Leisure-time Physical Activity Index Research Articles

How Consistent are Genetic Factors in Explaining Leisure-Time Physical Activity and Sport Participation? The Portuguese Healthy Families Study

This study investigates how consistent genetic factors are, as measured by heritability estimates (h2), in the leisure-time physical activity index (LTPAI) and sport participation index (SPI) from early (10-14 yrs) to late adolescence (15-19 yrs). The sample comprises 12,385 subjects from 3,378 Portuguese nuclear families. Height and weight were measured and body mass index (BMI) was calculated, and the LTPAI and SPI were estimated by questionnaire. Socioeconomic status (SES) was assessed by parental occupation. Analyses were done using S.A.G.E. software. Our results showed that h2 estimates for the LTPAI and SPI in the two age groups (10-14 yrs and 15-19 yrs) were stable: for the LTPAI, h2 = 0.297 and 0.322, respectively; and for the SPI, h2 = 0.413 and 0.428, respectively. Sibling correlations and environmental correlations are higher in the younger age group for both the LTPAI and the SPI. Spousal correlations are higher in the younger age group for the LTPAI and lower for the SPI than the older group. Parent-offspring correlations are similar in both age groups for the LTPAI and SPI. In conclusion, the influence of genetic factors on physical activity and sport participation remains stable across age in adolescence. However, variation in sibling correlations - in particular, environmental correlations - was observed. These findings suggest that shared/non-shared environmental factors express different degrees of importance across age. Future intervention programs aiming to promote change in behaviors need to consider these results to bring about positive changes in physical activity and sport participation behaviors within the family setting.

Convergent Validity of a Physical Activity Questionnaire against Objectively Measured Physical Activity in Adults: The Cardiovascular Risk in Young Finns Study

Background: Traditionally, a self-reported questionnaire has been a cost-effective method of gathering information about physical activity (PA). An objective measurement, such as the use of a pedometer, can be used to validate the findings of a PA questionnaire in a large population. Objective: The study objective was to determine the convergent validity of a PA questionnaire against objectively measured PA in adults obtained with the use of a pedometer. Methods: Data from the Cardiovascular Risk in Young Finns Study (YFS) were collected from 1853 participants aged 30 - 45 years. The participants completed a self-reported questionnaire that included items on leisure time, commuting and habitual PA. PA was expressed as leisure-time physical activity index (PAI) and metabolic equivalent hours/week (METh/wk). The participants wore a pedometer for seven consecutive days and used it to record their total daily and aerobic steps. Results: There was a low to moderate association between the self-reported questionnaire and pedometer measurements regarding both total steps and aerobic steps taken during leisure time and commuting PA. An association was not observed between pedometer data and habitual PA. Of the individual items in the questionnaire, questions that described the frequency of PA and the duration of vigorous PA correlated the most strongly with the pedometer values obtained for total and aerobic steps (r = 0.28 - 0.44, p ≤ 0.010). Conclusions: These findings suggest that the YFS PA questionnaire showed acceptable convergent validity in assessing, in particular, exercise-type PA in an adult population.

Menstrual Cycle Abnormalities in Healthy Women With Low Physical Activity: The North-Trøndelag Population-based Health Study

Menstrual dysfunctions are often found in athletic women. This study evaluated the association between leisure time physical activity (LTPA) and menstrual function in healthy nonathletic women. During 1984-1986, a population-based health survey (HUNT 1) was conducted in Nord-Trøndelag, Norway, with follow-up (HUNT 2) in 1995-1997. Women < 45 years old in HUNT 2 were included in the current study. LTPA was assessed by questionnaire in HUNT 1 and HUNT 2, and menstrual function by questionnaire in HUNT 2. Adjusted odds ratios (OR's) for long cycles were increased in women who reported < 1 hour of light LTPA (OR = 1.4, 95% CI = 1.0-2.0) and 1-2 hours (OR = 1.3, 95% CI = 1.0-1.8) per week compared with women with ≥ 3 hours/week. Adjusted OR for irregular cycles was decreased in women constantly in the lowest tertile of LTPA index in HUNT 1 and HUNT 2 (OR = 0.4, 95% CI = 0.2-0.9). Adjusted OR for prolonged bleeding was 2.6 (95% CI = 1.3-5.4) for women with < 1 hour/week of light LTPA and 2.3 (95% CI = 1.3-4.3) for women with 1-2 hours, compared with ≥ 3 hours/week. Very low physical activity may increase the risk of menstrual cycle disruptions. Moderate PA should be encouraged for optimum reproductive health.

