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Guo J, Dove A, Shang Y, Marseglia A, Johnell K, Rizzuto D, Xu W. Associations Between Mid- to Late-Life Body Mass Index and Chronic Disease-Free Survival: A Nationwide Twin Study. J Gerontol A Biol Sci Med Sci 2024; 79:glad111. [PMID: 37096341 PMCID: PMC10733179 DOI: 10.1093/gerona/glad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Some studies have linked late-life overweight to a reduced mortality risk compared to normal body mass index (BMI). However, the impact of late-life overweight and its combination with mid-life BMI status on healthy survival remains unclear. We aimed to investigate whether and to what extent mid- and/or late-life overweight are associated with chronic disease-free survival. METHODS Within the Swedish Twin Registry, 11 597 chronic disease-free twins aged 60-79 years at baseline were followed up for 18 years. BMI (kg/m2) was recorded at baseline and 25-35 years before baseline (ie, midlife) and divided as underweight (<20), normal (≥20-25), overweight (≥25-30), and obese (≥30). Incident chronic diseases (cardiovascular diseases, type 2 diabetes, and cancer) and deaths were ascertained via registries. Chronic disease-free survival was defined as years lived until the occurrence of any chronic diseases or death. Data were analyzed using multistate survival analysis. RESULTS Of all participants, 5 640 (48.6%) were overweight/obese at baseline. During the follow-up, 8 772 (75.6%) participants developed at least 1 chronic disease or died. Compared to normal BMI, late-life overweight and obesity were associated with 1.1 (95% CI, 0.3, 2.0) and 2.6 (1.6, 3.5) years shorter chronic disease-free survival. Compared to normal BMI through mid- to late life, consistent overweight/obesity and overweight/obesity only in mid-life led to 2.2 (1.0, 3.4) and 2.6 (0.7, 4.4) years shorter disease-free survival, respectively. CONCLUSIONS Late-life overweight and obesity may shorten disease-free survival. Further research is needed to determine whether preventing overweight/obesity from mid- to late life might favor longer and healthier survival.
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Affiliation(s)
- Jie Guo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Abigail Dove
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Ying Shang
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Anna Marseglia
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Kasović M, Štefan L, Kalčik Z. The Importance of Cardiorespiratory vs. Muscular Fitness in Reducing the Odds of Hypertension in War Veterans: A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111120. [PMID: 34769639 PMCID: PMC8583623 DOI: 10.3390/ijerph182111120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/24/2022]
Abstract
Purpose: The purpose of the study was to examine separate and combined associations between cardiorespiratory fitness (CRF) and musculoskeletal fitness (MF) with hypertension. Methods: In this cross-sectional study, participants were 764 men and women aged 45–75 years, who were part of the Homeland War between 1990 to 1995 (33.5% women). CRF included the 2-min step test, while MF was consisted of push-ups in 30 s, chair-stands in 30 s and sit-ups in 30 s. The prevalence of hypertension was defined according to new American College of Cardiology and American Hearts Association Blood Pressure Guidelines for systolic and diastolic blood pressure of ≥130 mmHg and/or ≥80 mmHg. Results: In models adjusted for sex, age, fatness and fasting blood glucose, we found a graded inverse association between CRF and MF with hypertension. Less cardiorespiratory and muscular fit individuals were more likely to have hypertension. When CRF and MF were combined, individuals with high MF and low CRF, low MF and high CRF and low MF and CRF were 1.77, 2.15 and 7.09 more likely to have of hypertension. Conclusion: Both CRF and MF are associated with the prevalence of hypertension, while the magnitude of the associations between MF and hypertension was more pronounced.
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Affiliation(s)
- Mario Kasović
- Faculty of Kinesiology, Department of General and Applied Kinesiology, University of Zagreb, 10000 Zagreb, Croatia;
- Faculty of Sports Studies, Department of Sport Motorics and Methodology in Kinanthropology, Masaryk University, 62500 Brno, Czech Republic
| | - Lovro Štefan
- Faculty of Kinesiology, Department of General and Applied Kinesiology, University of Zagreb, 10000 Zagreb, Croatia;
- Faculty of Sports Studies, Department of Sport Motorics and Methodology in Kinanthropology, Masaryk University, 62500 Brno, Czech Republic
- Faculty of Science, Department of Recruitment and Examination (RECETOX), Masaryk University, 62500 Brno, Czech Republic
- Correspondence: ; Tel.: +385-09891-77-060
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Navarrete-Villanueva D, Gómez-Cabello A, Gómez-Bruton A, Gesteiro E, Rodríguez-Gómez I, Pérez-Gómez J, Villa-Vicente JG, Espino-Toron L, Gusi N, González-Gross M, Ara I, Vicente-Rodríguez G, Casajús JA. Fitness vs. fatness as determinants of survival in non-institutionalized older adults: The EXERNET multi-center study. J Gerontol A Biol Sci Med Sci 2021; 77:1079-1087. [PMID: 34153109 DOI: 10.1093/gerona/glab179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Physical fitness and body composition are important health indicators, nevertheless their combined pattern inter-relationships and their association with mortality are poorly investigated. METHODS This longitudinal study is part of the Spanish EXERNET-Elder project. Person-months follow-up were calculated from the interview date, performed between June 2008 and November 2009, until date of death or censoring on March 2018 (whichever came first). In order to be included, participants had to fulfill the following criteria: 1) be over 65 years old, 2) live independently at home, 3) not suffer dementia and/or cancer and 4) have a BMI above 18.5. Body fat and weight were assessed by a bioelectrical impedance analyzer. Fitness was measured with the Senior Fitness and the one leg static balance tests. The Spanish Death Index was consulted for the death's identification. Cluster analysis was performed to identify Fat-Fit patterns and traditional cut points and percentiles to create the Fat-Fit groups. Cox proportional hazards regression models were used to calculate the hazard ratios of death in clustered Fat-Fit patterns and in traditional Fat-Fit groups. RESULTS A total of 2299 older adults (76.8% of women) were included with a baseline mean age of 71.9 ± 5.2 years. A total of 196 deaths (8.7% of the sample) were identified during the 8 years of follow up. Four clustered Fat-Fit patterns (Low fat-Fit, Medium fat-Fit, High fat-Unfit and Low fat-Unfit) and nine traditional Fat-Fit groups emerged. Using the Low fat-Fit pattern as the reference, significantly increased mortality was noted in High fat-Unfit (HR: 1.68, CI: 1.06 - 2.66) and Low fat-Unfit (HR: 2.01, CI: 1.28 - 3.16) groups. All the traditional Fit groups showed lower mortality risk when compared to the reference group (obese-unfit group). CONCLUSIONS Physical fitness is a determinant factor in terms of survival in community-dwelling older adults, independently of adiposity levels.
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Affiliation(s)
- David Navarrete-Villanueva
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.,Faculty of Health Sciences (FCS), Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain.,Red española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, Zaragoza, Spain
| | - Alba Gómez-Cabello
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.,Red española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, Zaragoza, Spain.,Centro Universitario de la Defensa, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Alejandro Gómez-Bruton
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.,Red española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, Zaragoza, Spain.,Faculty of Health and Sport Sciences (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Huesca, Spain
| | - Eva Gesteiro
- Red española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, Zaragoza, Spain.,ImFine Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
| | - Irene Rodríguez-Gómez
- Red española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, Zaragoza, Spain.,GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | | | | | - Luis Espino-Toron
- Unit of Sport Medicine, Cabildo of Gran Canaria, Gran Canaria, Spain
| | - Narcís Gusi
- Red española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, Zaragoza, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.,International Institute for Aging, Cáceres, Spain.,Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Sciences, University of Extremadura, Cáceres, Spain
| | - Marcela González-Gross
- Red española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.,ImFine Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
| | - Ignacio Ara
- Red española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, Zaragoza, Spain.,GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Germán Vicente-Rodríguez
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.,Red española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.,Faculty of Health and Sport Sciences (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Huesca, Spain
| | - José Antonio Casajús
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.,Faculty of Health Sciences (FCS), Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain.,Red española de Investigación en Ejercicio Físico y Salud, EXERNET, University of Zaragoza, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
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Abstract
PURPOSE OF REVIEW The focus of this review is to discuss obesity, physical activity (and physical inactivity/sedentary behavior), cardiovascular disease (CVD), and their often interrelated health implications. The authors summarize the pathophysiological changes associated with obesity, which lead to the development of CVD, recommendations for interventions such as diet, increased physical activity, and weight loss according to current literature and guidelines, and the critical importance of cardiorespiratory fitness (CRF). RECENT FINDINGS Clinical trials continue to demonstrate improved outcomes among overweight or obese individuals who achieve a healthy weight using various methods. Increasing CRF levels appears to demonstrate the largest health improvements, regardless of underlying comorbidities or achieving weight loss. CRF, which is perhaps the single most important predictor of overall health, seems more important than weight loss alone regarding improved CVD outcomes in the obese population. These findings are reproduced in studies involving patients with various forms of CVD and CVD risk factors. The importance of CRF is well established; future endeavors to establish specific CRF targets for various patient cohorts are needed.
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Affiliation(s)
- Andrew Elagizi
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121-2483, USA
| | - Sergey Kachur
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121-2483, USA
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121-2483, USA.
| | - Steven N Blair
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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5
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Dose–response relationship between body mass index and risks of all-cause mortality and disability among the elderly: A systematic review and meta-analysis. Clin Nutr 2019; 38:1511-1523. [DOI: 10.1016/j.clnu.2018.07.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/18/2018] [Indexed: 01/01/2023]
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6
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Myers J, Fonda H, Vasanawala M, Chung K, Segall G, Chan K, Nguyen P. PCI Alternative Using Sustained Exercise (PAUSE): Rationale and trial design. Contemp Clin Trials 2019; 79:37-43. [PMID: 30797041 DOI: 10.1016/j.cct.2019.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/09/2019] [Accepted: 02/19/2019] [Indexed: 01/09/2023]
Abstract
Cardiovascular disease (CVD) currently claims nearly one million lives yearly in the US, accounting for nearly 40% of all deaths. Coronary artery disease (CAD) accounts for the largest number of these deaths. While efforts aimed at treating CAD in recent decades have concentrated on surgical and catheter-based interventions, limited resources have been directed toward prevention and rehabilitation. CAD is commonly treated using percutaneous coronary intervention (PCI), and this treatment has increased exponentially since its adoption over three decades ago. Recent questions have been raised regarding the cost-effectiveness of PCI, the extent to which PCI is overused, and whether selected patients may benefit from optimal medical therapy in lieu of PCI. One alternative therapy that has been shown to improve outcomes in CAD is exercise therapy; exercise programs have been shown to have numerous physiological benefits, and a growing number of studies have demonstrated reductions in mortality. Given the high volume of PCI, its high cost, its lack of effect on survival and the potential for alternative treatments including exercise, the current study is termed "PCI Alternative Using Sustained Exercise" (PAUSE). The primary aim of PAUSE is to determine whether patients randomized to exercise and lifestyle intervention have greater improvement in coronary function and anatomy compared to those randomized to PCI. Coronary function and anatomy is determined using positron emission tomography combined with computed tomographic angiography (PET/CTA). Our objective is to demonstrate the utility of a non-invasive technology to document the efficacy of exercise as an alternative treatment strategy to PCI.
