at least 0.5 units of body mass index per decade between college entry and 1988 had a significantly increased Parkinson's disease risk, compared with men having stable body mass index (multivariate relative risk = 2.60, 95% confidence interval: 1.10, 6.10). The authors conclude that body mass index is unrelated to Parkinson's disease risk and speculate that the observation of increased risk with body mass index loss since late adolescence may reflect weight loss due to Parkinson's disease that preceded clinical diagnosis.

Physical activity and risk of Parkinson’s disease: a prospective cohort study

Background: Despite the fact that Parkinson’s disease is the second most common neurodegenerative disease, little is known about risk factors for the disease. Laboratory experiments indicate that physical activity may...

The "weekend warrior" and risk of mortality.

Physical activity improves health, and current recommendations encourage daily exercise. However, little is known about any health benefits associated with infrequent bouts of exercise (e.g., 1-2 episodes/week) that generate the recommended energy expenditure. The authors conducted a prospective cohort study among 8,421 men (mean age, 66 years) in the Harvard Alumni Health Study, without major chronic diseases, who provided details about physical activity on mailed questionnaires in 1988 and 1993. Men were classified as "sedentary" (expending <500 kcal/week), "insufficiently active" (500-999 kcal/week), "weekend warriors" (>/=1,000 kcal/week from sports/recreation 1-2 times/week), or "regularly active" (all others expending >/=1,000 kcal/week). Between 1988 and 1997, 1,234 men died. The multivariate relative risks for mortality among the sedentary, insufficiently active, weekend warriors, and regularly active men were 1.00 (referent), 0.75 (95% confidence interval (CI): 0.62, 0.91), 0.85 (95% CI: 0.65, 1.11), and 0.64 (95% CI: 0.55, 0.73), respectively. In stratified analysis, among men without major risk factors, weekend warriors had a lower risk of dying, compared with sedentary men (relative risk = 0.41, 95% CI: 0.21, 0.81). This was not seen among men with at least one major risk factor (corresponding relative risk = 1.02, 95% CI: 0.75, 1.38). These results suggest that regular physical activity generating 1,000 kcal/week or more should be recommended for lowering mortality rates. However, among those with no major risk factors, even 1-2 episodes/week generating 1,000 kcal/week or more can postpone mortality.

Alcohol consumption and risk of prostate cancer: The Harvard Alumni Health Study

Although many studies suggest that consumption of alcohol increases the risk of several site-specific cancers, the evidence remains unclear for prostate cancer. Few data exist on beverage-specific associations as well as lifetime patterns of alcohol consumption and prostate cancer risk. We prospectively followed 7612 Harvard alumni (mean age 66.6 years) from 1988 through 1993, during which 366 cases of incident prostate cancer occurred. Self-reported alcohol consumption was assessed at baseline from wine, beer, and liquor intake. Previous assessments during college and in 1977 were also available. Overall, the mean total alcohol consumption in 1988 was 123.1 g/week, of which 28.6% was from wine, 15.8% from beer, and 55.6% from liquor. Compared to men reporting almost never drinking alcohol in 1988, the multivariate relative risks (95% CI) for 1 drink/month to < 3 drinks/week, 3 drinks/week to < 1 drink/ day, 1 to < 3 drinks/day, and > or = 3 drinks/day were 1.33 (0.88-2.01), 1.65 (1.12-2.44), 1.85 (1.29-2.64), and 1.33 (0.86-2.05), respectively. Wine or beer consumption was unassociated with prostate cancer; however, moderate liquor consumption was associated with a significant 61-67% increased risk of prostate cancer (P, non-linear trend < 0.001). Men initiating alcohol consumption between 1977 and 1988 had a twofold increased risk of prostate cancer compared to men with almost no alcohol consumption at both times. In contrast to the majority of previous studies, we found a positive association between moderate alcohol consumption and the risk of prostate cancer. Liquor, but not wine or beer, consumption was positively associated with prostate cancer.

Physical Activity and Coronary Heart Disease Risk in Men

Physical activity is associated with a decreased risk of coronary heart disease (CHD). However, it is unclear whether the duration of exercise episodes is important: Are accumulated shorter sessions as predictive of decreased risk as longer sessions if the same amount of energy is expended? In the Harvard Alumni Health Study, we prospectively followed 7307 Harvard University alumni (mean age 66.1 years) from 1988 through 1993. At baseline, men reported their walking, stair climbing, and participation in sports or recreational activities. For each of the latter activities, they also reported the frequency and average duration per episode. During follow-up, 482 men developed CHD. In age-adjusted analysis, a longer duration of exercise episodes predicted lower CHD risk (P: trend=0.04). However, after total energy expended on physical activity and potential confounders was accounted for, duration no longer had an independent effect on CHD risk (P: trend=0.25); that is, longer sessions of exercise did not have a different effect on risk compared with shorter sessions, as long as the total energy expended was similar. In contrast, higher levels of total energy expenditure significantly predicted decreased CHD risk in both age-adjusted (P: trend=0.009) and multivariate (P: trend=0.046) analyses. These data clearly indicate that physical activity is associated with decreased CHD risk. Furthermore, they lend some support to recent recommendations that allow for the accumulation of shorter sessions of physical activity, as opposed to requiring 1 longer, continuous session of exercise. This may provide some impetus for those sedentary to become more active.

Physical Activity and Stroke Incidence: The Harvard Alumni Health Study

Physical Activity and Stroke Incidence: The Harvard Alumni Health Study

Life is sweet: candy consumption and longevity

Our attitude towards candy—“if it tastes that good, it can't be healthy”—betrays society's puritanical stance towards pleasure. Candy has been blamed for various ills, including hyperactivity in children; however, clinical...

Physical Activity and Public Health

<h3>To the Editor.</h3> —Exercise promotion has become a major disease prevention goal, but unfortunately, many attempts to have various population segments initiate and maintain exercise and activity have had limited success.¹Partly in response to disappointing outcomes, and partly based on empirical studies, guidelines for activity and exercise have been reduced to the accumulation of 30 minutes of moderate activity five times per week. While seemingly well-intentioned, these new guidelines and the public health message they deliver may be problematic and potentially counterproductive from both scientific and public policy perspectives in several ways, including: 1. The use of caloric expenditure as a standard. The revised guidelines are partly built around epidemiologic studies showing a relationship between gross measures of caloric expenditure in leisure-time activities and reduced morbidity and mortality.¹However, the most recent data from the Harvard Alumni Health Study clearly show that what is critical for risk

Exercise intensity and longevity in men. The Harvard Alumni Health Study

Exercise intensity and longevity in men. The Harvard Alumni Health Study