Objectives

Our aim was to examine the independent and combined associations of changes in fitness and fatness with the subsequent incidence of the cardiovascular disease (CVD) risk factors of hypertension, metabolic syndrome, and hypercholesterolemia.

Background

The relative and combined contributions of fitness and fatness to health are controversial, and few studies are available on the associations of changes in fitness and fatness with the development of CVD risk factors.

Methods

We followed 3,148 healthy adults who received at least three medical examinations. Fitness was determined by a maximal treadmill test. Fatness was expressed by percent body fat and body mass index. Changes in fitness and fatness between the first and second examinations were categorized into loss, stable, or gain groups.

Results

During the 6-year follow-up after the second examination, 752, 426, and 597 adults developed hypertension, metabolic syndrome, and hypercholesterolemia, respectively. Maintaining or improving fitness was associated with lower risk of developing each outcome, whereas increasing fatness was associated with higher risk of developing each outcome, after adjusting for possible confounders and fatness or fitness for each other (all p for trend <0.05). In the joint analyses, the increased risks associated with fat gain appeared to be attenuated, although not completely eliminated, when fitness was maintained or improved. In addition, the increased risks associated with fitness loss were also somewhat attenuated when fatness was reduced.

Conclusions

Both maintaining or improving fitness and preventing fat gain are important to reduce the risk of developing CVD risk factors in healthy adults.

Background

The combined associations of changes in cardiorespiratory fitness and body mass index (BMI) with mortality remain controversial and uncertain.

Methods and Results

We examined the independent and combined associations of changes in fitness and BMI with all-cause and cardiovascular disease (CVD) mortality in 14 345 men (mean age 44 years) with at least two medical examinations. Fitness, in metabolic equivalents (METs), was estimated from a maximal treadmill test. BMI was calculated using measured weight and height. Changes in fitness and BMI between the baseline and last examinations over 6.3 years were classified into loss, stable, or gain groups. During 11.4 years of follow-up after the last examination, 914 all-cause and 300 CVD deaths occurred. The hazard ratios (95% confidence intervals) of all-cause and CVD mortality were 0.70 (0.59 to 0.83) and 0.73 (0.54 to 0.98) for stable fitness, and 0.61 (0.51 to 0.73) and 0.58 (0.42 to 0.80) for fitness gain, respectively, compared with fitness loss in multivariable analyses including BMI change. Every 1-MET improvement was associated with 15% and 19% lower risk of all-cause and CVD mortality, respectively. BMI change was not associated with all-cause or CVD mortality after adjusting for possible confounders and fitness change. In the combined analyses, men who lost fitness had higher all-cause and CVD mortality risks regardless of BMI change.

Conclusions

Maintaining or improving fitness is associated with a lower risk of all-cause and CVD mortality in men. Preventing age-associated fitness loss is important for longevity regardless of BMI change.

Elevated serum bilirubin has been suggested to reduce the risk of mortality. Cardiorespiratory fitness (CRF) has also been reported to have inverse association with all-cause and cardiovascular disease (CVD) mortality. The association between serum bilirubin, all-cause and CVD mortality and the effect of CRF on the observed association was investigated. A total of 1279 men, ages 30-82 years old, who underwent baseline medical examinations during 1974 to 1997 at the Cooper Clinic in Dallas, Texas. During an average of 17 years follow-up, 698 men died, with 253 deaths due to CVD (36%). Men in the highest bilirubin quartiles had significantly lower risk of all-cause mortality compared to men in the lowest quartiles (p for trend=0.0043), after adjusting for age and examination year. This inverse association remained significant after further adjustment for known confounders (p for trend=0.0018). Additional adjustment for treadmill time attenuated the association (p trend=0.0090). Similar patterns of association were observed between serum bilirubin quartiles and CVD mortality. CRF was inversely associated with all-cause mortality (p for trend < .0001) after adjusting for age and examination year. This inverse association also was observed after further adjusting for known confounders (p for trend=0.0004). After additional adjustment for serum bilirubin, the association between the CRF and all-cause mortality remained significant (p for trend = 0.0012). All-cause mortality and CVD mortality were significantly lower among men in the moderate to high fit quartiles in both the low and high bilirubin groups. In Conclusion both serum bilirubin level and CRF level were strongly and independently associated with all-cause and CVD mortality.

Objective

To investigate associations of cardiorespiratory fitness (CRF) and different measures of adiposity with cardiovascular disease (CVD) and all-cause mortality in men with known or suspected coronary heart disease (CHD).

Patients and Methods

We analyzed data from 9563 men (mean age, 47.4 years) with documented or suspected CHD in the Aerobics Center Longitudinal Study (August 13, 1977, to December 30, 2002) using baseline body mass index (BMI) and CRF (quantified as the duration of a symptom-limited maximal treadmill exercise test). Waist circumference (WC) and percent body fat (BF) were measured using standard procedures.

