Higher Exercise Frequency Research Articles

Hypertension is More Affected by Fitness and Waist Circumference than Exercise Frequency and BMI in Middle Age: Hypertension is affected to cardiorespiratory fitness and waist circumference

Background and objectiveHypertension (HTN) is a representative cardiovascular disease worldwide. This study aimed to inves-tigate the prevalence of HTN in middle age using cardiorespiratory fitness (CRF), exercise habits, and obesity. Material and methodsA total of 4835 middle-aged individuals (2783 men and 2052 women; age range: 40–59 years) were analyzed. The diagnostic criterion for HTN was blood pressure ≥140/90 mmHg or current use of HTN medication. CRF was measured as VO2max by gas analysis. The exercise frequency was indicated as participant days per week. Obesity was assessed using waist circumference and body mass index (BMI). The odds ratio (OR) was determined by logistic regression analysis. The groups were divided by quar-tile and median and classified by sex. The significance level was set at a p-value <0.05. ResultsThe HTN OR in the highest CRF group decreased to 0.399 in men and 0.413 in women. The OR for exercise frequency decreased in the 5–7 days group by 0.428 in men and 0.488 in women than in the no-exercise group. The HTN OR in the normal BMI group decreased to 0.611 in men and 0.679 in women than in the obese group. The OR for waist circumference was 0.528 in men (≤89.9 cm) and 0.428 in women (≤84.9 cm). The OR of the high fitness-normal waist group was 0.244 in men and 0.191 in women. The OR of the low fitness-normal weight group was 0.872 in men and 0.766 in women (p<0.05), whereas that of the high fitness-overweight group was 0.561 in men and 0.582 in women (p<0.05). ConclusionThe higher the exercise frequency and CRF and the lower the BMI and waist circumference, the lower the prevalence of HTN. The prevalence of HTN decreased significantly with higher CRF and lower waist circumference than with higher exercise frequency and lower BMI.

ASSOCIATION OF FITNESS, BODY CIRCUMFERENCE, MUSCLE MASS, AND EXERCISE HABITS WITH METABOLIC SYNDROME

Background and objectiveMetabolic syndrome (MetS) can be improved by diet, cessation of smoking, and in particular exercise. The purpose of this study was to analyze the association of exercise-related factors such as fitness, exercise habits, muscle, and body fat with MetS. MethodsData were collected for research purposes from 398 males aged 40–50 years. Appendicular skeletal muscle mass (ASM) and body fat percentage were analyzed using bioelectrical impedance analysis (BIA). Fitness was evaluated using cardiopulmonary fitness, grip strength, and leg power. Exercise habits included exercise frequency, intensity, and duration. Data were analyzed using the odds ratio (OR), calculated by logistic regression analysis. ResultsThere was no significant difference in age between the non-MetS (51.1 years) and the MetS (51.5 years) groups. Differences in dyslipidemia and fitness variables classified as MetS risk factors were significant between groups. The group with the highest cardiopulmonary fitness had an OR of 0.426 (95% confidence interval [CI], 0.191–0.948) when compared with the lowest group, while grip strength was not significantly different. Obesity factors such as body fat percentage, body mass index, and waist circumference were significantly prevalent. The group with the largest thigh circumference had an OR of 0.299 (95% CI, 0.101–0.881) when compared to the group with the smallest thigh circumference. Calf circumference did not yield significant results. The group with the highest ASM had an OR of 0.346 when compared with the lowest group. Higher exercise frequency and longer duration were associated with a lower prevalence of MetS. ConclusionAmong physical strength, circumference, muscle mass, and obesity factors, MetS was most affected by obesity factors. Furthermore, higher cardiopulmonary fitness and frequent exercise can be helpful for MetS prevention.

