Physical activity trajectories and mortality: population based cohort study.
BMJ (Clinical research ed.)
BMJ Publishing Group
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Mok, A., Khaw, K., Luben, R., Wareham, N., & Brage, S. (2019). Physical activity trajectories and mortality: population based cohort study.. BMJ (Clinical research ed.), 365 l2323. https://doi.org/10.1136/bmj.l2323
Objective To assess the prospective associations of baseline and long-term trajectories of physical activity on mortality from all-causes, cardiovascular disease, and cancer. Design: Population-based prospective cohort study with repeated exposure assessments. Setting: Adults from the general population in the United Kingdom. Participants: 14,599 men and women (aged 40 to 79 years) from the European Prospective Investigation into Cancer and Nutrition – Norfolk cohort, assessed at baseline (1993 to 1997) up to 2004 for lifestyle and other risk factors; then followed till 2016 for mortality (median of 12.5 years of follow-up, after the last exposure assessment). Main exposure Physical activity energy expenditure (PAEE) derived from questionnaires, calibrated against combined movement and heart-rate monitoring. Main outcome measures Mortality from all-causes, cardiovascular disease and cancer. Multivariable proportional hazards regression models were adjusted for age, sex, socio-demographics; and time-updated medical history, overall diet quality, body mass index, blood -pressure, -triglycerides, LDL- and HDL-cholesterol levels. Results During 171,277 person-years of follow-up, 3,148 deaths occurred. Long-term increases in PAEE were inversely associated with mortality, independent of baseline PAEE. For each 1 kJ/kg/day per year increase in PAEE (equivalent to a trajectory of being inactive at baseline and subsequently meeting the World Health Organization minimum physical activity guidelines of 150 minutes/week of moderate-intensity physical activity, five years later), hazard ratios (95% CI) were: 0.76 (0.71 to 0.82) for all-cause mortality; 0.71 (0.62 to 0.82) for cardiovascular mortality; and 0.89 (0.79 to 0.99) for cancer mortality, adjusted for baseline PAEE, and established risk factors. Similar results were observed when stratified for prevalent cardiovascular disease and cancer. Joint analyses with baseline and trajectories of physical activity demonstrate that, compared to consistently inactive individuals, those with increasing physical activity trajectories over time experienced lower risks of mortality from all causes, with hazard ratios of: 0.76 (0.65 to 0.88); 0.62 (0.53 to 0.72); and 0.58 (0.43 to 0.78) at low, medium and high baseline physical activity, respectively. At the population level, meeting and maintaining at least the minimum activity recommendations would potentially prevent 46% of deaths associated with physical inactivity. Conclusions Middle-aged and older adults can gain substantial longevity benefits by becoming more physically active, irrespective of past physical activity levels, established risk factors, and existing cardiovascular disease or cancer. Considerable population impacts can be realised with consistent engagement in physical activity during mid-to-late life.
Humans, Neoplasms, Cardiovascular Diseases, Exercise, Population Surveillance, Mortality, Cause of Death, Risk Factors, Longitudinal Studies, Prospective Studies, Energy Metabolism, Adult, Aged, Middle Aged, Female, Male, United Kingdom, Healthy Lifestyle
The EPIC-Norfolk study is supported by programme grants from the Medical Research CouncilandCancer Research UKwith additional support from the Stroke Association, British Heart Foundation, Department of Health, Food Standards Agency, and the Wellcome Trust. Alexander Mok was supported by the National Science Scholarship from Singapore, A*STAR (Agency for Science, Technology and Research).The work of Nick Wareham and Soren Brage was funded by the Medical Research Council UK [MC_UU_12015/1 and MC_UU_12015/3].The funders had no role in the study design; the collection, analysis, and interpretation of data; the writing of the manuscript; or the decision to submit the article for publication.
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10149)
MEDICAL RESEARCH COUNCIL (MR/N003284/1)
External DOI: https://doi.org/10.1136/bmj.l2323
This record's URL: https://www.repository.cam.ac.uk/handle/1810/292375
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