Results

There were 733 deaths (348 of CVD) during a mean follow-up of 13.4 years. After adjustment for age, examination year, and multiple baseline risk factors, men with low fitness had a higher risk of all-cause mortality in the BMI categories of normal weight (hazard ratio [HR], 1.60; 95% confidence interval [CI], 1.24-2.05), obese class I (HR, 1.38; 95% CI, 1.04-1.82), and obese class II/III (HR, 2.43; 95% CI, 1.55-3.80) but not overweight (HR, 1.09; 95% CI, 0.88-1.36) compared with the normal-weight and high-fitness reference group. We observed a similar pattern for WC and percent BF tertiles and for CVD mortality. Among men with high fitness, there were no significant differences in CVD and all-cause mortality risk across BMI, WC, and percent BF categories.

Conclusion

In men with documented or suspected CHD, CRF greatly modifies the relation of adiposity to mortality. Using adiposity to assess mortality risk in patients with CHD may be misleading unless fitness is considered.

Left ventricular diastolic dysfunction (LVDD) has been reported to have strong correlation with exercise capacity. However, this relationship has not been studied extensively in community-dwelling older adults. Data on pulse and tissue Doppler echocardiographic estimates of resting early (E) and atrial (A) transmitral peak inflow and early (Em) mitral annular velocities, and six-minute walk test were obtained from 89 community-dwelling older adults (mean age, 74; range, 65 -93 years; 54% women), without a history of heart failure. Overall, 47% had cardiovascular morbidity and 60% had normal diastolic function (E/A 0.75 -1.5 and E/Em <10). Among the 36 individuals with LVDD, 83%, 14% and 3% had grade I (E/A<0.75, regardless of E/Em), II (E/A 0.75–1.5 and E/Em ≥10) and III (E/A>1.5 and E/Em ≥10) LVDD respectively. Those with LVDD were older (77 versus 73 years; p=0.001) and tended to have a higher prevalence of cardiovascular morbidity (58% versus 40%; p=0.083). LVDD negatively correlated with six-minute walk distance (1013 versus 1128 feet; R=−0.25; p=0.017). This association remained significant despite adjustment for cardiovascular morbidity (R=−0.35; p=0.048), but lost significance when adjusted for age (R=−0.32; p=0.105), both age and cardiovascular morbidity (R=−0.38; p=0.161), and additional adjustment for sex, race, body mass index, and systolic blood pressure (R=−0.44; p=0.365). In conclusion, most community-dwelling older adults without heart failure had normal left ventricular diastolic function or grade-I LVDD. Although LVDD was associated with decreased performance on a six-minute walk test, that association was no longer evident after adjustment for age, body mass index and cardiovascular morbidity.

BACKGROUND

Few prospective studies have evaluated the risk for incident hypertension (HTN) across the normal range of body mass index (BMI). Even fewer studies included body composition and fat distribution measurements in their analyses. In the Aerobics Center Longitudinal Study, we examined HTN risk in women across a wide spectrum of baseline BMI (kg/m2) values and also studied waist circumference (WC, cm), percent body fat, fat mass (FM, kg), and fat-free mass (FFM, kg) on incident HTN in subgroup analyses.

METHODS

A total of 5,296 healthy normotensive women between 20 and 77 years of age completed a baseline examination during 1971–2004, and were followed for HTN incidence. Incident HTN was identified using mail-back surveys.

RESULTS

A total of 592 women reported HTN during a mean 16.7 years of follow-up. Higher BMI, even within the “normal” range, was associated with greater risk of HTN. Compared with women in the lowest fifth of BMI (18.5–20.0 kg/m2), the hazard ratios (HRs) (95% confidence interval (CI)) of developing HTN for women with a BMI of 20.1–21.2, 21.3–22.5, 22.6–24.7, and >24.7 were 1.19 (0.89–1.60), 1.33 (0.99–1.78), 1.36 (1.03–1.81), and 2.01 (1.52–2.66), respectively (Ptrend < 0.001). In a subgroup (n = 3,189) with complete data on all the five adiposity measures, significant positive associations with HTN were seen across incremental fifths of BMI, percent body fat, and FM (Ptrend < 0.05 each), but not WC and FFM.

CONCLUSIONS

Clinicians should emphasize the importance of weight management for the primary prevention of HTN in women.

OBJECTIVES

To examine associations between functional capacity estimated from cardiorespiratory fitness (CRF) and mortality risks in adults aged 60 and older.

DESIGN

Prospective study, averaging 13.6 years follow-up.

SETTING

Preventive medical clinic.