Responses of healthy young males to fine-particle exposure are modified by exercise habits: a panel study

BackgroundAerobic exercise benefits health but increases inhalation of fine particles (PM2.5) in ambient air. Acute cardiopulmonary responses to PM2.5 exposure in individuals with different exercise habits, especially in areas with severe air pollution, are not well understood.MethodsTo examine acute cardiopulmonary responses to PM2.5 exposure modified by exercise habits, a panel of 20 healthy non-smoking male subjects, recruited in Beijing, China, completed seven visits. The exercise frequency per week and preferred exercise place were recorded using a baseline questionnaire to describe exercise habits. Fractional exhaled nitric oxide (FeNO), cytokines in exhaled breath condensate, blood pressure, and pulse-wave analysis (PWA) indices were measured during each visit as biomarkers of acute cardiopulmonary responses. The hourly average mass concentration of PM2.5 and black carbon (BC), and the number concentrations of ultrafine particles (UFP) and accumulation mode particles (AMP) were monitored throughout the follow-up period at an outdoor fixed monitoring station beginning 14 days prior to each visit. Linear mixed-effects models were used to evaluate the associations between acute changes in biomarker levels and exposure to PM2.5 and its constituents. The primary aim was to assess the modification of long-term exercise habits on these associations.ResultsFeNO concentration, systolic blood pressure, ejection duration, aortic augmentation pressure, and aortic pressure index were positively associated with exposure to PM2.5 and its constituents. However, no associations with cytokine levels or diastolic blood pressure were observed. In a stratified analysis, we found that acute cardiopulmonary responses were modified by exercise habit. Specifically, the interquartile ranges (IQR) of increases in the 6–12-h moving average (MA) PM2.5 and AMP exposure were associated with 19–21% and 24–26% increases in FeNO, respectively, in subjects with high exercise frequency; these associations were significantly stronger than those in subjects with low exercise frequency. An IQR increase in 3–11-d MA AMP exposure was associated with a 10–26% increase in aortic augmentation pressure in subjects with low exercise frequency; this association was significantly stronger than that in subjects with high exercise frequency. An IQR increase in 9–13-d MA UFP exposure was associated with a 13–17% increase in aortic augmentation pressure in subjects who preferred outdoor exercise; this association was stronger than that in subjects who preferred indoor exercise.ConclusionsIn highly polluted areas, frequent exercise might protect against PM2.5-associated arterial stiffness but exacerbate airway inflammation.

Abstract 16627: Predictors of Response to Exercise Training in Patients With Hypertrophic Cardiomyopathy

Introduction: RESET-HCM was a randomized clinical trial of 16 weeks of moderate-intensity exercise training (ExT) in patients with hypertrophic cardiomyopathy (HCM). Compared with usual activity (UA), ExT resulted in a modest but significant 6% improvement in mean peak oxygen consumption (VO 2peak ), the best measure of cardiorespiratory fitness (CRF). Studies of heart failure populations have shown that ≥15% improvement in VO 2peak can be achieved with ExT. Hypothesis: We hypothesize that intervention-, disease-, and patient-specific factors differentially influence VO 2peak response to ExT. Methods: Data from 113 subjects were analyzed. Those who achieved ≥ 15% improvement in VO 2peak in response to ExT were categorized as high responders (HR), while low responders (LR) were those who did not. Baseline characteristics and activity log data were compared between HR and LR. Logistic regression investigated associations between VO 2peak response and these measures. Results: Twenty-two subjects were HR (16/57 [28.1%] in the ExT group vs. 6/56 [10.7%] in the UA group, p=0.02). HR had fewer comorbidities such as hypertension (9.1% vs 26.4%, p=0.03) and diabetes mellitus (0% vs 7.7%, p=0.01). Ejection fraction (EF) was lower among HR than LR (68.6% vs 71%, p=0.02), but other measures of cardiac remodeling, including hypertrophy and fibrosis burden, resting left ventricular outflow obstruction, and diastolic function did not differ. HR had lower baseline VO 2peak (18.4 vs 22.6 mL/kg/min, p=0.01). Although adherence to the frequency element of exercise prescriptions decreased over time in both groups, HR were 25% more adherent (p=0.02), exercising an average of 1 more day per week (3.8 vs 2.8, p=0.02). On multivariate analysis, baseline VO 2peak (OR: 0.79; 95% CI: 0.68-0.92) and EF (OR: 0.85; 95% CI: 0.74-0.98) were independent predictors of ≥15% improvement in VO 2peak after adjustment for age and sex. Higher exercise frequency (OR: 1.37; 95% CI: 0.97-1.95) was also an important factor. Conclusions: Higher exercise frequency, lower CRF at baseline, and lower EF predicted a greater magnitude of response to moderate intensity ExT in HCM patients. Future studies will be necessary to make the response to ExT more uniform across a heterogeneous group of HCM patients.

