Sedentary Persons Research Articles

A pilot study of brisk walking in sedentary combination antiretroviral treatment (cART)- treated patients: benefit on soluble and cell inflammatory markers

BackgroundChronic HIV infection is associated with low-level inflammation and increased risk of chronic diseases and mortality. The objective was to assess the effects of moderate intensity exercise on metabolic and inflammatory markers in HIV-infected treated persons.MethodsThis was a pilot study enrolling cART-treated, sedentary persons with metabolic complications in a 12-week protocol, consisting of three sessions per week of 60 min brisk walking with (strength-walk group) or without (walk group) 30 min circuit-training. Assessments at baseline and week 12 (W12) included body morphometrics and total body dual-energy X-ray absorptiometry; lipid and glucose blood profile; plasma level of high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), D-dimer, interleukin-18 (IL-18), soluble CD14, and CD38 and HLA-DR expression on CD4+ and CD8+ T-cells.ResultsForty-nine patients were included and 35 (71%) completed the program: 21 in the walk and 14 in the strength-walk group. At W12, significant improvements were observed of body mass index, waist and hip circumference, and total cholesterol both overall and in the walk group, and of LDL cholesterol in both training groups. In the whole group, significant reductions were observed in hsCRP, IL-6, D-dimer, IL-18, and of CD8+/CD38+/HLA-DR+ cell frequencies. HsCRP and CD8+/CD38+/HLA-DR+ frequency decreased significantly in both training groups when examined separately whereas IL-6 and D-dimer in the walk group only.ConclusionsBrisk walking, with or without strength exercise, could improve lipid profile and inflammatory markers in chronic HIV infection.Trial registrationACTRN12615001258549, registered 17 November 2015, “retrospectively registered” Web address of trial: http://www.ANZCTR.org.au/ACTRN12615001258549.aspx

Long-term cyclic aerobic training preserves the brain's health in elderly persons (brief review)

It was identified on the base of special periodical literature analyze that cyclic muscular work systematically performed during large part of the person's life (former athlete) provides mainly the favorable effect on the brain. Ventricular-arterial coupling improvement ameliorates brain perfusion, and creates function advantages to brain health in old age. At that, the gray and white matter fading hampered, especially in structures that associated with visual control and human body spatial orientation, motor control and memory state, and age-related attenuation of cognitive functions in comparison with sedentary persons of the same age.

Independent and cumulative effect of diet and exercise on reduction of adiposity measures among obese people

Purpose The epidemic of obesity is escalating worldwide. This paper aims to focus on feasible and affordable measures to reduce obesity among sedentary persons aged 30 to 50 years, to provide suitable intervention to overcome excess body weight and to prevent further weight gain. To the authors’ knowledge, this is the first study to examine such effects in India. Design/methodology/approach In total, 288 sedentary office going people were motivated to reduce weight and on the basis of their being obese and willingness to participate in the study, 144 of them were selected for the intervention study. They were randomly divided into four groups. Subjects of Group I formed the control, Group II were given a high fiber and low glycemic diet mix, Group III participated in an exercise program and Group IV followed both. Anthropometric measurements were measured initially and at 30 days of interval up to 120 days, and biochemical tests were done before and after the intervention. Findings The subjects in Groups II, III and IV had 5 per cent reduction in anthropometric measurements. The biochemical tests revealed that the rate of decrease of mean total cholesterol and low density lipoprotein (LDL) cholesterol were greatest in Group II. In Group IV, there was maximum decrease of mean total cholesterol and high density lipoprotein (HDL) ratio, mean LDL and HDL ratio, mean fasting blood glucose and also a favorable increase of HDL cholesterol. In Group III, there was maximum increase of hemoglobin. All the central obesity measures, except body mass index, are highly and positively correlated with the biochemical parameters. Research limitations/implications It was observed that, in some individuals, the weight loss was 8 to 10 kg, and for a few, the weight loss was less in the range of 1 to 2 kg. This indicated that the same kind of diet and exercise brought about weight reduction to different extents due to individual response. Because of the individual differences, there is a need to highlight the response of the intervention by examining the individual variability referring to age and gender rather than pooling the mean data. Originality/value It was observed that the inclusion of high fiber and low glycemic diet in the intervention had a profound influence in the reduction of weight. Exercise alone may not be very effective when opted as a single measure for reducing obesity, and it can only act as a complementary program along with diet for any weight reduction program.