Leisure-time Physical Activity And Vascular Endothelial Function In Adolescents

Exercise training improves vascular endothelial function in high-risk adolescents. The effect of leisure-time physical activity on endothelial function in healthy adolescents is unknown. PURPOSE: To study the association of leisure-time physical activity and brachial artery endothelial function in adolescents. METHODS: Physical activity habits and brachial artery flow-mediated endothelial function were assessed in 483 13-year-old adolescents participating in an atherosclerosis prevention study (STRIP). Endothelial function was examined with ultrasound and physical activity with a validated self-administered questionnaire. A leisure-time physical activity index (PAI; MET h/wk) was calculated by multiplying weekly mean leisure-time exercise intensity, duration and frequency [mean±SD PAI: boys 31.2±23.0 MET h/wk, girls 24.0±20.9 MET h/wk; P(gender difference)<0.001]. Maximum flow-mediated dilatation (FMDmax; %) and total FMD response [the area under the dilatation curve 40-180 sec after hyperemia (FMDauc; % x s)], were used as measures of endothelial function. RESULTS: In boys, FMDmax and FMDauc were directly associated with PAI in regression analyses adjusted for brachial artery diameter (FMDmax: P=0.020, FMDauc: P=0.0055). The associations remained significant also after further adjustments for BMI, HDL-cholesterol, LDL-cholesterol, triglycerides, hs-C-reactive protein and systolic blood pressure. The similar association was not found in girls. A difference of ∼50 MET h/wk corresponding to ∼10 h of moderate intensity activity weekly between sedentary and active boys was associated with ∼1% unit difference in FMDmax. CONCLUSIONS: Leisure-time physical activity is directly associated with brachial artery FMD responses in 13-year-old boys. This confirms that physical activity beneficially influences endothelial function in healthy male adolescents. Lack of association in girls may be explained by their overall lower physical activity level. Indeed, girls and boys having the same leisure-time physical activity level have an identical FMDmax response. Supported by the Finnish Ministry of Education, the Finnish Cultural Foundation and the Juho Vainio Foundation.

Vascular Endothelial Function and Leisure-Time Physical Activity in Adolescents

Exercise training improves endothelial function in high-risk adolescents, but the influence of habitual leisure-time physical activity on endothelial function in healthy adolescents is unknown. Brachial artery flow-mediated endothelial function and physical activity habits were assessed in 483 adolescents (13 years of age) participating in an atherosclerosis prevention study (Special Turku Coronary Risk Factor Intervention Project for Children [STRIP]). Endothelial function was examined with ultrasound; physical activity was assessed with self-administered questionnaires. A leisure-time physical activity index was calculated by multiplying mean weekly leisure-time exercise intensity, duration, and frequency [boys, 31.2 +/- 23.0 MET h/wk (mean +/- SD); girls, 24.0 +/- 20.9 MET h/wk; P for gender difference=0.0003]. Maximum flow-mediated dilatation (FMD) and total FMD response (the area under the dilatation curve 40 to 180 seconds after hyperemia) were calculated. In boys, maximum FMD and area under the dilatation curve 40 to 180 seconds after hyperemia were directly associated with leisure-time physical activity index in regression analyses adjusted for brachial artery diameter (maximum FMD, P=0.020; area under the dilatation curve 40 to 180 seconds after hyperemia, P=0.0055). These associations remained significant after further adjustments for body mass index, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, high-sensitivity C-reactive protein, and systolic blood pressure. A difference of approximately 50 MET h/wk corresponding to approximately 10 hours of moderate intensity activity weekly between sedentary and active boys was associated with an approximately 1% unit difference in maximum FMD. Leisure-time physical activity is directly associated with brachial artery FMD responses in 13-year-old boys, providing evidence that physical activity beneficially influences endothelial function in healthy male adolescents. Lack of association in girls may reflect their overall lower physical activity level.