Health Behavior and Quality of Life Outcome in Breast Cancer Survivors: Prevalence Rates and Predictors

PurposeHealth behavior (HB) has been identified as contributing to breast cancer (BC) disease outcome. The present study was subjected to gain more in-depth insight into breast cancer survivors' (BCS) HB and its associations with patient quality of life (QOL) outcome. We investigated HB focusing on eating disturbances comparing the latter with a reference population sample (PS). Materials and MethodsThe research cohort included 303 BCS completing a comprehensive patient-reported-outcome assessment on HB (eating disturbances, exercise, substance use) and QOL. Data from an age- and education-matched reference PS (n = 303) on eating disturbances were included. ResultsOverall, 30% of BCS were overweight; 11.7% of BCS (2-11 years after diagnosis, mean = 5.2 years) reported eating disturbances compared with 5% of PS (P < .05). Approximately three-fourths of BCS indicated they exercise regularly, one-fourth smoke regularly, and 30% consume alcohol. Lower consumption of analgesics and tranquilizers, higher frequency of exercise, lower eating concern (EDE-Q), younger age, and lower body mass index were significant predictors for better physical QOL. Lower eating and shape concern were next to age-identified predictive for better psychological QOL. DiscussionObesity and eating disturbances are a considerable HB problem in women with a history of BC. Considering that HB is predictive for long-term QOL in BCS, routine counseling on HB should be integrated into survivorship care to increase patient education and contribute to behavioral changes.

Perceived cognitive function for breast cancer survivors: association of genetic and behaviorally related variables for inflammation.

We explored relationships between genetic variability and behaviorally related variables (body mass index and exercise frequency) for inflammation, and perceived cognitive function (PCF) for breast cancer survivors (BCS). Our primary aim was to explore relationships between select single-nucleotide polymorphisms (SNPs) for IL1R1, IL6, TNF genes, and PCF. Our secondary aim was to explore whether body mass index (BMI) and exercise frequency moderate these relationships. We conducted an exploratory candidate gene substudy. Saliva samples from participants (N=101) in a larger, cross-sectional study were genotyped. Multiple linear regression analysis was used to explore relationships between SNPs and PCF, controlling for age, education level, fatigue, and distress. Hierarchical expansion of regression models included main effects for BMI and exercise frequency and interaction effects between BMI, exercise frequency, and each SNP. The most parsimonious regression model included fatigue, exercise frequency, and IL1R1rs2287047 minor alleles (AA+GG) (R 2=0.244, adjusted R 2=0.220, p=0.013). No other SNPs were significant. Higher exercise frequency (b=7.300, p=0.013) and IL1R1rs2287047 (AA+AG) (b=6.512, p=0.025) predicted better PCF. Greater fatigue predicted poorer PCF (b=-2.359, p<0.01). No interaction was demonstrated between BMI and exercise related to PCF or between BMI, exercise, and SNPs. Our results suggest a protective relationship between IL1R1rs2287047 (AA+AG) and PCF and provide further evidence supporting exercise as a potential intervention for poorer PCF. Ours is the first study to investigate genetic variability associated with inflammation, behaviorally related variables, and PCF for BCS.

Effects of exercise on disability in older adults with arthritis: A 3-year follow-up

The purpose of this study was to investigate the effects of exercise on functional disability outcomes in older adults with arthritis. Exercise was operationalized as frequency of exercise per week at baseline and follow-up, and as miles walked per week at baseline and follow-up. Results indicated that subjects reporting high exercise frequency at baseline and follow-up were least impaired after 3 years. Surprisingly, changing from low rate of exercise to a high rate of exercise by follow-up was not associated with less impairment. These data suggest that benefit is secured only with adoption and continuity of exercise. Additional results indicated that frequent walking at follow-up yielded benefit, irrespective of walking mileage at baseline. Implications and applications for therapeutic recreation inducing comparable outcomes in practice are discussed.

