All-cause mortality risk as a function of sedentary behavior, moderate-to-vigorous physical activity and cardiorespiratory fitness

Water-Based Training Programs Improve Functional Capacity, Cognitive and Hemodynamic Outcomes? The ACTIVE Randomized Clinical Trial

Purpose: To compare the effects of 16 weeks of aerobic training (AT) to 8 weeks of AT followed by 8 weeks of combined training (CT), as well as to a control group (CG), on the functional, cognitive and hemodynamic responses of older women exercising in the aquatic environment. Materials and Methods: The study is a three-armed parallel randomized controlled clinical trial. For this, 52 older women were first randomized in an aerobic training (AT; n = 35) or control group (CG; n = 17). After 8 weeks of intervention, participants from AT group were again randomized into another 8-week period of either AT (n = 17) or combined training (CT; n = 18). AT was performed at the percentage of the heart rate corresponding to the anaerobic threshold, resistance training was performed with sets at maximal effort and the control group performed low-intensity therapeutic exercises in water. All outcomes were assessed before (week 0) and after the intervention (week 17). In addition, some outcomes were also investigated in the middle timepoint (week 9). Generalized Estimating Equations (GEE) and Bonferroni post-hoc tests (α = 0.05) were used to compare timepoints and groups. Results: All groups similarly improved functional capacity (3-11%) and blood pressure (-4 to -10%), whereas cognitive function was not modified for any group. Conclusion: Water-based training programs and therapeutic exercises (i.e., CG) improve functional capacity and blood pressure responses in older women. Clinical Trials NCT03892278.

The Multistage 20-Meter Shuttle Run Test Reference Values for Tibetan Children and Adolescents in Tibet, China

OBJECTIVE

Cardiorespiratory fitness (CRF) reference data for Tibetan (Zang ethnicity) children and adolescents at high altitudes in Tibet of China are lacking. The present study aimed to develop sex- and age-specific 20mSRT norms for Chinese Tibetan children and adolescents at high altitudes.

METHOD

A total of 4667 participants from Lhasa (3650 m), Nagqu (4500 m), and Amdo (4700 m) were selected by a stratified random cluster sampling method in two stages. The 20 m SRT test was used to estimate cardiorespiratory fitness. The 20 m SRT norms were developed by the lambda, mu, and sigma method (LMS).

RESULTS

The 20 m SRT laps, completed stages/minutes, and the speed at the last complete stage of Chinese Tibetan children and adolescents aged 7-18 years increased with age.

CONCLUSION

Given the importance of CRF for children and adolescents' health, the government should strengthen the monitoring of the CRF of Tibetan children and adolescents in high-altitude areas, strengthen physical education curriculum reform, and increase the level of physical activity in order to improve the level of CRF in children and adolescents.

Association between cardiorespiratory fitness and risk of all-cause and cause-specific mortality

OBJECTIVE

The association of cardiorespiratory fitness (CRF) with all-cause and cause-specific mortality remains unclear in Chinese population. This study aimed to evaluate the risk of all-cause, cardiovascular disease (CVD), cancer and other-cause mortality in Chinese adults using estimated CRF (eCRF).

PATIENTS AND METHODS

We analysed data for 15,566 participants aged ≥20 years recruited in The Rural Chinese Cohort Study during 2007 to 2008 and followed for mortality during 2013 to 2014. eCRF was calculated with sex-specific longitudinal non-exercise algorithms. Cox proportional-hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality risk according to baseline eCRF.

RESULTS

During a median of 6.01 years of follow-up, 859 deaths occurred, including 359 from CVD, 221 from cancer, and 279 from other causes. Each 1 metabolic equivalent increment in eCRF was associated with decreased risk of all-cause mortality (men: HR 0.70, 95% CI [0.66-0.74]; women: 0.59, [0.54-0.64]); CVD mortality (men: 0.70 [0.64-0.77]; women: 0.55, [0.48-0.62]); and other-cause mortality (men: 0.68 [0.62-0.75]; women: 0.57, [0.49-0.66]). The area under receiver operating characteristic curve was significantly higher for eCRF than its modifiable components (waist circumference, body mass index and resting heart rate) in predicting all-cause and cause-specific mortality incidence (all p < .001).

CONCLUSION

eCRF was inversely associated with all-cause, CVD and other-cause mortality.