Acquired obesity and poor physical fitness impair expression of genes of mitochondrial oxidative phosphorylation in monozygotic twins discordant for obesity

Defects in expression of genes of oxidative phosphorylation in mitochondria have been suggested to be a key pathophysiological feature in familial insulin resistance. We examined whether such defects can arise from lifestyle-related factors alone. Fourteen obesity-discordant (BMI difference 5.2 +/- 1.8 kg/m(2)) and 10 concordant (1.0 +/- 0.7 kg/m(2)) monozygotic (MZ) twin pairs aged 24-27 yr were identified among 658 MZ pairs in the population-based FinnTwin16 study. Whole body insulin sensitivity was measured using the euglycemic hyperinsulinemic clamp technique. Transcript profiles of mitochondrial genes were compared using microarray data of fat biopsies from discordant twins. Body composition of twins was determined using DEXA and maximal oxygen uptake (Vo(2max)) and working capacity (W(max)) using a bicycle ergometer exercise test with gas exchange analysis. The obese cotwins had lower insulin sensitivity than their nonobese counterparts (M value 6.1 +/- 2.0 vs. 9.2 +/- 3.2 mg x kg LBM(-1) x min(-1), P < 0.01). Transcript levels of genes involved in the oxidative phosphorylation pathway (GO:0006119) in adipose tissue were lower (P < 0.05) in the obese compared with the nonobese cotwins. The obese cotwins were also less fit, as measured by Vo(2max) (50.6 +/- 6.5 vs. 54.2 +/- 6.4 ml x kg LBM(-1) x min(-1), for obese vs. nonobese, P < 0.05), W(max) (3.9 +/- 0.5 vs. 4.4 +/- 0.7 W/kg LBM, P < 0.01) and also less active, by the Baecke leisure time physical activity index (2.8 +/- 0.5 vs. 3.3 +/- 0.6, P < 0.01). This implies that acquired poor physical fitness is associated with defective expression of the oxidative pathway components in adipose tissue mitochondria.

Does an Overweight Child Transform into a Sedentary Adolescent?

Childhood overweight is an increasing epidemic in all western societies. Sedentary lifestyle has a major influence on this worrisome phenomenon. Since overweight is associated with physical inactivity at all ages, it is important to study if childhood overweight increases the risk of becoming sedentary in adolescence. PURPOSe:To assess the prevalence of overweight since early childhood in 13-year-old physically active and sedentary adolescents. METHODS: This study is a part of the prospective randomized Special Turku Coronary Risk Factor Intervention Project for children on-going in Turku, Finland since infancy of the participants and based on annual nutrition and lifestyle counseling. Leisure-time physical activity habits were assessed at the age of 13 years by a self-reported questionnaire (n=558). Leisure-time physical activity index (PAI; MET h/wk) was calculated by multiplying mean weekly leisure-time exercise intensity, duration and frequency. According to PAI tertile cut-off points the girls and boys were divided into 3 groups and the least and most active groups were compared: 1) Sedentary, mean PAI 3.1 for girls (n=88) and 8.2 MET h/wk for boys (n=114) and 2) Active, mean PAI 54.8 (n=53) and 58.7 MET h/wk (n=91), respectively. Body mass index (BMI) was calculated annually as body weight (kg)/height (m2). International age and sex specific BMI criteria (Cole et al. BMJ 2000) were used to classify overweight from the age of 2 years onwards on altogether 338 Sedentary and Active children. Binary response logistic regression analysis with generalized estimating equations was used to detect longitudinal differences in the proportion of overweight girls and boys. RESULTS: 13-year-old Sedentary girls had been more often overweight than Active girls already since the age of 2 years (P<0.05). In the Sedentary and Active boys the proportion of overweight children at 2–13 years of age was, however, similar. Interestingly, ∼80% of girls being overweight at the age of 6 years (n=31, 22%) were Sedentary as adolescents. CONCLUSIONS: Girls who are overweight as children are at a special risk of becoming sedentary adolescents. Supported by the Finnish Ministry of Education, the Finnish Cultural Foundation and the Juho Vainio Foundation.