Association Between Exercise Participation and Quality of Sleep and Life Among University Students in Taiwan.

This cross-sectional survey study examined exercise, sleep quality, and quality of life (QOL) in 1230 Taiwanese university students. Compared with women, men had higher body mass index (BMI) (22.3 ± 4.1 vs 20.7 ± 3.5 kg/m(2)), higher exercise frequency (2.6 ± 1.7 vs 2.0 ± 1.4 d/wk), better sleep quality (global Pittsburgh Sleep Quality Index 6.0 ± 2.8 vs 6.5 ± 2.7), better physical QOL (physical component summary 52.7 ± 6.2 vs 51.7 ± 6.6), and higher reporting of good self-perceived health (62.2% vs 43.3%) (P <01). However, gender differences were nonsignificant after multivariable adjustment. Exercise frequency, sleep quality, and QOL were significantly intercorrelated. After multivariable adjustment, self-perceived health and satisfaction with exercise participation predicted quality of sleep and QOL (P <01). Exercise frequency was positively correlated (P =012), and exercise intensity was negatively associated (P <001) with physical QOL. In conclusion, those who regularly exercised (at least 1 d/wk or 2.5 h/wk) had better QOL. Students with better self-perceived health or satisfaction with exercise participation also had better quality of sleep and better QOL.

Daily salt intake estimated by overnight urine collections indicates a high cardiovascular disease risk in Thailand.

This cross-sectional study (February 2012 to March 2013) was conducted to estimate daily salt intake and basic characteristics among 793 community-dwelling participants at high risk of cardiovascular disease (Framingham risk score >15%), who had visited diabetes or hypertension clinics at health centres in the Muang district, Chiang Rai, Thailand. We performed descriptive analysis of baseline data and used an automated analyser to estimate the average of 24-hour salt intake estimated from 3 days overnight urine collection. Participants were divided into two groups based on median estimated daily salt intake. Mean age and proportion of males were 65.2 years and 37.6% in the higher salt intake group (>=10.0 g/day, n=362), and 67.5 years and 42.7% in the lower salt intake group (<10.0 g/day, n=431), respectively (p=0.01, p<0.01). The higher salt intake group comprised more patients with a family history of hypertension, antihypertensive drug use, less ideal body mass index (18.5-24.9), higher exercise frequency (>=2 times weekly) and lower awareness of high salt intake. Among higher salt intake participants, those with lower awareness of high salt intake were younger and more often had a family history of hypertension, relative to those with more awareness. Our data indicated that families often share lifestyles involving high salt intake, and discrepancies between actual salt intake and awareness of high salt intake may represent a need for salt reduction intervention aiming at family level. Awareness of actual salt intake should be improved for each family.

Alcohol and Exercise Affect Declining Kidney Function in Healthy Males Regardless of Obesity: A Prospective Cohort Study.

BackgroundAlthough lifestyle is associated with metabolic syndrome and cardiovascular diseases, there has been no sufficient evidence of lifestyles on incident chronic kidney disease (CKD). The purpose of this prospective cohort study is to investigate the effects of lifestyles on kidney function in healthy people.MethodsA total of 7473 healthy people were enrolled in this Saitama Cardiometabolic Disease and Organ Impairment Study, Japan. Data on alcohol consumption, exercise frequency, and sleep duration were collected. The outcome event was incident CKD or decrease in estimated glomerular filtration rate (eGFR) by >25% in 3 years.ResultsSubjects were classified into four groups according to body mass index and gender. Mean ± standard deviation of age was 38.8±10.5 years; eGFR, 78.1±15.2 ml/min/1.73m2. In the male groups, multivariate logistic regression models showed that the outcome events were associated with a small amount of alcohol consumed (20 to 140g of alcohol/week) (ref. more than 140g of alcohol/week); non-obese male, adjusted odds ratio 1.366 (95% confidence interval, 1.086, 1.718); obese male (body mass index ≥25), 1.634 (1.160, 2.302); and with frequent exercise (twice a week or more) (ref. no exercise); non-obese male, 1.417 (1.144, 1.754); obese male, 1.842 (1.317, 2.577). Sleep duration was not associated with the outcome events.ConclusionThese findings suggest that, regardless of obesity, a small amount of alcohol consumed and high exercise frequency were associated with the increased risk of loss of kidney function in the male groups.

