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140,000 people research: do it for too long and still be in vain?

 Last Update: 2021-12-26
 Source: Internet
 Author: User

Too long to not read the version (author's summary):

Why do this research?

Heart vascular whether the health affects physical activity (PA) and health outcomes between dose - response association is still controversial
Studies of cardiovascular disease (CVD) patients found different associations between PA and reduced mortality.
Recent studies have shown that the cardiovascular health benefits of PA or the risk of death may be field-specific, because PA during leisure time and PA during work report different outcomes

Heart vascular whether the health affects physical activity (PA) and health outcomes between dose - response association is still controversial

Blood vessel

Studies of cardiovascular disease (CVD) patients found different associations between PA and reduced mortality.

Recent studies have shown that the cardiovascular health benefits of PA or the risk of death may be field-specific, because PA during leisure time and PA during work report different outcomes

What did the researchers do and what did they find?

A cohort study (median follow-up of 6.
For healthy individuals and CVRF patients, the shape of the dose-response relationship between MVPA and cardiovascular events and death is curvilinear, while a linear relationship is found in CVD patients
The association between MVPA and the risk of cardiovascular disease or death is scenario-specific, because leisure time activities are associated with most benefits, non-leisure time activities have little benefit, and work activities have no benefit

A cohort study (median follow-up of 6.

Cardiovascular events

For healthy individuals and CVRF patients, the shape of the dose-response relationship between MVPA and cardiovascular events and death is curvilinear, while a linear relationship is found in CVD patients

The association between MVPA and the risk of cardiovascular disease or death is scenario-specific, because leisure time activities are associated with most benefits, non-leisure time activities have little benefit, and work activities have no benefit
.

What do these findings mean?

MVPA is associated with risk reduction in all groups, but CVD patients should be encouraged in particular, and PA should be encouraged to "the more the better
.
"
PA recommendations can be optimized by considering cardiovascular health status and MVPA scenarios
.

MVPA is associated with risk reduction in all groups, but CVD patients should be encouraged in particular, and PA should be encouraged to "the more the better
.
"

MVPA is associated with risk reduction in all groups, but CVD patients should be encouraged in particular, and PA should be encouraged to "more of the better"

PA recommendations can be optimized by considering cardiovascular health status and MVPA scenarios
.

PA recommendations can be optimized by considering cardiovascular health and MVPA scenarios

Regular physical activity (PA) is closely related to reducing the risk and mortality of non-communicable diseases
.
The 2020 WHO Physical Activity Guidelines recommends that adults do at least 150 minutes of moderate-intensity PA per week, or 75 minutes of vigorous-intensity PA per week, or an equivalent combination of the two
.
It also pointed out that people with chronic diseases should not follow a "one size fits all" approach and may benefit from alternative exercise prescriptions
.
This is especially important in light of the debate about whether health status affects the dose-response association between PA and event rate
.

The 2020 WHO Physical Activity Guidelines recommends that adults do at least 150 minutes of moderate-intensity PA per week, or 75 minutes of vigorous-intensity PA per week, or an equivalent combination of the two
.
guide

Data from the general population indicate that the benefits of PA on mortality and morbidity follow a curvilinear dose-response relationship, indicating that PA with low or moderate physical activity can produce a greater risk reduction, while further increases in physical activity have only a small additional benefit
.
In contrast, studies of patients with cardiovascular disease (CVD) have shown conflicting results
.
Some studies have found a linear relationship between PA and reduced mortality, while other studies support the existence of a reverse J-shaped or U-shaped relationship
.
An important limitation of these studies is that they only included a single group.
No studies directly compared the PA dose-response relationship between individuals with different cardiovascular health conditions
.

It shows that PA with low or moderate exercise volume can produce greater risk reduction, while further increase in exercise volume has only a small additional benefit
.

This study compared healthy individuals, individuals with elevated levels of cardiovascular risk factors (CVRF) and CVD individuals with moderate to severe (MV) PA doses and the relationship between major adverse cardiovascular events (MACE) and all-cause mortality
.
The association of specific scenarios of cumulative moderate to vigorous physical activity (MVPA) (including leisure, non-leisure, and professional activities) on the outcome has also been studied, because recent studies have shown that the health benefits of PA may vary depending on the PA scenario
.

1.
Research population data

142，493
。（42[SD 12））、（40%）BMI（25 [Q₂₅23 Q₇₅28]CVRF（54[SD 11]，45%，BMI 27 [Q₂₅25， Q₇₅30]）CVD（60 [SD 11]，65% ，BMI 28 [Q₂₅25， Q₇₅31]) （1）
。：，，HDL，，
。MVPA（3666 MET/[Q₂₅1825;Q₇₅7344]），CVRF（3420 MET/[Q₂₅1,674;Q₇₅6，567]）CVD（ MET 3333 / [Q₂₅1,460;Q₇₅6,093]3MVPA
。MVPA68%，CVRF78%，CVD89%
。

₂₅₇₅₂₅₇₅₂₅₇₅₂₅₇₅₂₅₇₅₂₅₇₅MVPA68%，CVRF78%，CVD89%
。

2、

6.
8 （Q₂₅5.
7;Q₇₅7.
9），5799：1605，4194MACE
。2.
2%（1120182485），CVRF7.
9%（279822214），CVD40.
9%（24931019）
。Kaplan-Meier，，（1）
。

