Quantifying the Association Between Physical Activity and Cardiovascular Disease and Diabetes: A Systematic Review and Meta-Analysis

Ahad Wahid, Nishma Manek, Melanie Nichols, Paul Kelly, Charlie Foster, Premila Webster, Asha Kaur, Claire Friedemann Smith, Elizabeth Wilkins, Mike Rayner, Nia Roberts, Peter Scarborough, Ahad Wahid, Nishma Manek, Melanie Nichols, Paul Kelly, Charlie Foster, Premila Webster, Asha Kaur, Claire Friedemann Smith, Elizabeth Wilkins, Mike Rayner, Nia Roberts, Peter Scarborough

Abstract

Background: The relationships between physical activity (PA) and both cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) have predominantly been estimated using categorical measures of PA, masking the shape of the dose-response relationship. In this systematic review and meta-analysis, for the very first time we are able to derive a single continuous PA metric to compare the association between PA and CVD/T2DM, both before and after adjustment for a measure of body weight.

Methods and results: The search was applied to MEDLINE and EMBASE electronic databases for all studies published from January 1981 to March 2014. A total of 36 studies (3 439 874 participants and 179 393 events, during an average follow-up period of 12.3 years) were included in the analysis (33 pertaining to CVD and 3 to T2DM). An increase from being inactive to achieving recommended PA levels (150 minutes of moderate-intensity aerobic activity per week) was associated with lower risk of CVD mortality by 23%, CVD incidence by 17%, and T2DM incidence by 26% (relative risk [RR], 0.77 [0.71-0.84]), (RR, 0.83 [0.77-0.89]), and (RR, 0.74 [0.72-0.77]), respectively, after adjustment for body weight.

Conclusions: By using a single continuous metric for PA levels, we were able to make a comparison of the effect of PA on CVD incidence and mortality including myocardial infarct (MI), stroke, and heart failure, as well as T2DM. Effect sizes were generally similar for CVD and T2DM, and suggested that the greatest gain in health is associated with moving from inactivity to small amounts of PA.

Keywords: cardiovascular diseases; meta‐analysis; physical activity; systematic review.

© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Figures

Figure 1
Figure 1
Flow chart for inclusion of studies. CVD indicates cardiovascular disease; diabetes, diabetes mellitus.
Figure 2
Figure 2
Relative risk for CVD mortality against MET hours per day. Results from 14 studies, including the 0.25 power transformation fit line as well as linear, log‐linear, 0.375, 0.5, and 0.750 power transformations. Relative risk estimates are weighted by the inverse of the reported SE, with larger circles for results with greater weighting. The red line represents a log‐linear transformation, and the orange line represents a 0.25 power transformation. CVD indicates cardiovascular disease; MET, metabolic equivalent of task; RR, relative risk.
Figure 3
Figure 3
Meta‐analysis of 11.25 MET h/week increase in physical activity on CVD mortality, with a 0.25 power transformation, adjusted for body weight. CVD indicates cardiovascular disease; MET, metabolic equivalent of task; RR, relative risk.
Figure 4
Figure 4
Funnel plot for meta‐analyses of 11.25 MET h/week increase in physical activity, with a 0.25 power transformation, for CVD mortality, adjusted for body weight. CVD indicates cardiovascular disease; MET, metabolic equivalent of task.

