Table 11 Studies examining the relationship between physical activity and all-cause mortality.

Blair et al 1989 [7]

To study physical fitness (PF) and risk of all-cause mortality in men and women.

• n = 13,344 (10,224 men; 3,120 women)

Baseline and 8 year follow-up

   • 283 deaths

Low levels of PF increase the risk for premature mortality.

• Sex: Men and women

Adjusted risk ratio (RR), 95% confidence interval (CI)

USA

• Age: 20->60 years (yr)

PF assessment: Maximal treadmill exercise test.

Prospective cohort

• Characteristics: Participants were given a preventative Medicine examination including maximal treadmill exercise test

Fitness categorized into quintiles:

Men

D & B score = 12

Q1 = least fit

   • Q1 = 3.44 (2.05-5.77)

Q2

   • Q2 = 1.37 (0.76-2.50)

Q3

   • Q3 = 1.46 (0.81-2.63)

Q4

   • Q4 = 1.17 (0.63-2.17)

Q5 = most fit

   • Q5 = 1.00 (referent)

Women

   • Q1 = 4.65 (2.22-9.75)

   • Q2 = 2.42 (1.09-5.37)

   • Q3 = 1.43 (0.60-3.44)

   • Q4 = 0.76 (0.27-2.11)

   • Q5 = 1.00 (referent)

Myers et al 2004 [32]

To determine the effects of PF and physical activity (PA) on all-cause mortality.

• n = 6,213

Baseline and mean 5.5 ± 2.0 year follow-Up

   • 1,256 deaths

Being fit or active is associated with >50% reductions in mortality risk.

• Sex: Men

USA

• Age: Mean 59.0 ± 11.2 yr

PF Level hazard ratio (HR) (95% CI)

• Characteristics: Men referred for exercise testing

PF assessment: Treadmill test to measure VO₂ peak

   • G1 = 1.00 (referent)

PF predicted mortality more strongly than PA.

Prospective cohort

   • G2 = 0.59 (0.52-0.68)

   • G3 = 0.46 (0.39-0.55)

   • G4 = 0.28 (0.23-0.34)

Increasing PA (by 1000 kcal/wk or 1 MET) confers a mortality benefit of 20%.

D & B score = 12

PA assessment: Self reported PA divided into 4 groups

PA Level HR (95% CI)

G1 = Lowest level

   • G1 = 1.00 (referent)

G2

   • G2 = 0.63 (0.36-1.10)

G3

   • G3 = 0.42 (0.23-0.78)

G4 = Highest level

   • G4 = 0.38 (0.19-0.73)

Blair et al 1995 [36]

To evaluate the relationship between changes in PF and risk of mortality in men.

• n = 9,777

4.9 year mean follow-up

   • 223 deaths

Men who maintained or increased adequate PF had a reduced risk for all-cause mortality than individuals who were consistently unfit.

• Sex: Men

• Age: 20-82 yr

RR (95% CI)

USA

• Characteristics: Participants were given a preventative medicine examination including maximal treadmill exercise test

PF assessment: Maximal exercise test at baseline and follow-up

   • G1 = 1.00 (referent)

Prospective cohort

   • G2 = 0.56 (0.41-0.75)

   • G3 = 0.52 (0.38-0.70)

   • G4 = 0.33 (0.23-0.47)

D & B score = 13

Groups based on changes in PF

G1 = unfit to unfit

G2 = unfit to fit

G3 = fit to unfit

G4 = fit to fit

Bijnen et al 1999 [37]

To examine the association of PA at baseline and 5 years

• n = 472

1985 and 1990

   • 118 deaths

Recent levels of PA were more important for mortality risk than PA 5 years previously.

• Sex: Men

• Age: >65 yr

PA assessment: Questionnaire, divided into tertiles: Lowest Middle Highest

Multivariate adjusted RR (95% CI)

Netherlands

previously with all- cause mortality risk in a cohort of elderly Dutch men.

• Characteristics: Mostly independently living elders (~95%)

PA in 1985: Lowest tertile = 1.00 (referent) Middle tertile

Retrospective cohort

• Zutphen Elderly Study

   • Total activity = 1.25 (0.79- 1.99)

Becoming or remaining sedentary increased the mortality risk.

D & B score = 12

   • Walking = 0.97 (0.60-1.57)

   • Bike = 0.97 (0.59-1.57)

   • Gardening = 0.66 (0.39-1.10)

   • Other = 1.08 (0.66-1.78)

   • Heavy activity = 0.73 (0.45-1.17)

   • Non heavy activity = 0.89 (0.57-1.40)

Highest tertile

   • Total activity = 1.25 (0.73-2.12)

   • Walking = 0.94 (0.58-1.55)

   • Bike = 1.07 (0.61-1.88)

   • Gardening = 0.77 (0.42-1.39)

   • Other = 1.24 (0.74-2.07)

   • Heavy activity = 0.76 (0.44-1.32)

   • Non heavy activity = 0.94 (0.58-1.53)

PA in 1990:

Lowest tertile = 1.00 (referent)

Middle tertile

   • Total activity = 0.56 (0.35-0.89)

   • Walking = 0.82 (0.51-1.32)

   • Bike = 0.49 (0.29-0.82)

   • Gardening = 1.67 (1.00-2.79)

   • Other = 0.93 (0.53-1.65)

   • Heavy activity = 1.19 (0.73-1.92)

   • Non heavy activity = 0.61 (0.38-0.99)

Highest tertile

   • Total activity = 0.44 (0.25-0.80)

   • Walking = 1.17 (0.70-1.96)

   • Bike = 0.43 (0.23-0.80)

   • Gardening = 1.03 (0.55-1.94)

   • Other = 0.74 (0.44-1.23)

   • Heavy activity = 0.72 (0.40-1.31)

   • Non heavy activity = 0.65 (0.40-1.05)

Gregg et al 2003 [39]

To examine the relationship of changes in PA and mortality among older women.

• n = 9,518

Baseline (1986-1988) and median 10.6 year follow-up (1992-1994)

   • 2,218 deaths

Increasing and maintaining PA levels could lengthen life for older women but appears to provide less benefit for women aged at least 75 years and those with poor health status.

• Sex: Women

PA Assessment: Questionnaire, divided into quintiles of PA (kcal/wk)

• Age: ≥ 65 yr

Multivariate adjusted HRR

USA

• Characteristics: White community dwelling participants from 4 US research centres

(95% CI): Quintiles of total

Q1= <163

PA

Prospective cohort

Q2 = 163-503

   • Q1 = 1.00 (referent)

Q3 = 504-1045

   • Q2 = 0.73 (0.64-0.82)

Q4 = 1046-1906

   • Q3 = 0.77 (0.68-0.87)

D & B score = 13

Q5 = ≥ 1907

   • Q4 = 0.62 (0.54-0.71)

   • Q5 = 0.68 (0.59-0.78)

Walking HRR (95% CI)

   • Q1 = 1.00 (referent)

Quintiles of walking(kcal/wk)

   • Q2 = 0.91 (0.81-1.02)

Q1 = <70

   • Q3 = 0.78 (0.68-0.88)

Q2 = 70-186

   • Q4 = 0.71 (0.63-0.82)

Q3 = 187-419

   • Q5 = 0.71 (0.62-0.82)

Q4 = 420-897

Q5 = 898

Multivariate adjusted HRR (95% CI)

Change in activity level: Sedentary at baseline

   • Staying sedentary = 1.00 (referent)

   • Became active = 0.52 (0.40-0.69)

Mod / high active at baseline

   • Became sedentary = 0.92 (0.77-1.09)

   • Stayed active = 0.68 (0.56-0.82)

Wannamethee et al 1998 [40]

To study the relationship between heart rate, PA and all- cause mortality.