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Affiliation(s)
- Jonathan Myers
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America.
| | - Holly Fonda
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - Minal Vasanawala
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - Kieran Chung
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - George Segall
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - Khin Chan
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - Patricia Nguyen
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
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de Oliveira Bristot VJ, de Bem Alves AC, Cardoso LR, da Luz Scheffer D, Aguiar AS. The Role of PGC-1α/UCP2 Signaling in the Beneficial Effects of Physical Exercise on the Brain. Front Neurosci 2019; 13:292. [PMID: 30983964 PMCID: PMC6449457 DOI: 10.3389/fnins.2019.00292] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 03/13/2019] [Indexed: 01/12/2023] Open
Abstract
In understanding the pathology of neurological diseases, the role played by brain energy metabolism is gaining prominence. Animal models have demonstrated that regular physical exercise improves brain energy metabolism while also providing antidepressant, anxiolytic, antioxidant and neuroprotective functions. This review summarizes the latest evidence on the roles played by peroxisome proliferator-activated receptor gamma (PPAR-γ) coactivator 1-alpha (PGC-1α) and mitochondrial uncoupling protein (UCP) in this scenario. The beneficial effects of exercise seem to depend on crosstalk between muscles and nervous tissue through the increased release of muscle irisin during exercise.
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Affiliation(s)
- Viviane José de Oliveira Bristot
- Research Group on Biology of Exercise, Department of Health Sciences, Centro Araranguá, Federal University of Santa Catarina, Araranguá, Brazil
| | - Ana Cristina de Bem Alves
- Research Group on Biology of Exercise, Department of Health Sciences, Centro Araranguá, Federal University of Santa Catarina, Araranguá, Brazil.,Laboratório de Bioenergética e Estresse Oxidativo, Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Liziane Rosa Cardoso
- Research Group on Biology of Exercise, Department of Health Sciences, Centro Araranguá, Federal University of Santa Catarina, Araranguá, Brazil
| | - Débora da Luz Scheffer
- Research Group on Biology of Exercise, Department of Health Sciences, Centro Araranguá, Federal University of Santa Catarina, Araranguá, Brazil.,Laboratório de Bioenergética e Estresse Oxidativo, Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Aderbal Silva Aguiar
- Research Group on Biology of Exercise, Department of Health Sciences, Centro Araranguá, Federal University of Santa Catarina, Araranguá, Brazil.,Laboratório de Bioenergética e Estresse Oxidativo, Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, Brazil
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Temporal Trends in the Cardiorespiratory Fitness of 2,525,827 Adults Between 1967 and 2016: A Systematic Review. Sports Med 2018; 49:41-55. [DOI: 10.1007/s40279-018-1017-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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9
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Kim S, Kim DI. Association of regular walking and body mass index on metabolic syndrome among an elderly Korean population. Exp Gerontol 2018. [PMID: 29522861 DOI: 10.1016/j.exger.2018.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Aging is associated with increased body fat and lower lean body mass, which leads to increased prevalence of obesity and metabolic syndrome. This study aimed to investigate the association of regular participation in walking and body mass index (BMI) with metabolic syndrome and its 5 criteria in elderly Koreans. A total of 3554 (male = 1581, female = 1973) elderly subjects (age ≥ 65 years), who participated in the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V) were analyzed in this cross-sectional study. Participation in walking activity, BMI, metabolic syndrome and its 5 criteria; waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose (FG) levels, triglyceride (TG) levels, and high-density lipoprotein cholesterol (HDLC) levels, were measured. Subjects were categorized into four groups based on the duration and regularity of their walks and BMI. In the regular walking (≥30 min of continuous walking a day, on ≥5 days a week) and normal weight (BMI < 23 kg/m2) group, WC, SBP, DBP, FG, and TG levels were significantly lower, and HDL-C levels were significantly higher, compared to the non-regular walking and overweight (BMI ≥ 23 kg/m2) group. Furthermore, the odds of metabolic syndrome was 4.36 times higher (Odds ratio [OR]: 4.36, 95% confidence interval [CI]: 3.37-5.63) in the non-regular walking and overweight group than that of the regular walking and normal weight group after controlling for the influence of age, sex, and smoking status. Moreover, The BMI (β = 0.328, R2 = 0.152) were more contributing factors than Regular walking (β = -0.011) for metabolic syndrome. In conclusions, regular participation in walking activity and implementing weight control may reduce the incidence rate of metabolic syndrome in elderly Koreans, with weight management serving as the greater influences of the two.
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Affiliation(s)
- Soonyoung Kim
- Department of Physical Education, Gachon University, Gyeonggi-do, Republic of Korea
| | - Dong-Il Kim
- Department of Professional Therapy, Graduate School of Professional Therapy, Gachon University, Gyeonggi-do, Republic of Korea.
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Harber MP, Kaminsky LA, Arena R, Blair SN, Franklin BA, Myers J, Ross R. Impact of Cardiorespiratory Fitness on All-Cause and Disease-Specific Mortality: Advances Since 2009. Prog Cardiovasc Dis 2017; 60:11-20. [DOI: 10.1016/j.pcad.2017.03.001] [Citation(s) in RCA: 221] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 02/06/2023]
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11
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Sandbakk SB, Nauman J, Lavie CJ, Wisløff U, Stensvold D. Combined Association of Cardiorespiratory Fitness and Body Fatness With Cardiometabolic Risk Factors in Older Norwegian Adults: The Generation 100 Study. Mayo Clin Proc Innov Qual Outcomes 2017; 1:67-77. [PMID: 30225403 PMCID: PMC6135019 DOI: 10.1016/j.mayocpiqo.2017.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective To investigate the independent and combined associations of fitness and fatness with cardiometabolic risk factors in older Norwegian women and men. Patients and Methods We conducted a cross-sectional study of 505 women and 417 men aged 70 to 77 years enrolled in the Generation 100 study in Norway. Fitness was assessed as peak oxygen uptake and fatness as high body mass index (BMI; ≥25 kg/m2), waist circumference (WC) of 88 cm or greater for women and 102 cm or greater for men, and percent body fat (%BF) of 35% or greater and 25% or greater for women and men, respectively. High cardiometabolic risk was defined as the presence of 2 or more of the following risk factors: elevated triglyceride level, reduced high-density lipoprotein cholesterol concentration, elevated blood pressure, and elevated fasting glucose level or pharmacological treatment of these conditions. Results Receiver operating characteristic curve analyses identified fitness levels of less than 25.7 and less than 30.7 mL/kg per minute in women and men, respectively, as critical thresholds for having high cardiometabolic risk. Individuals with levels below these thresholds had an adjusted odds ratio of 2.77 (95% CI, 2.09-3.66) for having high cardiometabolic risk, while high BMI, WC, and %BF had odds ratios (95% CIs) of 3.58 (2.69-4.77), 3.06 (2.29-4.10), and 3.26 (2.47-4.30), respectively. In our combined analyses, being lean did not attenuate the cardiometabolic risk associated with low fitness, and combinations of low fitness and/or high BMI, WC, or %BF cumulatively increased cardiometabolic risk. Conclusion Low fitness and indication of fatness were independently and cumulatively associated with poor cardiometabolic health. Our results emphasize the importance of including both physical fitness and body fatness in the assessment of cardiometabolic risk and health promotion efforts in older adults.
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Key Words
- %BF, percent body fat
- AUC, area under the curve
- BMI, body mass index
- BP, blood pressure
- CV, cardiovascular
- CVD, CV disease
- HDL-C, high-density lipoprotein cholesterol
- HTN, hypertension
- HbA1c, glycated hemoglobin
- OR, odds ratio
- PA, physical activity
- ROC, receiver operating characteristic
- T2D, type 2 diabetes
- TG, triglyceride
- VO2peak, peak oxygen uptake
- WC, waist circumference
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Affiliation(s)
- Silvana B. Sandbakk
- K. G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Javaid Nauman
- K. G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Carl J. Lavie
- University of South Carolina, Columbia, SC
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA
| | - Ulrik Wisløff
- K. G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
- Correspondence: Address to Ulrik Wisløff, PhD, K. G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, NTNU, Post Box 8905, Medisinsk Teknisk Forskningssenter, 7491 Trondheim, Norway.
| | - Dorthe Stensvold
- K. G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Leon AS. Attenuation of Adverse Effects of Aging on Skeletal Muscle by Regular Exercise and Nutritional Support. Am J Lifestyle Med 2017; 11:4-16. [PMID: 30202306 PMCID: PMC6124840 DOI: 10.1177/1559827615589319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/06/2015] [Indexed: 12/19/2022] Open
Abstract
Beginning early in midlife, natural/primary aging is inevitably associated with a progressive reduction in muscle mass and function. This process can progress with aging to a substantial loss of strength, particularly in the lower extremities, reducing mobility. This condition, commonly referred to as sarcopenia, can result in frailty, reducing one's ability to live independently. This article reviews the underlying biological process contributing to the development of sarcopenia and the roles of regular exercise and nutritional support for attenuating aging-associated muscle loss as well as risk and management of sarcopenia and associated frailty.
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Shaya GE, Al-Mallah MH, Hung RK, Nasir K, Blumenthal RS, Ehrman JK, Keteyian SJ, Brawner CA, Qureshi WT, Blaha MJ. High Exercise Capacity Attenuates the Risk of Early Mortality After a First Myocardial Infarction: The Henry Ford Exercise Testing (FIT) Project. Mayo Clin Proc 2016; 91:129-39. [PMID: 26848000 DOI: 10.1016/j.mayocp.2015.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/01/2015] [Accepted: 11/20/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine the effect of objectively measured exercise capacity (EC) on early mortality (EM) after a first myocardial infarction (MI). PATIENTS AND METHODS This retrospective cohort study included 2061 patients without a history of MI (mean age, 62±12 years; 38% [n=790] women; 56% [n=1153] white) who underwent clinical treadmill stress testing in the Henry Ford Health System from January 1, 1991, through May 31, 2009, and suffered MI during follow-up (MI event proportion, 3.4%; mean time from the exercise test to MI, 6.1±4.3 years). Exercise capacity was categorized on the basis of peak metabolic equivalents (METs) achieved: less than 6, 6 to 9, 10 to 11, and 12 or more METs. Early mortality was defined as all-cause mortality within 28, 90, or 365 days of MI. Multivariable logistic regression models were used to assess the effect of EC on the risk of mortality at each time point post-MI adjusting for baseline demographic characteristics, cardiovascular risk factors, medication use, indication for stress testing, and year of MI. RESULTS The 28-day EM rate was 10.6% overall, and 13.9%, 10.7%, 6.9%, and 6.0% in the less than 6, 6 to 9, 10 to 11, and 12 or more METs categories, respectively (P<.001). Patients who died were more likely to be older, be less fit, be nonobese, have treated hypertension, and have a longer duration from baseline to incident MI (P<.05). Adjusted regression analyses revealed a decreased risk of EM with increasing EC categories. A 1-MET higher EC was associated with an 8% to 10% lower risk of mortality across all time points (28 days: odds ratio [OR], 0.92; 95% CI, 0.87-0.98; P=.006; 90 days: OR, 0.90; 95% CI, 0.86-0.95; P<.001; 365 days: OR, 0.91; 95% CI, 0.87-0.94; P<.001). CONCLUSION Higher baseline EC was independently associated with a lower risk of early death after a first MI.
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Affiliation(s)
- Gabriel E Shaya
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; University of Miami Miller School of Medicine, Miami, FL
| | - Mouaz H Al-Mallah
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia; Henry Ford Hospital, Detroit, MI
| | - Rupert K Hung
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; Baptist Health South Florida, Miami
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | | | | | | | - Waqas T Qureshi
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.
