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Physical activity and public health
Dose-response of pa and health(hand-out)
Pekka Oja
MPH courseSchlosshofen, 12 January 2008
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IntensityFrequencyDurationMode
>60 % VO max3-5/week15-60 minaerobic, continuous
50-75 % VO maxevery day> 30 minvaried, intermittent
Health-enhancingFitness-related
Physical activity
. .2 2
Other resistance training total amount
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Lifestyle activity for health M.Murphy: (2004)
• Increasing evidence shows that lifestyle physical activities improve fitness and health of previously inactive people.
• Encourageing, if not yet convinsing, evidence that lifestyle activities are better than traditional exercises in supporting sustained activity behaviour.
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Fitness/health dose response
Health
Activity/Fitness
A
B
C
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Nonexercise physical activity and mortality in Chinese women
Matthews et al. Am J Epidemiol 165,2007
• 67143 Chinese women
• 40-70 y• free of heart disease,
stroke, cancer• 5,7 y follow-up
• all-cause, CVD, cancer, other cause mortality
• physical activity at baseline– exercise– nonexercise
• housework• walking• cycling• stairclimbing
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Matthews, C. E. et al. Am. J. Epidemiol. 2007 165:1343-1350; doi:10.1093/aje/kwm088
Risk for all-cause mortality, by exercise and nonexercise physical activity, the Shanghai Women's Health Study, 1997-2004
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Effects of walking on coronary heart disease
Manson et al 1999:
• 72 488 female nurses, 40-65 years old in 1986
• 8-year follow-up
• incidence of new coronary events– non-fatal Myocardial Infarction– death from coronary causes
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0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0,9
1
<3.2 (easy or casual)
3.2-4.6(average)
>4.7 (brisk or very brisk)
Age-adjusted
Multivariate
Risk of coronary eventsRelative Risk
Walking PaceManson et al. 1999
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Walking and cardiovascular risk factorsA meta-analysis
Murphy et al. Prev Med 44, 2007
24 studies– RCT’s– Walking the only
interventio– Min of 4 weeks
intervention– CV risk factors
measured pre and post
– Subjects sedentary but healthy at baseline
– Subjects 18- y
CV risk factors
– VO2max
– Body weight– Body fat– BMI– SBP– DBP
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Walking and cardiovascular risk factorsA meta-analysis
Murphy et al. Prev Med 44, 2007
variable n Wighted mean TE p
VO2max 24 2.73 <0.001
Body weight 27 -0.95 <0.001
Body fat 18 -0.63 0.035
BMI 16 -0.28 0.015
SBP 14 -1.06 0.316
DPB 12 -1.54 0.026
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0
2
4
6
8
10
Stairclimbing at work
25 flights per day effective
Treatment Upper 50% Treatment
VO max2
.
%
(l/min)
30 men12 weeksControl using liftsTreatment using stairs
Control
Source: Fardy & Ilmarinen 1975
NS
NS
*
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Nordic walking and fitnessKukkonen-Harjula et al. Scand J Med Sci Sports 17,2007
• Randomised study• 121 non-obese
sedentary women, 50-60 y
• 2 groups: walking with or without poles
• Intervention– 13 weeks– 4 times/week– 40 min/session– 52-54 % HRR
• Outcomes– Cardiorespiratory
fitness– Neuromuscular fitness
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Nordic walking and fitnessKukkonen-Harjula et al. Scand J Med Sci Sports 17,2007
• HR and lactate at submaximal work decreased equally in both groups
• Both groups improved VO2max similarly
• Leg strength improved more in regular walking group
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”Back to the dogs”Tatschl et al. Am J Prev Med 30, 2006
68-year-old Caucasian woman• suffered
– hypertension– hypercholesterolemia– depression – tinnitus
• status– gained 12 kg in 13 years– BMI 28
• physical activity– walked 2-3 times/week
got a golden retriever as gift• status
– lost 7 kg ->BMI 25,5– cholesterol down– in good mood– tinnitus remains
• physical activity– 3 hours daily with dog
• what can a dog do?”Most probably, the woman’s
reduction in weight and cholesterol and regression of the depression were consequences of dog ownership…”
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+30 min4 km5000 steps
7 km9000 steps
10 km13000 steps.