Effect of Structured Physical Activity on Overall Burden and Transitions Between States of Major Mobility Disability in Older Persons: Secondary Analysis of a Randomized Trial.

The total time a patient is disabled likely has a greater influence on his or her quality of life than the initial occurrence of disability alone. To compare the effect of a long-term, structured physical activity program with that of a health education intervention on the proportion of patient assessments indicating major mobility disability (MMD) (that is, MMD burden) and on the risk for transitions into and out of MMD. Single-blinded, parallel-group, randomized trial. (ClinicalTrials.gov: NCT01072500). 8 U.S. centers between February 2010 and December 2013. 1635 sedentary persons, aged 70 to 89 years, who had functional limitations but could walk 400 m. Physical activity (n= 818) and health education (n= 817). MMD, defined as the inability to walk 400 m, was assessed every 6 months for up to 3.5 years. During a median follow-up of 2.7 years, the proportion of assessments showing MMD was substantially lower in the physical activity (0.13 [95% CI, 0.11 to 0.15]) than the health education (0.17 [CI, 0.15 to 0.19]) group, yielding a risk ratio of 0.75 (CI, 0.64 to 0.89). In a multistate model, the hazard ratios for comparisons of physical activity with health education were 0.87 (CI, 0.73 to 1.03) for the transition from no MMD to MMD; 0.52 (CI, 0.10 to 2.67) for no MMD to death; 1.33 (CI, 0.99 to 1.77) for MMD to no MMD; and 1.92 (CI, 1.15 to 3.20) for MMD to death. The intention-to-treat principle was maintained for MMD burden and first transition out of no MMD, but not for subsequent transitions. A structured physical activity program reduced the MMD burden for an extended period, in part through enhanced recovery after the onset of disability and diminished risk for subsequent disability episodes. National Institute on Aging, National Institutes of Health.

Dietary Weight Loss and Exercise Effects on Serum Biomarkers of Angiogenesis in Overweight Postmenopausal Women: A Randomized Controlled Trial.

Obese and sedentary persons have an increased risk for cancer, but underlying mechanisms are poorly understood. Angiogenesis is common to adipose tissue formation and remodeling, and to tumor vascularization. A total of 439 overweight/obese, healthy, postmenopausal women [body mass index (BMI) > 25 kg/m(2)] ages 50-75 years, recruited between 2005 and 2008 were randomized to a 4-arm 12-month randomized controlled trial, comparing a caloric restriction diet arm (goal: 10% weight loss, N = 118), aerobic exercise arm (225 minutes/week of moderate-to-vigorous activity, N = 117), a combined diet + exercise arm (N = 117), or control (N = 87) on circulating levels of angiogenic biomarkers. VEGF, plasminogen activator inhibitor-1 (PAI-1), and pigment epithelium-derived factor (PEDF) were measured by immunoassay at baseline and 12 months. Changes were compared using generalized estimating equations, adjusting for baseline BMI, age, and race/ethnicity. Participants randomized to the diet + exercise arms had statistically significantly greater reductions in PAI-1 at 12 months compared with controls (-19.3% vs. +3.48%, respectively, P < 0.0001). Participants randomized to the diet and diet + exercise arms had statistically significantly greater reductions in PEDF (-9.20%, -9.90%, respectively, both P < 0.0001) and VEGF (-8.25%, P = 0.0005; -9.98%, P < 0.0001, respectively) compared with controls. There were no differences in any of the analytes in participants randomized to the exercise arm compared with controls. Increasing weight loss was statistically significantly associated with linear trends of greater reductions in PAI-1, PEDF, and VEGF. Weight loss is significantly associated with reduced circulating VEGF, PEDF, and PAI-1, and could provide incentive for reducing weight as a cancer prevention method in overweight and obese individuals. Cancer Res; 76(14); 4226-35. ©2016 AACR.