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Mišigoj-Duraković M, Sorić M, Matika D, Jukić I, Duraković Z. Which is more important for reducing the odds of metabolic syndrome in men: Cardiorespiratory or muscular fitness? Obesity (Silver Spring) 2016; 24:238-44. [PMID: 26637962 DOI: 10.1002/oby.21264] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/27/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine combined associations of cardiorespiratory fitness (CRF) and muscular fitness (MF) with metabolic syndrome (MetSy) in a sample of young men. METHODS Participants were 557 men aged 19-47 years. CRF was quantified as peak oxygen uptake measured during an incremental treadmill test by a metabolic cart, while a composite MF score was calculated as the sum of z-scores from a push-ups and sit-ups test. The presence of MetSy was defined according to the updated NCEP-ATP III criteria. RESULTS We found a graded inverse relationship between CRF and MetSy presence. The most aerobically fit individuals had 90% lower odds of having MetSy compared to their least fit counterparts, independent of MF (odds ratio [OR] = 0.10, 95% CI = 0.04-0.21). Conversely, an increment in MF across the first three quartiles was not associated with lower odds of MetSy; only the most muscularly fit men were 2.5 times less likely to have MetSy (OR = 0.41, 95% CI = 0.21-0.78). Finally, participants with high CRF but low MF exhibited a 50% decrease in odds of having MetSy (OR = 0.49, 95% CI = 0.26-0.91), while no protective effect was found for having high MF but low CRF (OR = 0.95, 95% CI = 0.55-1.62). CONCLUSIONS CRF exhibited a strong protective effect against having MetSy, while the effect of MF was less pronounced.
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Affiliation(s)
| | - Maroje Sorić
- Department of Sport and Exercise Medicine, Faculty of Kinesiology, University of Zagreb, Croatia
| | - Dario Matika
- Croatian Defence Academy 'Petar Zrinski', Zagreb, Croatia
| | - Igor Jukić
- Department of Sport and Exercise Medicine, Faculty of Kinesiology, University of Zagreb, Croatia
| | - Zijad Duraković
- The World Life College, Waterport, New York, USA
- The Croatian Academy of Sciences and Arts in Bosnia and Herzegovina, Mostar, Bosnia and Herzegovina
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Yerrakalva D, Mullis R, Mant J. The associations of "fatness," "fitness," and physical activity with all-cause mortality in older adults: A systematic review. Obesity (Silver Spring) 2015; 23:1944-56. [PMID: 26337029 DOI: 10.1002/oby.21181] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/12/2015] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This review explored whether cardiorespiratory fitness or physical activity act as either confounders or effect modifiers of the relationship between adiposity markers and all-cause mortality in older adults. METHODS Systematic searches were carried out to identify observational studies that examined the association of adiposity markers (BMI, waist circumference, and waist-hip ratio) with all-cause mortality in adults aged ≥ 60 which took into account cardiorespiratory fitness or physical activity. Data from each included study was analyzed to produce a graphical representation of this relationship. RESULTS Fourteen of the fifteen identified studies found that increasing BMI had a non-positive association with all-cause mortality, with persistence of the obesity paradox despite adjustment for physical activity or cardiorespiratory fitness. Physical activity measurement methods were all subjective and often unvalidated. The two studies stratifying for cardiorespiratory fitness did not find that fitness had a significant impact on the relationship between excess adiposity and mortality but found that overweight and fit people had better survival than normal-weight unfit people, CONCLUSIONS The predominant use of poor physical activity measurement suggests that studies are currently not adequately accounting for possible physical activity confounding. More studies are needed for addressing the modification of the relationship between adiposity markers and mortality by cardiorespiratory fitness.
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Affiliation(s)
- Dharani Yerrakalva
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ricky Mullis
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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MARTINEZ-GOMEZ DAVID, GUALLAR-CASTILLÓN PILAR, HALLAL PEDROC, LOPEZ-GARCIA ESTHER, RODRÍGUEZ-ARTALEJO FERNANDO. Nonexercise Cardiorespiratory Fitness and Mortality in Older Adults. Med Sci Sports Exerc 2015; 47:568-74. [DOI: 10.1249/mss.0000000000000435] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Li H, Sui X, Huang S, Lavie CJ, Wang Z, Blair SN. Secular change in cardiorespiratory fitness and body composition of women: the Aerobics Center Longitudinal Study. Mayo Clin Proc 2015; 90:43-52. [PMID: 25500108 DOI: 10.1016/j.mayocp.2014.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 08/05/2014] [Accepted: 08/26/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate secular change of cardiorespiratory fitness (CRF) and body composition during 35 years in a large sample of women enrolled in the Aerobics Center Longitudinal Study. PATIENTS AND METHODS A cross-sectional analysis of baseline fitness data collected during preventive medical examination of 13,037 women aged 20 to 64 years evaluated at the Cooper Clinic in Dallas, Texas, from January 1, 1970, through December 30, 2004, who underwent a body composition assessment and a maximal treadmill exercise test. Women were stratified by examination year (5 years for each group) and age. Analysis of covariance was used to ascertain secular change of CRF and body composition. RESULTS Adjusted CRF levels, as indicated by maximal metabolic equivalent or relative maximum oxygen consumption, among women in the cohort increased significantly during a 35-year period for both age groups (P<.001). The greatest change occurred during the 1970s to 1980s, with a small decrease in 2000 through 2004 in both age groups. Adjusted body mass index increased 9.05% during the past 35 years (P<.001), but adjusted percentage of body fat was significantly higher in 1980 through 1984 than in the other groups (P<.001). CONCLUSIONS In a large cohort of women, the mean CRF has improved during the past 35 years, with a slight decrease in 2000 through 2004. From 1980 through 2004, the increase in body weight was mainly attributable to the increase in fat-free mass.
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Affiliation(s)
- Haiwei Li
- School of Physical Education, Shanxi Normal University, Linfen, China; Department of Exercise Rehabilitation, Beijing Sport University, Beijing, China
| | - Xuemei Sui
- Department of Exercise Science, University of South Carolina, Columbia, SC.
| | - Shouqing Huang
- The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Zhengzhen Wang
- Department of Exercise Rehabilitation, Beijing Sport University, Beijing, China
| | - Steven N Blair
- Department of Exercise Science, University of South Carolina, Columbia, SC; Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
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Hung RK, Al-Mallah MH, McEvoy JW, Whelton SP, Blumenthal RS, Nasir K, Schairer JR, Brawner C, Alam M, Keteyian SJ, Blaha MJ. Prognostic value of exercise capacity in patients with coronary artery disease: the FIT (Henry Ford ExercIse Testing) project. Mayo Clin Proc 2014; 89:1644-54. [PMID: 25440889 DOI: 10.1016/j.mayocp.2014.07.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/22/2014] [Accepted: 07/29/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the prognostic value of exercise capacity in patients with nonrevascularized and revascularized coronary artery disease (CAD) seen in routine clinical practice. PATIENTS AND METHODS We analyzed 9852 adults with known CAD (mean ± SD age, 61±12 years; 69% men [n=6836], 31% black race [n=3005]) from The Henry Ford ExercIse Testing (FIT) Project, a retrospective cohort study of patients who underwent physician-referred stress testing at a single health care system between January 1, 1991, and May 31, 2009. Patients were categorized by revascularization status (nonrevascularized, percutaneous coronary intervention [PCI], or coronary artery bypass graft [CABG] surgery) and by metabolic equivalents (METs) achieved on stress testing. Using Cox regression models, hazard ratios for mortality, myocardial infarction (MI), and downstream revascularizations were calculated after adjusting for potential confounders, including cardiac risk factors, pertinent medications, and stress testing indication. RESULTS There were 3824 all-cause deaths during median follow-up of 11.5 years. In addition, 1880 MIs, and 1930 revascularizations were ascertained. Each 1-MET increment in exercise capacity was associated with a hazard ratio (95% CI) of 0.87 (0.85-0.89), 0.87 (0.85-0.90), and 0.86 (0.84-0.89) for mortality; 0.98 (0.96-1.01), 0.88 (0.84-0.92), and 0.93 (0.90-0.97) for MI; and 0.94 (0.92-0.96), 0.91 (0.88-0.95), and 0.96 (0.92-0.99) for downstream revascularizations in the nonrevascularized, PCI, and CABG groups, respectively. In each MET category, the nonrevascularized group had similar mortality risk as and higher MI and downstream revascularization risk than the PCI and CABG surgery groups (P<.05). CONCLUSION Exercise capacity was a strong predictor of mortality, MI, and downstream revascularizations in this cohort. Furthermore, patients with similar exercise capacities had an equivalent mortality risk, irrespective of baseline revascularization status.
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Affiliation(s)
- Rupert K Hung
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Mouaz H Al-Mallah
- King Abdul-Aziz Cardiac Center, Riyadh, Saudi Arabia; Henry Ford Health System, Detroit, MI
| | - John W McEvoy
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | | | | | | | | | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.
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Rolland Y, Gallini A, Cristini C, Schott AM, Blain H, Beauchet O, Cesari M, Lauwers-Cances V. Body-composition predictors of mortality in women aged ≥ 75 y: data from a large population-based cohort study with a 17-y follow-up. Am J Clin Nutr 2014; 100:1352-60. [PMID: 25332333 DOI: 10.3945/ajcn.114.086728] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The role of body composition as a risk factor for death remains controversial in older persons. OBJECTIVE We determined the role of body-composition variables in mortality in older women. DESIGN Longitudinal analyses were performed in a prospective cohort study of older women. Participants were 4574 community-dwelling women aged ≥ 75 y at the baseline visit (between January 1992 and April 1994). Several body-composition variables were assessed by using anthropometric measures and dual-energy X-ray absorptiometry at the baseline visit. The main outcome was overall mortality. Body-composition variables were body mass index (BMI; in kg/m(2)), hip circumference, waist circumference, waist-to-hip ratio, fat mass/height(2), lean mass/height(2), percentage of fat mass, percentage of lean mass, and the lean mass:fat mass ratio. RESULTS The mean (± SD) age at baseline was 80.2 ± 3.8 y. During the 17.7 y (IQR: 17.2-18.1 y) of follow-up, 2876 women died. U-shaped in crude analyses and reversed J-shaped relations in adjusted analyses between BMI, hip and waist circumferences, fat mass/height(2), and risk of death were shown. Adjusted risk of death was significantly higher in participants with BMI ≤ 24.6 and fat mass/height(2) ≤ 8.2 kg/m(2). There was a negative linear association between fat mass (%) and risk of death: a 10% increase in fat mass was associated with a 12% reduction of mortality risk (adjusted HR: 0.88; 95% CI: 0.84, 0.92; P < 0.001). Linear and statistically significant relations were shown between lean mass/height(2) and risk of death in crude but not adjusted analyses. CONCLUSIONS Risk of mortality was consistently higher in older women with low adiposity. No lean mass indicator was associated with risk of death. Clinicians should be alerted by low adiposity in older women.
