Temporal Changes in a Novel Metric of Physical Activity Tracking (Personal Activity Intelligence) and Mortality: The HUNT Study, Norway

Association between Activity Quotient and cause-specific mortality - A prospective cohort study of 0.5 million participants in Asia

BACKGROUND

Regular physical activity (PA) is important for reducing the risk of chronic diseases and improving overall health. Activity Quotient (AQ) is a novel metric that translates heart rate during PA into a weekly score, providing an objective measure of an individual's PA. We prospectively examined the association of AQ with cancer and cardiovascular (CVD) mortality outcomes, the two major causes of death, in a Taiwanese population.

METHODS

A cohort of 515,608 healthy adults (52 % women) enrolled in a standard medical screening program was followed for mortality outcomes. The weekly AQ score of each participant was estimated based on self-reported PA intensity and weekly duration, and placed into six categories (0, ≤50, 51-99,100-149, 150-199, or ≥ 200 AQ per week). We used multivariable Cox proportional hazard models adjusted for potential confounders to estimate the hazard ratios (HR) and 95 % confidence intervals (CI).

RESULTS

Higher weekly AQ scores were associated with lower risks of CVD, cancer, and all-cause mortalities. Compared with inactive individuals, HRs (CI) for the association of AQ scores of ≤50, 50-99, 100-149, 150-199, and ≥ 200 were 0.93 (0.89-0.97), 0.91 (0.85-0.96), 0.84 (0.77-0.91), 0.84 (0.74-0.96), and 0.81 (0.73-0.90) with cancer mortality; and 0.88 (0.83-0.93), 0.86 (0.80-0.93), 0.81 (0.73-0.90), 0.71 (0.60-0.85), and 0.73 (0.64-0.84) with CVD mortality, respectively. Subgroup analyses showed that meeting 50 AQ a week was associated with lower risk of disease specific mortality risk across age groups and among individuals with known risk factors. Higher weekly AQ scores were also associated with longer life expectancy, with the highest gains observed among those achieving 150-199 weekly AQ.

CONCLUSION

Our findings show that AQ may be an objective tool for assessing and tracking PA and predicting mortality risks. Encouraging individuals to achieve ≥50 AQ a week could have substantial public health benefits, including lower mortality from major chronic diseases as well as prolonged health- and life expectancy.

Association of weight loss strategies with all-cause and specific-cause mortality: a prospective cohort study

BACKGROUND

The health effects of different weight loss strategies vary greatly, and the relationship between weight loss strategies, especially the combination of multiple strategies, and death is still unclear. We aimed to examine the associations of various numbers and combinations of weight loss strategies with all-cause and specific-cause mortality and to further evaluate the associations of different total weight loss volumes with mortality.

METHODS

Using data from NHANES (1999-2018) with 48,430 participants aged 20 and above, we collected fourteen self-reported weight loss strategies and identified five clusters using latent class analysis. Cox proportional hazards models were used to examine the association between the amounts and clusters of weight loss strategies and mortality.

RESULTS

During a median follow-up of 9.1 years of 48,430 participants, 7,539 deaths were recorded (including 1,941 CVDs and 1,714 cancer). Participants who adopted 2, 3-4, and ≥ 5 weight loss strategies had a lower risk of all-cause mortality, with HRs of 0.88 (95% CI, 0.81 to 0.97), 0.89 (95% CI, 0.81 to 0.96) and 0.71 (95% CI, 0.61 to 0.82). Regardless of weight loss or weight gain categories, there was a significant trend toward reduced mortality as the number of weight loss strategies increased (P trend < 0.05). Participants who adopted cluster-1 (four strategies), cluster-2 (five strategies) and cluster-3 (three strategies) had a significantly lower risk of all-cause mortality, with HRs of 0.71 (95% CI, 0.60 to 0.84), 0.70 (95% CI, 0.55 to 0.89) and 0.81 (95% CI, 0.70 to 0.94). Among them, cluster-1 and cluster-2 are both characterized by eating less food, exercising, drinking plenty of water, lowering calories and eating less fat. Conversely, cluster-4 (five strategies) and cluster-5 (four strategies) had marginally significant effects, and they both had actual higher total energy intakes. Similar associations were observed for CVDs and cancer mortality.

