SAGE-Hindawi Access to Research Cardiology Research and Practice Volume 2011, Article ID 248626, 7 pages doi:10.4061/2011/248626 Research Article Physical Activity and Adherence to Mediterranean Diet Increase Total Antioxidant Capacity: The ATTICA Study Stavros A. Kavouras,1 Demosthenes B. Panagiotakos,1 Christos Pitsavos,2 Christina Chrysohoou,2 Giannis Arnaoutis,1 Yannis Skoumas,2 and Christodoulos Stefanadis2 1 Department of Nutrition and Dietetics, Harokopio University, 17671 Athens, Greece 2 First Cardiology Clinic, School of Medicine, University of Athens, Athens, 11528 Athens, Greece Correspondence should be addressed to Demosthenes B. Panagiotakos, d.b.panagiotakos@usa.net Received 26 July 2010; Accepted 4 October 2010 Academic Editor: D. Giugliano Copyright © 2011 Stavros A. Kavouras et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We studied the association of physical activity and adherence to the Mediterranean diet, in total antioxidant capacity (TAC). A random sample of 1514 men and 1528 women was selected from Attica region. Physical activity was assessed with a translated version of the validated “International Physical Activity Questionnaire” (iPAQ), and dietary intake through a validated Food Frequency Questionnaire (FFQ). Adherence to the Mediterranean diet was assessed by the MedDietScore that incorporated the inherent characteristics of this diet. TAC was positively correlated with the degree of physical activity (P < .05). TAC was also positively correlated with MedDietScore (r = 0.24, P < .001). Stratiﬁed analysis by diet status revealed that the most beneﬁcial results were observed to highly active people as compared to inactive, who also followed the Mediterranean diet (288 ± 70 μmol/L, 230 ± 50 μmol/L, resp.), after adjusting for various confounders. Increased physical activity and greater adherence to the Mediterranean diet were associated with increased total antioxidant capacity. 1. Introduction Physical activity has been evolved as a signiﬁcant factor towards the prevention of cardiovascular and metabolic diseases as well as some kinds of cancer [1–5]. From early studies, however, it has been reported that strenuous physical activity induces a decrease in antioxidant levels and a concomitant increase in the markers of lipid peroxidation in target tissues and blood [6]. It is also known that vigorous exercise induces mitochondrial generation and/or leakage of superoxide and hydrogen peroxide with or without reduction in tocopherol (vitamin E) content in both muscle and liver [7]. Furthermore, from animal studies it has been found that exercise could accelerate the development of mammary tumors linked to exercise-induced oxidants production [8]. Simultaneously, the impact of a high fat diet has shown to reverse the beneﬁcial eﬀect of caloric restriction in oxidative stress in the muscle tissue of rats [9]. Moreover, a recent study in experimental animals fed with high fat diet showed that physical exercise did not provide any beneﬁcial eﬀect on oxidative stress and antioxidant defenses [10]. Lastly, in a group of 30 sportsmen, antioxidant supplements oﬀered protection against exercise-induced oxidative stress [10]. Likewise, it is well documented from numerous epidemi- ological studies that diets rich in vegetables, fruits, whole grains, legumes, ﬁsh, and low-fat dairy products are asso- ciated with lower incidence of various chronic diseases [11, 12]. The dietary characteristics found in the olive growing areas of the Mediterranean region (i.e., Greece, Spain, Italy, and France) have been also associated with lower incidence of cardiovascular diseases, metabolic disorders, and several types of cancer [13–18]. Furthermore, a recent meta-analysis showed that greater adherence to a Mediterranean diet is associated with a signiﬁcant improvement in health status, as seen by a signiﬁcant reduction in overall mortality (9%), mortality from cardiovascular diseases (9%), incidence of or