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Affiliation(s)
- Yves Rolland
- From the Gerontopôle, Toulouse University Hospital, Toulouse, France (YR and MC); the Institut national de la santé et de la recherche médicale (INSERM) Unité Mixte de Recherche 1027, University of Toulouse III, France (YR, AG, and MC); the Laboratory of Epidemiology and Community Health, Faculty of Medicine, Toulouse, France (CC, AG, and VL-C); the Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University of Lyon, INSERM U1033, Lyon, France (A-MS); the Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University Montpellier 1, Montpellier, France (HB); and the Department of Neuroscience, Division of Geriatric Medicine, Unité Propre de Recherche et d'Enseignement Supérieur-Equipe d'Accueil 4638, Université Nantes Angers Le Mans, Angers University Hospital, Angers, France (OB)
| | - Adeline Gallini
- From the Gerontopôle, Toulouse University Hospital, Toulouse, France (YR and MC); the Institut national de la santé et de la recherche médicale (INSERM) Unité Mixte de Recherche 1027, University of Toulouse III, France (YR, AG, and MC); the Laboratory of Epidemiology and Community Health, Faculty of Medicine, Toulouse, France (CC, AG, and VL-C); the Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University of Lyon, INSERM U1033, Lyon, France (A-MS); the Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University Montpellier 1, Montpellier, France (HB); and the Department of Neuroscience, Division of Geriatric Medicine, Unité Propre de Recherche et d'Enseignement Supérieur-Equipe d'Accueil 4638, Université Nantes Angers Le Mans, Angers University Hospital, Angers, France (OB)
| | - Christelle Cristini
- From the Gerontopôle, Toulouse University Hospital, Toulouse, France (YR and MC); the Institut national de la santé et de la recherche médicale (INSERM) Unité Mixte de Recherche 1027, University of Toulouse III, France (YR, AG, and MC); the Laboratory of Epidemiology and Community Health, Faculty of Medicine, Toulouse, France (CC, AG, and VL-C); the Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University of Lyon, INSERM U1033, Lyon, France (A-MS); the Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University Montpellier 1, Montpellier, France (HB); and the Department of Neuroscience, Division of Geriatric Medicine, Unité Propre de Recherche et d'Enseignement Supérieur-Equipe d'Accueil 4638, Université Nantes Angers Le Mans, Angers University Hospital, Angers, France (OB)
| | - Anne-Marie Schott
- From the Gerontopôle, Toulouse University Hospital, Toulouse, France (YR and MC); the Institut national de la santé et de la recherche médicale (INSERM) Unité Mixte de Recherche 1027, University of Toulouse III, France (YR, AG, and MC); the Laboratory of Epidemiology and Community Health, Faculty of Medicine, Toulouse, France (CC, AG, and VL-C); the Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University of Lyon, INSERM U1033, Lyon, France (A-MS); the Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University Montpellier 1, Montpellier, France (HB); and the Department of Neuroscience, Division of Geriatric Medicine, Unité Propre de Recherche et d'Enseignement Supérieur-Equipe d'Accueil 4638, Université Nantes Angers Le Mans, Angers University Hospital, Angers, France (OB)
| | - Hubert Blain
- From the Gerontopôle, Toulouse University Hospital, Toulouse, France (YR and MC); the Institut national de la santé et de la recherche médicale (INSERM) Unité Mixte de Recherche 1027, University of Toulouse III, France (YR, AG, and MC); the Laboratory of Epidemiology and Community Health, Faculty of Medicine, Toulouse, France (CC, AG, and VL-C); the Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University of Lyon, INSERM U1033, Lyon, France (A-MS); the Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University Montpellier 1, Montpellier, France (HB); and the Department of Neuroscience, Division of Geriatric Medicine, Unité Propre de Recherche et d'Enseignement Supérieur-Equipe d'Accueil 4638, Université Nantes Angers Le Mans, Angers University Hospital, Angers, France (OB)
| | - Olivier Beauchet
- From the Gerontopôle, Toulouse University Hospital, Toulouse, France (YR and MC); the Institut national de la santé et de la recherche médicale (INSERM) Unité Mixte de Recherche 1027, University of Toulouse III, France (YR, AG, and MC); the Laboratory of Epidemiology and Community Health, Faculty of Medicine, Toulouse, France (CC, AG, and VL-C); the Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University of Lyon, INSERM U1033, Lyon, France (A-MS); the Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University Montpellier 1, Montpellier, France (HB); and the Department of Neuroscience, Division of Geriatric Medicine, Unité Propre de Recherche et d'Enseignement Supérieur-Equipe d'Accueil 4638, Université Nantes Angers Le Mans, Angers University Hospital, Angers, France (OB)
| | - Matteo Cesari
- From the Gerontopôle, Toulouse University Hospital, Toulouse, France (YR and MC); the Institut national de la santé et de la recherche médicale (INSERM) Unité Mixte de Recherche 1027, University of Toulouse III, France (YR, AG, and MC); the Laboratory of Epidemiology and Community Health, Faculty of Medicine, Toulouse, France (CC, AG, and VL-C); the Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University of Lyon, INSERM U1033, Lyon, France (A-MS); the Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University Montpellier 1, Montpellier, France (HB); and the Department of Neuroscience, Division of Geriatric Medicine, Unité Propre de Recherche et d'Enseignement Supérieur-Equipe d'Accueil 4638, Université Nantes Angers Le Mans, Angers University Hospital, Angers, France (OB)
| | - Valérie Lauwers-Cances
- From the Gerontopôle, Toulouse University Hospital, Toulouse, France (YR and MC); the Institut national de la santé et de la recherche médicale (INSERM) Unité Mixte de Recherche 1027, University of Toulouse III, France (YR, AG, and MC); the Laboratory of Epidemiology and Community Health, Faculty of Medicine, Toulouse, France (CC, AG, and VL-C); the Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, University of Lyon, INSERM U1033, Lyon, France (A-MS); the Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University Montpellier 1, Montpellier, France (HB); and the Department of Neuroscience, Division of Geriatric Medicine, Unité Propre de Recherche et d'Enseignement Supérieur-Equipe d'Accueil 4638, Université Nantes Angers Le Mans, Angers University Hospital, Angers, France (OB)
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Bouchard C, Antunes-Correa LM, Ashley EA, Franklin N, Hwang PM, Mattsson CM, Negrao CE, Phillips SA, Sarzynski MA, Wang PY, Wheeler MT. Personalized preventive medicine: genetics and the response to regular exercise in preventive interventions. Prog Cardiovasc Dis 2014; 57:337-46. [PMID: 25559061 DOI: 10.1016/j.pcad.2014.08.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Regular exercise and a physically active lifestyle have favorable effects on health. Several issues related to this theme are addressed in this report. A comment on the requirements of personalized exercise medicine and in-depth biological profiling along with the opportunities that they offer is presented. This is followed by a brief overview of the evidence for the contributions of genetic differences to the ability to benefit from regular exercise. Subsequently, studies showing that mutations in TP53 influence exercise capacity in mice and humans are succinctly described. The evidence for effects of exercise on endothelial function in health and disease also is covered. Finally, changes in cardiac and skeletal muscle in response to exercise and their implications for patients with cardiac disease are summarized. Innovative research strategies are needed to define the molecular mechanisms involved in adaptation to exercise and to translate them into useful clinical and public health applications.
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Affiliation(s)
- Claude Bouchard
- Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA.
| | | | - Euan A Ashley
- Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA; Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA USA
| | - Nina Franklin
- Department of Physical Therapy, Department of Medicine, Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL, USA
| | - Paul M Hwang
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - C Mikael Mattsson
- Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA; The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Carlos E Negrao
- Heart Institute (InCor), Medical School, University of Sao Paulo, Sao Paulo, Brazil; School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Shane A Phillips
- Department of Physical Therapy, Department of Medicine, Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, IL, USA
| | - Mark A Sarzynski
- Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Ping-Yuan Wang
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew T Wheeler
- Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA; Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA USA
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Navaneethan SD, Kirwan JP, Arrigain S, Schold JD. Adiposity measures, lean body mass, physical activity and mortality: NHANES 1999-2004. BMC Nephrol 2014; 15:108. [PMID: 25005601 PMCID: PMC4099406 DOI: 10.1186/1471-2369-15-108] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 05/21/2014] [Indexed: 12/23/2022] Open
Abstract
Background Obesity and physical inactivity are major public health problems. We studied the associations between measures of adiposity, lean body mass, leisure time physical activity (LTPA), and death in those with and without chronic kidney disease (CKD). Methods Associations between body mass index (BMI), waist circumference (WC), percent body fat, lean body mass (assessed with Dual-Energy X-ray Absorptiometry[DEXA]), leisure time physical activity (LTPA) and death were examined using the National Health and Nutrition Examination Surveys (NHANES 1999–2004). All-cause mortality was ascertained by linkage of NHANES files with the National Death Index. Results 9,433 non-CKD participants and 2,153 CKD participants who had fat mass measured using DEXA, BMI, WC, LTPA and mortality data were included. After adjusting for demographics, comorbid conditions, kidney function measures, C-Reactive Protein (CRP), and sodium intake there was no significant risk for death noted with higher WC, fat mass and BMI in those with and without CKD. When examining normal, overweight, and obese groups based on BMI criteria, being overweight (BMI 25–29.9 kg/m2) was associated with lower risk of death in those without CKD (Hazard ratio 0.62, 95% CI 0.40, 0.95). Higher lean body mass was associated with lower risk for death in those without kidney disease but not in the CKD population. There was a significantly higher risk for death among those who did not meet the minimum LTPA goals compared to those who met or exceeded the recommended activity levels (>450 MET/min/week) in those with and without CKD (CKD Hazard ratio: 1.36, 95% CI 1.003, 1.85; non-CKD HR 1.65, 95% CI 1.21, 2.26). Conclusions In a representative sample of the US population, higher LTPA levels and lean body mass were associated with lower mortality in those without kidney disease. In CKD, higher LTPA was associated with lower risk of death. There was no association between adiposity measures and death in those with and without CKD except for lower mortality associated with overweight among those without CKD. The data suggests the need to develop programs to facilitate an increase in physical activity in people with and without kidney disease.
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Affiliation(s)
- Sankar D Navaneethan
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue- Q7, Cleveland, OH 44195, USA.
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22
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Faselis C, Doumas M, Pittaras A, Narayan P, Myers J, Tsimploulis A, Kokkinos P. Exercise Capacity and All-Cause Mortality in Male Veterans With Hypertension Aged ≥70 Years. Hypertension 2014; 64:30-5. [DOI: 10.1161/hypertensionaha.114.03510] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Charles Faselis
- From the Department of Medicine, Veterans Affairs Medical Center, Washington, DC (C.F., M.D., A.P., P.N., A.T., P.K.); Department of Cardiology, School of Medicine, Georgetown University, Washington, DC (P.K.); Department of Medicine, School of Medicine, George Washington University, Washington, DC (C.F., M.D., A.P., P.N., P.K.); and Department of Cardiology, Veterans Affairs Palo Alto Health Care System and Stanford University, CA (J.M.)
| | - Michael Doumas
- From the Department of Medicine, Veterans Affairs Medical Center, Washington, DC (C.F., M.D., A.P., P.N., A.T., P.K.); Department of Cardiology, School of Medicine, Georgetown University, Washington, DC (P.K.); Department of Medicine, School of Medicine, George Washington University, Washington, DC (C.F., M.D., A.P., P.N., P.K.); and Department of Cardiology, Veterans Affairs Palo Alto Health Care System and Stanford University, CA (J.M.)
| | - Andreas Pittaras
- From the Department of Medicine, Veterans Affairs Medical Center, Washington, DC (C.F., M.D., A.P., P.N., A.T., P.K.); Department of Cardiology, School of Medicine, Georgetown University, Washington, DC (P.K.); Department of Medicine, School of Medicine, George Washington University, Washington, DC (C.F., M.D., A.P., P.N., P.K.); and Department of Cardiology, Veterans Affairs Palo Alto Health Care System and Stanford University, CA (J.M.)