CONCLUSIONS

Employing two or more weight loss strategies was associated with a lower risk of death, even among those who gained weight. Eating less food, exercising, drinking plenty of water, lowering calories and eating less fat is a better combination of strategies. On this basis, limiting the actual intake of total energy is necessary.

Personal Activity Intelligence and Ischemic Heart Disease in a Healthy Population: China Kadoorie Biobank Study

BACKGROUND

Personal Activity Intelligence (PAI) is a physical activity metric that translates heart rate during physical activity into a simple score, where a weekly score of 100 or greater is associated with a lower risk of cardiovascular disease and mortality. Here, we prospectively investigated the association between PAI and ischemic heart disease (IHD) mortality in a large healthy population from China.

METHODS

Using data from the China Kadoorie Biobank, we studied 443,792 healthy adults (60% women). The weekly PAI score of each participant was estimated based on the questionnaire data and divided into four groups (PAI scores of 0, ≤50, 51-99, or ≥100). Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for fatal IHD and nonfatal myocardial infraction (MI) related to PAI were estimated using Cox proportional hazard regression analyses.

RESULTS

There were 3050 IHD deaths and 1808 MI events during a median follow-up of 8.2 years (interquartile range, 7.3-9.1; 3.6 million person-years). After adjustments for multiple confounders, a weekly PAI score ≥ 100 was associated with a lower risk of IHD (aHR: 0.91 (95% CI: 0.83-1.00)), compared with the inactive group (0 PAI). The corresponding aHR for MI was 0.94 (95% CI: 0.83-1.05). In participants aged 60 years or older at baseline, the aHR associated with a weekly PAI score ≥ 100 was 0.84 (95% CI, 0.75-0.93) for IHD and 0.84 (95% CI, 0.73-0.98) for MI.

CONCLUSION

Among healthy Chinese adults, a weekly PAI score of 100 or greater was associated with a lower risk of IHD mortality across all age groups; moreover, a high PAI score significantly lowered the risk of MI but only in those 60 years and older at baseline. The present findings extend the scientific evidence that PAI may have prognostic significance in diverse settings for IHD outcomes and suggest that the PAI metric may be useful in delineating the magnitude of weekly physical activity needed to reduce the risk of IHD mortality.

Using Personal Activity Intelligence With Patients in a Clinic Setting

BACKGROUND

Personal Activity Intelligence (PAI) is a novel heart-rate-based metric used to assess cardiorespiratory fitness and quantify physical activity.

OBJECTIVE

The aim of this study was to examine the feasibility, acceptability, and effectiveness of PAI with patients in a clinic setting.

METHODS

Patients (n = 25) from 2 clinics underwent 12 weeks of heart-rate-monitored physical activity interfaced with aPAI Health phone app. We used a pre-post design with the Physical Activity Vital Sign and the International Physical Activity Questionnaire. Feasibility, acceptability, and PAI measures were used to evaluate the objectives.

RESULTS

Twenty-two patients (88%) completed the study. There were significant improvements in International Physical Activity Questionnaire metabolic equivalent task minutes per week ( P = .046) and a decrease in sitting hours ( P = .0001). The Physical Activity Vital Sign activity increase in minutes per week was not significant ( P = .214). Patients achieved a mean PAI score of 116 ± 81.1 and 100 or greater 71% of the days. Most patients (81%) expressed satisfaction with PAI.

CONCLUSIONS

Personal Activity Intelligence is feasible, acceptable, and effective when used with patients in a clinic setting.

Temporal changes in personal activity intelligence and the risk of incident dementia and dementia related mortality: A prospective cohort study (HUNT)

BACKGROUND

The Personal Activity Intelligence (PAI) translates heart rate during daily activity into a weekly score. Obtaining a weekly PAI score ≥100 is associated with reduced risk of premature morbidity and mortality from cardiovascular diseases. Here, we determined whether changes in PAI score are associated with changes in risk of incident dementia and dementia-related mortality.