Status and Relationships among Lifestyle, Food Habits, and Stress Scores of Adults in Chungnam

This study was conducted to investigate the association among demographic characteristics, lifestyle, food habits, and stress status of 437 males and females aged over 25 years in Chungnam. Overall, the stress status of the subjects was high showing an average of 103 points out of 156 points based on the something scale. Results of the study revealed that marital status, exercise status, and health status had significant relationships with food habits and stress scores. The subjects who were married, had a higher frequency of exercise, and were healthier, had a significantly higher food habit score but a significantly lower stress score compared with their counterparts. Also, food habit scores had a significantly negative relationship with stress scores. Thus, this research showed possible links among healthy food habits, desirable lifestyle, and low stress status. In other words, people who experience a high level of stress may be more likely to have unhealthy food habits, resulting in a poor healthy conditions. These results show that appropriate food habits and adequate dietary management are deemed necessary for people with a high degree of stress. Further in-depth studies are needed to clarify a direct relationship between stress and food habits and to determine the proper diet that may help relieve stress. (Korean J Community Nutr 17(5) : 579~588, 2012)

Factors Related to Body Mass Index and Body Mass Index Change in Korean Children: Preliminary Results from the Obesity and Metabolic Disorders Cohort in Childhood

BackgroundThis preliminary study is to assess risk factors associated with children's body mass index (BMI) and their changes over a 2-year period based on the analysis of the Obesity and Metabolic Disorders Cohort in Childhood registry.MethodsA total of 1,504 children comprised of 474 1st graders and 1,030 4th graders were included in the study. Data on physical activity, dietary intake, and socioeconomic status were obtained through self-administered questionnaires, and height and weight were measured annually for 2 years.ResultsIn a cross-sectional analysis, BMI of 1st graders was associated with higher parental BMI (both P < 0.001) and frequent snack consumption (P = 0.049). BMI of 4th graders was additionally associated with shorter sleep duration (P = 0.001), lower household income (P = 0.016), higher fat intake (P = 0.017), and frequent meal skipping (P = 0.020). During a 2-year follow-up, BMI increased by 0.8 ± 1.4 kg/m2 in 1st graders and by 1.3 ± 1.4 kg/m2 in 4th graders. In a longitudinal analysis, higher exercise frequency (P = 0.007), shorter sleep duration (P = 0.027), lower household income (P = 0.002), and higher paternal BMI (P = 0.002, 0.043) were significant predictors of BMI changes in the 1st graders whereas only higher maternal BMI (P=0.035), and frequent snack consumption (P = 0.010) were predictors for the 4th graders BMI changes.ConclusionOur findings indicate that parental obesity, short sleep duration, low socioeconomic status, and frequent snacking are associated with BMI and BMI changes.

Good maintenance of physical benefits in a 12-month exercise and nutritional intervention by voluntary, home-based exercise: a 6-month follow-up of a randomized controlled trial

We assessed the maintenance of physical benefits in a 12-month exercise and nutritional intervention in postmenopausal women (55-75 years of age) after 6-month postintervention follow-up by voluntary, home-based exercise, and examined whether physical factors responded differently to high or low exercise frequency during the 6-month postintervention period. Forty-five women completed the 12-month intervention program, followed by 6-month cessation of intervention, and were compared with 19 matched controls. Twenty-one of the former exercisers reported that they continued exercise training at least 30 min at least 3 days/week (high-frequency exerciser, HFE), while the remaining 24 former exercisers reported that they had done exercise training at least 30 min twice per week or less during the postintervention follow-up (low-frequency exerciser, LFE). The following items were measured at baseline, 12, and 18 months: bone strength, CS-30 test, 10-m obstacle walk, whole-body reaction time, one-leg stance, and grip strength. After 6-month postintervention follow-up, the beneficial effect on bone was not fully maintained. These benefits in physical performance obtained in the 12-month intervention program, except one-leg stance, were fully maintained for 6 months by voluntary, home-based exercise. The gained benefit in one-leg stance was not fully maintained; LFE showed a significant decrease over the 6-month postintervention follow-up period, suggesting that continued exercise training of at least 30 min at least 3 days/week is required to maintain the balance benefit. These findings suggest that a continued exercise program of voluntary, home-based exercise may be effective to maintain the physical benefits of exercise intervention that may lower fracture risk in later life.