• n = 5,934

Baseline (1978-1980) and 12-14 year follow-up

   • 219 deaths

Maintaining or taking up light or moderate PA reduces mortality in older men.

• Sex: Men

• Age: Mean 63 yr

Multivariate adjusted RR (95% CI),

UK

• Characteristics: Healthy, sedentary(4,311 were considered "healthy" in 1992)

PA assessment: Questionnaire, split into groups

PA

Prospective cohort

• The British Regional Heart Study

   • G1 = 1.00 (referent)

   • G2 = 0.61 (0.43-0.86)

   • G3 = 0.50 (0.31-0.79)

D & B score = 12

PA score

   • G4 = 0.65 (0.45-0.94)

G1 =

Inactive/occasional

Regular walking

G2 = Light

   • G1 = 1.00 (referent)

G3 = Moderate

   • G2 = 1.15 (0.73-1.79)

G4 = Moderately

   • G3 = 1.06 (0.75-1.50)

vigorous/Vigorous

   • G4 = 0.97 (0.65-1.46)

Regular walking (min/d)

   • G5 = 0.62 (0.37-1.05)

G1 = 0

Recreational activity

G2 = <20

   • G1 = 1.00 (referent)

G3 = 21-40

   • G2 = 0.95 (0.43-1.07)

G4 = 41-60

   • G3 = 0.68 (0.43-1.07)

G5 = ≥ 60

   • G4 = 0.34 (0.35-1.00)

Recreational activity, 4 groups

Sporting activity

G1 = Inactive/fairly Inactive

   • G1 = 1.00 (referent)

G2 = Average 4 hr/weekend

   • G2 = 0.50 (0.25-1.03)

G3 = Fairly active >4 h/weekend

   • G3 = 0.88 (0.64-1.23)

G4 = Very active

Sporting activity, 3 Groups

G1 = None

G2 = Occasional

G3 = >1 time/month

Paffenbarger et al 1986 [63]

To examine the PA and life-style characteristics of Harvard alumni for the relationship with all-cause mortality.

• n = 16,936

12-16 year follow-up (1962 to 1978)

   • 1,413 deaths

The findings suggest a protective effect of exercise against all-cause mortality.

• Sex: Men

Age adjusted RR (95% CI):

• Age: 35-74

USA

• Characteristics: Harvard alumni

Records of freshman year physical examinations and records of intercollegiate sport

Those who walked

Prospective cohort

   • G1 = 1.00 (referent)

   • G2 = 0.85

   • G3 = 0.79

D & B score = 14

Trend p = 0.0009

PA assessment: Mailed questionnaires surveying post college

Physical Activity Index (95% CI):

PA

   • G1 = 1.00 (referent)

   • G2 = 0.78

   • G3 = 0.73

   • G4 = 0.63

Exercise reported: Walking (miles/wk) 3

   • G5 = 0.62

groups

   • G6 = 0.52

G1 = <3

   • G7 = 0.46

G2 = 3-8

   • G8 = 0.62

G3 = ≥ 9

Trend p = <0.0001

PA index (kcal/wk) 3 groups:

G1 = <500

G2 = 500-999

G3 = 1000-1499

G4 = 1500-1999

G5 = 2000-2499

G6 = 2500-2999

G7 = 3000-3499

G8 = >3500

Cox proportional hazard models

Schnohr et al 2007 [64]

To determine the impact of walking duration and intensity on all-cause mortality.

• n = 7,308 (3,204 male; 4,104 female)

Baseline and an average of 12 year

   • 1,391 deaths

The findings indicate that the relative intensity and not duration of walking is the most important in relation to all-cause mortality.

Denmark

• Sex: Male and female

follow-up

Multivariate adjusted HR (95% CI):

• Age: 20-93 yr

PA assessment: Questionnaire, 4 durations and 3 intensities

Prospective cohort

• Characteristics: Participants with no history of CHD, stroke or cancer and who had no difficulty in walking

Men

D & B score = 12

• The Copenhagen City Heart Study

   • G1 = 1.00 (referent)

   • G2 = 0.38 (0.25-0.58)

   • G3 = 0.38 (0.18-0.79)

Duration (hours/day)

   • G4 = 0.69 (0.44-1.07)

1 = <0.5

   • G5 = 0.37 (0.26-0.54)

2 = 0.5-1

   • G6 = 0.33 (0.18-0.61)

3 = 1-2

   • G7 = 0.78 (0.50-1.23)

4 = >2

   • G8 = 0.41 (0.29-0.59)

   • G9 = 0.33 (0.20-0.54)

Intensity

   • G10 = 0.43 (0.22-0.82)

Slow intensity (SI)

   • G11 = 0.42 (0.29-0.60)

Average intensity (AI)

   • G12 = 0.28 (0.16-0.48)

Fast intensity (FI)

Women

12 groups

   • G1 = 1.00 (referent)

G1 = 1 and SI

   • G2 = 0.82 (0.52-1.29)

G2 = 1 and AI

   • G3 = 0.78 (0.27-2.21)

G3 = 1 and FI

   • G4 = 1.22 (0.82-1.81)

G4 = 2 and SI

   • G5 = 0.74 (0.52-1.05)

G5 = 2 and AI

   • G6 = 0.56 (0.33-0.96)

G6 = 2 and FI

   • G7 = 0.94 (0.60-1.47)

G7 = 3 and SI

   • G8 = 0.87 (0.61-1.23)

G8 = 3 and AI

   • G9 = 0.48 (0.28-0.83)

G9 = 3 and FI

   • G10 = 0.88 (0.40-1.88)

G10 = 4 and SI

   • G11 = 0.64 (0.44-0.95)

G11 = 4 and AI

   • G12 = 0.38 (0.21-0.69)

G12 = 4 and FI

Kushi et al 1997 [65]

To evaluate the association between PA and all-cause mortality in postmenopausal women.

• n = 40,417

7 year follow-up

• 2,260 deaths

The results demonstrate a graded inverse association between PA and all-cause mortality in postmenopausal women.

• Sex: Women

• Age: 55-69 yr

PA assessment: Questionnaire for frequency of moderate and vigorous LTPA

Multivariate adjusted Frequency of moderate PA per week RR (95% CI):

USA

• Characteristics: Postmenopausal Iowa women

Prospective cohort

• G1 = 1.00 (referent)

• G2 = 0.71 (0.63-0.79)

D & B score = 13

Divided by frequency/week

• G3 = 0.63 (0.56-0.71)

• G4 = 0.59 (0.51-0.67)

G1 = Rarely/never

Trend p = <0.001

G2 = 1 time/week to a few times/month

Frequency of vigorous PA per week

G3 = 2-4 times/week

G4 = >4 times/week

• G1 = 1.00 (referent)

• G2 = 0.83 (0.69-0.99)

• G3 = 0.74 (0.59-0.93)

Activity index

• G4 = 0.62 (0.42-0.90)

G1 = Low

Trend p = 0.009

G2 = Medium

G3 = High

• G1 = 1.00 (referent)

• G2 = 0.77 (0.69-0.86)

• G3 = 0.68 (0.60-0.77)

Trend p = <0.001

Paffenbarger et al 1993 [67]

To analyze changes in the lifestyles of Harvard College alumni and the association of these changes with mortality.

• n = 10,269

Baseline (1977) and 8 year follow-up (1985)

• 476 deaths

Beginning moderately vigorous sports activity was associated with lower rates of death from all causes among middle aged and older men.

