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Table 1 Summary of high quality studies (n = 25)

From: The impact of physical activity and an additional behavioural risk factor on cardiovascular disease, cancer and all-cause mortality: a systematic review

Author, year Study name Country Study length (years) Number in cohort Age at baseline (mean or range) years Validated physical activity? Physical activity measurement Adjustments Exposure variables Outcome
Shaw et al., 2014 [18] Level of Living Survey (LNU) and the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) Sweden 13 1682 44 Structured interview Index summarising activity over the past 12 months. Respondents engaging in gardening, hunting, dancing, and any type of sport “sometimes” received one point and two points if reported as “often”. Two points were also given for any person who engaged in a sport regardless of frequency. If one had a score of less than two they were defined as inactive. Age, gender, education, and occupational status. Also, to account for the potential influence of poor health on smoking and physical inactivity behavior, all models controlled for health status in 1981, including measures of circulatory problems mobility problems, and psychological problems. PA and smoking All-cause mortality
Prinelli et al., 2015 [14] Intervention title not mentioned. Italy 17.4 974 40–74 Not validated PA was assessed by questionnaire asking about the frequency that one played sports and a binary score was created. Physically active if they were engaged in at least one sport, and physically inactive if they did not play sports. Age, sex, education level, BMI, time spent watching television, and energy expenditure. PA, diet, and smoking. All-cause mortality
Behrens et al., 2013 [29] NIH-AARP Diet and Health Study. USA 12.5 170,672 62.5 Not validated Looked at vigorous and moderate PA. Used a cut-off of 3 times of vigorous PA per week to define adherence to the vigorous PA recommendations. Used a cut-off of 3 h/week of moderate activity to approximate adherence to the moderate PA recommendations. People were assumed to meet the American College of Sports Medicine guidelines if they met 1 of the moderate or vigorous criteria. Age, marital status, education, race/ethnicity, body height, hip circumference, and alcohol intake. PA, abdominal leanness, smoking, and diet. Sub-analysis included alcohol consumption All-cause mortality
Shaw & Agahi, 2012 [30] Health and Retirement Study (HRS) USA 10 19,662 Not mentioned because combined multiple cohorts. Not validated Were asked, “On average over the last 12 months have you participated in vigorous PA or exercise three times a week or more?” If they answered yes, they were classified as active, and no, inactive. Age, gender, race, education, household income, and marital status. Also, to control for potential health conditions, they controlled for self-rated health, self-reported presence of 5 serious chronic conditions, a count of functional limitations, and weight status. PA, smoking, alcohol consumption All-cause mortality
Carlsson et al., 2013 [31] Intervention title not mentioned. Sweden 11 4232 60 Not validated Leisure time PA during the past year was categorised as inactive, light PA if at least 2 h/week, moderate PA if at least once or twice per week, and intense PA if 3+ times per week. Healthy PA score was at least once per week. Age (everyone was 60 years old), sex, education level and BMI. PA, smoking, and diet. All-cause mortality and CVD
Hulsegge et al., 2016 [39] The Doetinchem Cohort Study Netherlands 9.8 5263 46 Validated Hours/week of spent on PA was summed. Only PA’s with a MET value of 4.0 or higher were included, which is in line with the Dutch PA recommendations. Age, sex, highest educational level achieved during follow-up, and employment status in model PA, diet, smoking, and alcohol consumption All-cause mortality and CVD
Petersen et al., 2015 [32] Diet Cancer and Health Study Denmark 14 6768 50–64 Not validated Examined the average number of hours/week spent in the past year on PA in leisure, moderate, and high intensity time during summer and winter months, which were averaged. Being physically active for at least 30 min/day at moderate intensity was set as the cut-off following the World Cancer Research Fund and Nordic recommendations. Age, civil status, and length of education. PA, smoking, alcohol consumption, waist circumference and diet. All-cause mortality, CVD, and Cancer
Yun et al., 2012 [20] Intervention title not mentioned. Korea 10.3 59,941 30–84 Structured interview Participants activity levels were assessed via interview, and participants were given a score of 1 (binary) if they reported PA (never, < 3 times per/week). Stratified by sex and adjusted for age, income, and education PA, smoking, alcohol consumption, BMI. Also, subgroup analysis included fruit and vegetable consumption All-cause mortality and Cancer
