The economic burden of physical inactivity in Canada. The Logan Healthy Living Program: a cluster randomized trial of a telephone-delivered physical activity and dietary behavior intervention for primary care patients with type 2 diabetes or hypertension from a socially disadvantaged community--rationale, design and recruitment. Physical Activity and Risk for Cardiovascular Events in Diabetic Women The Alberta moving beyond breast cancer (AMBER) cohort study: a prospective study of physical activity and health-related fitness in breast cancer survivors Leisure time physical activity and long-term cardiovascular and cancer outcomes: the Busselton Health Study Physical inactivity and short-term all-cause mortality in adults with chronic disease. The Role of Physical Activity in Chronic Kidney Disease in the Presence of Diabetes Mellitus: A Prospective Cohort Study Low Cardiorespiratory Fitness and Physical Inactivity as Predictors of Mortality in Men with Type 2 Diabetes Correlates of physical activity level in breast cancer survivors participating in the Women’s Healthy Eating and Living (WHEL) Study Sitting time and all-cause mortality risk in 222 497 Australian adults. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Long-term physical activity in leisure time and mortality from coronary heart disease, stroke, respiratory diseases, and cancer. The Copenhagen City Heart Study The association between periodontal disease, physical activity and healthy diet among adults in Jordan. The Relationship of Coffee Consumption with Mortality Self-rated walking pace and all-cause, cardiovascular disease and cancer mortality: individual participant pooled analysis of 50 225 walkers from 11 population British cohorts Is intake of breakfast cereals related to total and cause-specific mortality in men? Leisure-time physical activity and ischemic stroke risk: the Northern Manhattan Stroke Study. Effect of Moderate to Vigorous Physical Activity on All-Cause Mortality in Middle-aged and Older Australians. Prospective Association of Physical Activity and Heart Failure Hospitalizations Among Black Adults With Normal Ejection Fraction: The Jackson Heart Study Exercise and well-being: a review of mental and physical health benefits associated with physical activity Physical Activity Reduces Risk of Premature Mortality in Patients With Type 1 Diabetes With and Without Kidney Disease The effect of baseline physical activity on cardiovascular outcomes and new-onset diabetes in patients treated for hypertension and left ventricular hypertrophy: the LIFE study. Prospective study of adult onset diabetes mellitus (type 2) and risk of colorectal cancer in women.
BACKGROUND About two-thirds of Canadians are physically inactive . As a risk factor for several chronic diseases , physical inactivity can potentially be a substantial public health burden . We estimated the direct health care costs attributable to  physical inactivity  in Canada , the number of lives lost prematurely each year that are attributable to a sedentary lifestyle and the effect that a reduction of 10 % in inactivity levels ( a Canadian objective for 2003 ) could have on reducing direct health care costs . METHODS We calculated summary relative risk ( RR ) estimates from prospect i ve longitudinal studies of the effects of physical inactivity on coronary artery disease , stroke , colon cancer , breast cancer , type 2 diabetes mellitus and osteoporosis . We then computed the population -attributable fraction ( PAF ) for each illness from the summary RR and the prevalence of physical inactivity ( i.e. , 62 % ) and applied the PAF to the total direct health care expenditures for 1999 and to the number of deaths in 1995 associated with each disease to determine the health care costs and lives lost prematurely that were directly attributable to physical inactivity . RESULTS About $ 2.1 billion , or 2.5 % of the total direct health care costs in Canada , were attributable to physical inactivity in 1999 . A sensitivity analysis ( simultaneously varying each of the health care costs and PAF by + /- 20 % ) indicated that the costs could be as low as $ 1.4 billion and as high as $ 3.1 billion . About 21,000 lives were lost prematurely in 1995 because of inactivity . A 10 % reduction in the prevalence of physical inactivity has the potential to reduce direct health care expenditures by $ 150 million a year . INTERPRETATION Physical inactivity represents an important public health burden in Canada . Even modest reductions in inactivity levels could result in substantial cost savings BACKGROUND Physical activity and dietary behavior changes are important to both the primary prevention and secondary management of the majority of our most prevalent chronic conditions ( i.e. , cardiovascular disease , hypertension , type 2 diabetes , breast and colon cancer ) . With over 85 % of Australian adults visiting a general practitioner each year , the general practice setting has enormous potential to facilitate wide scale delivery of health behaviour interventions . However , there are also many barriers to delivery in such setting s , including lack of time , training , re sources and remuneration . Thus there is an important need to evaluate other feasible and effective means of delivering evidence -based physical activity and dietary behaviour programs to patients in primary care , including telephone counseling interventions . METHODS Using a cluster r and omized design with practice as the unit of r and omization , this study evaluated a telephone-delivered intervention for physical activity and dietary change targeting patients with chronic conditions ( type 2 diabetes or hypertension ) recruited from primary care practice s in a socially disadvantaged community in Queensl and , Australia . Ten practice s were r and omly assigned to the telephone intervention or to  usual care  , and 434 patients were recruited . Patients in intervention practice s received a workbook and 18 calls over 12 months . Assessment at baseline , 4- , 12- and 18-months allows for assessment of initial change and maintenance of primary outcomes ( physical activity and dietary behavior change ) and secondary outcomes ( quality of life , cost-effectiveness , support for health behavior change ) . CONCLUSIONS This effectiveness trial adds to the currently limited number of telephone-delivered intervention studies targeting both physical activity and dietary change . It also addresses some of the shortcomings of previous trials by targeting patients from a disadvantaged community , and by including detailed reporting on participant representativeness , intervention implementation and cost-effectiveness , as well as an evaluation of maintenance of health behavior change Cardiovascular disease is the leading cause of death in persons with diabetes mellitus . This disorder affects approximately 16 million Americans , at least 15 million of whom have type 2 diabetes mellitus ( 1 ) . Among diabetic persons , coronary heart disease causes more than 50 % of all deaths and stroke causes an additional 15 % ( 2 ) . Diabetic women are at particularly high risk for cardiovascular disease , and diabetes eliminates the usual female advantage for death from coronary disease . While an inverse association between increased physical activity and lower risk for cardiovascular disease is well established in the general population ( 3 ) , sparse data are available among diabetic persons ( 4 , 5 ) . Intervention studies have shown that exercise increases insulin sensitivity and glucose tolerance and induces favorable changes in blood lipid levels among persons with type 2 diabetes mellitus ( 6 ) . Exercise as an adjunct to diet regimens yields greater and more sustained weight loss in obese patients with type 2 diabetes mellitus ( 7 ) . Even moderately intense exercise , such as walking , improves insulin sensitivity and reduces body weight ( 8) . Because walking is safe and easy , it may provide a promising way to reduce risk for cardiovascular events among diabetic persons . In this study , we examined in detail the relationship between levels of physical activity  and incidence of coronary heart disease and stroke among women with type 2 diabetes mellitus in the Nurses ' Health Study . In particular , we evaluated  walking  ( the most common form of physical activity among diabetic persons ) in relation to cardiovascular events . Methods Study Sample The Nurses ' Health Study cohort was established in 1976 . The original cohort consisted of 121 700 female registered nurses who were 30 to 55 years of age and resided in 11 large U.S. states . The nurses completed a mailed question naire about their medical history and lifestyle , and follow-up question naires administered every 2 years up date information on potential risk factors and identify newly diagnosed cases of coronary heart disease and other illness . Our study includes 5125 women who , on any question naire from 1976 to 1992 , reported having physician-diagnosed diabetes mellitus and being 30 years of age or older at disease onset ( a working definition for type 2 diabetes mellitus ) . Women who reported a history