PARTICIPANTS

Four thousand sixty adults who completed preventive medical examinations between 1971 and 2001; 24.7% women, mean age ± standard deviation 64.6 ± 4.9, body mass index (BMI) 25.9 ± 3.8 kg/m2.

MEASUREMENTS

CRF was quantified as metabolic equivalents (METs) achieved during maximal treadmill exercise. The lowest 20% of the age- and sex-specific MET distribution was defined as having low CRF, the middle 40% moderate CRF, and the upper 40% high CRF. Cox regression was used to estimate death rates (per 1,000 person-years), hazard ratios (HRs), and their 95% confidence intervals (CIs).

RESULTS

Nine hundred eighty-nine deaths occurred during follow-up. Death rates adjusted for age, sex, and examination year were 30.9, 18.3, and 13.4 for all causes (P<.001); 15.9, 8.6, and 5.4 for cardiovascular disease (CVD) (P<.001); and 6.1, 4.9, and 4.2 for cancer (P=.04) for subjects with low, moderate, and high CRF, respectively. After adjusting for smoking, abnormal electrocardiograms at rest or while exercising, percentage of age-predicted maximal heart rate achieved during exercise testing, baseline medical conditions, BMI, hypercholesterolemia, and family CVD and cancer history, subjects with high CRF had notably lower mortality risk than those with low CRF from all causes (HR = 0.59, 95% CI = 0.47–0.74) and from CVD (HR = 0.57, 95% CI = 0.41–0.80).

CONCLUSION

CRF is an important independent predictor of death in older adults. The results add to the existing evidence that promoting physical activity in older adults provides substantial health benefits, even in the oldest old.

OBJECTIVE

The purpose of this study was to determine the independent and joint associations of cardiorespiratory fitness (CRF) and BMI with the incidence of type 2 diabetes in women.

RESEARCH DESIGN AND METHODS

An observational cohort of 6,249 women aged 20–79 years was free of baseline cardiovascular disease, cancer, and diabetes. CRF was measured using a maximal treadmill exercise test. BMI was computed from measured height and weight. The incidence of type 2 diabetes was identified primarily by 1997 American Diabetes Association criteria.

RESULTS

During a 17-year follow-up, 143 cases of type 2 diabetes occurred. Compared with the least fit third, the multivariate (including BMI)-adjusted hazard ratio (HR) (95% CI) was 0.86 (0.59–1.25) for the middle third and 0.61 (0.38–0.96) for the upper third of CRF. For BMI, the multivariate (including CRF)-adjusted HR (95% CI) was 2.34 (1.55–3.54) for overweight individuals and 3.70 (2.12–6.44) for obese individuals, compared with normal-weight patients. In the combined analyses, overweight/obese unfit (the lowest one-third of CRF) women had significantly higher risks compared with normal-weight fit (the upper two-thirds of CRF) women.

CONCLUSIONS

Low CRF and higher BMI were independently associated with incident type 2 diabetes. The protective effect of CRF was observed in individuals who were overweight or obese, but CRF did not eliminate the increased risk in these groups. These findings underscore the critical importance of promoting regular physical activity and maintaining normal weight for diabetes prevention.

Objective

To investigate whether a dose–response relationship existed between exercise and subjective sleep quality in postmenopausal women. This objective represents a post hoc assessment that was not previously considered.

Design

Parallel-group randomised controlled trial.

Setting

Clinical exercise physiology laboratory in Dallas, Texas.

Participants

437 sedentary overweight/obese postmenopausal women.

Intervention

Participants were randomised to one of four treatments, each of 6 months of duration: a non-exercise control treatment (n=92) or one of three dosages of moderate-intensity exercise (50% of VO2peak), designed to meet 50% (n=151), 100% (n=99) or 150% (n=95) of the National Institutes of Health Consensus Development Panel physical activity recommendations. Exercise dosages were structured to elicit energy expenditures of 4, 8 or 12 kilocalories per kilogram of body weight per week (KKW), respectively. Analyses were intent to treat.

Primary outcome measures

Continuous scores and odds of having significant sleep disturbance, as assessed by the Sleep Problems Index from the 6-item Medical Outcomes Study Sleep Scale. Outcome assessors were blinded to participant randomisation assignment.

Results

Change in the Medical Outcomes Study Sleep Problems Index score at 6 months significantly differed by treatment group (control: −2.09 (95% CI −4.58 to 0.40), 4 KKW: −3.93 (−5.87 to −1.99), 8 KKW: −4.06 (−6.45 to −1.67), 12 KKW: −6.22 (−8.68 to −3.77); p=0.04), with a significant dose–response trend observed (p=0.02). Exercise training participants had lower odds of having significant sleep disturbance at postintervention compared with control (4 KKW: OR 0.37 (95% CI 0.19 to 0.73), 8 KKW: 0.36 (0.17 to 0.77), 12 KKW: 0.34 (0.16 to 0.72)). The magnitude of weight loss did not differ between treatment conditions. Improvements in sleep quality were not related to changes in body weight, resting parasympathetic control or cardiorespiratory fitness.