METHODS

We conducted a prospective cohort study of 29,826 healthy individuals. Using data from the Trøndelag Health-Study (HUNT), PAI was estimated 10 years apart (HUNT1 1984-86 and HUNT2 1995-97). Adjusted hazard-ratios (aHR) and 95%-confidence intervals (CI) for incidence of and death from dementia were related to changes in PAI using Cox regression analyses.

FINDINGS

During a median follow-up time of 24.5 years (interquartile range [IQR]: 24.1-25.0) for dementia incidence and 23.6 years (IQR: 20.8-24.2) for dementia-related mortality, there were 1998 incident cases and 1033 dementia-related deaths. Individuals who increased their PAI score over time or maintained a high PAI score at both assessments had reduced risk of dementia incidence and dementia-related mortality. Compared with persistently inactive individuals (0 weekly PAI) at both time points, the aHRs for those with a PAI score ≥100 at both occasions were 0.75 (95% CI: 0.58-0.97) for incident dementia, and 0.62 (95% CI: 0.43-0.91) for dementia-related mortality. Using PAI score <100 at both assessments as the reference cohort, those who increased from <100 at HUNT1 to ≥100 at HUNT2 had aHR of 0.83 (95% CI: 0.72-0.96) for incident dementia, and gained 2.8 (95% CI: 1.3-4.2, P<0.0001) dementia-free years. For dementia-related mortality, the corresponding aHR was 0.74 (95% CI: 0.59-0.92) and years of life gained were 2.4 (95% CI: 1.0-3.8, P=0.001).

INTERPRETATION

Maintaining a high weekly PAI score and increases in PAI scores over time were associated with a reduced risk of incident dementia and dementia-related mortality. Our findings extend the scientific evidence regarding the protective role of PA for dementia prevention, and suggest that PAI may be a valuable tool in guiding research-based PA recommendations.

FUNDING

The Norwegian Research Council, the Liaison Committee between the Central Norway Regional Health Authority and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

Association Between Personal Activity Intelligence and Mortality: Population-Based China Kadoorie Biobank Study

OBJECTIVE

To prospectively investigate the association between personal activity intelligence (PAI) - a novel metabolic metric which translates heart rate during physical activity into a simple weekly score - and mortality in relatively healthy participants in China whose levels and patterns of physical activity in addition to other lifestyle factors are different from those in high-income countries.

PATIENTS AND METHODS

From the population-based China Kadoorie Biobank study, 443,792 healthy adults were recruited between June 2004 and July 2008. Participant's weekly PAI score was estimated and divided into four groups (PAI scores of 0, ≤50, 51-99, or ≥100). Using Cox proportional hazard analyses, we calculated adjusted hazard ratios (AHRs) for cardiovascular disease (CVD) and all-cause mortality related to PAI scores.

RESULTS

During a median follow-up of 8.2 (interquartile range, 7.3 to 9.1) years, there were 21,901 deaths, including 9466 CVD deaths. Compared with the inactive group (0 PAI score), a baseline weekly PAI score greater than or equal to 100 was associated with a lower risk of CVD mortality, an AHR of 0.87 (95% CI, 0.81 to 0.94) in men, and an AHR of 0.84 (95% CI, 0.78 to 0.92) in women, after adjusting for multiple confounders. Participants with a weekly PAI score greater than or equal to 100 also had a lower risk of all-cause mortality (AHR, 0.93; 95% CI, 0.89 to 0.97 in men, and AHR, 0.93; 95%, 0.88 to 0.98 in women). Moreover, this subgroup gained 2.7 (95% CI, 2.4 to 3.0) years of life, compared with the inactive cohort.

CONCLUSION

Among relatively healthy Chinese adults, the PAI metric was inversely associated with CVD and all-cause mortality, highlighting the generalizability of the score in different races, ethnicities, and socioeconomic strata.