| | - Puneet Narayan
- From the Department of Medicine, Veterans Affairs Medical Center, Washington, DC (C.F., M.D., A.P., P.N., A.T., P.K.); Department of Cardiology, School of Medicine, Georgetown University, Washington, DC (P.K.); Department of Medicine, School of Medicine, George Washington University, Washington, DC (C.F., M.D., A.P., P.N., P.K.); and Department of Cardiology, Veterans Affairs Palo Alto Health Care System and Stanford University, CA (J.M.)
| | - Jonathan Myers
- From the Department of Medicine, Veterans Affairs Medical Center, Washington, DC (C.F., M.D., A.P., P.N., A.T., P.K.); Department of Cardiology, School of Medicine, Georgetown University, Washington, DC (P.K.); Department of Medicine, School of Medicine, George Washington University, Washington, DC (C.F., M.D., A.P., P.N., P.K.); and Department of Cardiology, Veterans Affairs Palo Alto Health Care System and Stanford University, CA (J.M.)
| | - Apostolos Tsimploulis
- From the Department of Medicine, Veterans Affairs Medical Center, Washington, DC (C.F., M.D., A.P., P.N., A.T., P.K.); Department of Cardiology, School of Medicine, Georgetown University, Washington, DC (P.K.); Department of Medicine, School of Medicine, George Washington University, Washington, DC (C.F., M.D., A.P., P.N., P.K.); and Department of Cardiology, Veterans Affairs Palo Alto Health Care System and Stanford University, CA (J.M.)
| | - Peter Kokkinos
- From the Department of Medicine, Veterans Affairs Medical Center, Washington, DC (C.F., M.D., A.P., P.N., A.T., P.K.); Department of Cardiology, School of Medicine, Georgetown University, Washington, DC (P.K.); Department of Medicine, School of Medicine, George Washington University, Washington, DC (C.F., M.D., A.P., P.N., P.K.); and Department of Cardiology, Veterans Affairs Palo Alto Health Care System and Stanford University, CA (J.M.)
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Winter JE, MacInnis RJ, Wattanapenpaiboon N, Nowson CA. BMI and all-cause mortality in older adults: a meta-analysis. Am J Clin Nutr 2014; 99:875-90. [PMID: 24452240 DOI: 10.3945/ajcn.113.068122] [Citation(s) in RCA: 445] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Whether the association between body mass index (BMI) and all-cause mortality for older adults is the same as for younger adults is unclear. OBJECTIVE The objective was to determine the association between BMI and all-cause mortality risk in adults ≥65 y of age. DESIGN A 2-stage random-effects meta-analysis was performed of studies published from 1990 to 2013 that reported the RRs of all-cause mortality for community-based adults aged ≥65 y. RESULTS Thirty-two studies met the inclusion criteria; these studies included 197,940 individuals with an average follow-up of 12 y. With the use of a BMI (in kg/m2) of 23.0-23.9 as the reference, there was a 12% greater risk of mortality for a BMI range of 21.0-21.9 and a 19% greater risk for a range of 20.0-20.9 [BMI of 21.0-21.9; HR (95% CI): 1.12 (1.10, 1.13); BMI of 20.0-20.9; HR (95% CI): 1.19 (1.17, 1.22)]. Mortality risk began to increase for BMI >33.0 [BMI of 33.0-33.9; HR (95% CI): 1.08 (1.00, 1.15)]. Self-reported anthropometric measurements, adjustment for intermediary factors, and exclusion of early deaths or preexisting disease did not markedly alter the associations, although there was a slight attenuation of the association in never-smokers. CONCLUSIONS For older populations, being overweight was not found to be associated with an increased risk of mortality; however, there was an increased risk for those at the lower end of the recommended BMI range for adults. Because the risk of mortality increased in older people with a BMI <23.0, it would seem appropriate to monitor weight status in this group to address any modifiable causes of weight loss promptly with due consideration of individual comorbidities.
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Affiliation(s)
- Jane E Winter
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Melbourne, Australia (JEW, NW, and CAN); the Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia (RJM); and the Centre for MEGA Epidemiology, University of Melbourne, Melbourne, Australia (RJM)
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24
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Barry VW, Baruth M, Beets MW, Durstine JL, Liu J, Blair SN. Fitness vs. fatness on all-cause mortality: a meta-analysis. Prog Cardiovasc Dis 2013; 56:382-90. [PMID: 24438729 DOI: 10.1016/j.pcad.2013.09.002] [Citation(s) in RCA: 386] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to quantify the joint association of cardiorespiratory fitness (CRF) and weight status on mortality from all causes using meta-analytical methodology. Studies were included if they were (1) prospective, (2) objectively measured CRF and body mass index (BMI), and (3) jointly assessed CRF and BMI with all-cause mortality. Ten articles were included in the final analysis. Pooled hazard ratios were assessed for each comparison group (i.e. normal weight-unfit, overweight-unfit and -fit, and obese-unfit and -fit) using a random-effects model. Compared to normal weight-fit individuals, unfit individuals had twice the risk of mortality regardless of BMI. Overweight and obese-fit individuals had similar mortality risks as normal weight-fit individuals. Furthermore, the obesity paradox may not influence fit individuals. Researchers, clinicians, and public health officials should focus on physical activity and fitness-based interventions rather than weight-loss driven approaches to reduce mortality risk.
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Affiliation(s)
- Vaughn W Barry
- Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN.
| | - Meghan Baruth
- Health Science, Saginaw Valley, State University, University Center, MI
| | - Michael W Beets
- Exercise Science, University of South Carolina, Columbia, SC
| | | | - Jihong Liu
- Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - Steven N Blair
- Exercise Science, University of South Carolina, Columbia, SC; Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
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Abstract
BACKGROUND Recently a number of studies have found a lower risk of dying for obese individuals than for normal-weight individuals. The explanation for these paradoxical findings has not yet been identified. OBJECTIVE The objective was to assess whether this paradoxical pattern exists in the US population and whether it can be explained by reverse causation. DESIGN Survival analyses were used to calculate the RR of all-cause mortality for obesity by using data from 35,673 participants in NHANES I (1971-1975), NHANES II (1976-1980), and NHANES III (1988-1994), which reported 7087 deaths during 3 different 15-y follow-up periods. RESULTS With normal weight as a referent, a lower relative mortality risk of obesity was found only in NHANES III and only among men with a wide variety of preexisting serious illnesses. For this subgroup, the relative mortality risks in NHANES I, II, and III were 2.22 (95% CI: 1.45, 3.40), 0.89 (95% CI: 0.70, 1.15), and 0.65 (95% CI: 0.47, 0.91), respectively. Whereas the mortality rate among seriously ill normal-weight men did not change significantly between NHANES I and III, it did decrease significantly among seriously ill obese men, suggesting that reverse causation was not responsible for the lower relative mortality risk among seriously ill obese men in NHANES III. CONCLUSIONS Only obese NHANES male participants with a wide variety of serious illnesses experienced lower mortality risk than their normal-weight counterparts and only in NHANES III. Reverse causation seems unlikely to have played a role. These conclusions require confirmation.
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Affiliation(s)
- James A Greenberg
- Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York, Brooklyn, NY 11210, USA.
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Woo J, Yu R, Yau F. Fitness, fatness and survival in elderly populations. AGE (DORDRECHT, NETHERLANDS) 2013; 35:973-984. [PMID: 22391688 PMCID: PMC3636403 DOI: 10.1007/s11357-012-9398-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 02/20/2012] [Indexed: 05/31/2023]
Abstract
This study examines the relative importance of fitness versus fatness in predicting mortality in elderly populations aged 70 years and over, and whether fitness may account for the 'paradoxical' relationship between better survival and increasing weight. Four thousand community-living Chinese men and women aged 65 years or over were recruited and stratified so that approximately 33% were in each of the age groups: 65-69, 70-74, and 75 or above. Medical history, height, weight, waist-hip ratio, body composition using DEXA, and walking speed were obtained. They were followed up for a mean of 7.0 years to ascertain death. Compared with the high fitness category, those in the moderate and low categories have a 43% and 68% increased risk of mortality at 7 years adjusting for multiple confounders. When mortality risk according to various fatness indicators was examined, only the lowest quartile of BMI, BFI, and FLMR conferred statistically significant increased risk. Fitness categories were significantly associated with all fatness indicators. The finding of fewer people in the high fitness category among the highest quartiles of other fatness indicators suggests that fitness is not the underlying mechanism for the obesity paradox. Within each quartile of fatness indicator, there was a significant trend towards reduced mortality with increasing fitness. In conclusion, the study confirms the beneficial effects of cardiorespiratory fitness on mortality but does not explain the 'obesity paradox'. The findings underscore the importance of maintaining physical fitness through exercise and re-confirm the importance of weight maintenance in reducing mortality risk.
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Affiliation(s)
- Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, People's Republic of China.
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Beleigoli AM, Boersma E, Diniz MDFH, Lima-Costa MF, Ribeiro AL. Overweight and class I obesity are associated with lower 10-year risk of mortality in Brazilian older adults: the Bambuí Cohort Study of Ageing. PLoS One 2012; 7:e52111. [PMID: 23251690 PMCID: PMC3522641 DOI: 10.1371/journal.pone.0052111] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 11/14/2012] [Indexed: 01/16/2023] Open
Abstract
Background Prospective studies mostly with European and North-American populations have shown inconsistent results regarding the association of overweight/obesity and mortality in older adults. Our aim was to investigate the relationship between overweight/ obesity and mortality in an elderly Brazilian population. Methods and Findings Participants were 1,450 (90.2% from total) individuals aged 60 years and over from the community-based Bambuí (Brazil) Cohort Study of Ageing. From 1997 to 2007, 521 participants died and 89 were lost, leading to 12,905 person-years of observation. Body mass index (BMI) and waist circumference (WC) were assessed at baseline and at the 3rd and 5th years of follow-up. Multiple imputation was performed to deal with missing values. Hazard ratios (HR) of mortality for BMI or WC alone (continuous and categorical), and BMI and WC together (continuous) were estimated by extended Cox regression models, which were fitted for clinical, socioeconomic and behavioral confounders. Adjusted absolute rates of death at 10-year follow-up were estimated for the participants with complete data at baseline. Continuous BMI (HR 0.85; 95% CI 0.80–0.90) was inversely related to mortality, even after exclusion of smokers (HR 0.85; 0.80–0.90), and participants who had weight variation and died within the first 5 years of follow-up (HR 0.83; CI 95% 0.73–0.94). Overweight (BMI 25–30 kg/m2) was inversely (HR 0.76; 95%CI 0.61–0.93) and obesity (BMI ≥30 kg/m2; HR 0.85; 95% CI 0.64–1.14) not significantly associated with mortality. Subjects with BMI between 25–35 kg/m2 (23.8–25.9%) had the lowest absolute rates of death at 10-years follow-up. The association between WC and death was not significant, except after adjusting WC for BMI levels, when the relationship turned into marginally positive (HR 1.01; CI 95% 1.00–1.02). Conclusions The usual BMI and WC cut-off points should not be used to guide public health and clinical weight control interventions in elderly in Brazil.
