Exercise Tied to Cardiometabolic Markers in Clinic Patients

December 19, 2014

PASADENA, CA — Healthy, middle-aged outpatients who were physically active for at least 2.5 hours a week had better blood pressure and blood glucose levels than their sedentary peers in a large cross-sectional study in California[1]. The differences were especially notable in women, in this study published online December 18, 2014 in Preventing Chronic Disease.

Men and women who were consistently physically active—defined as performing moderate to vigorous activity such as brisk walking for at least 150 minutes a week, as self-reported at all three outpatient visits in a 33-month period—had lower diastolic blood pressure, glucose, and HbA1c levels than patients not reporting exercise at that level.

Thus, "routine clinical physical-activity assessment may give healthcare providers additional information about their patients' cardiometabolic risk factors," Dr Deborah Rohm Young (Kaiser Permanente Southern California, Pasadena) and colleagues write.

Moreover, on a population level, the observed associations "were comparable to those needed to reduce the risk of coronary heart disease, stroke, and diabetes," they continue. "If healthcare providers would routinely assess the physical activity of their patients and refer those who are physically inactive to effective physical-activity programs, it may reduce the burden of future chronic diseases."

"Real-World" Exercise Benefits

In the past 60 years, many studies have shown that regular physical activity can reduce illness and death from CAD, hypertension, and stroke, but few studies have examined this relationship in a "real-world" outpatient setting, the authors write.

They analyzed electronic records from over 622,000 adults covered by Kaiser Permanente Southern California healthcare insurance who made at least three clinic visits between April 2010 and December 2012 and were not being treated for diabetes or hypertension.

The patients had a mean age of 44, and 59% were women. About a third were non-Hispanic white and a third were Hispanic. Their mean body-mass index (BMI) was 28. They had a mean blood pressure of 120/72 mm Hg, a mean fasting glucose of 95 mg/dL, and a mean HbA1c of 5.9%.

At each clinic visit, trained medical assistants or nurses asked patients two questions: "On average, how many days per week do you engage in moderate to strenuous exercise (like a brisk walk)?" and "On average, how many minutes do you engage in exercise at this level?"

The patients were classed as "consistently physically active" if, at all three clinic visits, they reported that they performed at least 150 minutes of moderate to strenuous exercise in a week.

They were classed as "irregularly active" if they were at least moderately active some of the time; they were classed as "inactive" if they never performed moderately strenuous exercise.

Association Between Physical Activity and Cardiometabolic Risk Factors

Risk factor/physical-activity level Regression Coefficient*
Women, n=369,120 Men. n=253,777
Systolic BP (mm Hg)
Irregularly physically active -4.85 -0.09
Consistently physically active -4.60 0.98
Diastolic BP (mm Hg)
Irregularly physically active -3.40 0.78
Consistently physically active -3.28 -1.79
HbA1c (absolute %)
Irregularly physically active - 0.12 - 0.05
Consistently physically active - 0.15 - 0.13
*Controlled for age, sex, race/ethnicity, body-mass index, and smoking status

The consistently active women had systolic and diastolic blood pressures that were 4.60-mm-Hg lower and 3.28-mm-Hg lower, respectively, than inactive women. Perhaps surprisingly, somewhat active women had slightly better blood-pressure values than the more active group.

A previous study estimated that even a 2-mm-Hg lowering of blood pressure would decrease the US prevalence of hypertension by 17% and reduce the risk of CAD and stroke by 6% and 15%, respectively, Young and colleagues note[2].

Unlike women, consistently active men had systolic blood pressure that was, surprisingly, 0.98-mm-Hg higher and diastolic blood pressure that was only 0.09-mm-Hg lower than inactive men.

Active men and women had HbA1c levels that were around 0.14% absolute percentage points lower than their inactive peers. The Diabetes Prevention Program also reported an absolute decrease in HbA1c of 0.14 over 1 year with lifestyle changes, which reduced the incidence of diabetes by 58%, the researchers note[3].

The authors concede that study limitations include that it was a cross-sectional design, so it cannot determine cause and effect, and further study is needed to help "explain why the magnitude of differences between the consistently active and consistently inactive patients was greater for women than for men."

The study was supported by the Southern California Permanente Medical Group. The authors have reported they have no relevant financial relationships.

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