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Table 2 Overview of longitudinal studies on the association between PA and the outcome of CHD

From: The association between physical activity with incident obesity, coronary heart disease, diabetes and hypertension in adults: a systematic review of longitudinal studies published after 2012

AuthorCountryCharacteristicsFollow-up timePredictor variable: Physical activityOutcome of interestMain results
Chomistek et al. (2016) [28]USA, Nurses’ Health Study II (NHSII)N = 97,230 women, 36.6 ± 4.6 years20 years Baseline: 1991Self-reported LTPA (MET-h/wk, in quintiles)
- < 1
Incident CHD (nonfatal MI, fatal CHD)HR [95% CI] of CHD event for total LTPAa:
- < 1: 1.0 (reference)
- 1–5.9: 0.86 [0.68, 1.08]
Follow-up: 2011- 1–5.9- 6–14.9: 0.66 [0.52, 0.84]
- 6–14.9
- 15–29.9- 15–29.9: 0.48 [0.36, 0.63]
- ≥30- ≥30: 0.53 [0.41, 0.70]
Similarly, increasing MET-h/wk were associated with a decreased risk of incident CHD when looking at moderate-intensity PA only, as well as looking at vigorous-intensity PA only.
Delaney et al. (2013) [29]USA, Multi-Ethnic Study of Atherosclerosis (MESA)N = 5656, 47.4% male, 61.3 ± 9.9 years, BMI 28.3 ± 5.4 kg/m25 years Baseline 2000–2002Self-reported PA (total min/d, total MET-min/d)Incident CACRR [95% CI] of PA and incident CACb:
- Vigorous activity: 0.97 [0.94, 1.00], p = 0.048
Follow-up: 2005–2007No association between intentional, sedentary, MVPA and conditioning PA and incident CAC.
Ferrario et al. (2018) [30]Italy, MONICA, PAMELA, SEMMN = 3574 men, 25–64 yearsMedian 14 years (IQR 12.9–15.9)Self-reported, OPA score 1–5 (tertiles, cut-offs at 2.5, 3.125), SpPA index (min/wk of MPA or VPA based on METs of task)Incident CHD (first acute coronary event as MI, acute coronary syndrome or coronary revascularization)HR [95% CI] of first CHD event (fatal or non-fatal) by OPA groupc:
- Low: 1.66 [1.06, 2.59]
Baseline: 1989–1996- Intermediate: 1.0 (reference)
- High: 1.18 [0.72, 1.94]
Follow-up: 2008- Poor: 0HR [95% CI] of first CHD event (fatal or non-fatal) by SpPA groupc:
- Intermediate: 1–149 MPA or 1–74 VPA or 1–149 MPA plus VPA
- Poor: 1.0 (reference)
- Intermediate: 0.81 [0.50, 1.32]
- Recommended: ≥150 MPA or ≥ 75 VPA or ≥ 150 MPA plus VPA- Recommended: 0.58 [0.30, 1.12]
Jefferis et al. (2014) [31]UK, British Regional Heart StudyN = 3320 men, 68.3 ± 5.4 yearsMedian 11 years Baseline 1998–2000 Follow-up: 2010Self-reported usual PA (score)Incident CHD (First fatal or nonfatal MI events, ICD-9 Code 410–414, ICD − 10 Code I21-I23, I252)HR [95% CI] of first CHD event (fatal or non-fatal) by PA groupd:
- Inactive (0–2)
- Occasional (3–5)- None: 1.0 (reference)
- Light (6–8)- Occasional: 0.52 [0.34, 0.79]
- Moderate (9–12)- Light: 0.47 [0.30, 0.74]
- Moderately vigorous (13–20)- Moderate: 0.51 [0.32, 0.82]
- Moderately vigorous and vigorous: 0.44 [0.29, 0.65]
- Vigorous (> 21)
Change in PA (1996–2000)p = 0.004
- Always inactiveHR [95% CI] of first CHD event (fatal or non-fatal) by change in PA groupd:
- Became inactive
- Became active- Always inactive: 1.0 (reference)
- Always active- Became inactive: 0.87 [0.53, 1.45]
- Became active: 0.86 [0.55, 1.35]
- Always active: 0.73 [0.53, 1.02]
Koolhaas et al. (2016) [32]Netherlands, The Rotterdam StudyN = 5901, median age 67 years15 years Baseline 1997–2001 Follow-up: 2012Self-reported PA, tertiles (median (range) MET-h/wk in total PA)Incident CHD (fatal or nonfatal MI, surgical/ percutaneous coronary revascularization procedure)Total PA and risk of incident CHD evente: HR [95% CI]
- Tertile 1: 1.0 (reference)
- Tertiles 1: 42.0 (≤61.4) 1.5 h/d at 4 METs- Tertile 2: 0.76 [0.63, 0.92]
- Tertile 3:0.69 [0.57, 0.84]
- Tertiles 2: 77.5 (61.5–96.9) 2.8 h/d at 4 METsPer 10 MET-h/wk: 0.96 [0.94, 0.98]. p overall = < 0.001.