References

    1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair‐Rohani H, Amann M, Anderson HR, Andrews KG, Aryee M, Atkinson C, Bacchus LJ, Bahalim AN, Balakrishnan K, Balmes J, Barker‐Collo S, Baxter A, Bell ML, Blore JD, Blyth F, Bonner C, Borges G, Bourne R, Boussinesq M, Brauer M, Brooks P, Bruce NG, Brunekreef B, Bryan‐Hancock C, Bucello C, Buchbinder R, Bull F, Burnett RT, Byers TE, Calabria B, Carapetis J, Carnahan E, Chafe Z, Charlson F, Chen H, Chen JS, Cheng AT, Child JC, Cohen A, Colson KE, Cowie BC, Darby S, Darling S, Davis A, Degenhardt L, Dentener F, Des Jarlais DC, Devries K, Dherani M, Ding EL, Dorsey ER, Driscoll T, Edmond K, Ali SE, Engell RE, Erwin PJ, Fahimi S, Falder G, Farzadfar F, Ferrari A, Finucane MM, Flaxman S, Fowkes FG, Freedman G, Freeman MK, Gakidou E, Ghosh S, Giovannucci E, Gmel G, Graham K, Grainger R, Grant B, Gunnell D, Gutierrez HR, Hall W, Hoek HW, Hogan A, Hosgood HD III, Hoy D, Hu H, Hubbell BJ, Hutchings SJ, Ibeanusi SE, Jacklyn GL, Jasrasaria R, Jonas JB, Kan H, Kanis JA, Kassebaum N, Kawakami N, Khang YH, Khatibzadeh S, Khoo JP, Kok C, Laden F, Lalloo R, Lan Q, Lathlean T, Leasher JL, Leigh J, Li Y, Lin JK, Lipshultz SE, London S, Lozano R, Lu Y, Mak J, Malekzadeh R, Mallinger L, Marcenes W, March L, Marks R, Martin R, McGale P, McGrath J, Mehta S, Mensah GA, Merriman TR, Micha R, Michaud C, Mishra V, Mohd Hanafiah K, Mokdad AA, Morawska L, Mozaffarian D, Murphy T, Naghavi M, Neal B, Nelson PK, Nolla JM, Norman R, Olives C, Omer SB, Orchard J, Osborne R, Ostro B, Page A, Pandey KD, Parry CD, Passmore E, Patra J, Pearce N, Pelizzari PM, Petzold M, Phillips MR, Pope D, Pope CA III, Powles J, Rao M, Razavi H, Rehfuess EA, Rehm JT, Ritz B, Rivara FP, Roberts T, Robinson C, Rodriguez‐Portales JA, Romieu I, Room R, Rosenfeld LC, Roy A, Rushton L, Salomon JA, Sampson U, Sanchez‐Riera L, Sanman E, Sapkota A, Seedat S, Shi P, Shield K, Shivakoti R, Singh GM, Sleet DA, Smith E, Smith KR, Stapelberg NJ, Steenland K, Stöckl H, Stovner LJ, Straif K, Straney L, Thurston GD, Tran JH, Van Dingenen R, van Donkelaar A, Veerman JL, Vijayakumar L, Weintraub R, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams W, Wilson N, Woolf AD, Yip P, Zielinski JM, Lopez AD, Murray CJ, Ezzati M, AlMazroa MA, Memish ZA. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224–2260.
    1. Paffenbarger RS, Hale WE. Work activity and coronary heart mortality. N Engl J Med. 1975;292:545–550.
    1. Morris JN, ed. Exercise Versus Heart Attack: History of a Hypothesis. 2nd ed Oxford, UK: Oxford University Press; 2005.
    1. Department of Health . On the state of public health: annual report of the Chief Medical Officer. London: Department of Health; 2009.
    1. World Health Organization (WHO) . Global recommendations on physical activity for health. Geneva, Switzerland: WHO; 2010.
    1. Chief Medical Officers of England, Scotland, Wales, and Northern Ireland. Start active, stay active: a report on physical activity from the four home countries’ Chief Medical Officers. London: Department of Health.
    1. US Department of Health and Human Services (US DHHS) . 2008 physical activity guidelines for Americans. Washington, DC: US DHHS; 2008.
    1. Lee IM, Paffenbarger RS Jr. Associations of light, moderate, and vigorous intensity physical activity with longevity. The Harvard Alumni Health Study. Am J Epidemiol. 2000;151:293–299.
    1. Fujita K, Takahashi H, Miura C, Ohkubo T, Sato Y, Ugajin T, Kurashima K, Tsubono Y, Tsuji I, Fukao A, Hisamichi S. Walking and mortality in Japan: the Miyagi Cohort Study. J Epidemiol. 2004;14(suppl 1):S26–S32.
    1. Woodcock J, Franco OH, Orsini N, Roberts I. Non‐vigorous physical activity and all‐cause mortality: systematic review and meta‐analysis of cohort studies. Int J Epidemiol. 2011;40:121–138.
    1. Jeon CY, Lokken RP, Hu FB, van Dam RM. Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review. Diabetes Care. 2007;30:744–752.
    1. Wells G. The Newcastle‐Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta‐analyses. 2013. Available at: . Accessed June 7, 2016.