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Affiliation(s)
- Alline M Beleigoli
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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28
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Sandercock GRH, Cardoso F, Almodhy M, Pepera G. Cardiorespiratory fitness changes in patients receiving comprehensive outpatient cardiac rehabilitation in the UK: a multicentre study. Heart 2012. [DOI: 10.1136/heartjnl-2012-303055] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Lum HD, Studenski SA, Degenholtz HB, Hardy SE. Early hospital readmission is a predictor of one-year mortality in community-dwelling older Medicare beneficiaries. J Gen Intern Med 2012; 27:1467-74. [PMID: 22692634 PMCID: PMC3475824 DOI: 10.1007/s11606-012-2116-3] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 04/18/2012] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Hospital readmission within thirty days is common among Medicare beneficiaries, but the relationship between rehospitalization and subsequent mortality in older adults is not known. OBJECTIVE To compare one-year mortality rates among community-dwelling elderly hospitalized Medicare beneficiaries who did and did not experience early hospital readmission (within 30 days), and to estimate the odds of one-year mortality associated with early hospital readmission and with other patient characteristics. DESIGN AND PARTICIPANTS A cohort study of 2133 hospitalized community-dwelling Medicare beneficiaries older than 64 years, who participated in the nationally representative Cost and Use Medicare Current Beneficiary Survey between 2001 and 2004, with follow-up through 2006. MAIN MEASURE One-year mortality after index hospitalization discharge. KEY RESULTS Three hundred and four (13.7 %) hospitalized beneficiaries had an early hospital readmission. Those with early readmission had higher one-year mortality (38.7 %) than patients who were not readmitted (12.1 %; p<0.001). Early readmission remained independently associated with mortality after adjustment for sociodemographic factors, health and functional status, medical comorbidity, and index hospitalization-related characteristics [HR (95 % CI) 2.97 (2.24-3.92)]. Other patient characteristics independently associated with mortality included age [1.03 (1.02-1.05) per year], low income [1.39 (1.04-1.86)], limited self-rated health [1.60 (1.20-2.14)], two or more recent hospitalizations [1.47 (1.01-2.15)], mobility difficulty [1.51 (1.03-2.20)], being underweight [1.62 (1.14-2.31)], and several comorbid conditions, including chronic lung disease, cancer, renal failure, and weight loss. Hospitalization-related factors independently associated with mortality included longer length of stay, discharge to a skilled nursing facility for post-acute care, and primary diagnoses of infections, cancer, acute myocardial infarction, and heart failure. CONCLUSIONS Among community-dwelling older adults, early hospital readmission is a marker for notably increased risk of one-year mortality. Providers, patients, and families all might respond profitably to an early readmission by reviewing treatment plans and goals of care.
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Affiliation(s)
- Hillary D Lum
- Division of Geriatric Medicine, University of Colorado School of Medicine, Denver, CO, USA
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30
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Leeper NJ, Myers J, Zhou M, Nead KT, Syed A, Kojima Y, Caceres RD, Cooke JP. Exercise capacity is the strongest predictor of mortality in patients with peripheral arterial disease. J Vasc Surg 2012; 57:728-33. [PMID: 23044259 DOI: 10.1016/j.jvs.2012.07.051] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of this study was to assess the predictive value of clinical and exercise test variables in patients with peripheral arterial disease (PAD). METHODS A customized symptom-limited ramp treadmill protocol was used to assess 725 PAD patients referred for exercise testing at the Palo Alto Veterans Hospital between 1997 and 2011. Detailed clinical and exercise test data were collected at baseline, and patients were followed up for a mean of 11.3 ± 6.3 years. RESULTS During follow-up, there were 364 deaths. Baseline exercise capacity was 7.0 ± 2.6 metabolic equivalents (METs) among survivors and 5.5 ± 2.4 METs in those who died (P < .001). Although several physiologic parameters differed between survivors and nonsurvivors, age-adjusted Cox regression revealed that exercise capacity was the strongest independent predictor of death. Each additional MET achieved was associated with age-adjusted 18% and 20% reductions in all-cause and cardiovascular mortality, respectively (P < .001 for both). This variable surpassed all classical risk factors (including smoking and history of congestive heart failure) and all measured exercise test responses (including symptoms and electrocardiograph abnormalities). CONCLUSIONS Among PAD patients, reduced exercise capacity is the most powerful harbinger of long-term mortality. This factor has predictive power beyond traditional risk factors and confirms the critical importance of fitness in this cohort.
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Affiliation(s)
- Nicholas J Leeper
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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31
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Abstract
The prevalence of obesity is rising progressively, even among older age groups. By the year 2030 to 2035 over 20% of the adult US population and over 25% of the Europeans will be aged 65 years or older. The predicted prevalence of obesity in Americans, 60 years and older was 37% in 2010. The predicted prevalence of obesity in Europe in 2015 varies between 20% and 30% dependent on the model used. This means 20.9 million obese 60 years or older people in the United States in 2010 and 32 million obese elders in 2015 in EU. Although cutoff values of body mass index, waist circumference, and percentages of fat mass have not been defined for the elderly, it is clear from several meta-analyses that mortality and morbidity associated with overweight and obesity only increases at a body mass index >30 kg/m(2). Thus, treatment should only be offered to patients who are obese rather than overweight and who have functional impairments, metabolic complications, or obesity-related diseases, that can benefit from weight loss. The weight loss therapy should minimize muscle and bone loss and vigilance as regards the development of sarcopenic obesity--a combination of an unhealthy excess of body fat with a detrimental loss of muscle and fat-free mass including bone--is important. Lifestyle intervention should be the first step and consists of a diet with a 500 kcal energy deficit and an adequate intake of protein of high biological quality, together with calcium and vitamin D, behavioral therapy, and multicomponent exercise. Multicomponent exercise includes flexibility training, balance training, aerobic exercise, and resistance training. The adherence rate in most studies is around 75%. Knowledge of constraints and modulators of physical inactivity should be of help to engage the elderly in physical activity. The role of pharmacotherapy and bariatric surgery in the elderly is largely unknown as in most studies people aged 65 years and older were excluded.
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32
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Lee JSW, Auyeung TW, Kwok T, Li M, Leung J, Woo J. Survival benefit of abdominal adiposity: a 6-year follow-up study with Dual X-ray absorptiometry in 3,978 older adults. AGE (DORDRECHT, NETHERLANDS) 2012; 34:597-608. [PMID: 21667162 PMCID: PMC3337922 DOI: 10.1007/s11357-011-9272-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 05/18/2011] [Indexed: 05/30/2023]
Abstract
In contrast to that in the middle-aged, higher body mass index (BMI) in older people is associated with higher survival rates. Yet, BMI makes no distinction between fat elsewhere and abdominal fat, the latter being metabolically more harmful. We hypothesized that overall adiposity might be protective in old age, but that central fat might offset that benefit and remained harmful as in the middle-aged. Three thousand nine hundred seventy-eight Chinese elderly ≥65 years had demographics, medical conditions, physical activity, and body composition by DXA recorded at baseline. Overall adiposity was measured as whole body fat%, and abdominal adiposity as waist circumference, waist-hip ratio, and relative abdominal fat (RAF) (relative abdominal fat = abdominal fat according to anatomical landmarks/whole body fat). Deaths within 1 year from baseline were excluded from analysis. All-cause and cardiovascular mortality were analyzed using Cox regression, adjusted for covariates. The lowest quintile of adiposity measurements was used for comparison. After a mean follow-up of 72.3 months, 13.7% men and 4.5% women had died. In men, the highest two quintiles of whole body fat % and the upper four quintiles of RAF were associated with significantly lower all-cause mortality, and adjusted hazard ratio (95% CI) in ascending quintiles of RAF compared with the lowest quintile was 0.62 (0.43-0.89), 0.58 (0.4-0.85), 0.52 (0.36-0.77), and 0.67 (0.47-0.96). No relationship was found between abdominal adiposity and cardiovascular mortality in both genders. Higher whole body fat % as well as higher proportion of abdominal fat was associated with lower all-cause mortality in men. No such relation was found in women.
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Affiliation(s)
- Jenny Shun Wah Lee
- Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- The S H Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine and Geriatrics, Shatin Hospital, 33 A Kung Kok Street, Shatin, Hong Kong, China
| | - Tung Wai Auyeung
- The S H Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine and Geriatrics, Pok Oi Hospital, Hong Kong, China
| | - Timothy Kwok
- Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Martin Li
- Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason Leung
- The Jockey Club Centre of Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, China
| | - Jean Woo
- Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- The S H Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China
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McAuley PA, Smith NS, Emerson BT, Myers JN. The obesity paradox and cardiorespiratory fitness. J Obes 2012; 2012:951582. [PMID: 22523668 PMCID: PMC3317120 DOI: 10.1155/2012/951582] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 12/08/2011] [Indexed: 11/18/2022] Open
Abstract
Cardiorespiratory fitness as an explanation for the obesity paradox warrants further examination. We evaluated independent and joint associations of cardiorespiratory fitness and adiposity with all-cause mortality in 811 middle-aged (age, 53.3 ± 7.2 years) male never smokers without documented cardiopulmonary disease or diabetes from the Veterans Exercise Testing Study (VETS). Cardiorespiratory fitness was quantified in metabolic equivalents (METs) using final treadmill speed and grade achieved on a maximal exercise test. Subjects were grouped for analysis by METs: unfit (lowest third) and fit (upper two-thirds); and by body mass index (kg/m(2)): nonobese (18.5-29.9) and obese (≥30.0). Associations of baseline fitness and adiposity measures with all-cause mortality were determined by Cox proportional hazards analysis adjusted for age, ethnicity, hypertension, hypercholesterolemia, family history of coronary artery disease, and cardiovascular medication use. In multivariate analysis, mortality risk for obese/fit men did not differ significantly from the nonobese/fit reference group. However, compared to the reference group, nonobese and obese unfit men were 2.2 (P = 0.01) and 1.9 (P = 0.03) times more likely to die, respectively. Cardiorespiratory fitness altered the obesity paradox such that mortality risk was lower for both obese and nonobese men who were fit.
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Affiliation(s)
- Paul A. McAuley
- Department of Human Performance and Sport Sciences, Winston-Salem State University, C024 Anderson, 601 S Martin Luther King Jr Drive, Winston-Salem, NC 27110, USA
- *Paul A. McAuley:
| | - Nancy S. Smith
- Department of Physical Therapy, Winston-Salem State University, Winston-Salem, NC 27110, USA
| | - Brian T. Emerson
- Department of Physical Therapy, Winston-Salem State University, Winston-Salem, NC 27110, USA
| | - Jonathan N. Myers
- Department of Cardiology, Division of Cardiovascular Medicine, Veterans Affairs Palo Alto Health Care System, Stanford University, Palo Alto, CA 94304, USA
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34
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Mathus-Vliegen EMH. Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline. Obes Facts 2012; 5:460-83. [PMID: 22797374 DOI: 10.1159/000341193] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 06/04/2012] [Indexed: 01/18/2023] Open
Abstract
The prevalence of obesity is rising progressively, even among older age groups. By the year 2030-2035 over 20% of the adult US population and over 25% of the Europeans will be aged 65 years and older. The predicted prevalence of obesity in Americans, 60 years and older was 37% in 2010. The predicted prevalence of obesity in Europe in 2015 varies between 20 and 30% dependent on the model used. This means 20.9 million obese 60+ people in the USA in 2010 and 32 million obese elders in 2015 in the EU. Although cut-off values of BMI, waist circumference and percentages of fat mass have not been defined for the elderly (nor for the elderly of different ethnicity), it is clear from several meta-analyses that mortality and morbidity associated with overweight and obesity only increases at a BMI above 30 kg/m(2). Thus, treatment should only be offered to patients who are obese rather than overweight and who also have functional impairments, metabolic complications or obesity-related diseases, that can benefit from weight loss. The weight loss therapy should aim to minimize muscle and bone loss but also vigilance as regards the development of sarcopenic obesity - a combination of an unhealthy excess of body fat with a detrimental loss of muscle and fat-free mass including bone - is important in the elderly, who are vulnerable to this outcome. Life-style intervention should be the first step and consists of a diet with a 500 kcal (2.1 MJ) energy deficit and an adequate intake of protein of high biological quality together with calcium and vitamin D, behavioural therapy and multi-component exercise. Multi-component exercise includes flexibility training, balance training, aerobic exercise and resistance training. The adherence rate in most studies is around 75%. Knowledge of constraints and modulators of physical inactivity should be of help to engage the elderly in physical activity. The role of pharmacotherapy and bariatric surgery in the elderly is largely unknown as in most studies people aged 65 years and older have been excluded.