of coronary heart disease ( including myocardial infa rct ion , angina , or coronary revascularization ) , stroke , or cancer on or before the 1980 question naire ( when physical activity was first assessed ) were excluded at baseline . The follow-up rate for nonfatal events was 97 % of the total potential person-years . Confirmation of Diabetes Mellitus A supplementary question naire regarding symptoms , diagnostic tests , and hypoglycemic  therapy was mailed to women who indicated on any biennial question naire that they had received a diagnosis of diabetes . A case of diabetes was considered confirmed if at least one of the following was reported on the supplementary question naire : 1 ) classic symptoms plus a fasting plasma glucose level of at least 140 mg/dL ( 7.8 mmol/L ) or a r and om plasma glucose level of at least 200 mg/dL [ 11.1 mmol/L ] , 2 ) at least two elevated plasma glucose concentrations on different occasions ( a fasting level 140 mg/dL [ 7.8 mmol/L ] or a r and om level 200 mg/dL [ 11.1 mmol/L ] , a concentration 200 mg/dL after 2 hours or more on oral glucose tolerance testing , or both ] in the absence of symptoms , or 3 ) treatment  with hypoglycemic medication ( insulin or an oral hypoglycemic agent ) . The validity of this question naire has been verified in a sub sample of the study cohort ( 9 ) . Of a r and om sample of 84 women classified by the question naire as having type 2 diabetes mellitus , 71 gave permission for their medical records to be review ed ; records were available for 62 of 71 . An endocrinologist blinded to the information on the supplementary question naires review ed the records according to National Diabetes Data Group ( NDDG ) criteria ( 10 ) . The diagnosis of type 2 diabetes mellitus was confirmed in 61 of 62 women ( 98 % ) ( 9 ) . A secondary set of analyses included only women with definite type 2 diabetes mellitus according to the NDDG criteria . We used the NDDG diagnostic criteria because the analytic cohort preceded the American Diabetes Association guideline , which was published in 1997 ( 11 ) . Assessment of Physical Activity Women were first asked about physical activity on the 1980 question naire . They were asked to report the average number of hours they had spent each week during the past year on such moderate and vigorous recreational activities as vigorous sports , jogging , brisk walking or striding , bicycling , heavy gardening , and heavy housework . On the 1982 question naire , women were asked a slightly different question : For how many hours per week , on average , do you engage in activity strenuous enough to build up a sweat ? In 1986 , 1988 , and 1992 , women were asked to report the average time spent per week on the following activities : walking , jogging , running , bicycling , lap swimming , playing tennis or squash , and participating in calisthenics . They were also asked to report the average number of flights of stairs that they climbed each week . Women also reported their usual walking pace : easy ( < 2 miles per hour [ mph ] ) , average ( 2 to 2.9 mph ) , brisk ( 3 to 3.9 mph ) , or very brisk ( 4 mph ) . Because fewer than 2 % of women reported a very brisk pace , we combined the brisk and very brisk categories in analyses of walking pace and diabetes risk . For 1980 , 1982 , 1986 , 1988 , and 1992 , we created a measure of average hours per week spent in moderate or vigorous recreational activities ( all activities described above except for hours spent walking at an easy or average pace ) . For 1986 , 1988 , and 1992 , using a list of physical activities ( 12 ) , we calculated a weekly metabolic equivalent of task ( MET ) score for total physical activities , vigorous activities ( requiring 6 MET/h ) , nonvigorous activities ( requiring<6 MET/h ) , and walking . The validity of the question naire in assessing physical activity has been described elsewhere ( 13 ) . Correlation between activities reported in four 1-week diaries and those reported on the question naire was 0.62 . Ascertainment of End Points The primary end points for this study were incident coronary heart disease ( defined as nonfatal myocardial infa rct ion or fatal coronary heart disease ) and stroke that occurred after the 1980 question naire was returned but before 1 June 1994 . We requested permission to review the medical records of women who reported having a nonfatal myocardial infa rct ion or stroke on a follow-up question naire . Study physicians with no knowledge of the women 's self-reported risk factors review ed the records . Nonfatal myocardial infa rct ion was confirmed if it met the criteria of the World Health Organization of symptoms and the patient 's records showed diagnostic electrocardiographic changes or elevated cardiac enzyme levels ( 14 ) . Infa rct ions that required hospital admission and were confirmed by interview or letter but for which no medical records were available were design ated as probable ( 19 % ) . We included all confirmed and probable cases in the analyses because the results were the same after probable cases were excluded . Stroke was confirmed by medical records according to the criteria of the National Survey of Stroke ( 15 ) , which define it as a constellation of neurologic deficits , sudden or rapid in onset , lasting at least 24 hours . Events were further subclassified as hemorrhagic stroke ( subarachnoid or intraparenchymal ) , ischemic stroke ( thrombotic or embolic ) , or stroke of unknown cause . Deaths were reported by next of kin and the U.S. Postal Service or were ascertained through the National Death Index . After combining all sources , we estimated that follow-up for deaths was more than 98 % complete ( 16 ) . Fatal coronary heart disease was defined as fatal myocardial infa rct ion if confirmed by hospital records or autopsy or if coronary heart disease was listed as the cause of death on the death certificate , was the underlying and most plausible cause , and was supported by evidence of previous coronary heart disease . The cause of death on the death certificate was never in itself considered to provide sufficient confirmation of death from coronary heart disease . We also included sudden death within 1 hour of onset of symptoms in women with no plausible cause other than coronary disease ( 8 % of fatal cases ) . Fatal strokes were coded by using the same criteria as nonfatal cases , but autopsy evidence as well as the death certificate listing was accepted . Statistical Analysis The study base was defined as the pool of person-time that gives rise to incident cases of cardiovascular disease among patients with both prevalent and incident diabetes . We conducted two sets of analyses , one using 1980 as the baseline to evaluate long-term overall effects of moderate or vigorous activities and the other using 1986 as the baseline to examine specific effects of regular walking .  Person-time for each participant was calculated from the date of return of the 1980 or 1986 question naires to the date of confirmed cardiovascular disease , death from any cause , or 1 June 1994 , whichever came first . In the first set of analyses , relative risks were computed as the incidence rate in a specific category of average hours spent on moderate or vigorous activities per week divided by the incidence rate in the lowest category , with adjustment for 5-year categories of age . Tests of linear trend across increasing categories of average hours spent on moderate or vigorous activities were conducted by treating the categories as a single continuous variable and assigning the median score for the category as its value . To best represent long-term levels of physical activity for individual women and to reduce measurement error , we created measures of the cumulative average of physical Background Limited research has examined the association between physical activity , health-related fitness , and disease outcomes in breast cancer survivors . Here , we present the rationale and design of the Alberta Moving Beyond Breast Cancer ( AMBER ) Study , a prospect i ve cohort study design ed specifically to examine the role of physical activity and health-related fitness in breast cancer survivorship from the time of diagnosis and for the balance of life . The AMBER Study will examine the role of physical activity and health-related fitness in facilitating treatment completion , alleviating treatment side effects , hastening recovery after treatments , improving long term quality of life , and reducing the risks of disease recurrence , other chronic diseases , and premature death . Methods / Design The AMBER Study will enroll 1500 newly diagnosed , incident , stage I-IIIc breast cancer survivors in Alberta , Canada over a 5 year period . Assessment s will be made at baseline ( within 90 days of surgery ) , 1 year , and 3 years consisting of objective and self-reported measurements of physical activity , health-related fitness , blood collection , lymphedema , patient-reported outcomes , and determinants of physical activity . A final assessment at 5 years will measure patient-reported data only . The cohort members will be followed for an additional 