Kvaavik et al., 2010 [19] Health and Lifestyle Survey (HALS) United Kingdom 20 4886 43.7 Structured interview PA was assessed by number of leisure time exercise activities that one had performed during the past fortnight and time spent doing these activities. Poor PA was defined as spending little or no time on PA (< 120 min during 1 week). Age, sex, occupational social class, BMI, blood pressure, and the other three health behaviours. PA, smoking, diet, and alcohol. All-cause mortality, CVD, and Cancer
McCullough et al., 2011 [36] The CPS-II Nutrition Cohort USA 14 111,966 Men 63.6 years & women 61.9 years. Not validated Participants reported average time per week spent in 7 recreational activities. These were then converted into MET scores. MET-hours/week less than 8.75 received a score of 0, 8.75 to < 17.5 earned a score of 1, and ≥ 17.5 earned a score of two for reaching preferable levels according to the American Cancer Society. Age, education, smoking history. PA, BMI, diet, and alcohol consumption All-cause mortality, CVD, and Cancer
Larsson et al., 2016 [25] Cohort of Swedish Men (COSM) and the Swedish Mammography Cohort (SMC) Sweden 13 64,679 59.3 Validated PA was assessed in time spent on various activities during the previous year. Researchers added up time per week spent engaged in walking/bicycling and exercise. Those participants with ≥150 min/wk. of PA were classified as active. Age, education, family history of myocardial infarction before 60 years of age, aspirin, and history and diagnosis of hypertension, hypercholesterolemia, diabetes mellitus, and atrial fibrillation before baseline. PA, smoking, BMI, and diet Heart failure
Kabat et al., 2015 [15] NIH-AARP study USA 10.5 476,396 50–71 Not validated PA assessment was based on PA was based on 4 levels of strenuous activity (never/rarely/1–3 times per month, 1–2 times per week, 3–4 times per week, and ≥ 5 times per week). Age, education, race, 14-level smoking variable, marital status. In addition, they examined the association of adherence with risk of cancer at individual sites in men and women separately and, for sites with smaller numbers, in both sexes combined. PA, BMI, diet, and alcohol consumption. All-cause mortality and Cancer
Larsson et al., 2014 [33] Swedish Mammography Cohort Sweden 10.4 31,696 49–83 Not validated Women reported on average how many minutes per day they had walked/bicycled, and how many hours per week they had exercised. Binary PA was created and a low risk PA behaviour was considered to include both low to moderate activities (walk/cycling ≥40 min/day), or more vigorous PA (exercise ≥1 h/week). Age, educational, use of aspirin, diabetes, atrial fibrillation, family history of myocardial infarction before the age of 60 years, total energy intake, and non-recommended foodscore. PA, diet, alcohol consumption, smoking, and BMI Stroke
Akesson et al., 2014 [26] Intervention title not mentioned. Sweden 11 20,721 45–70 Validated Low risk PA included men who walked or cycled for ≥40 min/day and exercised ≥1 h/week. Age, level of education, marital status, family history of MI, use of aspirin, non-Recommended Food Score, and energy intake. PA, smoking, diet, alcohol consumption and waist circumference. MI
Chomistek et al., 2013 Women’s Health Initiative Observational Study USA 12.2 71,018 50–79 Not validated MET hours/week was computed as a sum of frequency, duration, and intensity of PA. Women were classified into 4 categories: inactive (≤1.7 MET hours/week), low PA (1.8–8.3 MET hours/week), medium PA (8.4–20 MET hours/week), and high PA (> 20 MET hours/week). Stratified by age, and covariates included race/ethnic group, family income, education, marital status, smoking, parental history of premature MI, depression, alcohol intake, hours of sleep, and intake of total calories, saturated fat, and fiber. PA and sitting time CVD
Wang et al., 2011 [35] Five independent cross-sectional, population-based health examination surveys (FINRISK) Finland 14.1 38,075 25–64 Not validated PA was merged into 3 categories: ‘low’, corresponding to light levels of both occupational and leisure time PA; ‘moderate’, corresponding to moderate or high level occupational or leisure time PA; and, ‘high’, corresponding to moderate or high level of both occupational and leisure time PA. This was then dichotomized into PA (low versus moderate or high). Age, study year, education, systolic blood pressure, total cholesterol, and history of myocardial infarction, valvular heart disease, diabetes, and using antihypertensive drug PA, smoking, BMI, and vegetable consumption Heart failure