Changes in the Frequency of Moderate-to-Vigorous Physical Activity and Subsequent Risk of All-Cause and Cardiovascular Disease Mortality

We investigated the association of changes in the frequency of moderate-to-vigorous physical activity (MVPA) and the risks of all-cause and cardiovascular disease (CVD) mortality. This study used the nationally representative National Health Insurance Service-National Sample Cohort database. We included 286,402 individuals aged ≥20 years and estimated changes in the frequency of MVPA over a two-year period. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard regression models. The HRs (95% CIs) for the risk of all-cause and CVD mortality for an increased frequency of MVPA from physical inactivity compared with continual physical inactivity were 0.82 and 0.68 (0.73–0.92 and 0.51–0.91) for 1–2, 0.72 and 0.48 (0.62–0.84 and 0.31–0.74) for 3–4, and 0.73 and 0.70 (0.63–0.85 and 0.50–0.98) for ≥5 sessions of MVPA/week. The HRs (95% CIs) for the risk of all-cause and CVD mortality were 1.28 and 1.58 (1.07–1.53 and 1.01–2.46), 1.25 and 2.17 (1.01–1.57 and 1.14–4.12), and 1.43 and 1.44 (1.15–1.77 and 0.84–2.47) for changes from 1–2, 3–4, and ≥5 sessions of MVPA/week to physical inactivity, respectively. This study showed the beneficial effect of increasing physical activity, particularly for those who were physically inactive at baseline, as well as the increased risk of all-cause and CVD mortality after adapting a physically inactive lifestyle regardless of their baseline physical activity status.

Personal Activity Intelligence e-Health Program in People with Type 2 Diabetes: A Pilot Randomized Controlled Trial

INTRODUCTION

Innovative strategies are needed to enable people with type 2 diabetes (T2D) to self-manage physical activity (PA). Personal Activity Intelligence (PAI) is a new metric that uses the heart rate response to PA to inform the user as to whether they are doing enough PA to reduce the risk of premature mortality. The PAI score reflects PA over the previous 7 d with the goal to maintain a score ≥100. The aim of this study was to investigate the feasibility, acceptability, and efficacy of the PAI e-Health Program in people with T2D.

METHODS

Thirty participants with T2D who were not meeting PA guidelines were randomly assigned to 12 wk of either 1) PAI e-Health Program or 2) PA attention control. The PAI e-Health Program consisted of receiving a wrist-worn heart rate monitor and an app with the PAI metric, and attending 4 × 2 h·wk-1 sessions of exercise and counseling. Feasibility and acceptability of the program were evaluated by achievement of a PAI score ≥100 and participant feedback. Efficacy was determined from changes in glycemic control, cardiorespiratory fitness, exercise capacity (time-on-test), body composition, sleep time, and health-related quality of life.

RESULTS

Program participants in the PAI e-Health Program had a mean ± SD PAI score of 119.7 ± 60.6 and achieved ≥100 PAI on 56.4% of the days. The majority of participants (80%) intended to continue to use PAI monitoring. Compared with control, the PAI group significantly improved their exercise capacity (mean difference, 95% confidence interval) (63 s, 17.9-108.0 s), sleep time (67.2 min, 7.2-127.1 min), total percent body fat (-1.3%, -2.6% to -0.1%), and gynoid fat percent (-1.5%, -2.6 to -0.5).

CONCLUSIONS

The PAI e-Health Program is feasible, acceptable, and efficacious in people with T2D.

Obesity treatment: Weight loss versus increasing fitness and physical activity for reducing health risks

We propose a weight-neutral strategy for obesity treatment on the following grounds: (1) the mortality risk associated with obesity is largely attenuated or eliminated by moderate-to-high levels of cardiorespiratory fitness (CRF) or physical activity (PA), (2) most cardiometabolic risk markers associated with obesity can be improved with exercise training independent of weight loss and by a magnitude similar to that observed with weight-loss programs, (3) weight loss, even if intentional, is not consistently associated with lower mortality risk, (4) increases in CRF or PA are consistently associated with greater reductions in mortality risk than is intentional weight loss, and (5) weight cycling is associated with numerous adverse health outcomes including increased mortality. Adherence to PA may improve if health care professionals consider PA and CRF as essential vital signs and consistently emphasize to their patients the myriad benefits of PA and CRF in the absence of weight loss.