5 years for disease outcomes . Discussion The AMBER cohort will answer key questions related to physical activity and health-related fitness in breast cancer survivors including : ( 1 ) the independent and interactive associations of physical activity and health-related fitness with disease outcomes ( e.g. , recurrence , breast cancer-specific mortality , overall survival ) , treatment completion rates , symptoms and side effects ( e.g. , pain , lymphedema , fatigue , neuropathy ) , quality of life , and psychosocial functioning ( e.g. , anxiety , depression , self-esteem , happiness ) , ( 2 ) the determinants of physical activity and health-related fitness including demographic , medical , social cognitive , and environmental variables , ( 3 ) the mediators of any observed associations between physical activity , health-related fitness , and health outcomes including biological , functional , and psychosocial , and ( 4 ) the moderators of any observed associations including demographic , medical , and biological/disease factors . Taken together , these data will provide a comprehensive inquiry into the outcomes , determinants , mechanisms , and moderators of physical activity and health-related fitness in breast cancer survivors Abstract The study aim ed to investigate whether meeting leisure time physical activity recommendations was associated with reduced incident and fatal cancer or cardiovascular disease ( CVD )  in a community-based cohort of middle- to late-aged adults with long-term follow-up . At baseline , 2,320 individuals were assessed on a large number of lifestyle and clinical parameters including their level of physical activity  per week , other risk factors ( e.g. smoking and alcohol use ) various anthropometric measures , blood tests and medical history . Individuals were linked to hospital and mortality registry data to identify future cancer and cardiovascular events ( fatal and non-fatal ) out to 15 years of follow-up . Cox regression analyses adjusted for relevant confounders identified a priori were used to estimate risk for all-cause , cancer-specific and CVD-specific mortality . In the full cohort an estimated 21 % decreased risk for all-cause mortality ( HR 0.79 ; 95 % CI 0.66–0.96 ) and 22 % decreased risk for fatal/non-fatal CVD events ( HR 0.78 ; 95 % CI 0.66–0.92 ) was associated with baseline self-reported physical activity levels of 150 min or more . After exclusion of those with chronic co-morbidities ( CVD , cancer , diabetes , chronic obstructive pulmonary disease , hypertension treatment ) at baseline , lower risk for fatal/non-fatal CVD events remained significantly associated with 150 min or more of physical activity ( HR 0.77 ; 95 % CI 0.62–0.96 ) . Results from this well established prospect i ve community-based cohort study support the role of leisure time physical activity in reducing all-cause mortality and CVD events ( fatal/nonfatal ) in the broader population studied . The data also suggest that physical activity associated reductions in risk for CVD events ( fatal/nonfatal ) were not overly impacted by prevalent key non-communicable diseases OBJECTIVE To ascertain the relationship of physical inactivity and short-term all-cause mortality in a prospect i ve cohort of r and omly selected managed care organization members aged 40 years and older who have multiple chronic diseases . METHODS Clinical data bases were used to identify all health plan members aged 40 years and older with 2 or more chronic health conditions ( hypertension , coronary heart disease , diabetes mellitus , or dyslipemia ) in 1994 . A r and om sample of 2336 members was surveyed by mail and telephone interview regarding their health-related behaviors .  Survey data were linked to mortality data from the 1995 to 1997 Minnesota Death Index . Cox proportional hazards regression was used to ascertain the association between physical inactivity and subsequent all-cause mortality , adjusting for potential confounders . RESULTS Members who reported less than 30 minutes a week of physical activity at baseline had a subsequent mortality risk ratio of 2.82 ( P<.001 ) vs those with 30 or more minutes of physical activity a week . Increased mortality risk persisted ( mortality risk ratio , 2.15 ; P<.001 ) after adjustments for age , sex , current smoking , functional impairment , and comorbidity score . CONCLUSIONS In adults with chronic diseases , the physically inactive had higher observed mortality within a 42-month period . If physical inactivity reflects an independent mortality risk , efforts to maintain physical activity in such patients may yield significant clinical benefits within a short period . By contrast , if inactivity is primarily a proxy for other factors that elevate mortality risks , a simple physician inquiry regarding inactivity may help to identify patients at risk of death Background / Aims : Although the effect of exercise on health is well established , nephrologists seldom consider physical activity in the treatment of chronic kidney disease ( CKD ) or CKD in the presence of diabetes mellitus ( DM/CKD ) . The aim of the present study was to analyze the benefits of leisure-time physical activity ( LTPA ) in DM/CKD . Methods : A total of 445,075 adult participants who underwent a medical screening program between 1996 and 2008 were prospect ively recruited . Of these , 7,863 DM/CKD subjects were identified . Each participant was categorized according to  LTPA level ( a product of duration and intensity ) as inactive , low-active or fully active .  Hazard ratios ( HRs ) for mortality risk were calculated . Results : Fully active LTPA was associated with lower odds of DM/CKD development and lower risk of mortality among patients with DM/CKD in a dose-response relationship . The fully active and low-active DM/CKD groups had a 26 % ( HR 0.74 , 95 % CI 0.66 - 0.85 ) and 13 % ( HR 0.87 , 95 % CI 0.75 - 1.01 ) lower risk of all-cause mortality , respectively , in comparison to the inactive group . The association of exercise with mortality rate reduction was more pronounced among DM/CKD subjects ( mortality rate reduction of 446.5 per 100,000 person-years ) than among subjects with diabetes alone or CKD alone . Conclusion : Exercise , at the recommended level or more , is associated not only with lower odds of DM/CKD but also with a 26 % lower mortality risk among DM/CKD patients . Nephrologists should encourage all DM/CKD subjects to be physically active Exercise has become a st and ard therapy for patients with type 2 diabetes ( 1 ) . Regular exercise improves conventional clinical risk factors , cardiorespiratory fitness , and components of the insulin resistance syndrome ( 2 - 6 ) . However , it is unclear whether physical activity improves the prognosis of patients with diabetes . No data are available on the association of physical activity or cardiorespiratory fitness with mortality in patients with diabetes . The overall benefit of exercise for these patients is unclear , and some experts are concerned that macrovascular and microvascular complications may be worsened by an exercise program ( 1 , 7 ) . Some consider exercise only as a supplement to diet therapy ( 8) . Studies have shown repeatedly that low cardiorespiratory fitness and physical inactivity are directly associated with cardiovascular disease and all-cause mortality ( 9 - 14 ) , and our preliminary study with a small number of end points suggested that this association might persist across plasma glucose levels ( 15 ) . In the current study , we evaluated the prospect i ve association of cardiorespiratory fitness and physical inactivity with mortality in men who have type 2 diabetes . Methods The material presented in this report was derived from the Aerobics Center Longitudinal Study ( ACLS ) , a prospect i ve observational study of patients examined at The Cooper Clinic in Dallas , Texas . The study was review ed and approved annually by the institutional review board at The Cooper Institute . Additional details of study methods and study group characteristics of this cohort have been published elsewhere ( 12 , 13 ) . Patients Participants were men with type 2 diabetes who completed a baseline medical evaluation at The Cooper Clinic in Dallas , Texas , during 1970 to 1993 . These men came to The Cooper Clinic for a medical examination and health counseling . Many were sent by their employers for these services , some were referred by their personal physicians , and others were self-referred . More than 92 % of the patients are white , and most are employed in executive or professional occupations ; more than 75 % are college graduates . Study participants come from middle and upper socioeconomic strata , but they are similar to other well-characterized study group-based cohorts in terms of blood pressure , cholesterol level , body weight , and cardiorespiratory fitness ( 6 , 16 , 17 ) . We excluded men taking insulin and those with a history of cancer at baseline . Clinical Examination The baseline evaluation was performed after participants gave informed written consent for the baseline medical examination and registration in the follow-up study . Examinations followed an overnight fast of at least 12 hours and included personal and family health histories , a question naire on demographic characteristics and health habits , a physical examination , a maximal exercise test on a treadmill , anthropometry , electrocardiography , blood chemistry analyses , and blood pressure measurement . Technicians who followed a st and ard manual of operations administered all procedures . Question naire Patients completed an extensive self-report of personal and family medical diseases and conditions . Each clinic physician examines only four or five patients per day and thus has time for thorough additional probing of items on the self-reported question naire . This complete review of the patient 's medical history and the subsequent physical examination are strengths of the ACLS and provide a more thorough evaluation of baseline health status than is possible in many epidemiologic studies . The question naire also featured items on health habits , including current smoking status and smoking history and whether the participant was currently dieting to lose weight or following any other special dietary plan . Physical activity pattern was ascertained by self-report on the question naire . An extensive list of leisure-time physical activities was presented , and participants indicated activities in which they had participated in the 3 months before the examination . In later study years , they gave additional details on the number of times per week and the duration of exercise sessions . Laboratory Evaluations Cardiorespiratory fitness was assessed by using a maximal exercise test that followed a modified version of Balke and Ware 's protocol ( 18 ) . Briefly , the test began with the participant walking on a horizontal treadmill at 88 m/min . After the first minute , the elevation increased to 2 % , and it further increased 1 % each minute up to 25 minutes . For the few patients who were still able to continue , the elevation was held constant after 25 minutes and the speed increased to 5.4 m/min until the participant reached volitional fatigue . Exercise test performance with this protocol correlates highly with measured maximal oxygen uptake ( r=0.92 ) ( 19 ) . Serum sample s were analyzed by using automated techniques in a laboratory that participates in and meets the quality control st and ards of the Centers for Disease Control and Prevention Lipid St and ardization Program . Blood pressure was measured by auscultatory methods with a mercury sphygmomanometer according to American Heart Association guidelines ( 20 ) . The lowest of three blood pressure measurements at the clinic examination was recorded as the baseline blood pressure . Height and weight were measured by using a st and ard beam-balance scale and stadiometer , and body mass index was calculated . Type 2 Diabetes Diabetes was defined according to criteria of the American Diabetes Association : fasting plasma glucose level of 7.0 mmol/L or greater ( 126 mg/dL ) ( 21 ) . Three hundred seventy patients who did not meet this criterion but who gave a history of physician-diagnosed diabetes were considered to have diabetes . Patients were classified as having known diabetes or unknown diabetes according to their diabetes status before the baseline Cooper Clinic examination . Definition of Exposure Variables The principal exposure variables used in our analyses were  cardiorespiratory fitness and self-reported physical activity .  These exposures were determined at the baseline examination . Cardiorespiratory Fitness  We categorized  total time from the maximal exercise test into frequency distributions for specific age groups ( 30 to 39 , 40 to 49 , 50 to 59 , and 60 years ) . The least fit 20 % of the participants in each age group were classified as low fit , the next 40 % of the distribution as moderately fit , and the highest 40 % as high fit . We have used these cut-points to define fitness in previous studies ( 12 , 13 ) , and they are based on our entire cohort rather than on diabetic patients only . We selected these cut-points before undertaking the current analysis . Cardiorespiratory fitness is expressed as maximal metabolic units ( METs ) attained during the exercise test . The METs are calculated as the working metabolic rate divided by the resting metabolic rate , and 1 MET is equivalent to an oxygen uptake of 3.5 mL1 kg 1 . Physical Activity Patients who reported walking , jogging , or participating in aerobic exercise programs in the 3 months before the examination were classified as active , regardless of the frequency and duration of exercise . Otherwise , patients were classified as inactive . In our cohort , more than 76 % of men who reported being active at baseline still reported being active at the second visit after more than 1 year . In comparison , only 34 % of men who reported being inactive at baseline reported being active at the second examination ( P<0.001 ) . Self-reported physical activity status in our cohort is correlated with maximal exercise test performance ( 6 , 22 ) . Baseline or Parental Cardiovascular Disease We defined baseline cardiovascular disease as a personal history of heart attack , stroke , or a revascularization procedure ; an abnormal resting or exercise electrocardiogram ; or the highest heart rate during exercise testing that was less than 85 % of the age-predicted maximal heart rate ( [ 220 age in years ] 0.85 ) . Men who reported a history of cardiovascular disease in either parent were classified as having parental cardiovascular disease . Conventional Cardiovascular Disease Risk Factors We assigned men to risk strata for conventional cardiovascular disease risk factors on the basis of recent recommendations ( 23 ) . We defined high blood pressure as systolic blood pressure of 140 mm Hg or more , diastolic blood pressure of 90 mm Hg or more , or a history of physician-diagnosed hypertension . We classified participants with a total cholesterol level of 6.2 mmol/L ( 240 mg/dL ) or more as having high cholesterol , those with self-reported current smoking as current smokers , those with a self-reported parental history of myocardial infa rct ion or stroke as having a history of parental cardiovascular disease , those with a body mass index less than 25.0 kg/m2 as normal weight , and those with a body mass index of 25.0 kg/m2 or more as overweight . Statistical Analysis Our primary outcome measure was all-cause mortality . We used the National Death Index to identify  decedents in the ACLS . The National Death Index has been shown to be an effective , accurate means of ascertaining deaths in the general population , with a sensitivity of about 96 % and a specificity of 100 % ( 24 ) . We obtained official death certificates from states in which there were ACLS decedents , and we had the certificates coded by a nosologist according to the International Classification of Diseases , Ninth Revision . Only the underlying cause of death was used in analyses for this report . Data were analyzed by using the SAS statistical package ( SAS Institute , Inc. , Cary , North Carolina ) . The analyses assumed that physical activity and fitness were essentially unchanged during the study period . We used survival curves to estimate survival function against time and log [ log ( survival time ) ] to check the proportional hazards model assumption . Log [ log ( survival function ) ] estimates were approximately parallel across exposure Background  Physical activity levels among breast cancer survivors are typically low , and knowledge of the correlates of increased physical activity among cancer survivors is limited . The purpose of this study was to examine factors that are associated with physical activity or inactivity among breast cancer survivors . Methods Data from 3088 women participating in the Women ’s Healthy Eating and Living ( WHEL ) Study , collected prior to r and omization , were the focus of the current analyses . Self-reports of physical activity levels , quality of life , depression , and dietary intakes  were collected . Pearson correlation analyses were employed to examine the associations among these variables , and multiple regression analyses were performed to examine the relationship between selected health behaviors and physical activity levels , after controlling for demographic , breast cancer-related , and psychosocial variables . Results Demographic and psychosocial variables were related to physical activity levels ( P < 0.001 for all ) . Cancer treatment type and cancer stage were correlated with survivors ’ physical activity levels ( P < 0.01 ) , but the associations were no longer significant after controlling for demographic variables . Physical activity levels were strongly associated with other health behaviors , especially dietary intakes ( P < 0.001 ) , even after controlling for demographic , cancer-related , and psychosocial factors . Conclusion Low physical activity  levels in breast cancer survivors are associated with specific behavioral and other factors , which can be considered as indicators of women at higher risk . Findings of significant differences in  