The Effects of Upper vs. Lower Body Fat and Aerobic Exercise on Indices of the Metabolic Syndrome

IntroductionApple shaped (higher waist to hip ratios; WHR) people have higher levels of abdominal and visceral adiposity and therefore higher risks of having type 2 diabetes and cardiovascular disease. Pear shaped (lower WHR) people have improved lipid homeostasis and insulin sensitivity compared to apple shaped people. Physical activity has been shown to improve indices of the metabolic syndrome. The purpose of this study was to examine the differential responses of indices of the metabolic syndrome to exercise in people with different body fat depots (i.e. apple vs. pear shapes).MethodsThe original study recruited healthy sedentary persons and randomized them to an aerobic exercise or control group. Data from female completers with pre and post CT scans were used in the analyses. Female participants were grouped based on the division of the WHR at the median. Thus, the present study had 4 groups.ResultsThe study population (N=92) had an average age of 51±1 y and BMI of 31.4±0.4 kg/m2. The average WHR were: 0.88±0.04 exercise apple, 0.79±0.03 exercise pear, 089 ±0.04 control apple, and 0.79±0.04 control pear. Visceral adipose tissue decreased in both the apple and pear exercise groups (p=0.05). Apple exercisers tended to have greater reductions in blood pressure compared to the apple control group (p=0.06). Pear shaped individuals tended to have better circulating triglyceride levels (p=0.085) and VLDL levels (p=0.085) compared to apple exercise group. Body shape in aerobic exercisers tended to predict change in the following metabolic syndrome parameters: BMI (r=.25; p=0.08), hip circumference (r=.25; p=0.08), VLDL (r=.27; p=0.08), Cholesterol: HDL ratio (r=.25; p=0.06), and triglycerides (r=.27; p=0.06).ConclusionApple and pear shaped participants decreased visceral adiposity with exercise. Persons with pear shapes should increase aerobic exercise to decrease circulating triglycerides and VLDL levels, while persons with apple shapes should increase aerobic exercise to decrease blood pressure. Aerobic exercise in pear shaped women predicted positive change in metabolic health outcomes.Support or Funding InformationThis research was funded by grants from the NIH including a T35 DK093428, U54 GM104940, and a HL 75442.

Perceptions of Sedentary Behavior Among Socially Engaged Older Adults.

To better understand the perceptions of sedentary behavior, its pros and cons, and the barriers associated with reducing sedentary time as it pertains to older adults. Four focus group sessions were conducted with older adults (n = 26). Each focus group lasted approximately 45min, was led by an experienced qualitative researcher, and utilized probing questions on the definition of sedentary behavior, pros and cons of sedentary behavior, and programming needs for sedentary time reduction. Sessions were recorded and transcribed verbatim. Two researchers independently extracted data from the transcripts and identified major themes and subthemes. Data on sociodemographics and current activity levels were collected via questionnaires. Participants were 74±8.5 years old and were primarily women (77%). They self-reported sitting for 5.6±1.7h per day and engaging in physical activity for 172±115min/day. Four themes were identified. The first theme indicated that older adults have varied definitions of the term sedentary behavior and that they have a negative perception of this term. The second theme indicated that participants perceived social, cognitive, and physical benefits to the sedentary activities in which they engaged, and that these activities were meaningful. The third theme indicated that physical health was the only perceived disadvantage of engaging in sedentary activities. Finally, the fourth theme indicated that there were several perceived barriers to sedentary time reduction, both person and environment related. These findings have implications for use of terminology in policy and public health strategies targeting sedentary time reduction in older adults.

Introduction of antineoplastic drug NSC631570 in an inpatient and outpatient setting: Comparative evaluation of biological effects

The aim of this study is to evaluate the effect of moderate physical exercise and treatment time on the organism's response to NSC631570. The sensitivity of circulating phagocytes to the drug at different times of day was estimated in in vitro experiments. NSC631570 was administered intravenously to healthy volunteers (eleven men, 23 ± 2 years) in a single therapeutic dose in an inpatient and an outpatient setting. Blood samples were obtained before the drug administration, 30 min after the drug injection and every fourth hour throughout the 24 hour period. Biochemical parameters were determined using the hematological analyzer. Flow cytometry was used to evaluate phagocyte metabolism. Treatment of circulating phagocytes with NSC631570 in vitro resulted in an increase in ROS production along with a decrease in their phagocytic activity, most expressed in the morning time. Drug injection to sedentary persons resulted in pro-inflammatory metabolic polarization of circulating phagocytes. Introduction of NSC631570 to active persons was accompanied by a significant increase in phagocyte endocytosis along with a decrease in the daily mean of ROS generation. Significant oscillation (but in the normal ranges) of urea, creatinine, alanine aminotransferase and aspartate aminotransferase after NSC631570 introduction in the outpatient setting was shown during the day. Physical activity interferes with immunomodulatory action of NSC631570 and abrogates pro-inflammatory shift of circulating phagocytes. Biochemical parameters of blood from patients treated with NSC631570 in the outpatient setting must be interpreted cautiously considering the effect of physical activity on some metabolic biomarkers.