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Affiliation(s)
- Elisabeth M H Mathus-Vliegen
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Sandercock G, Hurtado V, Cardoso F. Changes in cardiorespiratory fitness in cardiac rehabilitation patients: a meta-analysis. Int J Cardiol 2011; 167:894-902. [PMID: 22206636 DOI: 10.1016/j.ijcard.2011.11.068] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 11/26/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES Improving patients' cardiorespiratory fitness is an important therapeutic outcome in cardiac rehabilitation. The ability of cardiac rehabilitation to reduce mortality and morbidity has been evidenced through several meta-analyses. Whether cardiac rehabilitation can increase cardiorespiratory fitness and which factors may influence such gains are less well quantified. METHODS We performed detailed literature searches of electronic databases and manually searched papers concerning changes in cardiorespiratory fitness in cardiac rehabilitation patients. We performed random-effects meta-analysis of mean improvements in cardiorespiratory fitness and subgroup analyses to determine potential sources of heterogeneity. RESULTS Data from 31 studies produced 48 groups (n=3827) with a mean improvement of 1.55 (95% CI 1.21-1.89) METs, (p<0.001); equivalent to standardised effect size of ES=0.97 (95% CI 0.80-1.13). As this value was highly heterogeneous (Q=852, p<0.001) we performed subgroup analyses on the effect size data. Gains in fitness were highest in patients receiving >36 exercise sessions in studies where fitness was assessed using the Naughton Protocol. Patient characteristics associated with the highest fitness gains were age (being young) and sex (being male training in a male-only exercise group). Changes in fitness were unrelated to programme type (comprehensive or exercise-only), duration or study design. There was no association with patient's baseline fitness levels. CONCLUSION This is the first meta-analysis of changes in cardiovascular fitness in cardiac rehabilitation patients and shows clinically significant improvements in a large sample of patients from a variety of rehabilitation programmes. This analysis helps describe the characteristics of cardiac rehabilitation programmes which can increase patients' cardiorespiratory fitness.
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Affiliation(s)
- Gavin Sandercock
- Centre for Sports and Exercise Science, Department of Biological Sciences, University of Essex, Colchester CO43SQ, UK.
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Abstract
Physical activity seems to be an important component of lifestyle interventions for weight loss and maintenance. Although the effects of physical activity on weight loss may seem to be modest, there seems to be a dose-response relationship between physical activity and weight loss. Physical activity also seems to be a critically important behavior to promote long-term weight loss and the prevention of weight regain. The benefits of physical activity on weight loss are also observed in patients with severe obesity (BMI ≥ 35 kg/m²) and in patients who have undergone bariatric surgery. Moreover, independent of the effect of physical activity on body weight, engagement in physical activity that results in improved cardiorespiratory fitness can contribute to reductions in health risk in overweight and obese adults. Thus, progression of overweight and obese patients to an adequate dose of physical activity needs to be incorporated into clinical interventions for weight control.
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Myers J, Lata K, Chowdhury S, McAuley P, Jain N, Froelicher V. The obesity paradox and weight loss. Am J Med 2011; 124:924-30. [PMID: 21798508 DOI: 10.1016/j.amjmed.2011.04.018] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 04/09/2011] [Accepted: 04/13/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND An "obesity paradox," in which overweight and obese individuals with established cardiovascular disease have a better prognosis than normal weight subjects, has been reported in a number of clinical cohorts, but little is known about the effects of weight loss on the obesity paradox and its association with health outcomes. METHODS Weight was determined in 3834 men at the time of a clinically referred exercise test and again during a clinical evaluation a mean of 7 years later. The associations among weight changes, baseline fitness, and other risk markers with cardiovascular and all-cause mortality were determined by Cox proportional hazards analysis. RESULTS During the follow-up period, 314 subjects died (72 of cardiovascular causes). In a multivariate analysis (including baseline weight, weight change, exercise capacity, and cardiovascular disease), weight gain was associated with lower mortality and weight loss was associated with higher mortality (4% higher per pound lost per year, P<.001) compared with stable weight. For all-cause mortality, the relative risks for the no change, weight gain, and weight loss groups were 1.0 (referent), 0.64 (95% confidence interval, 0.50-0.83), and 1.49 (95% confidence interval, 1.17-1.89), respectively (P<.001). Those who died and exhibited weight loss had a significantly higher prevalence of deaths due to cancer and cardiovascular causes. CONCLUSION Weight loss was related to higher mortality and weight gain was related to lower mortality when compared with stable weight. The obesity paradox in our sample is explained in part by a combination of non-volitional weight loss related to occult disease and a protective effect of weight gain.
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Affiliation(s)
- Jonathan Myers
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA.
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Zunzunegui MV, Sanchez MT, Garcia A, Casado JMR, Otero A. Body mass index and long-term mortality in an elderly Mediterranean population. J Aging Health 2011; 24:29-47. [PMID: 21628632 DOI: 10.1177/0898264311408419] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To describe the relationship of body mass index and mortality in older adults, examining the influence of sex and cardiovascular morbidity. METHODS Sixteen-year cohort of a population sample of 1,008 people aged 65 and over. BMI mortality hazard ratios are estimated controlling for age, sex, education, physical activity, smoking, chronic conditions, and ADL (activities of daily living) disability. RESULTS At baseline the median BMI is 26.8 (Interquartile range: 24.2-29.7 Kg/m(2)). Findings show that during 16 years there were 672 deaths. The U-shaped curve of the mortality hazard by BMI is wide. The minimum mortality occur at BMI = 30.5 Kg/m(2). Findings show that men had lower mortality risk with increasing BMI and that cardiovascular disease was associated with high mortality in the low-BMI category. DISCUSSION Underweight is a risk factor for mortality among elderly people, whereas overweight and mild obesity are associated with the lowest mortality particularly among men and those with cardiovascular morbidity.
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Abstract
With increasing life expectancy in developed and developing countries, maintaining health and function in old age has become an important goal, including avoidance or optimal control of chronic diseases; maintenance or retarding the decline of physical and cognitive function; optimizing psychological health; and maintaining independent functioning in tasks related to self-care and societal interaction. This article discusses all of those, as well as other components of successful aging such as social network and socioeconomic status.
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Affiliation(s)
- Jean Woo
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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Goel K, Thomas RJ, Squires RW, Coutinho T, Trejo-Gutierrez JF, Somers VK, Miles JM, Lopez-Jimenez F. Combined effect of cardiorespiratory fitness and adiposity on mortality in patients with coronary artery disease. Am Heart J 2011; 161:590-7. [PMID: 21392616 DOI: 10.1016/j.ahj.2010.12.012] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 12/06/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND High cardiorespiratory fitness and body mass index (BMI) are associated with decreased mortality in patients with coronary artery disease. Our objective was to determine the joint impact of fitness and adiposity measures on all-cause mortality in this subgroup. METHODS Coronary artery disease patients (n = 855) enrolled in the Mayo Clinic cardiac rehabilitation program from 1993 to 2007 were included. Fitness levels were determined by cardiopulmonary exercise testing. Patients were divided into low and high fitness by sex-specific median values of peak oxygen consumption and total treadmill time. Adiposity was measured through BMI and waist-to-hip ratio (WHR). RESULTS There were 159 deaths during 9.7 ± 3.6 years of mean follow-up. After adjusting for potential confounding factors, low fitness, shorter treadmill time, low BMI, and high WHR were significantly associated with increased mortality. Using low WHR-high fitness group as reference, significantly increased mortality was noted in low WHR-low fitness (hazard ratio 4.2, 95% CI, 1.8-9.8), centrally obese-high fitness (2.3, 1.0-5.4), and centrally obese-low fitness (6.1, 2.7-13.6) groups. Overweight-high fitness (2.2, 0.63-7.4), obese-high fitness (3.2, 0.88-11.4), and obese-low fitness (3.3, 0.96-11.4) subjects did not have a significantly different mortality as compared with the reference group of normal weight-high fitness subjects, whereas normal weight-low fitness (9.6, 2.9-31.8) and overweight-low fitness (6.8, 2.1-22.2) groups had significantly increased mortality. CONCLUSIONS Low fitness and central obesity were independently and cumulatively associated with increased mortality in coronary artery disease patients attending cardiac rehabilitation. The association of BMI with mortality is complex and altered by fitness levels.
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Affiliation(s)
- Kashish Goel
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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Le Couteur DG, Benson VL, McMahon AC, Blyth F, Handelsman DJ, Seibel MJ, Kennerson M, Naganathan V, Cumming RG, de Cabo R. Determinants of serum-induced SIRT1 expression in older men: the CHAMP study. J Gerontol A Biol Sci Med Sci 2010; 66:3-8. [PMID: 20819794 DOI: 10.1093/gerona/glq158] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Circulating factors that have an effect on SIRT1 expression are influenced by caloric restriction. To determine the association between frailty and such circulating factors, we measured serum-induced SIRT1 expression from a nested cohort of frail (n = 77) and robust (n = 82) participants from Concord Health and Ageing in Men Project, a population-based study of community-dwelling men older than 70 years. Serum-induced SIRT1 expression was not different between frail and robust men (103.1 ± 17.0 versus 100.4 ± 19.3 μg/L). However, subsequent analyses showed that men with the lowest values (first quartile) were less likely to be frail (odds ratio = 0.5, 95% confidence interval = 0.2-1.0, p = .04) and had higher total body lean mass (p = .001) than the other participants. Serum-induced SIRT1 expression did not correlate with age, diseases, medications, albumin, fasting glucose, or lipids. Overall, there was no association between frailty and serum-induced SIRT1 expression; however, post hoc analysis suggested that there might be a paradoxical association between low serum-induced SIRT1 expression and robustness.
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Affiliation(s)
- David G Le Couteur
- Centre for Education and Research on Ageing, Concord Repatriation General Hospital, University of Sydney, Hospital Road, Concord, NSW 2139, Australia.
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Kokkinos P, Myers J, Faselis C, Panagiotakos DB, Doumas M, Pittaras A, Manolis A, Kokkinos; JP, Karasik P, Greenberg M, Papademetriou V, Fletcher R. Exercise Capacity and Mortality in Older Men. Circulation 2010; 122:790-7. [DOI: 10.1161/circulationaha.110.938852] [Citation(s) in RCA: 237] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Epidemiological findings, based largely on middle-aged populations, support an inverse and independent association between exercise capacity and mortality risk. The information available in older individuals is limited.