Conclusion

Exercise training induced significant improvement in subjective sleep quality in postmenopausal women, with even a low dose of exercise resulting in greatly reduced odds of having significant sleep disturbance.

Trial registration number

clinicaltrials.gov identifier: NCT00011193.

Article summary

Article focus

Sleep disturbance is prevalent in postmenopausal women, with 35%–60% reporting significant sleep problems.

Effective, safe and easily available treatment options for disturbed sleep in postmenopausal women are lacking.

There has been equivocal evidence as to whether exercise improves sleep in postmenopausal women, though possible dose–response effects have been noted.

Key messages

Exercise resulted in significant improvement in subjective sleep quality in postmenopausal women, with reduced odds of having sleep disturbance at postintervention with even 50% of the recommended dose of exercise for adults.

The effects of exercise on sleep quality were independent of changes in body weight, resting parasympathetic control or cardiorespiratory fitness.

Strengths and limitations of this study

The study constitutes the largest randomised controlled trial on exercise and sleep quality, using a structured dose of exercise and a validated measure of sleep quality.

Only self-reported sleep was assessed; objective measurement of sleep, with either actigraphy or polysomnography, was not conducted.

Despite the high prevalence of sleep disturbance in the sample, participants were not selected on the basis of sleep complaints.

Background

Cardiorespiratory fitness (CRF) in adults decreases with age and is influenced by lifestyle. Low CRF is associated with risk of diseases and the ability of older persons to function independently. We defined the longitudinal rate of CRF decline with aging and the association of aging and lifestyle with CRF.

Methods

We studied a cohort of 3429 women and 16 889 men, aged 20 to 96 years, from the Aerobics Center Longitudinal Study who completed 2 to 33 health examinations from 1974 to 2006. The lifestyle variables were body mass index, self-reported aerobic exercise, and smoking behavior. Cardiorespiratory fitness was measured by a maximal Balke treadmill exercise test.

Results

Linear mixed models regression analysis stratified by sex showed that the decline in CRF with age was not linear. After 45 years of age, CRF declined at an accelerated rate. For each unit of increase in body mass index, the CRF of women declined 0.20 metabolic equivalents (METs) (95% confidence interval, −0.21 to −0.19); that of men, 0.32 METs (−0.33 to −0.20). Current smokers of both sexes also had lower CRF (−0.29 METs [95% confidence interval, −0.40 to −0.19] for women and −0.41 METS [−0.44 to −0.38] for men). Cardiorespiratory fitness was positively associated with self-reported physical activity.

Conclusions

Cardiorespiratory fitness in men and women declines at a nonlinear rate that accelerates after 45 years of age. Maintaining a low BMI, being physically active, and not smoking are associated with higher CRF across the adult life span.

Background

Habitual physical activity (PA) is associated with higher cardiorespiratory fitness values, but additional information is needed on the contributions of specific types and amounts of PA. Therefore the main aim of this study was to analyze the heart and lung function of a large cohort of men and compare these outcomes with various modes and volumes of PA.

Methods

We used data from 30,594 men from the Aerobics Center Longitudinal Study who were categorized into sedentary, swimmer, walker, and runner groups using self-report PA data collected during 1970-2005. Additional PA categories using MET-minutes/week were used to group men into 5 distinct levels of activity (0 MET-min, 1-499 MET-min, 500-999 MET-min, 1000-1499 MET-min, and ≥ 1500 MET-min). Each participant also completed a maximal treadmill exercise test to quantify their fitness level. Cross-sectional analyses included general linear modeling and multiple comparisons adjusted for age, smoking status, and histories of myocardial infarction, stroke, diabetes, and hypertension.

Results

A dose-response linear effect was found for heart function variables across PA MET-min categories. Stronger associations for resting heart rate (HR), heart rate recovery (HRR), exercise HR, and exercise blood pressure were found with the runner and swimming groups when compared to the walkers and sedentary groups. Walkers had significantly better heart function than the sedentary group but only about half the effect seen in the swimmers and runners. Lung function findings showed greater absolute values in FVC and FEV1 across PA categories, but found no difference in lung function ratios (e.g FEV1/FVC%).

Conclusions

We found beneficial linear associations with resting HR, exercise HR, HRR, fitness values, FVC, and FEV1 over increasing MET-min categories. This implies that habitual PA, such as walking, but especially swimming and running, when performed with adequate volume, are viable ways to gain benefits for heart health.