    1. Kelly P, Kahlmeier S, Götschi T, Orsini N, Richards J, Roberts N, Scarborough P, Foster C. Systematic review and meta‐analysis of reduction in all‐cause mortality from walking and cycling and shape of dose response relationship. Int J Behav Nutr Phys Act. 2014;11:132.
    1. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor‐Locke C, Greer JL, Vezina J, Whitt‐Glover MC, Leon AS. 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43:1575–1581.
    1. Moody A. Adult Anthropometric Measures, Overweight and Obesity. Health and Social Care Information Centre. Health Survey for England 2013. HSCIC: Leeds; 2015.
    1. Alaike H. A new look at the statistical model identification. IEEE Trans Automat Contr. 1974;19:716–723.
    1. Egger M, Smith GD, Phillips AN. Meta‐analysis: principles and procedures. BMJ. 1997;315:1533–1537.
    1. Wattanakit K, Lutsey PL, Bell EJ, Gornik H, Cushman M, Heckbert SR, Rosamond WD, Folsom AR. Association between cardiovascular disease risk factors and occurrence of venous thromboembolism. A time‐dependent analysis. Thromb Haemost. 2012;108:508–515.
    1. Sherman SE, D'Agostino RB, Cobb JL, Kannel WB. Does exercise reduce mortality rates in the elderly? Experience from the Framingham Heart Study. Am Heart J. 1994;128:965–972.
    1. Soedamah‐Muthu SS, De Neve M, Shelton NJ, Tielemans SM, Stamatakis E. Joint associations of alcohol consumption and physical activity with all‐cause and cardiovascular mortality. Am J Cardiol. 2013;112:380–386.
    1. Clays E, De Bacquer D, Janssens H, De Clercq B, Casini A, Braeckman L, Kittel F, De Backer G, Holtermann A. The association between leisure time physical activity and coronary heart disease among men with different physical work demands: a prospective cohort study. Eur J Epidemiol. 2013;28:241–247.
    1. Arem H, Moore SC, Patel A, Hartge P, Berrington de Gonzalez A, Visvanathan K, Campbell PT, Freedman M, Weiderpass E, Adami HO, Linet MS, Lee IM, Matthews CE. Leisure time physical activity and mortality: a detailed pooled analysis of the dose‐response relationship. JAMA Intern Med. 2015;175:959–967.
    1. Oguma Y, Shinoda‐Tagawa T. Physical activity decreases cardiovascular disease risk in women: review and meta‐analysis. Am J Prev Med. 2004;26:407–418.
    1. Diep L, Kwagyan J, Kurantsin‐Mills J, Weir R, Jayam‐Trouth A. Association of physical activity level and stroke outcomes in men and women: a meta‐analysis. J Womens Health (Larchmt). 2010;19:1815–1822.
    1. Nocon M, Hiemann T, Müller‐Riemenschneider F, Thalau F, Roll S, Willich SN. Association of physical activity with all‐cause and cardiovascular mortality: a systematic review and meta‐analysis. Eur J Cardiovasc Prev Rehabil. 2008;15:239–246.
    1. Sattelmair J, Pertman J, Ding EL, Kohl HW III, Haskell W, Lee IM. Dose response between physical activity and risk of coronary heart disease: a meta‐analysis. Circulation. 2011;124:789–795.
    1. Bao Y, Michaud DS. Physical activity and pancreatic cancer risk: a systematic review. Cancer Epidemiol Biomarkers Prev. 2008;17:2671–2682.
    1. O'Rorke MA, Cantwell MM, Cardwell CR, Mulholland HG, Murray LJ. Can physical activity modulate pancreatic cancer risk? A systematic review and meta‐analysis. Int J Cancer. 2010;126:2957–2968.
    1. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT; Lancet Physical Activity Series Working Group . Effect of physical inactivity on major non‐communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380:219–229.
    1. Scowcroft H. Is being inactive really ‘as bad as smoking’? Science Update Blog; 2012. Available at: . Accessed June 7, 2016.
    1. Prince SA, Adamo KB, Hamel ME, Hardt J, Connor Gorber S, Tremblay M. A comparison of direct versus self‐report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act. 2008;5:56.
    1. Sofi F, Valecchi D, Bacci D, Abbate R, Gensini GF, Casini A, Macchi C. Physical activity and risk of cognitive decline: a meta‐analysis of prospective studies. J Intern Med. 2011;269:107–117.
    1. Sofi F, Capalbo A, Cesari F, Abbate R, Gensini GF. Physical activity during leisure time and primary prevention of coronary heart disease: an updated meta‐analysis of cohort studies. Eur J Cardiovasc Prev Rehabil. 2008;15:247–257.

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