• Sex: Men

• Age: 45-84 yr (in 1977)

Beginning moderate sports activity was associated with 23% lower risk of death (95% CI 4%-42%, p = 0.015) than those not taking up moderate activity

USA

• Characteristics: Participants with no reported life- threatening disease

PA Assessment: Questionnaire -- blocks walked daily, stairs climbed daily and type, frequency and duration of weekly sports and recreational activities

Prospective cohort

D & B score = 13

Physical activity index (kcal/wk)

Sports and recreational activities

Light <4.5 METs

Moderate >4.5 METs

Weekly lists of deaths were obtained from the Harvard college alumni office

Proportional hazard models with Poisson regression methods

Katzmarzyk and Craig 2002 [154]

To quantify the relationship between musculoskeletal fitness and all-cause mortality.

• n = 8,116 (3,933 male; 4,183 female)

Baseline (1981) and

• 238 deaths

Some components of musculoskeletal fitness are predictive of mortality.

13 year follow-up

• Sex: Men and women

RR (95% CI) adjusted for age, smoking status, body mass and VO_2max

Canada

Musculoskeletal fitness (sit ups, push ups, grip strength, sit and reach) measures divided into quartiles

• Age: 20-69 yr

Q1 = lowest

Sit ups

Prospective cohort

• Characteristics: Participants who had musculoskeletal fitness measurements taken

Q2

Men

Q3

• Q1 = 2.72 (1.56-4.64)

Q4 = highest

• Q2 = 1.32 (0.73-2.41)

D & B score = 11

• Q3 = 1.61 (0.90-2.87)

• Q4 = 1.00 (referent)

• Canadian Fitness Survey

Cox proportional hazard ratio model

Women

• Q1 = 2.26 (1.15-4.43)

• Q2 = 2.24 (1.07-4.67)

• Q3 = 1.27 (0.59-2.72)

• Q4 = 1.00 (referent)

Push-ups

Men

• Q1 = 1.25 (0.77-2.05)

• Q2 = 1.17 (0.71-1.90)

• Q3 = 0.94 (0.55-1.62)

• Q4 = 1.00 (referent)

Women

• Q1 = 0.61 (0.32-1.17)

• Q2 = 0.81 (0.45-1.47)

• Q3 = 0.87 (0.48-1.58)

• Q4 = 1.00 (referent)

Grip strength (kg)

Men

• Q1 = 1.49 (0.86-2.59)

• Q2 = 1.42 (0.82-2.45)

• Q3 = 1.59 (0.95-2.68)

• Q4 = 1.00 (referent)

Women

• Q1 = 1.08 (0.58-1.99)

• Q2 = 0.62 (0.44-1.56)

• Q3 = 1.25 (0.70-2.23)

• Q4 = 1.00 (referent)

Sit and reach (cm)

Men

• Q1 = 1.06 (0.64-1.74)

• Q2 = 1.01 (0.61-1.66)

• Q3 = 1.20 (0.74-1.95)

• Q4 = 1.00 (referent)

Women

• Q1 = 1.18 (0.66-2.10)

• Q2 = 1.07 (0.60-1.91)

• Q3 = 0.77 (0.44-1.46)

• Q4 = 1.00 (referent)

Andersen et al 2000 [163]

To evaluate the relationship between levels of OPA, LTPA, cycling to work and sports participation and all-cause mortality.

• n = 30,640 (17,265 men; 13,375 women)

14.5 year follow-up

• 8,549 deaths

LTPA was inversely associated with all-cause mortality in both men and women in all age groups.

PA assessment: Questionnaire for LTPA, divided into:

Incidence of all-cause mortality and PA

Denmark

• Sex: Men and women

Prospective cohort

• Age: 20-93 years (yr)

Multivariate adjusted RR (95% CI)

G1 = Low

• Characteristics: Participants of the Copenhagen City Heart Study, Glostrup Population Study and Copenhagen Male Study

G2 = Moderate

D & B score = 13

G3 = High

Age 20-44 yr

Men

• G1 = 1.00 (referent)

• G2 = 0.73 (0.56-0.96)

• G3 = 0.74 (0.55-1.01)

Women

• G1 = 1.00 (referent)

• G2 = 0.75 (0.54-1.04)

• G3 = 0.66 (0.42-1.05)

Age 45-64 yr

Men

• G1 = 1.00 (referent)

• G2 = 0.75 (0.67-0.84)

• G3 = 0.75 (0.67-0.85)

Women

• G1 = 1.00 (referent)

• G2 = 0.73 (0.65-0.83)

• G3 = 0.66 (0.56-0.77)

Age >65 yr

Men

• G1 = 1.00 (referent)

• G2 = 0.62 (0.53-0.73)

• G3 = 0.60 (0.50-0.72)

Women

• G1 = 1.00 (referent)

• G2 = 0.52 (0.45-0.61)

• G3 = 0.49 (0.39-0.61)

All age groups

Men

• G1 = 1.00 (referent)

• G2 = 0.72 (0.66-0.78)

• G3 = 0.71 (0.65-0.78)

Women

• G1 = 1.00 (referent)

• G2 = 0.65 (0.60-0.71)

• G3 = 0.59 (0.52-0.67)

Barengo et al 2004 [164]

To investigate whether moderate or high LTPA are associated with reduced CVD and all-cause mortality, independent of CVD risk factors and other forms of PA in men and women.

• n = 31,677 (15,853 men; 16,824 women)

20 year follow-up

HRR (95% CI)

Moderate and high levels of LTPA and OPA are associated with reduced premature all-cause mortality.

• Sex: Men and women

PA assessment: Questionnaire self administered to measure OPA, LTPA and commuting activity

LTPA

Finland

• Age: 30-59 yr

   • 1.00 (referent) = low

• Characteristics: Participants from eastern and south-western Finland

   • 0.91 (0.84-0.98) = mod, Men

Prospective cohort

   • 0.79 (0.70-0.90) = high, Men

D & B score = 14

   • 0.89 (0.81-0.98) = mod, women

   • 0.98 (0.83-1.16) = high, women

OPA

   • 1.00 (referent) = low

   • 0.75 (0.68-0.83) = mod, men

   • 0.77 (0.71-0.84) = active, men

   • 0.79 (0.70-0.89) = mod, women

   • 0.78 (0.70-0.87) = active, women

Bath 2003 [165]

To examine differences between older men and women on the self-rated health mortality relationship.

• n = 1,042 (406 men; 636 women at baseline)

Baseline, 4 and 12 years post

Number of deaths: At 4 years 242 (106 men; 136 women)

The self-rated health-mortality relationship can be explained by health and related factors among older men and women.

UK

• Sex: Men and women

• At 12 years 665 (287 men; 378 women)

Prospective cohort

• Age: >65 yr

• Characteristics: Community-dwelling Elderly

General physical health

14-item health index (Ebrahin et al 1987) scoring from 0-14 (no health problems -- multiple health problems)

Multivariate adjusted HR (95% CI)

D & B score = 11

• The Nottingham Longitudinal Study of Activity and Ageing

Men after 4 years

• High = 1.00 (referent)

• Med = 1.19 (0.61-2.33)

PA assessment: Self-rated health surveys, divided into 3 levels of PA:

• Low = 1.51 (0.75-3.03)

High

Women after 4 years

Medium

• High = 1.00 (referent)

Low

• Med = 1.03 (0.58-1.82)

• Low = 1.51 (0.86-2.67)

Men after 12 years

Cox proportional hazards regression Models

• High = 1.00 (referent)

• Med = 1.28 (0.94-1.74)

• Low = 1.13 (0.82-1.55)

Women after 12 years

• High = 1.00 (referent)

• Med = 1.20 (0.90-1.61)

• Low = 1.23 (0.93-1.62)

Bijnen et al 1998 [166]

To describe the association between PA and mortality (CVD, stroke, all-cause) in elderly men.