Mortality in relation to changes in physical activity in middle-aged to older Chinese: An 8-year follow-up of the Guangzhou Biobank Cohort Study

BACKGROUND

Physical activity (PA) is generally encouraged. Studies from developed countries in the West have shown that maintenance of adequate PA or increasing PA are associated with lower mortality risk. It is unclear whether these associations apply to an older Chinese population. Hence, we examined the changes in PA prospectively among a middle-aged and older Chinese population over an average of 4 years and explored their subsequent mortality risks.

METHODS

Metabolic equivalent scores of PA among participants in the Guangzhou Biobank Cohort Study were calculated. Participants were divided into 3 groups related to PA level, and changes in PA were classified into 9 categories. Information on vital status and causes of death from March 2008 to December 2012 (the first repeated examination) until December 31, 2017, was obtained via record linkage with the Death Registry.

RESULTS

Of 18,104 participants aged 61.21 ± 6.85 years (mean ± SD), 1461 deaths occurred within 141,417 person-years. Compared to participants who maintained moderate PA, those who decreased PA from moderate or high levels to a low level had increased risks for all-cause mortality (hazard ratio (HR) = 1.47, 95% confidence interval (95%CI): 1.11-1.96). Participants who maintained a high level of PA (HR = 0.83, 95%CI: 0.70-0.98) or increased PA from low to high levels (HR = 0.71, 95%CI: 0.52-0.97) showed lower all-cause mortality risks. Those who maintained low PA levels showed a higher all-cause mortality risk, whereas those who increased their PA levels showed a non-significantly lower risk. Similar results were found for cardiovascular disease risk.

CONCLUSION

Even at an older age, maintaining a high PA level or increasing PA from low to high levels results in lower mortality risks, suggesting that substantial health benefits might be achieved by maintaining or increasing engagement in adequate levels of PA. The increased risk of maintaining a low PA level or decreasing PA to a low level warrants the attention of public health officials and clinicians.

Association between Personal Activity Intelligence (PAI) and body weight in a population free from cardiovascular disease - The HUNT study

BACKGROUND

Personal Activity Intelligence (PAI) is a new metric for physical activity tracking, and is associated with reduced risk of all-cause and cardiovascular mortality. We prospectively investigated whether PAI is associated with lower body weight gain in a healthy population.

METHODS

We included 85,243 participants (40,037 men and 45,206 women) who participated in at least one of three waves of the Trøndelag Health Study (HUNT1: 1984-86, HUNT2: 1995-97, and HUNT3: 2006-08). We used questionnaires to estimate PAI, and linear mixed models to examine body weight according to PAI levels at three study waves. We also conducted regression analyses to assess separate relationships between change in PAI and the combined changes in PAI and physical activity recommendations, according to body weight from HUNT1 to HUNT3.

FINDINGS

Compared with HUNT1, body weight was 8.6 and 6.7 kg higher at HUNT3 for men and women, respectively, but was lower among those with ≥200 PAI at HUNT3. For both sexes, a change from inactive (0 PAI) at HUNT1 to ≥100 weekly PAI-score at HUNT2 and HUNT3, and a ≥100 PAI-score at all three occasions were associated with lower body weight gain, compared with the reference group (0 PAI at all three waves). Importantly, among both sexes, obtaining ≥100 weekly PAI at HUNT1 and HUNT3 was associated with lower body weight gain regardless of adhering to physical activity guidelines.

INTERPRETATION

Adhering to a high PAI over time may be a useful tool to attenuate excessive body weight gain in a population free from cardiovascular disease.

FUNDING

Norwegian Research Council and the Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and technology.

Temporal changes in personal activity intelligence and mortality: Data from the aerobics center longitudinal study

BACKGROUND

Personal activity intelligence (PAI) is a metric developed to simplify a physically active lifestyle for the participants. Regardless of following today's advice for physical activity, a PAI score ≥100 per week at baseline, an increase in PAI score, and a sustained high PAI score over time were found to delay premature cardiovascular disease (CVD) and all-cause mortality in a large population of Norwegians. However, the association between long-term temporal change in PAI and mortality in other populations have not been investigated.