Objective

To assess the impact of muscular strength on mortality in men with hypertension.

Background

Muscular strength is inversely associated with mortality in healthy men, but this association has not been examined in men with hypertension.

Methods

We followed 1506 hypertensive men aged ≥ 40 years enrolled in the Aerobics Center Longitudinal Study from 1980 to 2003. Participants received an extensive medical examination at baseline. Muscular strength was quantified by combining one repetition maximum (1-RM) measures for leg and bench press, and cardiorespiratory fitness (CRF) assessed by maximum exercise test on a treadmill.

Results

During an average follow-up of 18.3 years, 183 deaths occurred. Age adjusted death rates per 10 000 man-years across incremental thirds of muscular strength were 81.8, 65.5 and 52.0 (P<0.05 for linear trend). Multivariable Cox regression hazard ratios were 1.0 (reference), 0.81 (95% confidence interval, 0.57 to 1.14), and 0.59 (0.40 to 0.86) across incremental thirds of muscular strength. After further adjustment for CRF, those participants in the upper third of muscular strength still had a lower risk of death (0.66; 0.45 to 0.98). In the muscular strength and CRF combined analysis, men simultaneously in the upper third of muscular strength and high fitness group had the lowest mortality risk among all combination groups (0.49; 0.30 to 0.82), with men in the lower third of muscular strength and low fitness group as reference.

Conclusions

High levels of muscular strength appear to protect hypertensive men against all-cause mortality, and this is in addition to the benefit provided by CRF.

OBJECTIVE: To examine the association between levels of fasting plasma glucose (FPG) and incidence of stroke outcomes in a large cohort of asymptomatic men.

PATIENTS AND METHODS: Participants were 43,933 men (mean ± SD age, 44.3±9.9 years) who were free of known cardiovascular disease at baseline and whose FPG levels were assessed during a preventive medical examination at the Cooper Clinic, Dallas, TX, between January 7, 1971, and March 11, 2002. Patients with diagnosed diabetes mellitus (DM) or low FPG (<80 mg/dL [to convert to mmol/L, multiply by 0.0555]) were excluded. Fatal stroke was identified through the National Death Index, and nonfatal stroke was ascertained from mail-back surveys.

RESULTS: A total of 595 stroke events (156 fatal and 456 nonfatal strokes; 17 men reported a nonfatal stroke before they died of stroke) occurred during 702,928 person-years of exposure. Age-adjusted fatal, nonfatal, and total stroke event rates per 10,000 person-years for normal FPG (80-109 mg/dL), impaired fasting glucose (110-125 mg/dL), and undiagnosed DM (≥126 mg/dL) were 2.1, 3.4, and 4.0 (Ptrend=.002); 10.3, 11.8, and 18.0 (Ptrend=.008); and 8.2, 9.6, and 12.4 (Ptrend=.008), respectively. After further adjusting for potential confounders, the direct association between FPG and fatal, nonfatal, or total stroke events remained significant (Ptrend=.02, .03, and .01, respectively). For FPG levels of 110 mg/dL or greater, each 10-unit increment of FPG was associated with a 6% higher risk of total stroke events (P=.05).

CONCLUSION: Hyperglycemia (FPG, ≥110 mg/dL), even below the DM threshold (such as with impaired fasting glucose), was associated with a higher risk of fatal, nonfatal, or total stroke events in asymptomatic men.

Objective

To examine the association between cardiorespiratory fitness (CRF) and risk of incident prostate cancer (PrCA).

Methods

Participants were 19,042 male subjects in the Aerobics Center Longitudinal Study (ACLS), ages 20 to 82 years, who received a baseline medical examination including a maximal treadmill exercise test between 1976 and 2003. CRF levels were defined as low (lowest 20%), moderate (middle 40%), and high (upper 40%) according to age-specific distribution of treadmill duration from the overall ACLS population. PrCA was assessed from responses to mail-back health surveys during 1982 to 2004. Cox proportional hazards regression models, adjusted for potential confounders, were used to compute hazard ratios (HRs), 95% confidence intervals (95% CIs), and incidence rates (per 10,000 person-years of follow-up).

Results

A total of 634 men reported a diagnosis of incident PrCA during an average of 9.3 ± 7.1 years of follow-up. Adjusted HRs (95% CIs) in men with moderate and high CRF relative to low CRF were, 1.68 (1.13–2.48) and 1.74 (1.15–2.62), respectively. The positive association between CRF and PrCA was observed only in the strata of men who were not obese, had ≥ 1 follow-up examination, or who were diagnosed ≤ 1995.

Conclusions

Rather than revealing a causal relationship, the unexpected positive association observed between CRF and incident PrCA is most likely due to a screening/detection bias in more fit men who also are more health-conscious. Results have important implications for understanding the health-related factors that predispose men to receive PrCA screening that may lead to over-detection of indolent disease.