Kirkegaard et al., 2010 [27] Diet, Cancer and Health Cohort Study Denmark 9.9 55,487 50–64 Validated Participants reported their PA via reporting avg. number of hours/week spent the past year engaged in leisure activity, or occupational activity. Participants were deemed active if they reported > 30 mins/day of activity or had a job with light manual activity or heavy manual activity. Age, education, use of non-steroidal anti-inflammatory drugs, hormone replacement therapy among women, and history of cancer in first degree relatives. PA, waist circumference, smoking, alcohol consumption, and diet. Colorectal cancer
Nomura et al., 2016 [28] The Black Women’s Health Study USA 13.9 49,103 21–69 Validated PA was scored against the World Cancer Research Fund/American Institute for Cancer Research recommendations. Age, geographic region, caloric intake, smoking, family history of colorectal cancer, education, menopausal status, diabetes, insulin usage, aspirin usage, colonoscopy, and sigmoidoscopy. PA, smoking, and diet Colorectal cancer
McKenzie et al., 2015 [37] European Prospective into Cancer and Nutrition (EPIC) cohort study Europe (mix of countries) 10.9 242,918 53.2 Not validated Healthiest behaviour was defined as scoring in the top quintile of PA based on recreational and household MET tasks. Height, age at menarche, age at full term pregnancy, education, oral contraceptive use, hormone replacement therapy use, breastfeeding, total energy intake excluding alcohol PA, smoking, alcohol consumption, BMI, and diet. Breast Cancer
Eriksen et al., 2015 [17] UK SABRE Study United Kingdom 21 2096 40–69 Not validated PA was computed as the total weekly energy expended in sporting activities, cycling, walking, and in other strenuous activity during leisure time. Being active and meeting the cutoff was defined as those undertaking moderate exercise for 5+ hours per week, or vigorous exercise for ≥2.5 h/week. Age, sex, systolic and diastolic blood pressure, hypertension treatment, total cholesterol, HDL-cholesterol, BMI, social class, employment status, and occupational physical activity. PA, smoking, alcohol consumption, and fruit and vegetable consumption CVD
Vergnaud et al., 2013 [38] European Prospective into Cancer and Nutrition (EPIC) cohort study Europe (mix of countries) 12.8 121,443 25–70 Not validated PA was scored against the World Cancer Research Fund/American Institute for Cancer Research recommendations. We looked at men only. Stratified for sex, age, and center and adjusted for educational, smoking, and intensity of smoking. Additional adjustment for total energy intake. PA, BMI, diet, and alcohol consumption All-cause mortality, CVD, and Cancer
Fazel-taber Malekshah et al., 2016 [16] Golestan Cohort Study (GCS) Iran 8.0 40,708 40–75 Not validated For PA, a low risk group was those that reported at least 30 min/day of moderate and vigorous PA on average. Adjusted for age, gender, resident area, ethnicity, socioeconomic status (Wealth Score), marital status, education, alcohol consumption, and opium use. PA, smoking, and alternative eating index. All-cause mortality, CVD, and cancer.
Zhang et al., 2017 [21] Shanghai Men’s Health Study China 9.3 59,503 40–74 Validated People were categorised as healthy if they engaged in > = 150 min/week of moderate-to-vigorous PA. Adjusted for age, occupation, education, income, and history of diabetes mellitus, and colorectal cancer family history of first degree relatives. PA, waist hip ratio, smoking, alcohol consumption, and dietary behaviour. Colorectal cancer
O’Donovan et al., 2017 [22] Health Survey for England (HSE) and Scottish Health Survey (SHS) UK 9.4 106,341 47 Validated Asked questions about PA frequency and duration in activity (domestic PA, light-intensity, moderate-intensity) and type/intensity for sports/exercise. MET-hours were calculated and 3 categories of PA were made (≥60 min/wk., < 60 min/wk., and none). Adjusted for age, sex, occupation, and longstanding illness. PA and smoking All-cause mortality, CVD, and cancer.
Larsson et al., 2017 [23] Cohort of Swedish Men and Swedish Mammography Cohort Sweden 15.3 for men and 15.7 for women 33,454 men and 30,639 women 45–79 Validated PA and sedentary behaviour was calculated by asking about previous year. Participants who had recorded on average at least 150 min per week of activity were categorised as healthy and those with < 150 min per week of activity as unhealthy. Adjusted for age, education, family history of MI and cancer, asprin use, sedentary time, BMI, and history of diabetes, hypertension and hypercholesterolemia. PA, smoking, alcohol consumption, and a healthy diet All-cause mortality
  1. BMI Body mass index, CVD Cardiovascular disease, MI Myocardial infarction, PA physical activity, UK United Kingdom, USA United States of America