Achilles Tendon Disorders.

Disorders of the Achilles tendon, the largest tendon in the human body, are common and occur in both active and sedentary persons. A thorough history and physical examination allow primary care physicians to make an accurate diagnosis and to initiate appropriate management. Mismanaged or neglected injuries markedly decrease a patient's quality of life. A growing body of related literature is the basis for current therapeutic regimens, which use a multimodal conservative approach, including osteopathic manipulative treatment. Although primary care physicians can manage most cases of Achilles tendon disorders, specialty care may be needed in certain instances. Procedural intervention should consider any comorbid conditions in addition to patients' lifestyle to help guide decision making. When appropriately managed, Achilles tendon disorders generally carry a favorable prognosis.

Living longer by sitting less and moving more.

Regular exercise, physical fitness and sedentary behaviours are each known to be associated with cardiovascular and total mortality. This review evaluates recent research on these associations and its implications for guidelines on physical activity. In several large cohort studies, modest levels of exercise, much less than recommended in current guidelines, were associated with lower mortality. Avoiding prolonged sitting has also been associated with lower mortality risk. Most research suggests graded decreases in long-term mortality with an increase in usual physical activity and fitness. However, at very high exercise levels, these benefits may be attenuated, particularly in patients with known coronary heart disease. In sedentary persons, a modest increase in physical activity and avoiding prolonged sitting are likely to have important health benefits. Further research is needed to determine the most effective strategies for increasing physical activity.

What turns off the angiogenic switch in skeletal muscle?

What turns off the angiogenic switch in skeletal muscle?

Increases in physical activity is as important as smoking cessation for reduction in total mortality in elderly men: 12 years of follow-up of the Oslo II study

BackgroundPhysical activity (PA) at leisure by the elderly, and its relationship to cardiovascular (CV) and non-CV mortality, with and without competing risk, has been scarcely described. We determined the relationships...

Press in Snatch

Training with a bar is a fundamental approach to exercise. Like dumbbells, kettlebells, sandbags, medicine balls, pulleys and other weighted devices it has it's own unique application. The Press in Snatch bar exercise shown here can be used by anyone from an Olympic Weight Lifter to a sedentary person. This self-care article will show it's purpose as well as show you how to perform this exercise properly.

Isokinetic evaluation of knee flexors and extensors in young male orienteers

Orienteering races usually develop in wooded lands with large differences in slopes. In addition to the climbs, long descents are frequently covered. Therefore, lower limb muscular strength is necessary to sustain these challenges on rough terrains (1). Eight male orienteers of junior Italian team (OR; age, 19±1.6yr), 8 cross country track and fields experienced runners (TF; 20±4.5yr), and 8 sedentary persons (control group CG; 23±2.7yr), all with right lower limb dominance volunteered. Between groups, no age-, weight-, height-, and BMI-related differences were found (ANOVA, p>0.05). Each participant performed and an isokinetic dynamometer measured 5 repetitions of right and left knee flexion and extension at the angular speeds of 60-120-180-240-300deg/sec respectively. The ratios of peak torques between knee flexors and extensors were also computed, at each angular speed. Descriptive statistics were calculated within subject, group, movement, angular speed, and side. For each movement, the effects of group and side, and group×side interactions on peak torques at different speeds were compared by ANOVA (statistical significance 5%). On average within group, flexor and extensor muscles of the right knee were stronger than those of contralateral limb, but no significant differences were found. Side-related differences were similar in all groups (p>0.05). In both sides and movements at each angular speed, OR performed larger peak torques than TF and CG (p<0.001). For each angular velocity, the ratios between flexors and extensors were larger in OR (p<0.001). For orienteers, overcoming natural obstacles, and engaging eccentric work of knee muscles when running downhill could represent effective training tools. Data could be of interest for athletes, coaches, physical therapists, and physicians to set efficient training plans, to prevent trauma, and to define rehabilitation treatments. Further investigations should be extended to other muscular districts, and to other sports.