Leisure-Time Physical Activity And Cardiovascular Risk Factors In Adolescents

Associations between leisure-time physical activity and cardiovascular risk factors are generally weak in observational studies in adolescents. PURPOSE: To study associations between leisure-time physical activity and blood lipids, lipoproteins and blood pressure in 13-year-old boys and girls. METHODS: This study is a part of the large prospective randomized STRIP study (Special Turku Coronary Risk Factor Intervention Project) on-going in Turku, Finland. In infancy, the children (n=1062) were randomized to an intervention group with regular dietary and lifestyle counselling and to a control group. Leisure-time physical activity habits were assessed during a study visit at age 13 by a self-reported questionnaire. Leisure-time physical activity index (PAI; MET h/wk) was calculated by multiplying mean leisure-time exercise intensity, duration and frequency (n=544). According to PAI, the girls and boys were divided into 3 groups and the least and most active groups were compared: 1) Sedentary, mean PAI 3.2 MET h/wk for intervention girls (n=39) and 3.1 for control girls (n=48), 8.6 for intervention boys (n=46) and 8.0 for control boys (n=64), 2) Active, mean PAI 56.3 MET h/wk (n=27) and 53.2 (n=26) for girls, 58.0 (n=49) and 59.7 (n=41) for boys, respectively. Cardiovascular risk factors included total cholesterol, HDL, HDL/total cholesterol ratio, LDL, triglyceride, systolic and diastolic blood pressure. ANCOVA with BMI and pubertal status as covariates was used to test differences in cardiovascular risk factors between the PAI groups. RESULTS: In the dietary counselling groups, HDL was higher in physically active boys than in sedentary boys (mean 1.24 vs. 1.13 mmol/L, adjusted p=0.034). In the control groups, HDL and HDL/total cholesterol ratio were higher in physically active girls than in sedentary girls (mean 1.29 vs. 1.16 mmol/L, adjusted p=0.021 and 0.31 vs. 0.27, adjusted p=0.0076, respectively). No other differences between groups were found. CONCLUSION: Cross-sectional associations between leisure-time physical activity and cardiovascular risk factors are weak and inconsistent in 13-year-old adolescents. However, it remains to be seen if this longitudinal study is able to find possible relationships in the future.

Leisure‐time physical activity of 13‐year‐old adolescents

The leisure-time physical activity of 13-year-old Finnish adolescents was assessed in the prospective STRIP study. A self-administered questionnaire (N=565) was used. The leisure-time physical activity index (PAI; MET h/week) was calculated on the basis of reported exercise intensity, duration and frequency (N=558; 53% boys). The participants were divided into Sedentary, Moderately Active and Active groups by PAI tertiles. A subpopulation (N=197) also used a heart rate monitor (3 days, >/=8 h/day) to assess the time spent on different activity intensities. The median male PAI was 31.3 (inter-quartile range (IQR) 44.2) MET h/week and female 19.5 (IQR 26.3) MET h/week (P=0.0002). The cutoff points of the PAI tertiles were similar for the Active girls (31.3 MET h/week) and boys (32.6 MET h/week), but for the Sedentary boys it was 19.5 MET h/week and only 5.0 MET h/week for the Sedentary girls. High self-reported leisure-time physical activity associated poorly with time spent on moderate or vigorous exercise measured by heart rate monitoring. Active mothers had more often Active daughters or sons. In conclusion, the amount of leisure-time physical activity of one-third of 13-year-old girls is extremely low. Sedentary adolescents, especially girls, should therefore be put into focus for active efforts to increase their leisure-time physical activity. Parental models may be important.

Association between hs-CRP, Leisure-time Physical Activity and Body Weight in Children

C-reactive protein (CRP) concentration is a novel risk marker for cardiovascular disease. Exercise training has been shown to reduce CRP concentration in adults. PURPOSE: To study if physically active children have lower CRP concentration than sedentary children. Additionally to study the association of CRP with body weight. METHODS: This study is a part of the large prospective randomized STRIP study (Special Turku Coronary Risk Factor Intervention Project) on-going in Turku, Finland. Leisure-time physical activity habits were assessed during a study visit at age 13 (n=565) by a self-reported questionnaire. Leisure-time physical activity index (PAI; MET h/wk) was calculated by leisure-time exercise intensity, duration and frequency (n=558: 294 boys, 264 girls). According to PAI the girls and boys were divided into 3 groups: 1) Sedentary, mean PAI 3.1 for girls (n=89) and 8.2 for boys (n=114) 2) Average Active, mean PAI 24.7 (n=121) and 30.7 (n=89), respectively and 3) Active, mean PAI 54.8 (n=54) and 58.7 (n=91), respectively. High-sensitivity C-reactive protein (hs-CRP) concentration (n=532) was assayed by a turbidimetric immunoassay (Wako Chemicals GmbH, Neuss, Germany). The sensitivity of the method was 0.06 mg/L. Concentration under the detection limit was interpreted as 0.05 mg/L (n=14) and concentration >10 mg/L as 10.0 mg/L (n=4). Due to the skewed distribution of the hs-CRP concentrations, log-transformation was used. ANCOVA with BMI as a covariate was used to test the differences in hs-CRP between the groups. T-test was used to compare overweight boys (BMI >21.9, 16%) and girls (BMI >22.6, 14%) to children with normal body weight. RESULTS: Physically active 13-year-old children had similar hs-CRP concentration to Sedentary and Average Active children. The mean (median) hs-CRP concentration in the Sedentary, Average Active and Active boys was 0.75 (0.23), 0.58 (0.21) and 0.46 (0.19) mg/L, respectively (NS). In girls the corresponding concentrations were 0.42 (0.19), 0.52 (0.16) and 0.44 (0.20) mg/L (NS). Overweight children were found in all 3 activity groups. Interestingly, overweight girls and boys had higher (p <0.0001) mean hs-CRP concentration (1.31 and 1.29 mg/L, respectively) than girls and boys with normal body weight (0.32 and 0.47 mg/L, respectively). CONCLUSION: Physically active 13-year-old children have similar hs-CRP concentration to sedentary children. It is evident that physical activity and body weight have interesting and challenging interrelations.