• n = 802

10 year follow-up

• 373 deaths

PA may protect against all- cause mortality in elderly men

• Sex: Men

• Age: 64-84 yr

PA assessment: Questionnaire, divided into groups:

Multivariate adjusted RR (95% CI)

Netherlands

• Characteristics: Retired Dutch men

• G1 = 1.00 (referent)

Prospective cohort

G1 = Lowest

• G2 = 0.80 (0.63-1.02)

G2 = Middle

• G3 = 0.77 (0.59-1.00)

G3 = Highest

p = 0.04

D & B score = 12

Blair et al 1993 [167]

To evaluate the relationship of sedentary living habits to all-cause mortality in women.

• n = 3,120

Baseline and 8 year follow-up

• 43 deaths

There is a graded inverse relationship between PF and all-cause mortality in women.

• Sex: Women

• Age: Not available

Age adjusted death rates (per 10,000 person years) by fitness

USA

• Characteristics: Participants were given a preventative medicine examination

PF assessment: PF measured via maximal treadmill exercise test;

Prospective

   • Low Fitness = 40

The lack of relationship between PA and death rate was believed to be due to an inadequate assessment of PA.

   • Mod Fitness = 16

D & B score = 14

   • High Fitness = 7

PA assessment: Questionnaire

No difference between levels of PA

Blair et al 1996 [168]

To review the association of PF to all-cause and CVD mortality.

• n = 32,421 (25,341 men; 7,080 women)

Baseline and average 8 year follow-up (range 0.1-19.1 years)

• 601 deaths in men

The study observed a steep inverse gradient of death rates across low, moderate and high PF levels. The association was strong and remained after adjustment for potential confounding factors.

• 89 deaths in women

• Sex: Men and women

USA

• Age: 20-80 yr (mean 43 yr)

RR (95% CI) in low PF vs.

PF assessment: Treadmill test; duration was used to assign participants to sex specific groups:

high PF

Prospective cohort

• Characteristics: Participants were excluded if they did not reach 85% of their age predicted maximal heart rate on the maximal exercise treadmill test

Men

• 1.52 (1.28-1.82)

Women

D & B score = 14

• 2.10 (1.36-3.26)

Low (least fit 20%)

Adjusted deaths per 10,000 person years according to PF

Moderate (next 40%)

High (most fit 40%)

Men

• Aerobics Center Longitudinal Study

Proportional hazard modeling

• Low = 49

• Med = 27

• High = 23

Women

• Low = 29

• Med = 13

• High = 14

Boyle et al 2007 [169]

To examine the association between PA and the risk of incident disability, including impairment in activities of daily living and instrumental activities of daily living in community based older persons free from dementia.

• n = 1,020

2.6 year follow-up

• 156 deaths

The risk of death decreased 11% with each hour of PA/wk.

• Sex: Men and women

• Age: 54-100 yr

PA assessment: Questionnaire, hr/wk of PA Incidence of all-cause mortality

HR for all-cause mortality

USA

• Characteristics: Participants from 40 retirement communities across Chicago

The risk of death was 11% lower for each hr/wk of PA

Prospective cohort

D & B score = 13

• Rush Memory and Aging Project

Bucksch et al 2005 [170]

To examine the effect of moderately intense PA on all-cause mortality.

• n = 7,187 (3,742 men; 3,445 women)

Baseline (1984-1986) and 12-14 yr follow-up (1998)

• 943 deaths

Participants who achieved recommended amounts of MPA or VPA were at a significantly lower risk of death than their sedentary counterparts.

• Sex: Men and women

RR (95% CI) for achieving recommended PA vs. not achieving recommendation

Germany

• Age: 30-69 yr

Prospective cohort

• Characteristics: Participants were healthy and physically active during leisure time

PA assessment: Questionnaire (Minnesota Leisure Time Physical Activity questionnaire) divided into groups based on: Achieving recommended amount of MPA (30 min, 5 d/wk (≥2.5 h/wk))

Women

• MPA = 0.65 (0.51-0.82)

D & B score = 13

• VPA = 0.78 (0.57-1.08)

• MPA or VPA = 0.60 (0.47-0.75)

Men

• MPA = 0.90 (0.77-1.01)

• VPA = 0.74 (0.61-0.90)

• MPA or VPA = 0.80 (0.68-0.94)

Achieving recommended amount of VPA (20 min, 3 d/wk (≥ 1 h/wk))

RR (95% CI) for volume of lifestyle activities (kcal/kg/wk)

Volume of lifestyle activities (kcal/kg/wk)

Women

G1 = 0

• G1 = 1.00 (referent)

G2 = <14

• G2 = 0.79 (0.57-1.08)

G3 = 14-33.5

• G3 = 0.68 (0.50-0.94)

G4 = ≥ 33.5

• G4 = 0.57 (0.41-0.79)

p < 0.001

Men

• G1 = 1.00 (referent)

• G2 = 0.98 (0.76-1.17)

• G3 = 0.80 (0.63-1.00)

• G4 = 0.91 (0.74-1.13)

p = 0.20

Adjusted for age, other recommendation, social class, smoking, BMI, cardio risk factor index, alcohol intake, chronic disease index and dietary factors

Bucksch and Helmert 2004 [171]

To examine LTPA and premature death in the general population of former West Germany.

• n = 7,187 (3,742 men; 3,445 women)

Baseline (1984-1986) and 12-14 year follow-up (1998)

• 943 deaths

LTPA is inversely associated with all-cause mortality in men and women.

• Sex: Men and women

RR (95% CI)

• Age: 30-69 yr

Men, LTPA

Germany

• Characteristics: Participants were selected on the basis of the German Cardiovascular Prevention Study

PA assessment: Questionnaire (Minnesota Leisure Time Physical Activity questionnaire) divided into groups based on: LTSA (h/wk)

• G1 = 1.00 (referent)

• G2 = 0.85 (0.78-0.93)

Prospective cohort

• G3 = 0.64 (0.50-0.82)

• G4 = 0.70 (0.54-0.91)

p < 0.001

D & B score = 14

• The National Health Survey of the German Federal Institute of Population Research (1984-1998)

Men, LTPA index

G1 = 0

• G1 = 1.00 (referent)

G2 = <1

• G2 = 0.92 (0.70-1.23)

G3 = 1-2

• G3 = 0.89 (0.69-1.17)

G4 = >2

• G4 = 0.61 (0.44-0.84)

p <0.01

The LTSA-index (kcal/kg/wk)

G1 = 0

Women, LTPA

G2 = 1-10

• G1 = 1.00 (referent)

G3 = 10-25

• G2 = 0.93 (0.82-1.04)

G4 = >25

• G3 = 0.69 (0.48-0.98)

• G4 = 0.57 (0.35-0.94)

Mortality -- Records from the mandatory population registries

p < 0.01

Women, LTPA index

• G1 = 1.00 (referent)

Cox proportional hazard regression model

• G2 = 0.68 (0.45-1.01)

• G3 = 0.79 (0.51-1.21)

• G4 = 0.46 (0.25-0.85)

p < 0.01

Adjusted for age, social class, smoking, BMI, cardio risk factor index, alcohol intake, chronic disease index and dietary factors

Carlsson et al 2006 [172]

To investigate the association between PA and mortality in post-menopausal women.

• n = 27,734

Baseline (1997) and 2-7 year follow-up (1999-2004)

• 1,232 deaths

The study indicates that even fairly small amounts of activity will reduce mortality in older women.