physical activity levels based on demographic characteristics suggest the importance of promoting physical activity particularly among breast cancer survivors of ethnic minority or lower education levels BACKGROUND Prolonged sitting is considered detrimental to health , but evidence regarding the independent relationship of total sitting time with all-cause mortality is limited . This study aim ed to determine the independent relationship of sitting time with all-cause mortality . METHODS We linked prospect i ve question naire data from 222 497 individuals 45 years or older from the 45 and Up Study to mortality data from the New South Wales Registry of Births , Deaths , and Marriages ( Australia ) from February 1 , 2006 , through December 31 , 2010 . Cox proportional hazards models examined all-cause mortality in relation to sitting time , adjusting for potential confounders that included sex , age , education , urban/rural residence , physical activity , body mass index , smoking status , self-rated health , and disability . RESULTS During 621 695 person-years of follow-up ( mean follow-up , 2.8 years ) , 5405 deaths were registered . All-cause mortality hazard ratios were 1.02 ( 95 % CI , 0.95 - 1.09 ) , 1.15 ( 1.06 - 1.25 ) , and 1.40 ( 1.27 - 1.55 ) for 4 to less than 8 , 8 to less than 11 , and 11 or more h/d of sitting , respectively , compared with less than 4 h/d , adjusting for physical activity and other confounders . The population -attributable fraction for sitting was 6.9 % . The association between sitting and all-cause mortality appeared consistent across the sexes , age groups , body mass index categories , and physical activity levels and across healthy participants compared with participants with preexisting cardiovascular disease or diabetes mellitus . CONCLUSIONS Prolonged sitting is a risk factor for all-cause mortality , independent of physical activity . Public health programs should focus on reducing sitting time in addition to increasing physical activity levels PURPOSE Although moderate-to-vigorous physical activity is related to premature mortality , the relationship between sedentary behaviors and mortality has not been fully explored and may represent a different paradigm than that associated with lack of exercise . We prospect ively examined  sitting time  and mortality in a representative sample of 17,013 Canadians 18 - 90 yr of age . METHODS Evaluation of  daily sitting time  ( almost none of the time , one fourth of the time , half of the time , three fourths of the time , almost all of the time ) ,  leisure time physical activity , smoking status , and alcohol consumption  was conducted at baseline . Participants were followed prospect ively for an average of 12.0 yr for the ascertainment of mortality status . RESULTS There were 1832 deaths  ( 759 of cardiovascular disease ( CVD ) and 547 of cancer ) during 204,732 person-yr of follow-up . After adjustment for potential confounders , there was a progressively higher risk of mortality across higher levels of sitting time from all causes ( hazard ratios ( HR ) : 1.00 , 1.00 , 1.11 , 1.36 , 1.54 ; P for trend < 0.0001 ) and CVD ( HR:1.00 , 1.01 , 1.22 , 1.47 , 1.54 ; P for trend < 0.0001 ) but not cancer . Similar results were obtained when stratified by sex , age , smoking status , and body mass index . Age-adjusted all-cause mortality rates per 10,000 person-yr of follow-up were 87 , 86 , 105 , 130 , and 161 ( P for trend < 0.0001 ) in physically inactive participants and 75 , 69 , 76 , 98 , 105 ( P for trend = 0.008 ) in active participants across sitting time categories . CONCLUSIONS These data demonstrate a dose-response association between  sitting time  and mortality from all causes and CVD , independent of leisure time physical activity . In addition to the promotion of moderate-to-vigorous physical activity and a healthy weight , physicians should discourage sitting for extended periods Background The purpose of this study was to describe the associations between different levels of long-term physical activity in leisure time and subsequent causes of deaths . Design The Copenhagen City Heart Study is a prospect i ve cardiovascular population study of 19 329 men and women aged 20–93 in 1976 .  Physical activity in leisure time was estimated at the examinations in 1976–78 and 1981–83 . This analysis consists of 2136 healthy men and 2758 women aged 20–79 years , with unchanged physical activity at the two examinations , and with all covariates included in the multivariate analyses : smoking , total-cholesterol , high-density lipoprotein-cholesterol , systolic blood pressure , diabetes mellitus , alcohol consumption , body mass index , education , income , and forced expiratory volume in 10.78 ( % predicted ) . Results Adjusted relative risks ( 95 % confidence interval ) for coronary heart disease were , for moderate physical activity 0.71 ( 0.51 , 0.99 ) and for high 0.56 ( 0.38 , 0.82 ) . For cancer , moderate activity 0.77 ( 0.61 , 0.97 ) and high activity 0.73 ( 0.56 , 0.95 ) and for all-cause mortality , moderate 0.78 ( 0.68 , 0.89 ) and high 0.75 ( 0.64 , 0.87 ) for both sexes combined . Using Kaplan — Meier plots we calculated gained years of expected lifetime from age 50 . Men with high physical activity  survived 6.8 years longer , and men with moderate physical activity 4.9 years longer than sedentary men . For women the figures were 6.4 and 5.5 years , respectively . Conclusion Long-term  moderate or high physical activity  was in both sexes associated with significantly lower mortality from coronary heart disease , cancer and all-causes . The same tendency was found for stroke and respiratory diseases , but the associations did not reach statistical significance . Eur J Cardiovasc Prev Rehabil 13:173–179 © 2006 The European Society of BACKGROUND AND OBJECTIVE Physical inactivity and an unhealthy diet have been implicated as risk factors for several chronic diseases that are known to be associated with periodontitis , such as cardiovascular diseases , obesity and diabetes . Studies investigating the relationship between periodontitis and physical activity and diet are limited . Therefore , this study was conducted to determine the relationship between physical activity , healthy eating habits and periodontal health status . MATERIAL AND METHODS A systematic r and om sample of 340 persons , 18 - 70 years of age , was selected from persons accompanying their relative patients who attended the outpatient clinics in the medical center of Jordan University of Science and Technology in north of Jordan . Data collected included socio-demographic and clinical characteristics , anthropometric measurements , physical activity level and dietary assessment . RESULTS Individuals who were highly physically active had a significantly lower average plaque index , average gingival index , average clinical attachment loss ( CAL ) and percentage of sites with CAL ≥ 3 mm compared to individuals with a low level of physical activity and individuals with a moderate level of physical activity . Those who had a poor diet had a significantly higher average number of missing teeth and an average CAL compared with those who had a good diet . In the multivariate analysis , a low level of physical activity and a poor diet ( diets with a healthy eating index score of < 50 points ) were significantly associated with increased odds of periodontitis . CONCLUSIONS A low physical activity level and a poor diet were significantly associated with increased odds of periodontal disease . Further studies are needed to underst and this relationship in greater detail Context Previous studies have examined the association between coffee consumption and a variety of specific diseases , such as type 2 diabetes , different types of cancer , and cardiovascular disease . However , the relationship between coffee consumption and all-cause mortality remains unclear . Contribution This study followed 2 large cohorts of men and women who provided data on coffee consumption , other behaviors , and health outcomes every 2 to 4 years over 2 decades . High coffee consumption was not related to increased mortality and may even be associated with lower total and cardiovascular mortality . Caution Misclassification of coffee consumption or confounding by other behavioral factors may account for these observations . The Editors Several epidemiologic studies have examined coffee consumption and risk for coronary heart disease and other chronic diseases , but data on coffee consumption in relation to all-cause and disease-specific mortality are sparse . Some studies found that those who drank coffee were the healthiest cohort members ( 15 ) , an inverse association that has been attributed to a possible confounding effect by morbidity . However , it has recently been suggested that the inverse association between coffee and all-cause mortality is attributable to the beneficial effect of coffee consumption on inflammation ( 6 ) . The Appendix Table lists the previous studies that have examined coffee consumption and the risk for mortality by different causes . Appendix Table . Cohort Studies Addressing the Association