Exercise‐induced modulation of calcineurin activity parallels the time course of myofibre transitions

This study establishes a causal link between the limitation of myofibre transitions and modulation of calcineurin activity, during different exercise paradigms. We have designed a new swimming-based training protocol in order to draw a comparison between a high frequency and amplitude exercise (swimming) and low frequency and amplitude exercise (running). We initially analysed the time course of muscle adaptations to a 6- or 12-week swimming- or running-based training exercise program, on two muscles of the mouse calf, the slow-twitch soleus and the fast-twitch plantaris. The magnitude of exercise-induced muscle plasticity proved to be dependent on both the muscle type and the exercise paradigm. In contrast to the running-based training which generated a continuous increase of the slow phenotype throughout a 12-week training program, swimming induced transitions to a slower phenotype which ended after 6 weeks of training. We then compared the time course of the exercise-induced changes in calcineurin activity during muscle adaptation to training. Both exercises induced an initial activation followed by the inhibition of calcineurin. In the muscles of animals submitted to a 12-week swimming-based training, this inhibition was concomitant with the end of myofibre transition. Calcineurin inhibition was a consequence of the inhibition of its catalytic subunit gene expression on one hand, and of the expression increase of the modulatory calcineurin interacting proteins 1 gene (MCIP1), on the other. The present study provides the first experimental cues for an interpretation of muscle phenotypic variation control.

Plans and Predictions for Exercise Frequency Change

The nature of people's plans for exercise frequency change, and the basis of their optimistic predictions for such change, was examined in 2 studies. Study 1 participants' conceptions of changing their exercise frequency over the subsequent month ("realistic scenarios") were compared to their "best case" and "worst case" scenarios. Realistic scenarios more resembled best case scenarios than worst case scenarios. In Study 2, generation of a plausible best case scenario led to predictions of higher exercise frequency, but generation of an equally plausible worst case scenario had no discernible effect. Study 2 participants overestimated the negative impact of not meeting their exercise frequency predictions on their self-satisfaction. There was no such bias for those participants who met or exceeded their predictions.

Association between hormonal changes at menopause and the risk of a coronary event: a longitudinal study.

To investigate the association of hormone levels at menopause, lifestyle variables, and body composition with the predicted 10-year risk of a coronary event, calculated using the PROCAM scoring system, in a population-based sample of Australian-born, middle-aged women. A 9-year prospective study of 438 Australian-born women, who at baseline were aged 45 to 55 years and had menstruated in the prior 3 months. Interviews, fasting blood, and physical measurements were taken annually. The risk of an acute coronary event was calculated using the PROCAM scoring system (includes: age, low-density lipoprotein cholesterol, smoking, high-density lipoprotein cholesterol, systolic blood pressure, family history of premature myocardial infarction, diabetes mellitus, and triglycerides). Retention rate after 8 years of follow-up was 88% (n = 387). In women not using hormone therapy (HT): higher than average body mass index (BMI) (P < 0.001), BMI that increased (P < 0.005), lower than average estradiol levels (P < 0.005), estradiol levels that decreased (P < 0.001), and high free testosterone levels (P < 0.05) were associated with increased risk of a coronary event. There was a trend for high exercise frequency to be associated with a decreased risk (P < 0.07). After BMI and lifestyle variables were taken into account, use of HT did not have a significant effect on risk of a coronary event. In this longitudinal observational study of middle-aged Australian-born women, high BMI, an increase in BMI, high free testosterone, low estradiol, and a decrease in estradiol levels were the main determinants of increased risk of an acute coronary event, based on the PROCAM scoring system calculation. More frequent exercise tended to lower the risk.