Effect of Tai Chi Practice on Stress, Self-Esteem, and Perceived Life Expectancy and a Structural Model of Relation Among These Variables Taking Into Account Age

The aims of this article were to (a) investigate whether practicing Tai Chi has an effect on stress, self-esteem, and perceived life expectancy and (b) contrast a structural model of relation between the three latter variables taking into account age. One scale to assess stress, another scale to assess perceived life expectancy, and the 10-item Rosenberg’s Self-Esteem Scale were administrated to a nonprobability sample of 86 Tai Chi practitioners and 91 sedentary persons. Tai Chi practitioners had a lower level of stress, a greater self-esteem, and a greater perceived life expectancy than sedentary persons. Self-esteem had an effect on stress and perceived life expectancy, and stress had an effect on perceived life expectancy in both Tai Chi practitioners and sedentary persons. Age was correlated to self-esteem among sedentary persons, but not among Tai Chi practitioners. Age had a direct effect on perceived life expectancy among Tai Chi practitioners, but not among sedentary persons. It is concluded that...

PC-FACS

PC-FACS

Exploring the path of Mediterranean diet on 10-year incidence of cardiovascular disease: The ATTICA study (2002–2012)

Background and aimsA Mediterranean diet has been associated with lower all-cause and cardiovascular disease (CVD) morbidity and mortality, but the clinical and behavioral pathway has not been well understood and appreciated. The aim of this work was to explore the path between adherence to a Mediterranean-type diet, lifestyle behaviors, clinical status, and a 10-year incidence of CVD. Methods and resultsThe ATTICA study was carried out in the Athens area during 2001–2002 and included 3042 participants free of CVD at baseline (49.8% men, aged 18–89). Adherence to a Mediterranean diet was assessed using the MedDietScore (range 0–55). During 2011–2012, 2583 out of the 3042 participants were found during the 10-year follow-up (15% lost to follow-up). Adherence to a Mediterranean diet decreased CVD risk (relative Risk (RR) per 1/55 unit = 0.96, 95% confidence interval (CI): 0.93, 1.00), independently of various sociodemographic, lifestyle, and clinical factors. Subgroup analyses revealed that participants with an unhealthy lifestyle (i.e., smokers, and obese and sedentary persons) remained protected from CVD through a greater adherence to a Mediterranean diet (RR for smokers = 0.92, 95%CI: 0.88, 0.97; RR for obese participants = 0.90, 95%CI: 0.82, 0.979; and RR for sedentary participants = 0.95, 95%CI: 0.90, 0.99). Path analysis revealed that adherence to a Mediterranean diet not only decreases the levels of C-reactive protein and interleukin-6 but also has an independent protective role against CVD risk per se (total effect of the MedDietScore on CVD = −0.003, 95%CI: −0.005 to 0.000). ConclusionAdherence to a Mediterranean diet confers a considerable reduction on CVD risk, independent of various factors. Therefore, even subjects with unhealthy lifestyle behaviors may benefit from adherence to this diet, suggesting another dimension to prevention strategies.

Combined Reduced Forced Expiratory Volume in 1 Second (FEV1) and Peripheral Artery Disease in Sedentary Elders With Functional Limitations

ObjectivesBecause they are potentially modifiable and may coexist, we evaluated the combined occurrence of a reduced forced expiratory volume in 1 second (FEV1) and peripheral artery disease (PAD), including its association with exertional symptoms, physical inactivity, and impaired mobility, in sedentary elders with functional limitations. DesignCross sectional. SettingLifestyle Interventions and Independence in Elder (LIFE) Study. ParticipantsA total of 1307 sedentary community-dwelling persons, mean age 78.9, with functional limitations (Short Physical Performance Battery [SPPB] <10). MeasurementsA reduced FEV1 was defined by a z-score less than −1.64 (<lower limit of normal), whereas PAD was defined by an ankle-brachial index less than 1.00. Exertional dyspnea was defined as moderate to severe (modified Borg index) immediately after a 400-meter walk test (400MWT). Exertional leg symptoms were established by the San Diego Claudication Questionnaire. Physical inactivity was evaluated by percent of accelerometry wear-time with activity less than 100 counts per minute (top quartile established high sedentary time). Mobility was evaluated by the 400MWT (gait speed <0.8 m/s defined as slow) and SPPB (≤7 defined moderate-to-severe mobility impairment). ResultsA combined reduced FEV1 and PAD was established in 6.0% (78/1307) of participants. However, among those who had a reduced FEV1, 34.2% (78/228) also had PAD, whereas 20.8% (78/375) of those who had PAD also had a reduced FEV1. The 2 combined conditions were associated with exertional dyspnea (adjusted odds ratio [adjOR] 2.59 [1.20–5.60]) and slow gait speed (adjOR 3.15 [1.72–5.75]) but not with exertional leg symptoms, high sedentary time, and moderate-to-severe mobility impairment. ConclusionsIn sedentary community-dwelling elders with functional limitations, a reduced FEV1 and PAD frequently coexisted and, in combination, were strongly associated with exertional dyspnea and slow gait speed (a frailty indicator that increases the risk of deleterious outcomes).