Methods and Results—
Between 1986 and 2008, we assessed the association between exercise capacity and all-cause mortality in 5314 male veterans aged 65 to 92 years (mean±SD, 71.4±5.0 years) who completed an exercise test at the Veterans Affairs Medical Centers in Washington, DC, and Palo Alto, Calif. We established fitness categories based on peak metabolic equivalents (METs) achieved. During a median 8.1 years of follow-up (range, 0.1 to 25.3), there were 2137 deaths. Baseline exercise capacity was 6.3±2.4 METs among survivors and 5.3±2.0 METs in those who died (
P
<0.001) and emerged as a strong predictor of mortality. For each 1-MET increase in exercise capacity, the adjusted hazard for death was 12% lower (hazard ratio=0.88; confidence interval, 0.86 to 0.90). Compared with the least fit individuals (≤4 METs), the mortality risk was 38% lower for those who achieved 5.1 to 6.0 METs (hazard ratio=0.62; confidence interval, 0.54 to 0.71) and progressively declined to 61% (hazard ratio=0.39; confidence interval, 0.32 to 0.49) for those who achieved >9 METs, regardless of age. Unfit individuals who improved their fitness status with serial testing had a 35% lower mortality risk (hazard ratio=0.65; confidence interval, 0.46 to 0.93) compared with those who remained unfit.
Conclusions—
Exercise capacity is an independent predictor of all-cause mortality in older men. The relationship is inverse and graded, with most survival benefits achieved in those with an exercise capacity >5 METs. Survival improved significantly when unfit individuals became fit.
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Affiliation(s)
- Peter Kokkinos
- From the Cardiology Division, Veterans Affairs Medical Center, Washington, DC (P. Kokkinos, C.F., M.D., A.P., A.M., J.P.K., P. Karasik, M.G., V.P., R.F.); Georgetown University School of Medicine, Washington, DC (P. Kokkinos); Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (J.M.); Stanford University, Stanford, Calif (J.M.); Harokopio University, Athens, Greece (D.B.P.); and Asklepeion General Hospital, Athens, Greece (A.M.)
| | - Jonathan Myers
- From the Cardiology Division, Veterans Affairs Medical Center, Washington, DC (P. Kokkinos, C.F., M.D., A.P., A.M., J.P.K., P. Karasik, M.G., V.P., R.F.); Georgetown University School of Medicine, Washington, DC (P. Kokkinos); Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (J.M.); Stanford University, Stanford, Calif (J.M.); Harokopio University, Athens, Greece (D.B.P.); and Asklepeion General Hospital, Athens, Greece (A.M.)
| | - Charles Faselis
- From the Cardiology Division, Veterans Affairs Medical Center, Washington, DC (P. Kokkinos, C.F., M.D., A.P., A.M., J.P.K., P. Karasik, M.G., V.P., R.F.); Georgetown University School of Medicine, Washington, DC (P. Kokkinos); Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (J.M.); Stanford University, Stanford, Calif (J.M.); Harokopio University, Athens, Greece (D.B.P.); and Asklepeion General Hospital, Athens, Greece (A.M.)
| | - Demosthenes B. Panagiotakos
- From the Cardiology Division, Veterans Affairs Medical Center, Washington, DC (P. Kokkinos, C.F., M.D., A.P., A.M., J.P.K., P. Karasik, M.G., V.P., R.F.); Georgetown University School of Medicine, Washington, DC (P. Kokkinos); Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (J.M.); Stanford University, Stanford, Calif (J.M.); Harokopio University, Athens, Greece (D.B.P.); and Asklepeion General Hospital, Athens, Greece (A.M.)
| | - Michael Doumas
- From the Cardiology Division, Veterans Affairs Medical Center, Washington, DC (P. Kokkinos, C.F., M.D., A.P., A.M., J.P.K., P. Karasik, M.G., V.P., R.F.); Georgetown University School of Medicine, Washington, DC (P. Kokkinos); Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (J.M.); Stanford University, Stanford, Calif (J.M.); Harokopio University, Athens, Greece (D.B.P.); and Asklepeion General Hospital, Athens, Greece (A.M.)
| | - Andreas Pittaras
- From the Cardiology Division, Veterans Affairs Medical Center, Washington, DC (P. Kokkinos, C.F., M.D., A.P., A.M., J.P.K., P. Karasik, M.G., V.P., R.F.); Georgetown University School of Medicine, Washington, DC (P. Kokkinos); Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (J.M.); Stanford University, Stanford, Calif (J.M.); Harokopio University, Athens, Greece (D.B.P.); and Asklepeion General Hospital, Athens, Greece (A.M.)
| | - Athanasios Manolis
- From the Cardiology Division, Veterans Affairs Medical Center, Washington, DC (P. Kokkinos, C.F., M.D., A.P., A.M., J.P.K., P. Karasik, M.G., V.P., R.F.); Georgetown University School of Medicine, Washington, DC (P. Kokkinos); Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (J.M.); Stanford University, Stanford, Calif (J.M.); Harokopio University, Athens, Greece (D.B.P.); and Asklepeion General Hospital, Athens, Greece (A.M.)
| | - John Peter Kokkinos;
- From the Cardiology Division, Veterans Affairs Medical Center, Washington, DC (P. Kokkinos, C.F., M.D., A.P., A.M., J.P.K., P. Karasik, M.G., V.P., R.F.); Georgetown University School of Medicine, Washington, DC (P. Kokkinos); Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (J.M.); Stanford University, Stanford, Calif (J.M.); Harokopio University, Athens, Greece (D.B.P.); and Asklepeion General Hospital, Athens, Greece (A.M.)
| | - Pamela Karasik
- From the Cardiology Division, Veterans Affairs Medical Center, Washington, DC (P. Kokkinos, C.F., M.D., A.P., A.M., J.P.K., P. Karasik, M.G., V.P., R.F.); Georgetown University School of Medicine, Washington, DC (P. Kokkinos); Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (J.M.); Stanford University, Stanford, Calif (J.M.); Harokopio University, Athens, Greece (D.B.P.); and Asklepeion General Hospital, Athens, Greece (A.M.)
| | - Michael Greenberg
- From the Cardiology Division, Veterans Affairs Medical Center, Washington, DC (P. Kokkinos, C.F., M.D., A.P., A.M., J.P.K., P. Karasik, M.G., V.P., R.F.); Georgetown University School of Medicine, Washington, DC (P. Kokkinos); Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (J.M.); Stanford University, Stanford, Calif (J.M.); Harokopio University, Athens, Greece (D.B.P.); and Asklepeion General Hospital, Athens, Greece (A.M.)
| | - Vasilios Papademetriou
- From the Cardiology Division, Veterans Affairs Medical Center, Washington, DC (P. Kokkinos, C.F., M.D., A.P., A.M., J.P.K., P. Karasik, M.G., V.P., R.F.); Georgetown University School of Medicine, Washington, DC (P. Kokkinos); Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (J.M.); Stanford University, Stanford, Calif (J.M.); Harokopio University, Athens, Greece (D.B.P.); and Asklepeion General Hospital, Athens, Greece (A.M.)
| | - Ross Fletcher
- From the Cardiology Division, Veterans Affairs Medical Center, Washington, DC (P. Kokkinos, C.F., M.D., A.P., A.M., J.P.K., P. Karasik, M.G., V.P., R.F.); Georgetown University School of Medicine, Washington, DC (P. Kokkinos); Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (J.M.); Stanford University, Stanford, Calif (J.M.); Harokopio University, Athens, Greece (D.B.P.); and Asklepeion General Hospital, Athens, Greece (A.M.)
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Garber CE, Greaney ML, Riebe D, Nigg CR, Burbank PA, Clark PG. Physical and mental health-related correlates of physical function in community dwelling older adults: a cross sectional study. BMC Geriatr 2010; 10:6. [PMID: 20128902 PMCID: PMC2835714 DOI: 10.1186/1471-2318-10-6] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 02/03/2010] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Physical function is the ability to perform both basic and instrumental activities of daily living, and the ability of older adults to reside in the community depends to a large extent on their level of physical function. Multiple physical and health-related variables may differentially affect physical function, but they have not been well characterized. The purpose of this investigation was to identify and examine physical and mental health-related correlates of physical function in a sample of community-dwelling older adults. METHODS Nine hundred and four community dwelling older men (n = 263) and women (n = 641) with a mean (95% Confidence Interval) age of 76.6 (76.1, 77.1) years underwent tests of physical function (Timed Up and Go; TUG), Body Mass Index (BMI) was calculated from measured height and weight, and data were collected on self-reported health quality of life (SF-36), falls during the past 6 months, number of medications per day, depression (Geriatric Depression Scale; GDS), social support, and sociodemographic variables. RESULTS Subjects completed the TUG in 8.7 (8.2, 9.2) seconds and expended 6,976 (6,669, 7,284) Kcal.wk-1 in physical activity. The older persons had a mean BMI of 27. 6 (27.2, 28.0), 62% took 3 or more medications per day, and 14.4% had fallen one or more times over the last 6 months. Mean scores on the Mental Component Summary (MCS) was 50.6 (50.2, 51,0) and the Physical Component Summary (PCS) was 41.3 (40.8, 41.8).Multiple sequential regression analysis showed that, after adjustment for TUG floor surface correlates of physical function included age, sex, education, physical activity (weekly energy expenditure), general health, bodily pain, number of medications taken per day, depression and Body Mass Index. Further, there is a dose response relationship such that greater degree of physical function impairment is associated with poorer scores on physical health-related variables. CONCLUSIONS Physical function in community-dwelling older adults is associated with several physical and mental health-related factors. Further study examining the nature of the relationships between these variables is needed.
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Affiliation(s)
- Carol Ewing Garber
- Teachers College, Columbia University, Department of Biobehavioral Sciences, Program in Movement Sciences and Education, 525 West 120th Street, Box 199, New York, NY 10027, USA
| | - Mary L Greaney
- Dana Farber Cancer Institute, The Center for Community-Based Research, 44 Binney Street, Boston, MA 02115, USA
| | - Deborah Riebe
- The University of Rhode Island, Department of Kinesiology, 25 West Independence Way, Kingston, RI 20881, USA
| | - Claudio R Nigg
- University of Hawaii, Department of Public Health Studies, Social and Behavioral Sciences, 1960 East West Road, Honolulu, HI 96822, USA
| | - Patricia A Burbank
- University of Rhode Island, College of Nursing, 2 Heathman Road, White Hall, Kingston, RI 02881, USA
| | - Phillip G Clark
- The University of Rhode Island, Program in Gerontology, 55 Lower College Road, 100 Quinn Hall, Kingston, RI 02881, USA
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Perceived constraints on physical exercise among obese and non-obese older people. Prev Med 2009; 49:506-10. [PMID: 19833148 DOI: 10.1016/j.ypmed.2009.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 09/28/2009] [Accepted: 10/06/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine what older obese people consider as constraints on their physical exercise and to determine whether these constraints can explain the differences in physical activity. METHODS Six hundred nineteen community-living people aged 75-81 years living in Jyväskylä, Central Finland, in 2003 were included in these cross-sectional analyses. Weight and height were measured at the research center, and physical activity and perceived constraints on physical exercise were assessed using validated questionnaires. Participants were categorized as non-obese (n=436), moderately obese (n=127) or severely obese (n=56). RESULTS The risk of physical inactivity was two times higher in the moderately obese group (OR 1.99, 95% CI 1.27-3.12) and over four times higher in the severely obese group (OR 4.58, 95% CI 2.55-8.24) compared to the non-obese group. Higher prevalence of comorbidities, pain, tiredness, fear of falling and injury, discomfort and feelings of insecurity when exercising explained almost half of the increased risk of physical inactivity of older severely obese people. CONCLUSIONS Results suggest that physical activity promotion among older obese people may be well received as long as it focuses on factors that enable participation in physical activity and takes into account their constraints on physical activity.
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