• Sex: Women

• Age: 51-83 yr

RR (95% CI) adjusted for lifestyle and medical problems

Sweden

• Characteristics: Women who participated in a population based Screening programme in 1987

Prospective cohort

PA assessment: Questionnaires for: METs/day, different PA (walking/biking), LTPA, OPA, household PA, TV watching and reading

PA (METs/day)

• >50 = 1.00 (referent)

D & B score = 12

• 45-50 = 1.05 (0.77-1.42)

• The Swedish Mammography Cohort

• 40-45 s = 1.09 (0.81-1.46)

• 45-40 = 1.26 (0.94-1.70)

• <35 = 2.56 (1.85-3.53)

Mortality -- Records from the National Population Register

Different PA

Walking/biking (min/d)

• > 90 = 1.00 (referent)

• 60-90 = 1.01 (0.76-1.34)

• 40-60 = 0.92 (0.70-1.20)

• 20-40 = 0.96 (0.75-1.23)

• <20 = 1.16 (0.90-1.50)

• Almost never = 1.94 (1.51-2.50)

LTPA (hr/wk)

• >5 = 1.00 (referent)

• 4-5 = 0.95 (0.74-1.22)

• 2-3 = 1.02 (0.83-1.26)

• 1 = 1.09 (0.88-1.36)

• <1 = 1.91 (1.56-2.35)

OPA

• Heavy manual labour = 1.00 (referent)

• Walking/lifting/ a lot carrying = 0.96 (0.55-1.70)

• Walking/lifting/ not a lot carrying = 1.00 (0.60-1.68)

• Mostly standing = 0.91 (0.52-1.61)

• Seated 50% of time = 0.97 (0.58-1.62)

• Mostly sedentary = 1.93 (1.15-3.25)

Household work (hr/d)

• >8 h/d = 1.00 (referent)

• 7-8 = 0.68 (0.49-0.93)

• 5-6 = 0.66 (0.51-0.87)

• 3-4 = 0.83 (0.64-1.06)

• 1-2 = 0.89 (0.69-1.15)

• <1 = 1.73 (1.30-2.32)

Adjusted for age

Crespo et al 2002 [173]

To study the relationship between PA and obesity with all- cause mortality in Puerto Rican men.

• n = 9,136 (1962-1965)

Baseline and 12 year follow-up

• 1,445 deaths

Some PA is better than none in protecting against all-cause mortality. The benefits are independent of body weight.

Puerto Rico

• Sex: Men

PA assessment: Questionnaire, divided into 4 groups based on METs

Multivariate OR (95% CI) adjusted for age

G1 = low

G2

G3

G4 = high

Prospective cohort

• Age: 35-79 yr

Multivariate logistic function model

• C1 = 1.00 (referent)

D & B score = 12

• Characteristics: Participants with no known coronary heart disease

• C2 = 0.67 (0.57-0.78)

• The Puerto Rico Heart Health Program

• C3 = 0.63 (0.54-0.74)

• C4 = 0.54 (0.46-0.64)

p < 0.0001

Multivariate adjusted OR (95% CI)

• C1 = 1.00 (referent)

• C2 = 0.68 (0.58-0.79)

• C3 = 0.63 (0.54-0.75)

• C4 = 0.55 (0.46-0.65)

p < 0.0001

Davey Smith et al

2000 [174]

To examine the relationship of PA and various causes of death.

• n = 6,702 (at baseline)

Baseline (1969-1970) and 25 year follow-up

• 926 deaths

In the study, an inverse association of both LTPA and walking pace with mortality from all-causes was seen.

UK

• Sex: Men

PA assessment: Questionnaire with 3 groups for walking pace (Slower, same, faster) and 3 groups for LTPA (inactive, moderately active, active)

Age adjusted RR (95% CI) for walking pace

Prospective cohort

• Age: 40-64 yr

• Slower = 2.47 (2.2-2.8)

D & B score = 13

• Characteristics: Participants from rural northern Japan

• Same = 1.35 (1.2-1.5)

• Whitehall study

• Faster = 1.00 (referent)

p < 0.001

Fully adjusted RR (95% CI) for walking pace

• Slower = 1.87 (1.6-2.1)

• Same = 1.21 (1.1-1.3)

• Faster = 1.00 (referent)

p < 0.001

Age adjusted RR (95% CI) for LTPA

• Inactive = 1.44 (1.3-1.6)

• Mod = 1.13 (1.0-1.2)

• Active = 1.00 (referent)

p < 0.001

Fully adjusted RR (95% CI) for LTPA

• Inactive = 1.20 (1.1-1.3)

• Mod = 1.07 (1.0-1.2)

• Active = 1.00 (referent)

p < 0.001

Eaton et al 1995 [175]

To determine whether self-reported PA predicts a decreased rate of CHD and all- cause mortality in middle aged men.

• n = 8,463

21 year follow-up

• 2,593 deaths

Baseline levels of self- reported LTPA predicted a decreased rate of CHD and all-cause mortality.

Europe, Israel, mid eastern Asia, Northern Africa

• Sex: Men

PA assessment: Questionnaire for LTPA

Age adjusted RR (95% CI) LTPA

Prospective cohort

• Age: ≥40 yr

G1 = Sedentary

• G1 = 1.00 (referent)

D & B score = 12

• Characteristics: Government employees without known CVD

G2 = Light

• G2 = 0.84 (0.74-0.94)

G3 = Light daily

• G3 = 0.81 (0.73-0.90)

G4 = Heavy

• G4 = 0.84 (0.72-0.98)

OPA

Questionnaire for OPA

• G1 = 1.00 (referent)

G1 = Sitting

• G2 = 0.99 (0.88-1.12)

G2 = Standing

• G3 = 1.09 (0.99-1.20)

G3 = Walking

• G4 = 1.16 (1.03-1.30)

G4 = Physical labour

Fang et al 2005 [176]

To assess the association of exercise and CVD outcome among persons with different blood pressure status.

• n = 9,791 (3,819 men; 5,972 women)

17 year follow-up

Incidence of all-cause mortality and PA

A significant effect of exercise on mortality in normotensive subjects was not found.

USA

• Sex: Men and women

PA assessment: Questionnaire with 3 groups

Multivariate adjusted HR (95% CI)

Prospective cohort

• Age:25-74 yr

G1 = Least exercise

• G1 = 1.00 (referent)

D & B score = 12

• Characteristics: Non- institutionalized participants

G2 = Moderate exercise

• G2 = 0.75 (0.53-1.05)

G3 = Most exercise

• G3 = 0.71 (0.45-1.12)

Fried et al 1998 [177]

To determine the disease, functional and personal characteristics that jointly predict mortality.

• n = 5,886

5 year follow-up

• 646 deaths

PA was a predictor of 5-year mortality.

USA

• Sex: Men and women

PA assessment: Self reported exercise (5 groups)

Incidence of all-cause mortality and PA

Prospective cohort

• Age: ≥65 yr

MPA or VPA (kJ/wk)

Multivariate adjusted RR (95% CI)

D & B score = 11

• Characteristics: Community dwelling elders

G1 = ≤282

• G1 = 1.00 (referent)

G2 = 283-1789

• G2 = 0.78 (0.60-1.00)

G3 = 1790-4100

• G3 = 0.81 (0.63-1.05)

G4 = 4101-7908

• G4 = 0.72 (0.55-0.93)

G5 = >7908

• G5 = 0.56 (0.43-0.74)

p < 0.005

Fujita et al 2004 [178]

To examine the relationship between walking duration and all-cause mortality in a Japanese cohort.