The authors examined the prospective associations between marital status transitions and changes in fitness in men and women. Between 1987 and 2005, a total of 8,871 adults (6,900 men) aged 45.6 (standard deviation, 9.1) years were examined at the Cooper Clinic, Dallas, Texas; the median follow-up was ∼3 years. Marital transition categories (from single to married, married to divorced, divorced to remarried) were derived from self-reported marital status at baseline and follow-up. Fitness (maximal oxygen consumption) was assessed by a maximal treadmill test. Analyses were adjusted for baseline levels and changes in body mass index, physical activity, smoking, alcohol consumption, and major chronic diseases. Compared with the corresponding “control” groups (remaining single, married, or divorced), transitioning from being single to married was associated with a reduction in fitness in women (P = 0.03); divorce was associated with an increase in fitness in men (P = 0.04); and remarriage was associated with a reduction in fitness in men (P = 0.05). The authors conclude that the transitions to being married (from single to married or from divorced to remarried) are associated with a modest reduction, while divorce is associated with a modest increase in fitness levels in men. Study results suggest that these patterns may be different in women, but further research is required to confirm this.

Background

Psychological well-being is associated with mortality/survival. Although cardiorespiratory fitness (CRF) is one of the strongest predictors of mortality, studies examining the relationship between well-being and survival seldom account for the possible effects of CRF.

Purpose

This study examined the independent associations of psychological well-being components (low level of negative emotion and high level of positive emotion) and CRF, as well as their combined effects, with survival.

Methods

Participants (N=4888) were examined in 1988–1997 and followed up for a median period of ~15 years (212 deaths, 4.3%). CRF was assessed by a maximal exercise test on a treadmill. Low-level negative emotion was defined as the minimum score of the negative emotion subscale of the CES-D scale, and high-level positive emotion as the maximum score of positive emotion subscale. Results are presented as hazard ratios (95% CIs). Data were analyzed in 2009.

Results

After adjustment for a set of established risk factors, men and women with low levels of negative emotion had lower risk of death than those with higher levels of negative emotion, 0.66 (0.50, 0.87). The association persisted after additional adjustment for CRF and positive emotion. High level of positive emotion was not associated with survival. A high level of CRF independently predicted lower risk of death, 0.54 (0.37, 0.79), compared to a low level of CRF. The risk of death in participants with both a low level of negative emotion and a high level of CRF was 0.37 (0.22, 0.63), compared to their peers with higher levels of negative emotion/low levels of CRF.

Conclusions

Low levels of negative emotion and high levels of CRF are independent predictors of long-term survival in men and women. A strong combined effect was observed, as individuals with both a low level of negative emotion and a high level of CRF had a 63% lower risk of death than those with higher levels of negative emotion and a low level of CRF.

Self-rated health (SRH) and cardiorespiratory fitness (fitness) are independent risk factors for all-cause mortality. The purpose of this report is to examine the single and joint effects of these exposures on mortality risk. The study included 18,488 men who completed a health survey, clinical examination, and a maximal exercise treadmill test during 1987–2003. Cox regression analysis was used to quantify the associations of SRH and fitness with all-cause mortality. There were 262 deaths during 17 years of follow-up. There was a significant inverse trend (Ptrend < 0.05) for mortality across SRH categories after adjustment for age, examination year, body mass index, physical activity, smoking, alcohol consumption, abnormal ECG, hypertension, and hypercholesterolemia, cardiovascular disease, diabetes, and cancer. Adjustment for fitness attenuated the association (P value =0.09). We also observed an inverse association between fitness and mortality after controlling for the same covariates and SRH (Ptrend = 0.006). The combined analysis of SRH and fitness showed that fit men with good or excellent SRH had a 58% lower risk of mortality than their counterparts. SRH and fitness were both associated with all-cause mortality in men. Fit men with good or excellent SRH live longer than unfit men with poor or fair SRH.

Background

Clustering of unhealthy behaviors has been reported in previous studies; however the link with all-cause mortality and differences between those with and without chronic disease requires further investigation.

Objectives

To observe the clustering effects of unhealthy diet, fitness, smoking, and excessive alcohol consumption in adults with and without chronic disease and to assess all-cause mortality risk according to the clustering of unhealthy behaviors.

Methods

Participants were 13,621 adults (aged 20–84) from the Aerobics Center Longitudinal Study. Four health behaviors were observed (diet, fitness, smoking, and drinking). Baseline characteristics of the study population and bivariate relations between pairs of the health behaviors were evaluated separately for those with and without chronic disease using cross-tabulation and a chi-square test. The odds of partaking in unhealthy behaviors were also calculated. Latent class analysis (LCA) was used to assess clustering. Cox regression was used to assess the relationship between the behaviors and mortality.