- Tertiles 3: 126.7 (≥97.0) 4.5 h/d at 4 METs
Petersen et al. (2012) [33]Denmark, Copenhagen City Heart StudyN = 10,443, 57% female, median age 58 yearsBaseline 1976–78Self-reported LTPAIncident CHD fatal and non-fatal cases (MI: ICD-8 Code 410, ICD-10 Code I21–22; IHD: ICD-8 Code 410–414, ICD-10 Code I20–25)HR [95% CI] of IHD by PA changef:
Women | Men
- Sedentary
Follow-up: 1981–1983, 2008- Light- -2: 1.60 [1.02, 2.32] | 1.33 [0.97, 1.83]
-Moderate
- Vigorous- -1: 1.28 [1.10, 1.49] | 1.12 [0.96, 1.31]
Change in PA categories (1976/78–1981/83)
- 0: 1.0 (reference)
- -2/−3 categories- 1: 0.97 [0.85, 1.12] | 1.09 [0.96, 1.25]
- -1 category
- 0 (stable)- 2: 1.01 [0.75, 1.38] | 1.16 [0.89, 1.51]
- + 1 category
- + 2/+ 3 categoriesHR [95% CI] of MI by PA changef:
Women | Men
- -2: 1.56 [0.89, 2.75] | 1.74 [1.17, 2.60]
- -1: 1.30 [1.03, 1.65] | 1.13 [0.91, 1.39]
- 0: 1 (reference)
- 1: 0.98 [0.79, 1.22] | 1.14 [0.95, 1.36]
- 2: 1.08 [0.67, 1.75] | 1.30 [0.92, 1.84]
Soares-Miranda et al. (2016) [34]USAN = 4207, 39% males, 72.5 ± 5.5 years10 years Baseline: 1989Self-reported LTPA (kcal/wk), exercise intensityIncident CHD (fatal & nonfatal MI & CHD death)HR [95% CI] for exercise intensityg, none as reference:
Follow-up: 1999- None- Low: 0.56 [0.43, 0.72], p < 0.001
- Low- Moderate: 0.53 [0.41, 0.69], p < 0.001
- Moderate- High: 0.47 [0.32, 0.69], p < 0.001
- High
Tikkanen et al. (2018) [35]UKN = 502,635, 54% female, 56.5 ± 8.1 yearsMedian 6.1 years Baseline: 2006–10Self-reported (MET-h/wk)Incident CHD (ICD-9 Code 410–411, ICD-10 Code I20.0, I21, I22)HR [95% CI] association CHD and PA levelh:
- 0.95 [0.93, 0.97], p < 0.001
Follow-up: 2015–2016
Williams & Thompson (2012) [50]USAN = 47,921Median 6.2 yearsSelf-reported PA MET-h/dIncident CHD (MI, CABG, percutaneous coronary intervention, and angina pectoris)Greater MET-h/d is associated with lower risk of incident CHD: HR [95% CI]i
- Light
Baseline: 1998–1999- Moderate- Running: 0.955 [0.91, 1.00]
- Vigorous- Walking: 0.907 [0.839, 0.98]
Follow-up: 2006- Other vigorous: 0.99 [0.966, 1.02]
- Other moderate: 0.98 [0.927, 1.04]
- Other light: 0.98 [0.807, 1.197]
  1. Abbreviation: BMI Body Mass Index, CABG coronary artery bypass graphs, CAC coronary artery calcification, CHD coronary heart disease, CI confidence interval, d day, h hour, HDL high density lipoprotein, HR hazard ratio, ICD International Classification of Diseases, IHD ischemic heart disease, IQR interquartile range, kcal kilocalories, LTPA leisure time physical activity, MET metabolic equivalent, MI Myocardial Infarction, min minutes, MPA moderate physical activity, MVPA moderate to vigorous physical intensity, N number of participants, OPA occupational physical activity, p p-value, PA physical activity, RR relative risk, SpPA sport physical activity, VPA vigorous physical activity, wk week
  2. a Model adjusted for age; b Model adjusted for age, sex, ethnicity, BMI, pack years of smoking, family history of MI, hypertension, dyslipidemia, diabetes, education, alcohol use, current smoking status, education, income, health insurance status; c: Model adjusted for age, cohort, educational level, OPA and SpPA; dModel adjusted for age and region; e Model adjusted for age and sex; f Model adjusted for physical activity level in 1976–1978, age, education, smoking habits, alcohol consumption, BMI, diabetes, cholesterol, blood pressure lowering therapy in 1981–1983; g Model adjusted for age, sex, race, education, income, clinical sites, smoking, BMI; h Model adjusted for age, sex, region; i Model adjusted for baseline age (age, age2), sex, race, education, smoking, intakes of red meat, fruit, alcohol
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