• n = 41,163 (20,004 men; 21,159 women)

Baseline (1990) and 11 year follow-up (2001)

• 1,879 deaths

Time spent walking was associated with a reduced risk for all-cause mortality.

Japan

• Sex: Men and women

PA assessment: Questionnaire Walking, 3 levels:

Age and sex adjusted RR (95% CI) for time spent walking (hr/d)

G1 = ≤30 min

G2 = 30 min to 1 hr

G3 = ≥1 hr

Prospective cohort

• Age: 40-64 yr

Cox proportional hazard model

Whole group

D & B score = 13

• Characteristics: Healthy, sedentary

• G1 = 1.22 (1.09-1.35)

• G2 = 1.09 (0.95-1.22)

• G3 = 1.00 (referent)

p < 0.001

Men only

• G1 = 1.14 (1.00-1.30)

• G2 = 1.03 (0.90-1.19)

• G3 = 1.00 (referent p = 0.061

Women only

• G1 = 1.40 (1.16-1.68)

• G2 = 1.23 (1.01-1.49)

• G3 = 1.00 (referent)

p < 0.001

RR (95% CI) for time spent walking (hr/d) (adjusted for age, education, marital status, past history of diseases, smoking, drinking, BMI and dietary variables)

Whole group

• G1 = 1.17 (1.04-1.31)

• G2 = 1.06 (0.93-1.20)

• G3 = 1.00 (referent)

p = 0.011

Men

• G1 = 1.08 (0.94-1.25)

• G2 = 0.98 (0.84-1.14)

• G3 = 1.00 (referent)

p = 0.318

Women

• G1 = 1.38 (1.12-1.70)

• G2 = 1.24 (1.00-1.54)

• G3 = 1.00 (referent)

p < 0.001

Glass et al 1999 [179]

To examine any association between social activity, productive activity and PA and mortality in older people.

• n = 2,761 (1,169 men; 1,143 women)

13 year follow-up

Incidence of all-cause mortality by fitness activity quartile

More active elderly people were less likely to die than those who were less active.

USA

• Sex: Men and women

PA assessment: Interview, Amount of activity

13 yr mortality by amount of activity

Prospective cohort

• Age: ≥ 65 yr

G1 = Low

• G1 = 74.0

D & B score = 12

• Characteristics: Healthy elders

G2 = Low-medium

• G2 = 69.8

G3 = Medium-high

• G3 = 62.4

G4 = High

• G4 = 55.2

Gulati et al 2003 [180]

To determine whether exercise capacity is a predictor for all-cause mortality in asymptomatic women.

• n = 5,721

Baseline (1992) and 8 year follow-up (2000)

• 180 deaths

This study confirmed that exercise capacity is an independent predictor of death in asymptomatic women, greater than what has been previously established among men.

USA

• Sex: Women

PF Assessment: Treadmill stress test Exercise capacity (METs)

G1 = <5

G2 = 5-8

G3 = >8

For every 1 MET increase there was a reduced death risk of 17% (p < 0.001)

Prospective cohort

• Age: Mean 52 ± 11 yr

Age-adjusted RR

D & B score = 11

• Characteristics: Asymptomatic women

• G1 = 2.0 (1.3-3.2)

• St James Women Take Heart Project

• G2 = 1.6 (1.1-2.4)

• G3 = 1.00 (referent)

Adjusted for Framingham

Risk Score

• G1 = 3.1 (2.1-4.8)

• G2 = 1.9 (1.3-2.9)

• G3 = 1.00 (referent)

Haapanen et al 1996 [181]

To examine the association between LTPA and all-cause mortality.

• n = 1,072

Baseline and a 10 yr

10 month follow-up

• 168 deaths

Low PA is a risk factor for all-cause mortality.

Finland

• Sex: Men

PA assessment: Self-reported LTPA, divided into 4 groups by EE (kJ/wk)

G1 = 0-3349

G2 = 3350-6279

G3 = 6280-8791

G4 = >8791

RR (95% CI) according to EE group

Prospective cohort

• Age: 35-63 yr

Mortality--National

Death Index search

• G1 = 2.74 (1.46-5.14)

D & B score = 14

• Characteristics: Healthy, sedentary

Cox proportional HR

• G2 = 1.10 (0.55-2.21)

• G3 = 1.74 (0.87-3.50)

• G4 = 1.00 (referent)

Hakim et al 1998 [182]

To examine the association between walking and mortality in retired men.

• n = 707

Baseline and 12 yr follow-up

• 208 deaths

The findings in older physically capable men indicate that regular walking is associated with a lower overall mortality rate.

USA

• Sex: Men

RR (95% CI) according to distance walked

Prospective cohort

• Age: 61-81 yr

Adjusted for age

D & B score = 12

• Characteristics: Retired non-smoking men who were physically capable of participating in low intensity activities on a daily basis

PA assessment: Questionnaire Distance walked (miles/day)

• G1 vs. G3 = 1.9 (1.3-2.9)

G1 = 0.0-0.9

• G1 vs. G3 = 1.6 (1.2-2.2)

G2 = 1.0-2.0

• G2 vs. G3 = 1.2 (0.8-1.7)

G3 = 2.1-8.0

Trend p = 0.002

• Honolulu Heart Program

Adjusted for risk factors

• G1 vs. G3 = 1.8 (1.2-2.7)

• G1 vs. G2 = 1.5 (1.1-2.1)

• G2 vs. G3 = 1.1 (0.8-1.7)

Trend p = 0.01

Hillsdon et al 2004 [183]

To examine whether VPA is associated with all-cause mortality.

• n = 10,522 (4,929 men; 5,593 women)

>10 year follow-up

• 825 deaths

Questionnaire respondents who reported engaging in VPA less than twice a week experienced a 37% reduced risk of all-cause mortality compared with respondents who reported a lower frequency of VPA.

• Sex: Men and women

PA assessment: Questionnaire for frequency of VPA

Age and sex adjusted RR (95% CI)

UK

• Age: 35-64 yr

G1 = Never, <1 time/month

• Characteristics: Healthy, sedentary

G2 = <2 times/wk

• G1 = 1.00 (referent)

Prospective Cohort

• OXCHECK study

G3 = >2 times/wk

• G2 = 0.57 (0.42-0.79)

• G3 = 0.72 (0.54-0.95)

D & B score = 11

Fully adjusted RR (95% CI)

• G1 = 1.00 (referent)

Mortality -- Recorded from the Office of National Statistics

• G2 = 0.63 (0.45-0.89)

• G3 = 0.81 (0.60-1.09)

Cox proportional HR

Hu et al 2005 [184]

To examine the association of PA and BMI and their combined effect with the risk of total, CVD and cancer mortality.

• n = 47,212 (22,528 men; 24,684 women)

17.7 year follow-up

• 7,394 deaths

Regular PA is an important indicator for decreased risk of all-cause mortality. PA has a strong independent effect on mortality.

• Sex: Men and women

Finland

• Age:25-64 yr

PA assessment: Questionnaire for PA level, divided into 3 groups

Adjusted HR (95% CI)

• Characteristics: Participants from eastern Finland

Men

Prospective cohort

• G1 = 1.00 (referent)

• G2 = 0.74 (0.68-0.81)

G1 = Low

• G3 = 0.63 (0.58-0.70)

D & B score = 12

G2 = Moderate

Trend p = <0.001

G3 = High

Women

• G1 = 1.00 (referent)

• G2 = 0.64 (0.58-0.70)

• G3 = 0.58 (0.52-0.64)

Trend p = <0.001

Hu et al 2004 [185]

To examine the association of BMI and PA with death.

• n = 116,564

Baseline (1976) and

• 10,282 deaths

Reduced PA is a strong and independent predictor of death.