Objectively measured physical activity and all cause mortality: A systematic review and meta-analysis

Current physical activity recommendations have been based on evidence from systematic reviews of questionnaire-based data. Questionnaire-based physical activity data are subject to both random and non-random error. If the estimated association between physical activity and health outcomes was different when a more accurate, objective measure was used, this would have important health policy implications for physical activity. We conducted a systematic review and meta-analysis of published cohort studies that investigated the association between an objective measure of physical activity and all cause mortality. We searched PubMed, Scopus, Embase, Cochrane library, and SPORTDiscus for prospective cohort studies that examined the association between objectively measured (accelerometer, pedometer, or doubly labeled water method) physical activity and mortality in adults aged≥18 years, of either sex. Summary hazard ratios and 95% confidence interval [CI]s were computed using random-effects models. Thirty-three articles from 15 cohort studies were identified that together ascertained 3903 deaths. The mean years of follow-up ranged from 2.3-14.2 years. Individuals in the highest category of light, moderate-to-vigorous, and total physical activity had 40% (95%CI 20% to 55%), 56% (95%CI 41% to 67%), and 67% (95%CI 57% to 75%), respectively, lower risk for mortality compared to individuals in the lowest category of light, moderate-to-vigorous, and total physical activity. The summary hazard ratio for objectively measured physical activity and all cause mortality is lower than previously estimated from questionnaire based studies. Current recommendations for physical activity that are based on subjective measurement may underestimate the true reduction in mortality risk associated with physical activity.

Cardiorespiratory fitness in late adolescence and long-term risk of psoriasis and psoriatic arthritis among Swedish men

BACKGROUND

Psoriasis is a chronic immune-mediated disease and psoriatic arthritis is a common coexisting condition. Cardiorespiratory fitness is the overall capacity to perform exertion exercise. Low levels of cardiorespiratory fitness are associated with negative health outcomes. Individuals with psoriasis have lower cardiorespiratory fitness compared with individuals without psoriasis. There are no previous studies exploring the association between cardiorespiratory fitness and new-onset psoriasis and psoriatic arthritis.

METHODS

With the objective to investigate whether low cardiorespiratory fitness in late adolescence increases the risk for onset of psoriasis and psoriatic arthritis, a cohort of Swedish men in compulsory military service between 1968 and 2005 was created using data from the Swedish Military Service Conscription Register. Cardiorespiratory fitness, estimated by maximum capacity cycle ergometer testing at conscription, was divided into three groups: high, medium, and low. Diagnoses were obtained using the Swedish National Patient Register and cohort members were followed from conscription until an event, new-onset psoriasis or psoriatic arthritis, occurred, or at the latest until 31 December 2016. Cox regression models adjusted for confounders at conscription were used to obtain hazard ratios with 95% confidence intervals for incident psoriasis and psoriatic arthritis.

RESULTS

During the follow-up period (median follow-up time 31 years, range 0-48 years), 20,679 cases of incident psoriasis and 6,133 cases of incident psoriatic arthritis were found among 1,228,562 men (mean age at baseline 18.3 years). There was a significant association between low cardiorespiratory fitness and incident psoriasis and psoriatic arthritis (hazard ratio 1.35 (95% confidence interval 1.26-1.44) and 1.44 (95% confidence interval 1.28-1.63), respectively).

CONCLUSIONS

These novel findings suggest that low cardiorespiratory fitness at an early age is associated with increased risk of incident psoriasis and psoriatic arthritis among men, and highlight the importance of assessing cardiorespiratory fitness early in life.

Developmental pathways of cardiorespiratory fitness from 6 to 15 years of age

Most of the information gathered about physical fitness of paediatric populations are cross-sectional, resulting in normative perspectives that account for average values relative to age, but not to a comprehensive understanding of developmental individual trajectories. The aim of this study was to model the longitudinal development of cardiorespiratory fitness of boys and girls from 6 to 15 years of age, using an individual centred approach. Two hundred twenty-nine school children (128 boys; 101 girls) were followed on their 20 metres shuttle run test (20mSRT) results from 6 to 15 years of age. Annual measurements were made during the four years of primary school, and again at grade 9th or 10th. Individual trajectories of 20mSRT development were modelled and grouped according to their similarities of change in three different developmental pathways that were included in subsequent hierarchical nested models for testing each sex developmental model of cardiorespiratory fitness. Final models including the developmental pathways showed better deviance statistics (p < .001). Interindividual slope variances were almost zero, and statistically non-significant (0.05 boys 0.01 girls; p > .50), meaning these models capture well the existing variability, in respect to the rate of change. Individual pathways of change in the performance of 20mSRT test can be detected in childhood and adolescence. Additionally, all individual's developmental trajectories in 20mSRT can be described using three significantly different slopes. These pathways are indicative of a high, average, or low rate of change in performance over the years and differ from the normative approach.

