Nonrecreational Physical Activity Reduces Death, CV Events

September 27, 2017

VANCOUVER, Canada — Higher rates of physical activity, whether recreational or nonrecreational, are associated with a lower risk for death and cardiovascular (CV) events in individuals from all regions of the world, latest findings from the PURE study show.

The study, which involved 130,843 individuals without pre-existing CV disease from 17 countries who were followed for almost 7 years, extends existing knowledge on the benefits of physical activity in high-income countries to low- and middle-income countries, the authors say.

"The findings suggest that, if the entire population met physical activity guidelines (which recommend the equivalent of 30 minutes' moderate exercise 5 days a week), 8% of deaths (equivalent to around 1 in 12 cases) and 4.6% of cardiovascular disease events (almost 1 in 20 cases) could be prevented," said lead author, Scott Lear, PhD, Simon Fraser University, Vancouver, British Columbia, Canada.

These latest findings from the PURE study were published online in The Lancet on September 21.

The researchers explain that studies investigating the role of physical activity in preventing death from CV disease have been primarily from high-income countries and focused on recreational or leisure time physical activity. In low-income and middle-income countries, physical activity is predominantly from nonrecreational activities, such as transportation, occupation, and housework, and these have not been well studied before.

"Our results show that meeting physical activity guidelines by recreational or nonrecreational activities for as little as 30 minutes most days of the week has a substantial benefit, and higher physical activity is associated with even lower risks," Dr Lear commented.

"The affordability of other cardiovascular disease interventions, such as generic drugs and consuming fruits and vegetables, are often beyond the reach of many people in low-income and middle-income countries. However, physical activity represents a low-cost approach to preventing cardiovascular disease, and our study provides robust evidence to support public health interventions to increase all forms of physical activity in these regions," he added.

For the study, participants completed the International Physical Activity Questionnaire (IPQA) and were followed for a mean of 6.9 years. The effects of physical activity on mortality and CV disease were adjusted for sociodemographic factors and other risk factors taking into account household, community, and country clustering

Results showed that compared with low physical activity (<150 minutes of moderate-intensity exercise per week), moderate (150 to 750 minutes per week) and high (>750 minutes per week) physical activity were associated with graded reduction in mortality (hazard ratios, 0.80 [95% confidence interval (CI), 0.74 - 0.87] and 0.65 [95% CI, 0.60 - 0.71]; P < .0001 for trend), and major CV events (hazard ratio, 0.86; 95% CI, 0.78 - 0.93; P < .001 for trend).

Similar effects were seen in high-income, middle-income, and low-income countries, and both recreational and nonrecreational physical activity were associated with benefits.

Risk for death was also higher for people who did not meet the recommended amount of activity: 6.4% compared with 4.2% for people who met guidelines.

The 5-year adjusted population attributable fraction of not meeting the physical activity guidelines was 8.0% for mortality and 4.6% for major CV events.

Our study found that high physical activity was only possible in people who completed physical activity as a form of transport, part of their job or through housework. Dr Scott Lear

 Overall, 18% of the study participants did not meet the physical activity guidelines, but 44% were highly active.

"Our study found that high physical activity was only possible in people who completed physical activity as a form of transport, part of their job or through housework — with 37.9% of people who acted in this way attaining high activity levels, compared to 2.9% who were only physically active in their leisure time," Dr Lear said. "This reflects the challenge of trying to be highly active during limited daily leisure time outside of work and domestic duties."

"The results of our study provide robust evidence to support public health interventions to increase all forms of physical activity in countries of different socioeconomic circumstances," the researchers conclude.

A Public Health "Imperative"

In an accompanying comment, Shifalika Goenka, Indian Institute of Public Health, New Delhi, and I-Min Lee, Brigham and Women's Hospital, Boston, Massachusetts, say these results provide an encouraging message in that the largest risk reductions were seen between participants not meeting current physical activity recommendations and those meeting these recommendations — the equivalent of 150 minutes of moderate activity per week.

Noting that physical activity also lowers the risk for diabetes and cancers, reduces air pollution, and is good for the environment, they state, "It is rare to find an intervention that has such powerful and far-reaching benefits across so many spheres."

"Creating a physical, social, and political environment where physical activity in daily living is desirable, accessible, and safe should be a developmental imperative; a planning, economic, social, and equity imperative; and a public health imperative," they add. This involves taking measures to encourage walking and cycling rather than driving, and ensuring there are more green spaces near homes, workplaces, and educational institutes.

"Promotion of physical activity, active transport, and active living by means of interventions contextualised to culture and context will have powerful and long-lasting effects on population health and developmental sustainability," they conclude.

The PURE study was funded by Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Ontario SPOR Support Unit, Ontario Ministry of Health and Long-Term Care, AstraZeneca, Sanofi-Aventis, Boehringer Ingelheim, Servier, GlaxoSmithKline, Novartis, King Pharma, and national and local organizations in participating countries that are listed at the end of the article. It was conducted by researchers from Simon Fraser University, Providence Health Care, Hamilton Health Sciences and McMaster University, University of Edinburgh, Aga Khan University, St John's National Academy of Health Sciences, Madras Diabetes Research Foundation, Postgraduate Institute of Medical Education & Research, University of Gothenburg, Fu Wai Hospital, Xishuangbanna Prefecture, Government Medical College, Estudios Clinicos Latinoamerica ECLA, Dubai Health Authority, Eternal Heart Care Centre & Research Institute, Isfahan University of Medical Sciences, Medical School Universidad de Santander, Istanbul Medeniyet University, Medical University of Wroclaw, Universidad de La Frontera, Dante Pazzanese Institute of Cardiology, and Institut universitaire de cardiologie et de pneumologie de Québec.  The authors have disclosed no relevant financial relationships.

Lancet.  Published online September 21, 2017. Abstract, Comment

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