Dose response between physical activity and risk of coronary heart disease: a meta-analysis

Abstract

Background: No reviews have quantified the specific amounts of physical activity required for lower risks of coronary heart disease when assessing the dose-response relation. Instead, previous reviews have used qualitative estimates such as low, moderate, and high physical activity.

Methods and results: We performed an aggregate data meta-analysis of epidemiological studies investigating physical activity and primary prevention of CHD. We included prospective cohort studies published in English since 1995. After reviewing 3194 abstracts, we included 33 studies. We used random-effects generalized least squares spline models for trend estimation to derive pooled dose-response estimates. Among the 33 studies, 9 allowed quantitative estimates of leisure-time physical activity. Individuals who engaged in the equivalent of 150 min/wk of moderate-intensity leisure-time physical activity (minimum amount, 2008 U.S. federal guidelines) had a 14% lower coronary heart disease risk (relative risk, 0.86; 95% confidence interval, 0.77 to 0.96) compared with those reporting no leisure-time physical activity. Those engaging in the equivalent of 300 min/wk of moderate-intensity leisure-time physical activity (2008 U.S. federal guidelines for additional benefits) had a 20% (relative risk, 0.80; 95% confidence interval, 0.74 to 0.88) lower risk. At higher levels of physical activity, relative risks were modestly lower. People who were physically active at levels lower than the minimum recommended amount also had significantly lower risk of coronary heart disease. There was a significant interaction by sex (P=0.03); the association was stronger among women than men.

Conclusions: These findings provide quantitative data supporting US physical activity guidelines that stipulate that "some physical activity is better than none" and "additional benefits occur with more physical activity."

Conflict of interest statement

Conflict of Interest Disclosures:

Jacob Sattelmair is an employee at Dossia.

Jeremy Pertman has no potential conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.

Eric Ding is supported by a fellowship from the American Diabetes Association.

Bill Kohl has no potential conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.

Bill Haskell has no potential conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.

I-Min Lee has received investigator-initiated research funding from the National Institutes of Health; she serves as a consultant to Virgin HealthMiles and sits on their Scientific Advisory Board.

Figures

Figure 1

Plot of Relative Risks of CHD by Category* of LTPA *All study categories were standardized to five categories for ease of comparison. The size of the data point corresponds to the study size; the larger the dot, the larger the sample size. Dashed linesStudies with physical activity categorized quantitativelySolid linesStudies with physical activity categorized categorically

Figure 2

Plot with Spline (Smoothed Fit), and 95% Confidence Intervals of Relative Risks of CHD by Kcal/wk of LTPA [Table: see text]

Figure 3

Generalized Least Squares (GLST) Regression Spline (Smoothed Fit) Models with 95% Confidence Intervals [Table: see text]

Figure 3

Generalized Least Squares (GLST) Regression Spline (Smoothed Fit) Models with 95% Confidence Intervals [Table: see text]