Results

The four health behaviors were related to each other. LCA results suggested that two classes existed. Participants in class 1 had a higher probability of partaking in each of the four unhealthy behaviors than participants in class 2. No differences in health behavior clustering were found between participants with and without chronic disease. Mortality risk increased relative to the number of unhealthy behaviors participants engaged in.

Conclusion

Unhealthy behaviors cluster together irrespective of chronic disease status. Such findings suggest that multi-behavioral intervention strategies can be similar in those with and without chronic disease.

We tested the hypothesis that risk of early mortality from cancers of the digestive system will be greater in men with, compared to men without, the metabolic syndrome (MetS). Participants were 33,230 men who were seen at the Cooper Clinic in Dallas, Texas and followed for 14.4 (SD=7.0) yrs. MetS was defined as having at least three of the following risk factors: abdominal obesity, fasting hypertriglyceridemia, low high-density lipoprotein cholesterol, high blood pressure, or high fasting glucose level or diabetes. MetS was associated with higher mortality (HR=1.90 [95% Confidence Interval=1.42-2.55]), and there was a graded positive association for the addition of more syndrome components (p < 0.01). Adjustment for cardiorespiratory fitness attenuated the risk estimates by 20 to 30%, but they remained significant following this adjustment. Evaluation of the independent contribution of each of the syndrome components revealed that both abdominal obesity (HR=1.89 [1.36-2.62]) and high glucose (HR=1.38 [1.02-1.87]) were independently associated with cancer mortality. Our results support the hypothesis that MetS is positively associated with mortality from cancers of the digestive system. Interventions which reduce abnormalities associated with the syndrome could reduce risk of premature death from these cancers.

This study examined the association between consumption of alcoholic beverages and all-cause and cardiovascular disease (CVD) mortality in a cohort of men (n = 31,367). In the Cox proportional hazards model adjusted for age, year of examination, body mass index (BMI), smoking, family history of CVD, and aerobic fitness, there were no significant differences in risk of all-cause mortality across alcohol intake groups. Risk of CVD mortality was reduced 29% in quartile 1 (HR = 0.71, 95% confidence interval (CI): 0.53, 0.95) and 25% in quartile 2 (HR = 0.75, 95% CI: 0.58, 0.98). The amount of alcohol consumed to achieve this risk reduction was <6 drinks/week; less than the amount currently recommended. The addition of other potential confounders and effect modifiers including blood pressure, insulin sensitivity, lipid levels, and psychological variables did not affect the magnitude of association. Future research is needed to validate the current public health recommendations for alcohol consumption.

Background

Falls are a major cause of deaths, hospitalizations, and emergency room visits in the U.S., but circumstances surrounding falls are not well described. Among the elderly, balance and gait disorders and muscle weakness are associated with increased risk for falling, but the relationship of cardiorespiratory fitness and physical activity with falls is unclear.

Purpose

This purpose of this study is to describe characteristics of falls among adults and assess the association of cardiorespiratory fitness and physical activity with walking-related falls.

Methods

Data on participants enrolled in the Aerobics Center Longitudinal Study (ACLS) from 1970 through 1989 who responded to questions on falls on the 1990 follow-up survey were analyzed in 2008–2009. The percentage of participants reporting at least one fall during the year before the follow-up survey was calculated and the activities at the time of falling were described. The relative risk and 95% CIs for the association of baseline fitness and physical activity with walking-related falls were calculated and logistic regression models for walking-related falls were developed.

Results

Of 10,615 participants aged 20–87 years, 20% (95% CI 19%, 21%) reported falling during the past year. Of those falling, 54% (95% CI 52%, 56%) fell during sports or exercise, 15% (95% CI 14%,17%) while walking, and 4% (95% CI 3%,5%) from a stool or ladder. People aged ≥65 years were no more likely than younger people to report falling in general, but they were more likely than people aged <45 years to report falling while walking (RR 1.9; 95% CI 1.2, 3.0 for men; RR 2.2; 95% CI 1.3, 3.9 for women). Men with a low level of fitness were more likely to fall while walking than men who were highly fit (RR 2.2; 95% CI 1.5,3.3). In the multivariate analysis, walking-related falls were associated with low levels of fitness (AOR 1.8; 95% CI 1.1,2.8) and with physical inactivity (AOR 1.7; 95% CI 1.1–2.7) in men but not in women.

Conclusions

Falls are common throughout adulthood but activities at time of falls differ by age. Low fitness levels and physical inactivity may increase risk for walking-related falls.

Background

The combined effect of modifiable health factors on the risk of cardiovascular disease (CVD) mortality has not been well established. The objective of this study was to determine the association between five modifiable health factors in combination on the risk of CVD mortality in a sample of adult males.