• Sex: Women

24 year follow-up

• Age: 30-55 yr

Multivariate RR (95% CI) by PA (hr/wk)

USA

• Characteristics: Females free of known CVD and cancer

PA assessment: Questionnaire for PA level, divided into 3 groups (hr/week)

• G1 = 1.00 (referent)

G1 = ≥ 3.5

• G2 = 1.18 (1.10-1.26)

Prospective cohort

G2 = 1.0-3.4

• G3 = 1.52 (1.41-1.63)

D & B score = 11

G3 = <1.0

Multivariate RR (95% CI) by PA adjusted for BMI

• G1 = 1.00 (referent)

BMI (kg/m²)

• G2 = 1.14 (1.06-1.22)

G1 = <25

• G3 = 1.44 (1.34-1.55)

G2 = 25-29

G3 = 30

Cox proportional HR

Kampert et al 1996 [186]

To examine PF and PA in relation to all-cause and cancer mortality.

• n = 32,421 (25,341 men; 7,080 women)

Baseline (1970) and ~8 year follow-up (1989)

• 690 deaths

The data support the hypothesis that an active and fit way of life delays death.

• Sex: Men and women

Adjusted RR (95% CI) by quintiles of activity

USA

• Age: 20-88 yr (mean ~43)

Prospective cohort

• Characteristics: Predominantly white and from the middle and upper socioeconomic strata

PA assessment: Questionnaire, divided into quintiles of activity (min/wk)

Men

• Sedentary = 1.00 (referent)

• C1-2 = 0.71 (0.58-0.97)

D & B score = 13

• C3 = 0.83 (0.59-1.16)

Male activity categories

• C4 = 0.57 (0.30-1.08)

• C5 = 0.92 (0.29-2.88)

Sedentary = 855

Trend p = 0.011

C1-2 = 1,072

C3 = 1,292

Women

C4 = 1,453

• Sedentary = 1.00 (referent)

C5 = 1,601

• C1-2 = 0.68 (0.39-1.17)

• C3 = 0.39 (0.09-1.65)

Females activity categories

• C4-5 = 1.14 (0.27-4.80)

Sedentary = 605

Trend p = 0.217

C1-2 = 792

C3 = 979

C4-5 = 1,158

Cox proportional HR

Kaplan et al 1996 [187]

To assess LTPA and its association with all cause mortality.

• n = 6,131 (3298 men; 2833 women)

28 year follow-up

• 1,226 deaths

The data provide further support for the importance of PA and indicate that the protective effect of PA is a robust one.

• Sex: Men and women

PA assessment: Three questions about PA, with scores 0 (never), 2 (sometimes) or 4 (often).

Incidence of all-cause mortality and PA

USA

• Age: 16-94 yr

• Characteristics: Northern Californian adults

Prospective cohort

Death rates/1000 person years

Men

D & B score = 13

• T1 = 24.68

Tertiles of PA score

• T2 = 11.37

T1 = 0-2

• T3 = 7.59

T2 = 4-6

Women

T3 = 8-12

• T1 = 18.03

• T2 = 7.66

• T3 = 3.88

Khaw et al 2006 [188]

To examine the relationship between PA patterns over 1 year and total mortality.

• n = 22,191 (9,984 men; 12,207 women)

8 year follow-up

• 1,553 deaths

Even very moderate levels of usual PA are associated with reductions in mortality.

• Sex: Men and women

PA assessment: Questionnaire, divided into 4 groups of PA

Incidence of all-cause mortality and PA

UK

• Age: 45-79 yr

Adjusted RR (95% CI)

• Characteristics: Community living participants

All

Prospective cohort

G1 = Inactive

• G1 = 1.00 (referent)

G2 = Moderately inactive

• G2 = 0.83 (0.73-0.95)

D & B score = 13

• G3 = 0.68 (0.58-0.80)

G3 = Moderately active

• G4 = 0.68 (0.57-0.81)

G4 = Active

Age <65

• G1 = 1.00 (referent)

• G2 = 1.01 (0.78-1.31)

• G3 = 0.81 (0.62-1.07)

• G4 = 0.82 (0.62-1.09)

Age >65

• G1 = 1.00 (referent)

• G2 = 0.77 (0.66-0.91)

• G3 = 0.65 (0.53-0.79)

• G4 = 0.64 (0.50-0.80)

Kohl et al 1996 [189]

To determine the association of maximal exercise hemodynamic responses with risk of all-cause mortality.

• n = 26,621 (20,387 men; 6,234 women)

Average 8.1 year follow-up

• 348 deaths in men and 66 in women

The results suggest an exaggerated SBP or an attenuated heart rate response to maximal exercise may indicate an elevated risk for mortality.

• Sex: Men and women

USA

• Age: Male mean 42.2 yr; female mean 41.9 Yr

Adjusted RH (95% CI) by maximal exercise test HR

Prospective cohort

Men

• Characteristics: Apparently healthy patients of a preventive medicine centre

PF assessment: Maximal exercise test HR (bpm), divided into 4 Groups:

• Q1 = 1.00 (referent)

G1 = <171

• Q2 = 0.61 (0.44-0.85)

D & B score = 12

G2 = 171-178

• Q3 = 0.69 (0.51-0.93)

G3 = 179-188

• Q4 = 0.60 (0.41-0.87)

G4 = >188

Trend p<0.05

Women

• Q1 = 1.00 (referent)

• Q2 = 1.23 (0.65-2.32)

• Q3 = 0.69 (0.30-1.63)

• Q4 = 0.71 (0.22-2.24)

Trend p>0.05

Kujala et al 1998 [190]

To investigate LTPA and mortality in a cohort of twins.

• n = 15,902 (7,925 men; 7,977 women)

Baseline 1975 and death outcome from 1977-1994

• 1,253 deaths

LTPA is associated with reduced mortality, even after genetic and other familial factors are taken into account.

• Sex: Men and women

HR (95% CI)

Finland

• Age: 25-64 yr

• Characteristics: Healthy, Finnish same sex twins

PA assessment: Questionnaire, quintiles of fitness in MET hours/day

Adjusted for age and sex

Prospective cohort

• Sedentary = 1.00 (referent)

• OE = 0.71 (0.62-0.81)

• The Finnish Twin Cohort

• CE = 0.57 (0.45-0.74)

D & B score = 13

Q1 = <58

Trend p = 0.001

Q2 = 59-1.29

Q3 = 1.30-2.49

Adjusted for age, sex, smoking

Q4 = 2.50-4.49

Q5 = >4.50

• Sedentary = 1.00 (referent)

• OE = 0.76 (0.67-0.87)

Categorized into:

• CE = 0.68 (0.53-0.88)

-Sedentary

-Occasional exerciser (OE)

Trend p = 0.001

-Conditioning exerciser (CE)

Adjusted for age, sex, smoking, occupational group, alcohol

• Sedentary = 1.00 (referent)

• OE = 0.80 (0.69-0.91)

• CE = 0.76 (0.59-0.98)

Trend p = 0.002

HR (95% CI) among 434 same sex twin pairs compared with sedentary category in 1975

• Sedentary = 1.00 (referent)

• OE = 0.66 (0.46-0.94)

• CE = 0.44 (0.23-0.83)

Trend p = 0.005

Adjusted for smoking

• Sedentary = 1.00 (referent)

• OE = 0.70 (0.48-1.01)

• CE = 0.56 (0.29-1.09)

Trend p = 0.04

Adjusted for smoking, occupational group, alcohol

• Sedentary = 1.00 (referent)

• OE = 0.73 (0.50-1.07)

• CE = 0.56 (0.29-1.11)

Trend p = 0.06

OR (95% CI) in quintiles among 434 same sex twin pairs compared with sedentary category in 1975

• Q1 = 1.00 (referent)

• Q2 = 0.85

• Q3 = 0.72

• Q4 = 0.68

• Q5 = 0.60

LaCroix et al 1996 [191]

To determine whether walking is associated with a reduced risk of CVD hospitalization and death in older adults.