Body mass index and physical activity in relation to asthma and atopic diseases in young adults

Obesity has been shown to increase the risk of asthma and wheezing. Conditioning exercise might decrease the asthma risk, and that could partly explain the association. The relation between obesity and allergic diseases is quite conflicting. The association between body mass index (BMI) and physician-diagnosed asthma, allergic rhinitis or conjunctivitis, atopic dermatitis, and self-reported wheezing was investigated in a questionnaire study among 10,667 Finnish first-year university students aged 18-25 years. Logistic regression was used to evaluate possible confounding by parental education, passive smoking at age 0-2, childhood residential environment, current and past smoking and leisure time physical activity index. In men, there was a greater risk of asthma, but not wheezing with increasing BMI. Compared to those with BMI below 20, OR for male asthma was 1.98 (95% CI 1.11-3.52) in BMI category 20.0-22.4, 1.90 (95% CI 1.05-3.41) in BMI 22.5-24.9, and 3.5 (95% CI 1.63-7.64) in BMI > or = 27.5. Among women, the risks of asthma and wheezing were about two-fold among the overweight-obese subjects. Moderate leisure time physical activity was associated with lower risk of asthma in men (OR 0.62, 95% CI 0.62 (0.42-0.92), but not among women. The risk of allergic rhinoconjunctivitis and atopic dermatitis increased quite linearly with BMI among women but not men. Low leisure time physical activity seems not to explain the greater risk of asthma among obese men and women. The quite linear association between BMI and both allergic rhinoconjunctivitis and wheezing among women suggests the independent effect of body fat on atopic diseases.

Leisure-time activity is an important determinant of long-term weight maintenance after weight loss in the Sibutramine Trial on Obesity Reduction and Maintenance (STORM trial)

The success rate of long-term maintenance of weight loss in obese patients is usually low. To improve the success rate, determinants of long-term weight maintenance must be identified. The objective of the study was to identify determinants of long-term success in weight maintenance in obese subjects who completed the Sibutramine Trial on Obesity Reduction and Maintenance (n = 261), a multicenter European study of weight loss and weight maintenance in obesity that combines sibutramine treatment with dietary restriction and advice on exercise and behavior. We studied weight maintenance over 18 mo in subjects who had completed a 6-mo weight-loss phase. Factors included in the analysis were initial body weight, the percentage of initial body weight lost, dietary intake, various components of physical activity (measured with the Baecke questionnaire), the type of treatment (sibutramine or placebo), age, and sex. Multiple regression analysis identified treatment group (sibutramine or placebo), the percentage of the initial body weight that was lost during the 6-mo weight-loss phase, and the leisure-time physical activity index as significant determinants of weight maintenance. Together, these 3 factors explained 20% of the variation in weight maintenance (P < 0.001). Dietary factors, age, and sex were not significant predictors of weight-maintenance success in this study. Weight-maintenance success after weight loss is positively influenced by sibutramine treatment during weight maintenance, by a greater initial weight loss, and by a higher leisure-time physical activity index, which reflects higher levels of activities such as walking and cycling and lower levels of television viewing.