Methods

A cohort of 38,110 men (aged 20 to 84 years and of middle and upper socioeconomic strata) was followed over time until their date of death or December 31, 2003. A health profile score (unweighted and weighted) was developed based on cardiorespiratory fitness (CRF; moderate or high vs. low), self-reported physical activity (active vs. inactive), smoking status (not current vs. current), alcohol consumption (1–14 drinks/wk vs. 0 or >14 drinks/wk), and body mass index (BMI; 18.5–24.9 kg/m2 vs. ≥25.0 kg/m2).

Results

During 16.1 ± 8.4 years of follow-up and 613,571 man-years of exposure, there were 949 deaths from CVD. High CRF, normal BMI, being physically active and not currently smoking were individually associated with reduced risk of CVD mortality, after adjusting for confounders. When considered in combination, a minimum of two out of five positive health factors reduced the risk of CVD mortality (HR=0.67; 95% CI 0.49–0.91). The weighted score indicated that a combination of high CRF, not currently smoking and normal BMI is of most clinical importance to CVD mortality (HR=0.31; 95% CI 0.24–0.39).

Conclusions

Exposure to increasing numbers of beneficial health factors in adulthood reduced the risk of CVD mortality in men, and multi-behavioral prevention efforts in adulthood should be encouraged.

Purpose:

This report examines the blood chemistry and blood pressure (BP) results from the Lifestyle Education for Activity and Nutrition (LEAN) study, a randomized weight loss trial. A primary purpose of the study was to evaluate the effects of real-time self-monitoring of energy balance (using the SenseWear™ Armband, BodyMedia, Inc Pittsburgh, PA) on these health factors.

Methods:

164 sedentary overweight or obese adults (46.8 ± 10.8 years; BMI 33.3 ± 5.2 kg/m2; 80% women) took part in the 9-month study. Participants were randomized into 4 conditions: a standard care condition with an evidence-based weight loss manual (n = 40), a group-based behavioral weight loss program (n = 44), an armband alone condition (n = 41), and a group plus armband (n = 39) condition. BP, fasting blood lipids and glucose were measured at baseline and 9 months.

Results:

99 participants (60%) completed both baseline and follow-up measurements for BP and blood chemistry analysis. Missing data were handled by baseline carried forward. None of the intervention groups had significant changes in blood lipids or BP when compared to standard care after adjustment for covariates, though within-group lowering was found for systolic BP in group and group + armband conditions, a rise in total cholesterol and LDL were found in standard care and group conditions, and a lowering of triglycerides was found in the two armband conditions. Compared with the standard care condition, fasting glucose decreased significantly for participants in the group, armband, and group + armband conditions (all P < 0.05), respectively.

Conclusion:

Our results suggest that using an armband program is an effective strategy to decrease fasting blood glucose. This indicates that devices, such as the armband, can be a successful way to disseminate programs that can improve health risk factors. This can be accomplished without group-based behavioral programs, thereby potentially reducing costs.

Background

Hypokalemia is common in heart failure (HF) and is associated with increased mortality. Potassium supplements are commonly used to treat hypokalemia and maintain normokalemia. However, their long-term effects on outcomes in chronic HF are unknown. We used a public-use copy of the Digitalis Investigation Group (DIG) trial dataset to determine the associations of potassium supplement use with outcomes using a propensity-matched design.

Methods

Of the 7788 DIG participants with chronic HF, 2199 were using oral potassium supplements at baseline. We estimated propensity scores for potassium supplement use for each patient and used them to match 2131 pairs of patients receiving and not receiving potassium supplements. Matched Cox regression models were used to estimate associations of potassium supplement use with mortality and hospitalization during 40 months of median follow-up.

Results

All-cause mortality occurred in 818 (rate, 1327/10000 person-years) and 802 (rate, 1313/10000 person-years) patients respectively receiving and not receiving potassium supplements (hazard ratio {HR} when potassium supplement use was compared with nonuse, 1.05; 95% confidence interval {CI}, 0.94–1.18; P=0.390). All-cause hospitalizations occurred in 1516 (rate, 4777/10,000 person-years) and 1445 (rate, 4120/10,000 person-years) patients respectively receiving and not receiving potassium supplements (HR, 1.15; 95% CI, 1.05–1.26; P=0.004). HR (95% CI) for hospitalizations due to cardiovascular causes and worsening HF were respectively 1.19 (95% CI, 1.08–1.32; P=0.001) and 1.27 (1.12–1.43; P<0.0001).

Conclusion

The use of potassium supplements in chronic HF was not associated with mortality. However, their use was associated with increased hospitalization due to cardiovascular causes and progressive HF.