+30 min
Daily walking steps for health
Insufficientdaily steps
Sufficientdaily steps
Optimal daily steps
Note: about 5000 steps needed for necessary daily chores
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Cycling and all-cause mortalityAndersen et al. Arch Intern Med 160, 2000
• Prospective cohort study
• 13 375 women, 17 265 men, 20-93 y
• Mean follow-up 14,5 y
• All-cause mortality• Cycling
– All cycling– Cycling to work– Changes in cycling
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Relative risk of cycling (yes/no)
00,10,20,30,40,50,60,70,80,91
No Yes
MenWomen
• N=8,466 men, 2,389 deaths, p<0.001
• 6,510 women, 1,398 deaths, p<0.01
• Both adjusted for LTPA
• (data from CCPPS)
Cycling
RR of mortality
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Changes in cycling over 5 years and subsequent mortality: Copenhagen City Heart Study
00,10,20,30,40,50,60,70,80,91
decreased increased
• Changes in cycling habits among 3291 men and women
• 618 death
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Commuting activity and healthHamer & Chida, PrevMed 2007
• Meta analysis• Prospective
epidemiological studies
• 8 studies, 173146 participants
• Health end points– Mortality– Incident CHD, stroke,
hypertension, diabetes
• Overall RR 0.89 (0.81-0.98)
• Women RR 0.87 (0.77-0.98)
• Men RR 0.91 (0.80-1.04)
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Is housework good for health?Lawlor et al. JECH 56, 2002
• Brittish Women’s Heart and Health Study
• 2341 women, 60-79 y• national cross-sectional
survey
• health– subjective– CHD– hypertensio– cancer– falls– depression
• physical activity– vigorous exercise– brisk walking– heavy house work
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Is housework good for health?Lawlor et al. JECH 56, 2002
Adj OR (95% CL) Adj OR (95% CL) Adj OR (95% CL)
n brisk walking heavy housework
exercise
subjective health, poor
730 0.3 (0.2-0.4) 0.5 (0.4-0.6) 0.3 (0.2-0.4)
CHD 297 o.4 (0.2-0.7) 0.7 (0.5-0.9) 0.6 (0.4-0.9)
hypertension
523 0.8 (0.5-1.1) 1.1 (0.9-1.3) 0.9 (0.6-1.1)
cancer 213 1.3 (0.8-1.9) 0.7 (0.5-0.9) 1.0 (0.7-1.6)
falls 386 0.6 (0.4-0.9) 0.7 (0.6-0.9) 0.9 (0.6-1.2)
depression 400 0.9 (0.7-1.3) 0.8 (0.6-1.0) 0.9 (0.7-1.2)
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How effective are lifestyle physical activities for function and health?
• moderate-intensity pa concept = HEPA• daily life-activities: all-cause mortality, hypertension
↓• walking
– brisk walking: CHD and risk factors ↓, function ↑– stair climbing: function ↑– nordic walking ~ brisk walking– 10 000 steps: promising– dog walking ?
• cycling: all-cause mortality ↓, function ↑, accidents ↓ • commuting pa: MI, stroke, type 2 diabetes, colon
cancer, CV risk factors ↓, function ↑ • domestic work: need more studies
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Fitness and risk factorsDuncan et al. Arch Int Med 2005;165: 2362-2369
Randomised trial 492 sedentary adults 5 groups
• Control, physician advice• Moderate intensity/low frequency• Moderate intensity/high frequency• Hard intensity/low frequency• Hard intensity/high frequency• All ex. Groups walking 30 min/session
6 and 24 months intervention Outcomes: VO2max, HDL-C, TotC/HDL-C
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Copyright restrictions may apply.Duncan, G. E. et al. Arch Intern Med 2005;165:2362-2369.
Mean {+/-} SEM change in maximum oxygen consumption (IMGf1.gif" BORDER="0">O2max) (measured in liters per minute) from baseline to 6 months (A) and
from baseline to 24 months (B) according to treatment condition
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ObesitySlentz et al. Arch Intern Med 2004;164:31-39
RCT 120 men and women, 40-65 years, sedentary
overweight with mild to moderate dyslipidemia 4 groups
• Control• High amount/vigorous (~32 km jogging/week)• Low amount/vigorous (~19 km jogging/week• Low amount/moderate (~19 km walking/week
8 months intervention Outcomes: body weight, body composition, waist
circumference
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Slentz, C. A. et al. Arch Intern Med 2004;164:31-39.
Effects of exercise amount and intensity on mean changes in body weight (A), fat mass (B), percent lean body mass (C), and lean body mass (D)
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Life expectancyFranco et al. Arch Intern Med 2005; 165: 2355-2360
Prospective cohort study 2336 men 2873 women, 28-62 years Follow-up 12 years Physical acitivity
• Low daily METs• Moderate daily METs • High daily MEDTs
outcome: life ecpectancy at 50 years of age
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Franco, O. H. et al. Arch Intern Med 2005;165:2355-2360.
Effect of physical activity level on life expectancy (LE) at age 50 years
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Conclusions
• Vigorous pa > moderate intensity pa– Fitness– CHD risk factors– Obesity– Life expectancy– Type 2 diabetes
• New evidence invites exercise & sport as HEPA