Associations between skeletal muscle properties, physical fitness, physical activity and coronary heart disease risk factors in men

High physical fitness and physical activity are associated with favourable lipid levels, especially a high level of high density lipoprotein cholesterol (HDL-C). A person's skeletal muscle properties, metabolism and percentage of different muscle fibres (ST-%), which may modify coronary heart disease (CHD) risk factors, such as serum insulin, obesity and serum sex hormones may also influence his fitness level and leisure-time physical activity. We studied the associations of physical fitness, physical activity and ST-% with serum lipids and lipoproteins in 72 healthy men. Their parameters were compared with those of 20 men with defined CHD. Significant interrelationships between ST-%, fitness and leisure-time physical activity index (LTPAI) were observed. Multiple regression analysis showed that ST-%, fitness and leisure-time physical activity explained about 32% of the variation in HDL-C in the healthy men. In healthy men ST-% correlated positively with fitness ( r s=0.62, P<0.001) and with LTPAI ( r s=0.62, P<0.001). Fitness level also correlated significantly with LTPAI ( r s=0.81, P<0.001). Serum insulin showed negative associations with ST-% ( r s=−0.63, P<0.001) and fitness ( r s=−0.54, P<0.001) and LTPAI ( r s=−0.62, P<0.001). Free fraction of testosterone correlated negatively with serum HDL-C level ( r s=−0.34, P<0.01), with fitness ( r s=−0.41, P<0.001) and with LTPAI ( r s=−0.54, P<0.001). In sedentary men with the lowest fitness and physical activity the mean of ST-% (45%) was similar to that in CHD patients (44%). However, ST-% in men in the highest tertile of physical activity and fitness (68%) was significantly higher than in CHD patients and in men in the lowest tertile of physical activity and fitness. Skeletal muscle enzyme activity in lipid metabolism was significantly lower in both CHD patients and in sedentary and low-fit men than that in fitter and physically active men. The present data imply that skeletal muscle properties are important determinants of risk profiles, such as physical activity, fitness and serum lipid and lipoprotein patterns. Although fitness is a graded, independent predictor of mortality from CHD, a relatively high fitness level is not enough. This was clearly observed in the clustering analysis, in which the healthy men, according to their ST-%, fitness, leisure-time physical activity and serum sex hormone binding globulin (SHBG), fell into three natural groups: (i) Inactive men with lowest ST-% (mean 42%), lowest fitness (10.7 METs) and lowest HDL-C (1.36 mm/l); (ii) Fit men with high ST-% (66%), high fitness (14.5 METs) and moderately high HDL-C (1.54 mol/l); (iii) Active men with high ST-% (66%), highest fitness (14.9 METs) and highest serum HDL (1.83 mmol/l). The results support the idea that both fitness and physical activity give further protection against CHD by modifying risk factors. Our findings also suggest that skeletal muscle properties should be considered in the studies which assess CHD risk factors and their modifications especially in the field of health-related fitness.

Characteristics of leisure time physical activity associated with decreased risk of premature all-cause and cardiovascular disease mortality in middle-aged men.

The association between leisure time physical activity and the risk of all-cause and cardiovascular disease mortality was analyzed in a Finnish cohort of 1,072 men age 35-63 years who were followed up for 10 years and 10 months. During the period, 168 deaths were recorded, 93 of which were the result of cardiovascular diseases. Leisure time physical activity was assessed by several measures: 1) a single question combining an estimate of the frequency and intensity of the total amount of leisure time physical activity, 2) a compiled measure of leisure time physical activity derived from three separate questions concerning the intensity and frequency of activity, 3) a physical energy expenditure index computed as an estimate of weekly energy expenditure for leisure time activity and commuting to work, 4) 16 separate specified activities of daily living and domestic chores included in the leisure time physical activity index. The association between baseline leisure time physical activity and the risk of death was assessed using the Cox proportional hazards model. After adjustment for potential confounders, the leisure time physical activity energy expenditure index and participation in several specific activities of daily living and domestic chores showed that the mortality risk for all causes and cardiovascular diseases was highest in the most sedentary men. With respect to the leisure time physical activity energy expenditure index, sedentary men ( those with an estimated weekly energy expenditure in leisure time physical activity of < 800 kcal) had an increased risk of 2.74 (95% confidence interval 1.46-5.14) for all-cause mortality and a risk of 3.58 (95% confidence interval 1.45-8.85) for cardiovascular disease mortality compared with the most active persons (those with an estimated weekly energy expenditure in leisure time physical activity of at least 2,100 kcal) when age, initial health status, marital status, employment status, and smoking were controlled.