between  Coffee Consumption and All-Cause and Disease-Specific Mortality  In support of this hypothesis , we found in a previous study an inverse association between  coffee consumption and several markers of inflammation and endothelial dysfunction ( 7 ) . In addition , in the NHS ( Nurses ' Health Study ) and HPFS ( Health Professionals Follow-up Study ) , consumption of 6 or more cups of coffee per day was associated with a slightly lower risk for fatal coronary heart disease versus nonconsumers in both men and women ( 8) . Moreover , epidemiologic studies have consistently found an association between higher coffee consumption and lower risk for type 2 diabetes ( 9 ) . Finally , several studies have suggested that coffee might decrease the risk for some types of cancer , such as liver , colon , oral , pharyngeal , and esophageal ( 1012 ) . The objective of this study was to assess the association of  coffee consumption with all-cause , cardiovascular disease ( CVD ) , and cancer mortality . The long follow-up and the use of repeated dietary measurements allowed us to assess long-term coffee consumption . In addition , information about incident diseases during the follow-up and up date d measurements of main risk factors for CVD and cancer allowed us to control for potential confounders in detail . Methods Study Population The HPFS was established in 1986 and the NHS in 1976 . Information ( excluding diet ) on the cohort members has been up date d every 2 years . Further details have been published elsewhere ( 13 ) . We used 1980 as baseline for the NHS because this was the first year in which dietary information was collected in this cohort . After excluding participants with CVD or cancer at baseline or those with no information about coffee consumption at baseline ( 1183 persons in the HPFS and 879 in the NHS ) , we included 41736 men and 86214 women who were followed until 2004 . The Harvard School of Public Health and Brigham and Women 's Hospital Human Subjects Committee Review Board approved the study protocol . Assessment of  Coffee Consumption  Dietary question naires were sent to the HPFS participants in 1986 , 1990 , 1994 , and 1998 and to the NHS participants in 1980 , 1984 , 1986 , 1990 , 1994 , and 1998 . In each question naire , participants were asked how often on average during the previous year they had consumed coffee and tea . The participants could choose from 9 responses .  Decaffeinated coffee and different types of caffeinated soft drinks  were first assessed in 1986 in the HPFS and in 1984 in the NHS . We also inquired at baseline about whether the participant 's consumption for each beverage had greatly increased or decreased during the preceding 10 years . Using the U.S. Department of Agriculture food composition sources supplemented with other sources , we estimated that the caffeine content was 137 mg per cup of coffee , 47 mg per cup of tea , 46 mg per can or 12-ounce bottle of a soft drink , and 7 mg per 1-ounce serving of chocolate c and y. We assessed the total intake of caffeine by summing the caffeine content for a unit of each food during the previous year multiplied by a weight proportional to the frequency of its consumption . In our validation study , we obtained high correlations between consumption of coffee and other caffeinated beverages estimated from the food frequency question naire and consumption estimated from repeated 1-week diet records ( coffee , r= 0.78 ; tea , r= 0.93 ; and caffeinated soft drinks , r= 0.85 ) ( 14 ) . Ascertainment of Mortality Deaths were reported by the next of kin or the postal authorities or were ascertained through the National Death Index . We estimated that follow-up for deaths was more than 98 % complete ( 15 ) . For all deaths , we sought death certificates and , when appropriate , requested permission from the next of kin to review medical records . The underlying cause of death was assigned according to the International Classification of Diseases , Eighth Revision ( ICD-8 ) . The primary end point in this analysis was death from any cause . We also conducted analyses according to the main causes of deaths in the cohorts , which were CVD ( ICD-8 codes 390.0 through 458.9 and 795.0 to 795.9 ) and cancer ( ICD-8 codes 140.0 through 207.9 ) , and according to secondary causes of death , such as chronic liver disease and cirrhosis ( ICD-8 code 571.0 ) , chronic obstructive pulmonary disease ( ICD-8 codes 492.0 , 496.0 , and 519.0 ) , diabetes ( ICD-8 codes 250.0 , 250.1 , and 250.9 ) , neurodegenerative diseases ( ICD-8 codes 331.0 and 332.0 ) , and sudden death ( ICD-8 code 798.0 ) . Assessment of Medical History , Anthropometric Data , and Lifestyle Factors In the baseline question naires , we requested information about age ; weight and height ; smoking status ; parental history with respect to myocardial infa rct ion ; menopausal status and use of hormone therapy in women ; and history of hypertension , hypercholesterolemia , and type 2 diabetes mellitus . We up date d this information , with the exception of height and parental history , in the biennial follow-up question naires . We assessed perceived health in 2000 by asking the participants to describe their health as excellent , very good , good , fair , or poor . We calculated body mass index , and we also assessed physical activity biennially . In the HPFS , participants were queried about the average time spent per week during the preceding year in specific activities ( for example , walking outdoors , jogging , and bicycling ) ( 16 ) . The time spent in each activity in hours per week was multiplied by its typical energy expenditure , expressed in metabolic equivalent tasks and then summed over all activities to yield a metabolic equivalent task or hour score . In the NHS , physical activity was reported in hours per week of moderate ( for example , brisk walking ) and vigorous exercise ( for example , strenuous sports and jogging ) ( 17 ) . St and ard portion sizes for alcoholic drinks were specified as a can , bottle , or glass for beer ; 4-oz glass for wine ; and 1 drink or shot for liquor . Detailed information on the validity and reproducibility of the information from the question naires about self-reported weight , physical activity , and alcohol consumption has been reported elsewhere ( 1820 ) . Statistical Analysis We classified participants according to levels of coffee consumption . We calculated person-years of exposure from the date of return of the baseline question naire to the date of death or 1 June 2004 , whichever came first . To reduce within-participant variation and best represent long-term diet , we used the cumulative average of coffee consumption from all available dietary question naires up to the start of each 2-year follow-up interval ( 21 ) ; for example , in the HPFS , the average of the 1986 and 1990 intake was used for the follow-up between 1990 and 1994 ; and the average of the 1986 , 1990 , and 1994 intake was used for the follow-up between 1994 and 1998 . When a food frequency question naire had a missing value for coffee , we used the value from the previous question naire . We used sex-specific Cox proportional hazard models to investigate the association between coffee consumption and incidence of all-cause and disease-specific mortality . To control as finely as possible for confounding by age and calendar time , we stratified the analysis jointly by age in months at start of follow-up and calendar year of the current question naire cycle . We used hazard ratios to estimate relative risks in each category in comparison with participants in the lower category of coffee consumption . We adjusted multivariable models for smoking status , body mass index , physical activity , alcohol intake , use of hormone therapy for women , parental history of myocardial infa rct ion , and dietary factors ( total energy intake ; use of multivitamin and vitamin E supplements ; polyunsaturated , saturated , n-3 , and trans fat intake ; glycemic load ; and folic acid intake ) by using categorical variables . To test for linear trends across categories , we modeled coffee consumption as a continuous variable by using the median value of each level of coffee consumption . In addition , we calculated pooled relative risks for all-cause mortality in men and women combined across categories of coffee consumption by using a r and om-effects method . We also examined a possible nonlinear relation between coffee consumption and total and cardiovascular mortality nonparametrically with restricted cubic splines ( 22 ) . We conducted stratified analyses according to smoking status , alcohol Background / objectives Walking pace is associated with risk of premature mortality . However , whether this relationship is independent of total volume of physical activity and highest physical activity intensity remains unclear . We examined the associations between  walking pace  and cause-specific mortality , investigating the potential modifying effect of factors such as total physical activity volume , highest physical activity intensity , age , sex and body mass index ( BMI ) . Methods Prospect i ve pooled analysis of 11 population -based baseline surveys in Engl and and Scotl and between 1994 and 2008 that were linked with mortality records . Multivariate-adjusted Cox proportional hazards models examined associations between  walking pace  ( slow , average , brisk/fast ) and all-cause , cancer and cardiovascular disease ( CVD ) mortality . Results 50 225 walkers were entered in the core analyses . Among participants who did not experience an event in the first 2 years of follow-up ( n=49 731 ) , walking at an average or brisk/fast pace was associated with a reduced risk of all-cause ( 20 % ( 95 % CI 12 % to 28 % ) and 24 % ( 95 % CI 13 % to 33 % ) , respectively ) and CVD mortality ( 24 % ( 95 % CI 9 % to 36 % ) and 21 % ( 95 % CI 1 % to 38 % ) , respectively ) , compared with reporting walking at a slow pace . In stratified analyses , such associations were evident among those over 50 years , those not meeting the physical activity recommendations and those who did not undertake vigorous-intensity activity . There were no interactions by sex or BMI . No associations were seen between pace and cancer mortality . Conclusion Walking benefits health . Assuming causality , these analyses suggest that increasing walking pace could reduce risk for all-cause and CVD mortality .  