OBJECTIVE

To test whether temporal change in PAI is associated with CVD and all-cause mortality in a large population from the United States.

METHODS

We studied 17,613 relatively healthy participants who received at least two medical examinations in the Aerobics Center Longitudinal Study between 1974 and 2002. The participant's weekly PAI scores were estimated twice, and adjusted hazard ratios (AHR) and 95% confidence intervals (CI) for CVD and all-cause mortality related to changes in PAI between baseline and last examination were assessed using Cox proportional hazard regression analyses.

RESULTS

During a median follow-up time of 9.3 years [interquartile range, 2.6-16.6; 181,765 person-years], there were 1144 deaths, including 400 CVD deaths. We observed an inverse linear association between change in PAI and risk of CVD mortality (P=0.007 for linear trend, and P=0.35 for quadratic trend). Compared to participants with zero PAI at both examinations, multivariable-adjusted analyses demonstrated that participants who maintained high PAI scores (≥100 PAI at both examinations) had a 51% reduced risk of CVD mortality [AHR, 0.49: 95% CI, 0.26-0.95)], and 42% reduced risk of all-cause mortality [AHR, 0.58: 95% CI, 0.41-0.83)]. For participants who increased their PAI scores over time (PAI score of zero at first examination and ≥100 at last examination), the AHRs were 0.75 (95% CI, 0.55-1.02) for CVD mortality, and 0.82 (95% CI, 0.69-0.99) for all-cause mortality. Participants who maintained high PAI score had 4.8 (95% CI, 3.3-6.4) years of life gained. For those who increased their PAI score over time, the corresponding years gained were 1.8 years (95% CI, 0.1-3.5).

CONCLUSION

Among relatively healthy participants, an increase in PAI and maintaining a high PAI score over time was associated with reduced risk of CVD and all-cause mortality.

CONDENSED ABSTRACT

Our objective was to investigate the association between temporal changes in PAI and mortality in a large population from the United States. In this prospective cohort study of 17,613 relatively healthy participants at baseline, maintaining a high PAI score and an increase in PAI score over an average period of 6.3 years was associated with a significant reduction in CVD and all-cause mortality. Based on our results, clinicians can easily recommend that patients obtain at least 100 PAI for most favourable protection against CVD- and all-cause mortality, but can also mention that significant benefits also occur at maintaining low-to-moderate PAI levels.

Association of level of leisure-time physical activity with risks of all-cause mortality and cardiovascular disease in an elderly Chinese population: a prospective cohort study

BACKGROUND

Implementing the current guidelines for leisure-time physical activity (LTPA) provides significant health benefits, especially for middle-aged adults, but it is unclear whether LTPA also translates into cardiovascular health benefits among elderly people. Therefore, we aimed to assess the association of LTPA with the risks of cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, and all-cause mortality in an elderly population.

METHODS

In this prospective cohort study, 32, 942 participants aged 60 years or older who participated in a health check-up programme in China between 2010 and 2018 were included. We evaluated the morbidity and mortality risks through the Cox regression model, competing risk model and restricted cubic spline model.

RESULTS

During a median of 6.84 years of follow-up, there were 6, 857 elderly people with incident CVD; a total of 6, 324 deaths occurred due to all causes and 2, 060 deaths occurred due to CVD. Compared with the inactive group, reductions in CVD morbidity and mortality were observed, with hazard ratios (HRs) of 0.89 (95% CI: 0.83-0.96) and 0.81 (95% CI: 0.71-0.92) in the insufficiently active group, 0.86 (95% CI: 0.80-0.92) and 0.79 (95% CI: 0.69-0.90) in the sufficiently active group, and 0.79 (95% CI: 0.70-0.89) and 0.58 (95% CI: 0.45-0.76) in the highly active group, respectively; but no significant reductions were observed in the very highly active group, with HRs of 0.87 (95% CI: 0.71-1.06) and 0.99 (95% CI: 0.70-1.40), respectively. Compared with the inactive group, reductions in all-cause mortality were also observed, with a HR of 0.90 (95% CI: 0.84-0.97) in the insufficiently active group, 0.82 (95% CI: 0.77-0.89) in the sufficiently active group, 0.77 (95% CI: 0.67- 0.87) in the highly active group, and 0.80 (95% CI: 0.64-0.98) in the very highly active group. A restricted cubic spline diagram showed that there was an L-shaped association between LTPA and the risk of all-cause mortality but a U-shaped or reverse J-shaped relationship between LTPA and the risk of CVD morbidity and mortality, especially stroke. In addition, a subgroup analysis showed that elderly population who consistently performed LTPA for ten years or more had a lower risk of morbidity and mortality.