Respiratory Impairment and Dyspnea and Their Associations with Physical Inactivity and Mobility in Sedentary Community‐Dwelling Older Persons

To evaluate the prevalence of respiratory impairment and dyspnea and their associations with objectively measured physical inactivity and performance-based mobility in sedentary older persons. Cross-sectional. Lifestyle Interventions and Independence for Elders Study. Community-dwelling older persons (n = 1,635, mean age 78.9) who reported being sedentary (<20 min/wk of regular physical activity and <125 min/wk of moderate physical activity in past month). Respiratory impairment was defined as low ventilatory capacity (forced expiratory volume in 1 second less than lower limit of normal (LLN)) and respiratory muscle weakness (maximal inspiratory pressure <LLN). Dyspnea was defined as moderate to severe ratings on the modified Borg index, immediately after a 400-m walk test (400-MWT). Physical inactivity was defined according to high sedentary time as the highest quartile of participants with accelerometry-measured activity of <100 counts/min. Performance-based mobility was evaluated using the Short Physical Performance Battery (≤ 7 defined as moderate to severe mobility impairment) and 400-MWT gait speed (<0.8 m/s defined as slow). Prevalence rates were 17.7% for low ventilatory capacity, 14.7% for respiratory muscle weakness, 31.6% for dyspnea, 44.7% for moderate to severe mobility impairment and 43.6% for slow gait speed. Significant associations were found between low ventilatory capacity and slow gait speed (adjusted odds ratio (aOR) = 1.41, 95% confidence interval (CI) = 1.03-1.92), between respiratory muscle weakness and moderate to severe mobility impairment (aOR = 1.42, 95% CI = 1.03-1.95), and between dyspnea and high sedentary time (aOR = 1.98, 95% CI = 1.28-3.06) and slow gait speed (aOR = 1.70, 95% CI = 1.22-2.38). Respiratory impairment and dyspnea are prevalent in sedentary older persons and are associated with objectively measured physical inactivity and poor performance-based mobility. Because they are modifiable, respiratory impairment and dyspnea should be considered in the evaluation of sedentary older persons.

Relation of Smoking, Drinking, and Physical Activity to Changes in Vision over a 20-Year Period: The Beaver Dam Eye Study

To describe the relationships of lifestyle characteristics to changes in vision and incidence of visual impairment (VI) over a 20-year period in the Beaver Dam Eye Study (BDES). Longitudinal, population-based cohort study. A cohort of 4926 persons aged 43 to 86 years participated in the baseline examinations in 1988-1990, and 3721, 2962, 2375, and 1913 persons participated in follow-up examinations in 1993-1995, 1998-2000, 2003-2005, and 2008-2010, respectively. Best-corrected visual acuity (BCVA) measured by a modified Early Treatment Diabetic Retinopathy Study protocol. Change in number of letters read correctly and incidence of VI based on BCVA in the better eye assessed at each examination over a 20-year period. The 20-year cumulative incidence of VI was 5.4%. There was a mean loss of 1.6 letters between examinations, with a 20-year loss of 6.6 letters. While adjusting for age, income, and age-related macular degeneration (AMD) severity, being a current or past smoker was related to a greater change in the numbers of letters lost. Persons who had not consumed alcoholic beverages over the past year and sedentary persons had higher odds of incident VI than persons who drank occasionally or who were physically active. For example, in women with early AMD and annual household income less than $10,000, the estimated 20-year cumulative incidence of VI in those who drank occasionally and were physically active was 5.9% compared with 25.8% in women who had not consumed alcoholic beverages over the past year and were sedentary. Three modifiable behaviors-smoking, drinking alcohol, and physical activity-were associated with changes in vision. Further evidence that changes in these behaviors will result in less loss of vision is needed because of the expected increase in the burden of VI due to the aging of the population.