A Threshold of Objectively-Assessed Daily Sedentary Time for All-Cause Mortality in Older Adults: A Meta-Regression of Prospective Cohort Studies

Background: This meta-analysis aimed to estimate the shape of the dose-response association between objectively-assessed daily sedentary time (ST) and all-cause mortality, and to explore whether there is a threshold of ST above which there is an increase in mortality risk in older adults. Methods: Searches for prospective cohort studies providing effect estimates of daily ST (exposure) on all-cause mortality (outcome) were undertaken in five databases up to 31 March 2019. A random-effects meta-regression model was conducted to quantify the dose-response relationship between daily ST and all-cause mortality. Sensitivity analyses were also performed to test the stability of the results. Results: Our analysis of pooled data from 11 eligible studies did not reveal a consistent shape of association between ST and mortality. After excluding three studies with potential confounding bias, there was a log-linear dose-response relationship between daily ST and all-cause mortality. Overall, higher amounts of time spent in sedentary behaviors were associated with elevated mortality risks in older adults. Visual assessments of dose-response relationships based on meta-regression analyses indicated that increased mortality risks became significant when total ST exceeded approximately 9 h/day. Conclusions: Based on a limited number of studies, this meta-analysis provides a starting point for considering a cut-off of daily sedentary time, suggesting older adults spend less time in daily sitting.

Associations of Muscle Mass and Strength with All-Cause Mortality among US Older Adults

INTRODUCTION

Recent studies suggested that muscle mass and muscle strength may independently or synergistically affect aging-related health outcomes in older adults; however, prospective data on mortality in the general population are sparse.

METHODS

We aimed to prospectively examine individual and joint associations of low muscle mass and low muscle strength with all-cause mortality in a nationally representative sample. This study included 4449 participants age 50 yr and older from the National Health and Nutrition Examination Survey 1999 to 2002 with public use 2011 linked mortality files. Weighted multivariable logistic regression models were adjusted for age, sex, race, body mass index (BMI), smoking, alcohol use, education, leisure time physical activity, sedentary time, and comorbid diseases.

RESULTS

Overall, the prevalence of low muscle mass was 23.1% defined by appendicular lean mass (ALM) and 17.0% defined by ALM/BMI, and the prevalence of low muscle strength was 19.4%. In the joint analyses, all-cause mortality was significantly higher among individuals with low muscle strength, whether they had low muscle mass (odds ratio [OR], 2.03; 95% confidence interval [CI], 1.27-3.24 for ALM; OR, 2.53; 95% CI, 1.64-3.88 for ALM/BMI) or not (OR, 2.66; 95% CI, 1.53-4.62 for ALM; OR, 2.17; 95% CI, 1.29-3.64 for ALM/BMI). In addition, the significant associations between low muscle strength and all-cause mortality persisted across different levels of metabolic syndrome, sedentary time, and LTPA.

CONCLUSIONS

Low muscle strength was independently associated with elevated risk of all-cause mortality, regardless of muscle mass, metabolic syndrome, sedentary time, or LTPA among US older adults, indicating the importance of muscle strength in predicting aging-related health outcomes in older adults.

Association of domain-specific physical activity and cardiorespiratory fitness with all-cause and cause-specific mortality in two population-based cohort studies

Physical activity (PA) reduces the risk for mortality. Whether the beneficial effects of PA are domain specific is unclear. We associated leisure time (LTPA), sports (SPA) and work (WPA) related PA and cardiorespiratory fitness (CRF) with all-cause mortality in two German population-based cohorts. We used data of the Study of Health in Pomerania (SHIP, n = 2,935, median age 53; 48% male) and the Cardiovascular Disease, Living and Ageing in Halle study (CARLA, n = 1,776, median age 64 and 54% male). Mortality was determined after a median follow-up of 8.2 years in SHIP (n = 332) and 11.5 years in CARLA (n = 409). LTPA (SHIP: hazard ratio [HR] per standard deviation [SD] 0.82 95%-CI 0.73 to 0.91 and CARLA: HR per SD 0.70: 95%-CI 0.59 to 0.82) and SPA (SHIP: HR per SD 0.80 95%-CI 0.71 to 0.91 and CARLA: HR per SD 0.70 95%-CI 0.60 to 0.82) but not WPA were inversely associated with all-cause mortality. In a subsample CRF was inversely related to mortality and positively to LTPA and sports SPA. No association was found for WPA. Our results may suggest that the inverse association between PA and mortality are partly influenced by higher CRF.

A cut-off of daily sedentary time and all-cause mortality in adults: a meta-regression analysis involving more than 1 million participants

BACKGROUND

The appropriate limit to the amount of daily sedentary time (ST) required to minimize mortality is uncertain. This meta-analysis aimed to quantify the dose-response association between daily ST and all-cause mortality and to explore the cut-off point above which health is impaired in adults aged 18-64 years old. We also examined whether there are differences between studies using self-report ST and those with device-based ST.