Walking pace could be emphasised in public health messages , especially in situations when increase in walking volume or frequency is less feasible BACKGROUND Prospect i ve studies suggested that substituting whole-grain products for refined-grain products lowers the risks of type 2 diabetes and cardiovascular disease ( CVD ) in women . Although breakfast cereals are a major source of whole and refined grains , little is known about their direct association with the risk of premature mortality . OBJECTIVE We prospect ively evaluated the association between whole- and refined-grain breakfast cereal intakes and total and CVD-specific mortality in a cohort of US men . DESIGN We examined 86,190 US male physicians aged 40 - 84 y in 1982 who were free of known CVD and cancer at baseline . RESULTS During 5.5 y , we documented 3114 deaths from all causes , including 1381 due to  CVD  ( 488 myocardial infa rct ions and 146 strokes ) . Whole-grain breakfast cereal intake was inversely associated with total and CVD-specific mortality , independent of age ; body mass index ; smoking ; alcohol intake ; physical activity ; history of diabetes , hypertension , or high cholesterol ; and use of multivitamins . Compared with men who rarely or never consumed whole-grain cereal , men in the highest category of whole-grain cereal intake ( > or = 1 serving/d ) had multivariate-estimated relative risks of total and CVD-specific mortality of 0.83 ( 95 % CI : 0.73 , 0.94 ; P for trend < 0.001 ) and 0.80 ( 0.66 , 0.97 ; P for trend < 0.001 ) , respectively . In contrast , total and refined-grain breakfast cereal intakes were not significantly associated with total and CVD-specific mortality . These findings persisted in analyses stratified by history of type 2 diabetes , hypertension , and high cholesterol . CONCLUSIONS Both total mortality and CVD-specific mortality were inversely associated with whole-grain but not refined-grain breakfast cereal intake . These prospect i ve data highlight the importance of distinguishing whole-grain from refined-grain cereals in the prevention of chronic diseases BACKGROUND AND PURPOSE Physical activity reduces the risk of premature death and cardiovascular disease , but the relationship to stroke is less well studied . The objective of this study was to investigate the association between leisure-time physical activity and  ischemic stroke in an urban , elderly , multiethnic population . METHODS The Northern Manhattan Stroke Study is a population -based incidence and case-control study . Case subjects had first ischemic stroke , and control subjects were derived through r and om-digit dialing with 1:2 matching for age , sex , and race/ethnicity .  Physical activity  was recorded through a st and ardized in-person interview regarding the frequency and duration of 14 activities over the 2 prior weeks . Conditional logistic regression was used to calculate odds ratios ( OR ) and 95 % confidence intervals after adjustment for medical and socioeconomic confounders . RESULTS Over 30 months , 369 case subjects and 678 control subjects were enrolled . Mean age was 69.9 + /- 12 years ; 57 % were women , 18 % whites , 30 % blacks , and 52 % Hispanics .  Leisure-time physical activity  was significantly protective for stroke after adjustment for cardiac disease , peripheral vascular disease , hypertension , diabetes , smoking , alcohol use , obesity , medical reasons for limited activity , education , and season of enrollment ( OR = 0.37 ; 95 % confidence interval=0.25 to 0.55 ) . The protective effect of  physical activity  was detected in both younger and older groups , in men and women , and in whites , blacks , and Hispanics . A dose-response relationship was shown for both intensity ( light-moderate activity OR = 0.39 ; heavy OR = 0.23 ) and duration ( < 2 h/wk OR = 0.42 ; 2 to < 5 h/wk OR = 0.35 ; > or = 5 h/wk OR = 0.31 ) of physical activity . CONCLUSIONS Leisure-time physical activity was related to a decreased occurrence of ischemic stroke in our elderly , multiethnic , urban subjects . More emphasis on physical activity in stroke prevention campaigns is needed among the elderly IMPORTANCE Few studies have examined how different proportions of moderate and vigorous physical activity affect health outcomes . OBJECTIVE To examine whether the proportion of total moderate to vigorous activity ( MVPA ) that is achieved through vigorous activity is associated with all-cause mortality independently of the total amount of MVPA . DESIGN , SETTING , AND PARTICIPANTS We performed a prospect i ve cohort study with activity data linked to all-cause mortality data from February 1 , 2006 , through June 15 , 2014 , in 204,542 adults aged 45 through 75 years from the 45 and Up population -based cohort study from New South Wales , Australia ( mean [ SD ] follow-up , 6.52 [ 1.23 ] years ) . Associations between different contributions of vigorous activity to total MVPA and mortality were examined using Cox proportional hazards models , adjusted for total MVPA and sociodemographic and health covariates . EXPOSURES Different proportions of total MVPA as vigorous activity . Physical activity was measured with the Active Australia Survey . MAIN OUTCOMES AND MEASURES All-cause mortality during the follow-up period . RESULTS During 1,444,927 person-years of follow-up , 7435 deaths were registered . Compared with those who reported no MVPA ( crude death rate , 8.34 % ) , the adjusted hazard ratios for all-cause mortality were 0.66 ( 95 % CI , 0.61 - 0.71 ; crude death rate , 4.81 % ) , 0.53 ( 95 % CI , 0.48 - 0.57 ; crude death rate , 3.17 % ) , and 0.46 ( 95 % CI , 0.43 - 0.49 ; crude death rate , 2.64 % ) for reporting 10 through 149 , 150 through 299 , and 300 min/wk or more of activity , respectively . Among those who reported any MVPA , the proportion of vigorous activity revealed an inverse dose-response relationship with all-cause mortality : compared with those reporting no vigorous activity ( crude death rate , 3.84 % ) the fully adjusted hazard ratio was 0.91 ( 95 % CI , 0.84 - 0.98 ; crude death rate , 2.35 % ) in those who reported some vigorous activity ( but < 30 % of total activity ) and 0.87 ( 95 % CI , 0.81 - 0.93 ; crude death rate , 2.08 % ) among those who reported 30 % or more of activity as vigorous . These associations were consistent in men and women , across categories of body mass index and volume of MVPA , and in those with and without existing cardiovascular disease or diabetes mellitus . CONCLUSIONS AND RELEVANCE Among people reporting any activity , there was an inverse dose-response relationship between proportion of vigorous activity and mortality . Our findings suggest that vigorous activities should be endorsed in clinical and public health activity guidelines to maximize the population benefits of physical activity Background Given high rates of obesity , hypertension , and diabetes mellitus , black persons are at risk to develop heart failure . The association of moderate to vigorous physical activity ( MVPA ) and heart failure  in black adults is under research ed . The purpose of this study was to explore whether greater MVPA was associated with lower risk of heart failure hospitalizations ( HFHs ) among black adults with normal ejection fractions . Methods and Results We performed a prospect i ve analysis of 4066 black adults who participated in the Jackson Heart Study and who had physical activity measured , had normal ejection fraction on 2‐dimensional echocardiograms , and were followed for 7 years for incident HFH . We used Cox proportional regression analyses adjusted for age , sex , body mass index , smoking status , hypertension , diabetes mellitus , chronic obstructive pulmonary disease , coronary heart disease , atrial fibrillation , and chronic kidney disease and examined effect modification by sex and body mass index . Of the eligible population , 1925 participants , according to the duration of MVPA , had poor health ( 0 minutes/week ) , 1332 had intermediate health ( 1–149 minutes/week ) , and 809 had ideal health ( ≥150 minutes/week ) . There were 168 incident HFHs .  