CONCLUSIONS

In an elderly population, even insufficient activity is associated with a decreased risk of all-cause mortality and CVD, and moderate levels of LTPA may be optimal for CVD prevention. In addition, elderly people who consistently perform LTPA over several years may experience greater health benefits.

Personal activity intelligence and mortality - Data from the Aerobics Center Longitudinal Study

IMPORTANCE

Personal activity intelligence (PAI) is a novel activity metric that can be integrated into self-assessment heart rate devices, and translates heart rate variations during exercise into a weekly score. Previous studies relating to PAI have been conducted in the same populations from Norway where the PAI metric has been derived, limiting generalizability of the results.

OBJECTIVE

To test whether PAI is associated with total and cause-specific mortality in a large cohort from the United States.

DESIGN

Aerobics Center Longitudinal Study (ACLS) - a prospective cohort between January 1974 and December 2002 with a mean follow-up of 14.5 years.

SETTING

Population-based.

PARTICIPANTS

56,175 relatively healthy participants (26.5% women) who underwent extensive preventive medical examinations at Cooper Clinic (Dallas, TX).

EXPOSURE

Personal activity intelligence (PAI) score per week was estimated and divided into 4 groups (PAI scores of 0, ≤50, 51-99, and ≥100).

MAIN OUTCOMES AND MEASURES

Total and cause-specific mortality.

RESULTS

During a median follow-up time of 14.9 (interquartile range, 6.7-21.4) years, there were 3434 total deaths including 1258 cardiovascular (CVD) deaths. Compared with the inactive (0 PAI) group, participants with a baseline weekly ≥100 PAI had lower risk of mortality: adjusted hazard ratio (AHR), 0.79: 95% CI, 0.71-0.87 for all-cause mortality, and AHR, 0.72: 95% CI, 0.60-0.87 for CVD mortality among men; AHR, 0.85: 95% CI, 0.64-1.12 for all-cause mortality, and AHR, 0.48: 95% CI, 0.26-0.91 for CVD mortality among women. For deaths from ischemic heart disease (IHD), PAI score ≥100 was associated with lower risk in both men and women (AHR, 0.70: 95% CI, 0.55-0.88). Obtaining ≥100 weekly PAI was also associated with significantly lower risk of CVD mortality in pre-specified age groups, and in participants with known CVD risk factors. Participants with ≥100 weekly PAI gained 4.2 (95% CI, 3.5-4.6) years of life when compared with those who were inactive at baseline.

CONCLUSIONS AND RELEVANCE

PAI is associated with long-term all-cause, CVD, and IHD, mortality. Clinicians and the general population can incorporate PAI recommendations and thresholds in their physical activity prescriptions and weekly physical activity assessments, respectively, to maximize health outcomes.

KEY POINTS

Question: What is the association between personal activity intelligence (PAI), a novel activity metric, and mortality in a large cohort from the United States?

FINDINGS

In this prospective study of 56,175 healthy participants at baseline, followed-up for a mean of 14.5 years, ≥100 PAI score/week was associated with significant 21% lower risk of all-cause and 30% lower risk of CVD mortality in comparison with inactive people. Participants with ≥100 PAI/week lived on average 4.2 years longer compared with inactive. Meaning: PAI is associated with long-term all-cause and CVD mortality. Clinicians and general population may incorporate PAI recommendations into weekly physical activity assessments to maximize CVD prevention.