• n = 1,645 (615 men; 1030 women)

4.2 year follow-up

RR (95% CI) by category of walking

Walking more than 4 hr/wk was associated with a reduced risk of mortality from all-causes.

• Sex: Men and women

PA assessment: Questionnaire for walking h/wk, divided into 3 groups

USA

• Age: ≥65 yr

G1 = <1 hr/week

Men

Characteristics: Participants from a group health co-operative

G2 = 1-4 hr/week

• G1 = 1.00 (referent)

Prospective cohort

G3 = >4 hr/week

• G2 = 0.78 (0.43-1.45)

• G3 = 0.89 (0.49-1.62)

D & B score = 12

Women

• G1 = 1.00 (referent)

• G2 = 0.50 (0.28-0.90)

• G3 = 0.48 (0.25-0.83)

Age 65-74 yr

• G1 = 1.00 (referent)

• G2 = 0.81 (0.40-1.61)

• G3 = 1.13 (0.60-2.15)

Age ≥75 yr

• G1 = 1.00 (referent)

• G2 = 0.63 (0.37-1.08)

• G3 = 0.46 (0.25-0.84)

High functioning

• G1 = 1.00 (referent)

• G2 = 0.73 (0.38-1.41)

• G3 = 0.89 (0.48-1.65)

Limited functioning

• G1 = 1.00 (referent)

• G2 = 0.60 (0.34-1.05)

• G3 = 0.51 (0.28-0.92)

Lam et al 2004 [192]

To investigate the relationship LTPA and mortality in Hong Kong.

• n = 24,079 cases (13,778 men; 10,301 women);

10 years prior

Multivariate adjusted OR (95% CI) by LTPA

The data confirm and extend previous findings in Caucasian populations on the association between LTPA and longevity.

PA assessment:

Men

Hong Kong

• n = 13,054 controls (3,918 men; 9,136 women)

Questionnaire for LTPA, divided into 3 groups

• G1 = 1.00 (referent)

• G2 = 0.60 (0.54-0.67)

Case-Control

• G3 = 0.66 (0.60-0.73)

• Sex: Men and women

G1 = <1 times per month

D & B score = 12

• Age: ≥35 yr

Women

• Characteristics: All ethnic Chinese

G2 = 1-3 times per month

• G1 = 1.00 (referent)

• G2 = 0.81 (0.74-0.88)

G3 = ≥4 times per month

• G3 = 0.71 (0.66-.077)

Lan et al 2006 [193]

To investigate the relationship between exercise and all-cause mortality.

• n = 2,113 (1,081 men; 1,032 women)

Baseline and 2 year follow-up

• 197 deaths

Older persons are recommended to expend at least 1000 kcal/wk through regular exercise for mortality reduction.

• Sex: Men and women

HR (95% CI) by LTPA frequency

Taiwan

• Age: ≥65 yr

PA assessment: Questionnaire for LTPA (frequency/wk)

Prospective cohort

• Characteristics: Non-institutionalized elders

Adjusted for age and sex

Protection of exercise against death also increases with the number of activities.

G1 = Sedentary

• G1 = 1.00 (referent)

• Taiwan National Health Interview Survey

G2 = 1 time/wk

• G2 = 0.49 (0.36-0.67)

D & B score = 13

G3 = ≥2 times/wk

• G3 = 0.20 (0.09-0.46)

Trend p = <0.001

Questionnaire for EE (kcal/wk), divided into 5 groups:

Multivariate adjusted

• G1 = 1.00 (referent)

G1 = Sedentary

• G2 = 0.70 (0.50-0.98)

G2 = <500

• G3 = 0.35 (0.15-0.82)

G3 = 500-999

Trend p = 0.014

G4 = 1000-1999

G5 = ≥2000

HR (95% CI) by EE

Adjusted for age and sex

• G1 = 1.00 (referent)

• G2 = 0.64 (0.41-1.01)

• G3 = 0.55 (0.35-0.85)

• G4 = 0.30 (0.17-0.53)

• G5 = 0.24 (0.12-0.48)

Trend p <0.001

Multivariate adjusted

• G1 = 1.00 (referent)

• G2 = 0.80 (0.49-1.30)

• G3 = 0.74 (0.46-1.17)

• G4 = 0.50 (0.27-0.90)

• G5 = 0.43 (0.21-0.87)

Trend p = 0.043

Laukkanen et al 2001 [194]

To examine the relationship between maximal oxygen uptake and overall mortality.

• n = 1,294

Baseline and 10.7 year follow-up

• 124 deaths

PF has a strong, graded, inverse association with overall mortality.

• Sex: Men

Adjusted RR (95% CI) by quartile

Finland

• Age: 42.0-61.3 yr (mean 52.1)

• Characteristics: Men free from CVD, COPD, and cancer at baseline

PF assessment: Exercise tolerance test, 4 groups by maximal oxygen uptake (ml/kg/min)

Prospective cohort

Maximal oxygen uptake

• G1 = 1.00 (referent)

• G2 = 1.47 (0.71-3.01)

D & B score = 14

• G3 = 2.79 (1.44-5.39)

G1 = >37.1

• G4 = 3.85 (2.02-7.32)

G2 = 32.3-37.1

Linear trend p = <0.001

G3 = 27.6-32.2

G4 = <27.6

Test duration

• G1 = 1.00 (referent)

Test duration (min)

• G2 = 2.22 (1.08-4.55)

G1 = >11.2

• G3 = 2.23 (1.11-4.49)

G2 = 9.6-11.2

• G4 = 3.94 (2.01-7.74)

G3 = 8.2-9.5

Linear trend p<0.001

G4 = <8.2

Lee and Paffenbarger 2000 [195]

To compare various levels of PA with mortality.

• n = 13,485

Baseline and 15 year follow-up

• 2,539 deaths

The study provides some support for recommendations that emphasize MPA. A benefit of VPA is also evident.

• Sex: Men

• Age: Mean 57.5 yr

RR (95% CI)

• Characteristics: Men who matriculated as undergraduates in 1916-1950

PA assessment:

• G1 = 1.00 (referent)

USA

Questionnaires for LTPA index (including walking, stair climbing, sports and recreational activity),

• G2 = 0.80 (0.72-0.88)

• G3 = 0.74 (0.65-0.83)

Prospective cohort

• G4 = 0.80 (0.69-0.93)

• The Harvard Alumni Health Study

• G5 = 0.73 (0.64-0.84)

Trend p = <0.001

D & B score = 12

5 groups (kJ/wk)

G1 = <4200

G2 = 4200-8399

G3 = 8400-12599

G4 = 12600-16799

G5 = ≥ 16800

Lee et al 1995 [196]

To examine the independent association of vigorous and non-vigorous PA with longevity.

• n = 17,321

Follow-up 22-26 years

• 3,728 deaths

There is a graded inverse relationship between PA and mortality. Vigorous, but not non-vigorous activities are associated with longevity.

• Sex: Men

• Age: Mean 46 yr

PA assessment: Questionnaires for EE (kJ/wk), quintiles

RR (95% CI) by EE (kJ/wk)

USA

• Characteristics: Harvard University alumni, without self-reported physician diagnosed cardiovascular disease, cancer or chronic obstructive pulmonary disease

Q1= 1.00 (referent)