MVPA for intermediate and ideal health was associated with decreasing risk of incident HFH ( hazard ratio : 0.70 [ 95 % confidence interval , 49–1.00 ] and 0.35 [ 95 % confidence interval , 0.19–0.64 ] , respectively ; P trend=0.003 ) . The full model revealed hazard ratios of 0.74 [ 95 % confidence interval , 0.52–1.07 ] and 0.41 [ 95 % confidence interval , 0.22–0.74 ] , respectively . There was no effect modification  between MVPA and body mass index or sex on incident HFH . Conclusions A dose‐response relationship between increasing levels of MVPA and protection from incident HFH was found in black men and women with normal ejection fractions Purpose of review This review highlights recent work evaluating the relationship between exercise , physical activity and physical and mental health . Both cross-sectional and longitudinal studies , as well as r and omized clinical trials , are included . Special attention is given to physical conditions , including obesity , cancer , cardiovascular disease and sexual dysfunction . Furthermore , studies relating physical activity to depression and other mood states are review ed . The studies include diverse ethnic population s , including men and women , as well as several age groups ( e.g. adolescents , middle-aged and older adults ) . Recent findings Results of the studies continue to support a growing literature suggesting that exercise , physical activity and physical-activity interventions have beneficial effects across several physical and mental-health outcomes . Generally , participants engaging in regular physical activity display more desirable health outcomes across a variety of physical conditions . Similarly , participants in r and omized clinical trials of physical-activity interventions show better health outcomes , including better general and health-related quality of life , better functional capacity and better mood states . Summary The studies have several implication s for clinical practice and research . Most work suggests that exercise and physical activity are associated with better quality of life and health outcomes . Therefore , assessment and promotion of exercise and physical activity may be beneficial in achieving desired benefits across several population s. Several limitations were noted , particularly in research involving r and omized clinical trials . These trials tend to involve limited sample sizes with short follow-up periods , thus limiting the clinical implication s of the benefits associated with physical activity . Abbreviations CAD : coronary artery disease ; COPD : chronic obstructive pulmonary disease ; CRP : cardiac rehabilitation program ; CVD : cardiovascular disease ; GMCB : group-mediated cognitive – behavioural ; HRQOL : health-related quality of life OBJECTIVE The aims of the study were to assess how baseline  leisure-time physical activity ( LTPA )  and its exercise components intensity , duration , and frequency are associated with all-cause and cardiovascular mortality in patients with type 1 diabetes 1 ) overall , 2 ) stratified by presence or absence of chronic kidney disease ( CKD ) , and 3 ) stratified by sex . RESEARCH DESIGN AND METHODS The study design was prospect i ve and observational and included 2,639 patients with type 1 diabetes from the ongoing nationwide multicenter Finnish Diabetic Nephropathy ( FinnDiane ) Study . Mean follow-up time was 11.4 ± 3.5 years . LTPA was assessed by using a vali date d self-report question naire .  Three hundred ten patients ( 11.7 % ) had CKD defined as an estimated glomerular filtration rate of ≤60 mL/min/1.73 m2 . RESULTS During follow-up , 270 deaths occurred . LTPA and all its components were associated with all-cause mortality , even after adjustment for the potential confounders sex , diabetic nephropathy , duration of diabetes , age at onset of diabetes , systolic blood pressure , triglycerides , BMI , and HbA1c . Only exercise intensity was associated with cardiovascular mortality after adjustment for the confounders . Of the patients with CKD , 127 died during follow-up . The total amount of LTPA and exercise frequency were independently associated with lower risk of all-cause mortality when adjusted for covariates . CONCLUSIONS Exercise is associated with a lower risk of premature all-cause and cardiovascular mortality in patients with type 1 diabetes . This study also demonstrates that physical activity is associated with a lower risk of mortality in patients with type 1 diabetes and CKD OBJECTIVES Physical activity ( PA ) is a preventive strategy for cardiovascular disease and for managing cardiovascular risk factors . There is little information on the effectiveness of PA for the prevention of cardiovascular outcomes once cardiovascular disease is present . Thus , we studied the relationship between PA at baseline and cardiovascular events in a high-risk population . DESIGN A prespecified analyses of observational data in a prospect i ve , r and omized hypertension study . SETTING Losartan Intervention For Endpoint reduction in hypertension ( LIFE ) study . SUBJECTS Hypertension and left ventricular hypertrophy ( LVH ) ( n = 9,193 ) . INTERVENTIONS Losartan versus atenolol . MAIN OUTCOME MEASURES Reported level of PA : never exercise , exercise < or=30 min twice per week , or exercise > 30 min twice per week at baseline and after a mean of 4.8 years of treatment with losartan- versus atenolol-based therapy . Risk reductions were calculated by level of PA for the primary composite end-point and its components cardiovascular death , stroke and myocardial infa rct ion , and also all-cause mortality and new-onset diabetes . RESULTS A modest level of PA ( > 30 min twice per week ) was associated with significant reductions in risk for the primary composite end-point [ adjusted hazard ratio ( aHR ) 0.70 , P < 0.001 ) and its components , all-cause mortality ( aHR 0.65 , P < 0.001 ) , and new-onset diabetes ( aHR 0.66 , P < 0.001 ) . CONCLUSION A modest level of self-reported PA ( > 30 min twice per week ) in patients with hypertension and LVH in the LIFE study was associated with significant reductions in risk for the primary composite end-point and its components of cardiovascular death , stroke , and myocardial infa rct ion , all-cause mortality , and new-onset diabetes BACKGROUND The remarkable similarity of lifestyle and environmental risk factors for type 2 ( non-insulin-dependent ) diabetes mellitus and colon cancer has led to the hypothesis that diabetes may increase the risk of this cancer . We prospect ively examined the relationship between diabetes and risk of colorectal cancer in a cohort of 118403 women aged 30 through 55 years who were without previously diagnosed cancer at baseline in 1976 . METHODS The women , who were enrolled in the Nurses ' Health Study , were assessed for history of diabetes at baseline and during follow-up by use of biennial question naires . Self-reported diabetes was vali date d by information obtained from a supplemental question naire on symptoms and treatment and was confirmed by medical record review in a sample of the participants . Incident cases of colorectal cancer were ascertained through medical record review . All reported P values are two-sided . RESULTS During 18 years of follow-up ( 201061 person-years ) , we documented 892 new cases of colorectal cancer . After adjustment for age , body mass index ( weight in kg/height in m2 ) , physical activity , and other covariates , relative risks ( RRs ) were 1.43 ( 95 % confidence interval [ CI ] = 1.10 - 1.87 ; P = .009 ) for colorectal cancer , 1.49 ( 95 % CI = 1.09 - 2.06 ; P = .01 ) for colon cancer , 1.11 ( 95 % CI = 0.56 - 2.21 ; P = .76 ) for rectal cancer , 1.56 ( 95 % CI = 1.07 - 2.28 ; P = .02 ) for advanced colorectal cancer , and 2.39 ( 95 % CI = 1.46 - 3.92 ; P = .0005 ) for fatal colorectal cancer . CONCLUSION Our data provide support for the hypothesis that diabetes is associated with an increased risk of colorectal cancer in women
Overall , the current literature supports clearly the dose-response relationship between physical activity and the seven chronic conditions identified .
Moreover , higher levels of physical activity reduce the risk for premature all-cause mortality .
The current Canadian guidelines appear to be appropriate to reduce the risk for the seven chronic conditions identified above and all-cause mortality
This systematic review examines critically the scientific basis for Canada 's Physical Activity Guide for Healthy Active Living for adults .
Particular reference is given to the dose-response relationship between physical activity and premature all-cause mortality and seven chronic diseases ( cardiovascular disease , stroke , hypertension , colon cancer , breast cancer , type 2 diabetes ( diabetes mellitus ) and osteoporosis ) .
The strength of the relationship between physical activity and specific health outcomes is evaluated critically .