Cardiovascular Health Effects of Shift Work with Long Working Hours and Night Shifts: Study Protocol for a Three-Year Prospective Follow-Up Study on Industrial Workers

There is a plausible association between shift work and cardiovascular disease (CVD), which may be due to disruption of the circadian rhythm causing hormonal changes and metabolic disturbances, resulting in high blood pressure, atherosclerosis, diabetes, and being overweight. However, few studies have investigated the association between several consecutive long work shifts, including night shifts, and risk factors for developing CVD. Moreover, knowledge is lacking on factors that may modify or enhance this suggested relationship. The study period is planned from the third quarter of 2018 to the fourth quarter of 2021, and will involve 125 industrial employees at two Norwegian enterprises producing insulation. The work schedule is either rotating shiftwork (morning, evening, night) or regular day work. At baseline, we will measure blood parameters, including markers of inflammation, lipids, and glycosylated hemoglobin. We will also collect measures of blood pressure, resting heart rate, arterial stiffness, carotid intima-media thickness, and aerobic fitness. At the end of baseline data collection, a subgroup will undergo a supervised high-intensity interval training intervention for eight weeks, initiated by the Occupational Health Service. At one-year follow-up, we repeat baseline measures with added measures of heart rate variability and additional five weeks monitoring of sleep and physical activity, and assessment of respirable dust. At the two year follow-up, we will measure CVD risk factors before and after a planned three-month shutdown in one of the studied plants. We will also assess respirable dust, monitor sleep, and compile a one-year retrospective detailed overview of working hours. A final data collection, similar to the one at baseline, will be carried out after three years. We will use a comprehensive set of methods to identify the effects of shift work with long working hours and night shifts on cardiovascular health. This will provide new knowledge on the association between early manifestations of CVD and occupational exposure to shift work. Further, we can study whether work organization such as extensive overtime, sleep loss, and dust exposure have detrimental effects, and if a three-month cease in shift work or increased physical activity will modify early manifestations of CVD.

Cross-country skiing and running's association with cardiovascular events and all-cause mortality: A review of the evidence

A large body of evidence demonstrates positive, graded effects of PA on cardiovascular disease (CVD) morbidity and mortality with increasing intensity compared with lower PA intensity. Running is often designated as a high-intensity PA with substantial evidence supporting its health benefits. Cross-country skiing is among the most demanding aerobic endurance exercises and requires engaging the upper- and lower-body. Cross-country skiing is often regarded as high-intensity PA, which has been associated with significant health benefits. However, a robust body of evidence identifying the dose-response relation between cross-country skiing volume and health outcomes is sparse. Therefore, this review aims to summarize the available evidence linking cross-country skiing with CVD morbidity and all-cause mortality; postulated pathways that may elucidate the relation between these associations; outline areas of ongoing uncertainty; and the implications for primary and secondary CVD prevention. To put the findings into perspective, we also summarized the evidence linking running with CVD morbidity and all-cause mortality. Though a head-to-head comparison is not available, the evidence indicates that performing PA as cross-country skiing associates with lower mortality risk when compared with that observed in those undertaking their PA as running. Potential adverse effects of extreme high weekly doses of cross-country skiing over decades may be cardiac arrhythmias, such as atrial fibrillation. Evidence suggests that cross-country skiing may reduce the risk of CVD events and all-cause mortality via anti-inflammatory pathways, improvements in endothelial function and reduced levels of CVD risk factors, such as lipids, glucose, and blood pressure; and enhancement of cardiorespiratory fitness.

An Update on the Role of Cardiorespiratory Fitness, Structured Exercise and Lifestyle Physical Activity in Preventing Cardiovascular Disease and Health Risk

The cardiovascular disease (CVD) pandemic has placed considerable strain on healthcare systems, quality of life, and physical function, while remaining the leading cause of death globally. Decades of scientific investigations have fortified the protective effects of cardiorespiratory fitness (CRF), exercise training, and physical activity (PA) against the development of CVD. This review will summarize recent efforts that have made significant strides in; 1) the application of novel analytic techniques to increase the predictive utility of CRF; 2) understanding the protective effects of long-term compliance to PA recommendations through large cohort studies with multiple points of assessment; 3) and understanding the potential harms associated with extreme volumes of PA.