健康指導教室参加高齢者の精神的健康の変化に関連する要因

The present study examined mental health promotion for elderly persons participating in physical fitness programs, and related factors. The subjects were 219 elderly persons (67 males, 152 females) participating in physical fitness programs. The results were as follows : 1) By participating in physical fitness programs and carrying out physical activity for 9 months, the "impulsiveness" and "nervousness" scales showed significant mental health promotion in elderly men. In elderly women participating in physical fitness programs, "impulsiveness", "mental instability", "depressiveness" and "nervousness" scales showed significant mental health promotion. 2) As a result of multiple regression analysis using the stepwise method to clarify the factors related to mental health promotion in elderly men participating in physical fitness programs, "frequency of exercise", "self-esteem", "negative social support from friends" and "THI・physical health promotion" were found to be statistically significant (p<0.05). The multiple correlation coefficient was R=0.719 (R^2=0.517).Judging from each standardized partial regression coefficient of factors, higher exercise frequency, lower self-esteem, less negative social support from frierds and higher THI・physical health promotion, each encouraged elderly men to improve their mental health. 3) As a result of multiple regression analysis using the stepwise method to clarify the factors related to mental health promotion in women, "age", "morbidity of chronic disease", "ADL", "frequency of exercise", "self-esteem", "positive social support from friend's" and "negative social support from friends" were found to be statistically significant (p<0.05). The multiple correlation coefficient was R=0.500 (R^2=0.250).Judging from each standardized partial regression coefficient of factors, younger age, high morbidity of chronic disease, normal ADL, higher exercise frequency, low self-esteem, high positive social support and low negative social support from triends, each promoted elderly women to improve their mental health.

Risk factors for prostate carcinoma in Taiwan

Although prostate carcinoma remains a rare disease among Chinese men, its incidence is on the rise. The authors conducted a hospital-based case-control study to identify risk factors for prostate carcinoma in northern Taiwan. Patients at a selected veterans hospital or 2 military hospitals who were newly diagnosed with prostate carcinoma between August 1995 and July 1996 were included as cases (n = 90). Controls (n = 180) were comprised noncancer patients who were treated in emergency rooms and departments other than those of urology and cardiology at the same hospitals; controls were matched to cases by age (+/-5 years) and admission date (+/-4 months). Subjects were interviewed in person to elicit information regarding sociodemographic characteristics, life-style, diet, height, and weight. Cases and controls were similar in terms of age and the majority of sociodemographic characteristics. However, cases tended to have received more education and were less likely to have blue-collar jobs than controls. The consumption of pork was moderately higher for cases than for controls, although this difference was not statistically significant. Cases were more likely than controls to engage in exercise (odds ratio [OR] = 2.16; 95% confidence interval [CI] = 1.18-3.96) and to have a body mass index > or = 24.75 kg/m2 at ages 40-45 years (OR = 2.00; 95%CI = 1.05-3.82). In addition, cases were less likely to cook vegetables with pork lard (OR = 0.47; 95%CI = 0.24-0.91). The higher frequency of exercise and lower use of pork lard for cooking among cases reported in the current study suggest that cases tended to have relatively affluent life-styles compared with controls. Because less affluent families are likely to consume more vegetables than meat, these preliminary findings indicate that vegetable intake appears to have a protective effect.

Instantaneous and Sudden Deaths

To the Editor.— I was surprised at the suggestion of the authors that moderate or severe physical activity should not be indulged in. The authors do not make clear whether they believe such restriction of activity should be limited to known coronary patients or to the public at large. Certainly their data do not support such a generalization. The classification of activity used by the authors is not very informative. There is a gross classification of intensity of exercise, but no indication of frequency or average duration of exercise, both of which are rather important factors. A person who plays handball or tennis once a week may think of himself as being accustomed to that level of activity, whereas substantial data indicate that a higher frequency of exercise is necessary to maintain fitness. Therefore, if one is going to examine exercise in relation to heart disease in any meaningful way,