Abstract MP014: Physical Activity and Risk of Coronary Heart Disease and Stroke in Older Adults: The Cardiovascular Health Study
Authors: Luisa Soares-Miranda, David S. Siscovick, Dariush Mozaffarian
Journal: Circulation (2012)

Introduction- While it is recommended that older adults engage in regular physical activity (PA) to reduce CVD risk, surprisingly few studies have evaluated this relationship, and even less data are available for individuals older than 75 yrs. Also, with advancing age, the ability to perform some types of PA might decrease in many older adults, and light-moderate exercise such as walking may be especially important to meet recommendations. Hypothesis-We assessed the hypothesis that greater PA, including walking, would be associated with lower incidence of CVD in older adults. Methods- Prospective cohort analysis among 3,941 men and women free of CVD and mean age 72.5 at baseline in the Cardiovascular Health Study (CHS), followed from 1989 to 1999. PA was assessed and updated over time by means of cumulative averaging to minimize misclassification and assess long-term effects of habitual activity. Walking (pace, blocks, and a combined walking score) was updated annually from baseline through 1999. Leisure-time activity and exercise intensity were updated from baseline, 1992-93, and 1996-97. Incident CVD was adjudicated using medical records. Cox-proportional hazards were used to estimate risk. Results- During follow-up, 560 CHD, 455 stroke, and 668 CVD (first of either CHD or stroke) events were identified. After multivariate adjustment, all types of PA were inversely associated with CHD, stroke (especially ischemic stroke), and total CVD ( Table ). Walking pace, distance, and an overall walking score were each associated with lower risk. Findings were generally similar by sex and by age (&lt; or &gt; 75 yrs), or when accounting for baseline comorbidity or poor health. In mutually adjusted analyses, only walking was significantly associated with lower CVD risk. Conclusions- These data provide evidence supporting PA recommendations, including walking, to reduce incidence of CVD among older adults. Table Relative-risk Total CHD p Total stroke p Total CVD p N= 2590 N= 3110 N=2551 Nº of cases 560 455 668 Walking-pace &lt; then 2 mph Reference Reference Reference 2–3 mph 0.65(0.54,0.79) &lt;0.001 0.85(0.69,1.05) 0.14 0.72(0.60,0.85) &lt;0.001 &gt; then 3 mph 0.48(0.36,0.65) &lt;0.001 0.55(0.38,0.78) 0.001 0.52(0.40,0.70) &lt;0.001 P- trend &lt;0.001 0.001 &lt;0.001 Walking-distance, blocks/week 0/6 Reference Reference Reference 6/15 0.95(0.72,1.25) 0.71 0.86(0.64,1.17) 0.34 0.79(0.62,1.02) 0.07 15/28 0.99(0.76,1.31) 0.97 0.83(0.61,1.12) 0.22 0.88(0.69,1.12) 0.28 28/51 0.68(0.51,0.92) 0.01 0.77(0.56,1.05) 0.10 0.66(0.51,0.86) 0.002 ≥51 0.68(0.50,0.93) 0.01 0.65(0.47,0.91) 0.01 0.64(0.49,0.84) 0.001 P- trend 0.001 0.01 0.001 Walking-Score I Reference Reference Reference II 0.99(0.75,1.30) 0.93 0.89(0.66,1.20) 0.45 0.97(0.76,1.24) 0.83 III 0.74(0.56,0.98) 0.03 0.78(0.58,1.06) 0.12 0.71(0.55,0.91) 0.008 IV 0.57(0.41,0.78) 0.001 0.62(0.44,0.88) 0.008 0.59(0.44,0.79) &lt;0.001 P- trend &lt;0.001 0.004 &lt;0.001 Leisure-time activity, kcal/week I Reference Reference Reference II 0.75(0.57,0.98) 0.04 0.91(0.67,1.22) 0.52 0.83(0.65,1.06) 0.14 III 0.68(0.52,0.89) 0.006 0.78(0.57,1.06) 0.11 0.70(0.55,0.90) 0.005 IV 0.76(0.58,1.00) 0.05 0.85(0.62,1.16) 0.30 0.75(0.58,0.96) 0.03 V 0.61(0.46,0.81) 0.001 0.74(0.54,1.03) 0.08 0.62(0.47,0.81) &lt;0.001 P- trend 0.005 0.09 0.001 Intensity None Reference Reference Reference Low 0.57(0.42,0.78) &lt;0.001 0.68(0.47,0.98) 0.04 0.58(0.43,0.78) &lt;0.001 Moderate 0.60(0.44,0.83) 0.002 0.62(0.42,0.91) 0.02 0.58(0.43,0.79) &lt;0.001 High 0.41(0.26,0.65) &lt;0.001 0.55(0.33,0.91) 0.02 0.47(0.31,0.70) &lt;0.001 P- trend 0.01 0.03 0.009 *All analyses are adjusted for age, gender, race, education, income, clinical sites, smoking and body mass index.