METHODS

Prospective cohort studies providing effect estimates of daily ST (exposure) on all-cause mortality (outcome) were identified via MEDLINE, PubMed, Scopus, Web of Science, and Google Scholar databases until January 2018. Dose-response relationships between daily ST and all-cause mortality were examined using random-effects meta-regression models.

RESULTS

Based on the pooled data for more than 1 million participants from 19 studies, the results showed a log-linear dose-response association between daily ST and all-cause mortality. Overall, more time spent in sedentary behaviors is associated with increased mortality risks. However, the method of measuring ST moderated the association between daily ST and mortality risk (p < 0.05). The cut-off of daily ST in studies with self-report ST was 7 h/day in comparison with 9 h/day for those with device-based ST.

CONCLUSIONS

Higher amounts of daily ST are log-linearly associated with increased risk of all-cause mortality in adults. On the basis of a limited number of studies using device-based measures, the findings suggest that it may be appropriate to encourage adults to engage in less sedentary behaviors, with fewer than 9 h a day being relevant for all-cause mortality.

Cardiorespiratory fitness versus physical activity as predictors of all-cause mortality in men

BACKGROUND

Although both cardiorespiratory fitness (CRF) and physical activity (PA) are associated with mortality, whether they are associated with all-cause mortality independent of each other is unclear.

METHODS

CRF was assessed by a maximal exercise test and PA was measured by self-report in 8,171 male veterans. The predictive power of CRF and PA, along with clinical variables, was assessed for all-cause mortality during a mean (±SD) follow-up 8.7 (4.4) years during which there were 1,349 deaths.

RESULTS

CRF was associated with mortality after adjusting for clinical variables and remained a strong predictor of mortality after further adjusting for PA (hazard ratio 0.85, 95% CI 0.83-0.87). PA was a significant predictor of mortality after controlling for clinical variables; however, the association was eliminated after further adjusting for CRF (hazard ratio 0.98, 95% CI 0.88-1.10). In CRF-stratified analysis, being active (≥150 min/wk) was not associated with mortality within the unfit or fit categories (P>.4). However, in PA-stratified analysis, subjects categorized as fit (≥7 metabolic equivalents [METS]) had a lower risk of mortality regardless of PA status (P<.001).

CONCLUSIONS

In adult men, PA was associated with mortality independent of established risk factors, but not CRF. Conversely, CRF remained a strong predictor of mortality independent of PA status and established risk factors.

Alternative Treatment Modalities and Its Effect in Older Populations

Aging is an inevitable multifactorial process. Advances in health care and technology have led to an increase on expected life span that can reach an average of 90 years in the next few decades. Lifestyle changes that include activity, nutrition, stress management, and alternatives low-impact exercises like yoga and tai chi can help us modify some of these age-related changes and lead to an increase in the health span and quality of life of the older adults.

Cross-sectional association of exercise, strengthening activities, and cardiorespiratory fitness on generalized anxiety, panic and depressive symptoms

OBJECTIVE

Limited research has evaluated the individual and combined associations of physical activity (PA), cardiorespiratory fitness (CRF) and muscle strengthening activities (MSA) on generalized anxiety, panic and depressive symptoms. We evaluated this topic in a representative sample of young (20-39 years) adults, with considerations by sex.

METHODS

Data from the 1999-2004 National Health and Nutrition Examination Survey (N = 2088) were used. Generalized anxiety, panic and depressive symptoms were assessed via self-report as well as using the Generalized Anxiety Disorder, Panic Disorder, and Depressive Disorders modules of the automated version of the World Health Organization Composite International Diagnostic Interview (CIDI-Auto 2.1). PA and MSA were assessed via validated self-report questionnaires and CRF was determined via a submaximal treadmill-based test. An index variable was created summing the number (range = 0-3) of these parameters for each participant. For example, those meeting PA guidelines, MSA guidelines and having moderate-to-high CRF were classified as having an index score of 3.

RESULTS

MSA was not independently associated with generalized anxiety, panic and depressive symptoms, but those with higher levels of PA and CRF had a reduced odds of these symptoms (ranging from 40 to 46% reduced odds). Compared to those with an index score of 0, those with an index score of 1, 2, and 3, respectively, had a 39%, 54% and 71% reduced odds of having generalized anxiety, panic and depressive symptoms. Results were consistent across both sexes.

CONCLUSION

PA and CRF, but not MSA, were independently associated with generalized anxiety, panic and depressive symptoms. There was evidence of an additive association between PA, CRF, and MSA on these symptoms.