6.
8 （Q₂₅5.
7;Q₇₅7.
9），5799：1605，4194MACE
。2.
2%（1120182485），CVRF7.
9%（279822214），CVD40.
9%（24931019）
。Kaplan-Meier，，（1）
。 6.
8 （Q₂₅5.
7;Q₇₅7.
9），5799：1605，4194MACE
。2.
2%（1120182485），CVRF7.
9%（279822214），CVD40.
9%（24931019）
。Kaplan-Meier，，（1）
。2.
2%CVRF7.
9%CVD40.
9%，

3、MVPA

，MVPA（HR 0.
998/500 MET min/[95% CI 0.
993， 1.
00]，P = 0.
36）MACE（HR 0.
997/500 MET min/ [95% CI 0.
986， 1.
01]，P = 0.
86）（2）
。，CVD，MVPA（HR 0.
991 [95%CI 0.
9830.
999]，P = 0.
04）
。，CVRFP(P = 0.
002<0.
001)，MVPA、MACE
。

CVRFP(P = 0.
002<0.
001)，MVPA、MACE
。MVPA、MACE

MVPA ，， MACE (2，2)
。（2），，（HR 0.
71 [95% CI 0.
560.
89]，P = 0.
004），（HR 0.
72 [95% CI 0.
570.
91]，P = 0.
006）（HR 0.
76 [95% CI 0.
600.
96]，P = 0.
02）HR
。 MVPA，CVRFHR（HRs Q1 0.
69 [95% CI 0.
57 - 0.
82]，P <0.
001，Q2 0.
66 [95% CI 0.
55 - 0.
80]，P <0.
001，Q3 0.
64 [95% CI 0.
530.
77]，P <0.
001，Q4 0.
69 [95% CI 0.
570.
84]，P <0.
001）
。，CVD，MACE（HRs Q1 0.
80 [95% CI 0.
62， 1.
03]，P = 0.
09，Q2 0.
82 [95% CI 0.
63， 1.
06]，P = 0.
13，Q3 0.
74 [95% CI 0.
57， 0.
95]，P = 0.
02，Q4 0.
70 [95% CI 0.
53， 0.
93]， P = 0.
01）
。

Therefore, the relationship between MVPA and health outcomes is different between healthy individuals and CVD patients (interaction P: Q1 P = 0.
39, Q2 P = 0.
01, Q3 P = 0.
20, Q4 P = 0.
11; Figure 2 Table 2)
.
In further adjustment of additional covariates (model 3), as the MVPA increases, the reduction in adverse consequences persists, but many estimates are no longer statistically significant, especially in healthy individuals
.
Repeating the analysis of these secondary results greatly strengthened the relationship between MVPA and event rates (S2 and S3 tables)
.
Sensitivity analysis (S4 table) confirmed the main analysis and showed that reverse causality bias and age restriction did not substantially change the results
.

The relationship between MVPA and health outcomes is different between healthy individuals and CVD patients (interaction P: Q1 P = 0.
39, Q2 P = 0.
01, Q3 P = 0.
20, Q4 P = 0.
11; the relationship between MVPA and health outcomes The relationship between healthy individuals and CVD patients is different ( Figure 2 and Table 2)
.
After further adjusting for additional covariates, as the MVPA increases, the reduction in adverse consequences persists, but many estimates are no longer statistically significant, especially in healthy individuals
.
Repeating the analysis of these secondary results greatly strengthened the relationship between MVPA and event rates (S2 and S3 tables)
.
(S4 form)

4.
The dose-response relationship of total MVPA

Dose-response relationship of total MVPA

Increasing the MVPA level reduced the risk for all groups (Figure 3)
.
For CVRF patients and healthy individuals, the shape of the dose-response relationship is curved, indicating that there is no additional health benefit above a certain dose of PA
.
This finding is in contrast with CVD patients, who exhibit a linear dose-response correlation, indicating that PA has no greatest impact on health
.
In the first part of the dose-response relationship (ie, at lower MVPA levels), the size and shape of the dose-response relationship of total MVPA and the primary outcome are significantly different between healthy individuals and CVD patients (P is the interaction: Spline 1 = 0.
004, Spline 2 = 0.
04, Spline 3 = 0.
08, Spline 4 = 0.
21)
.
For CVRF patients and healthy individuals, the shape of the dose-response relationship is curved, indicating that there is no additional health benefit above a certain dose of PA
.
This finding is in contrast with CVD patients, who exhibit a linear dose-response correlation, indicating that PA has no greatest impact on health
.
In the first part of the dose-response relationship (ie, at lower MVPA levels), the size and shape of the dose-response relationship of total MVPA and the primary outcome are significantly different between healthy individuals and CVD patients (P is the interaction: Spline 1 = 0.
004, Spline 2 = 0.
04, Spline 3 = 0.
08, Spline 4 = 0.
21)
.
In the first part of the dose-response relationship (ie, at lower MVPA levels), the size and shape of the dose-response relationship of total MVPA and the primary outcome are significantly different between healthy individuals and CVD patients (PIs the interaction: spline 1 = 0.
004, spline 2 = 0.
04, spline 3 = 0.
08, spline 4 = 0.
21)
.
(P Finally, it is also found that the education level of healthy individuals also has different dose-response correlations (P value for interaction: spline 1 = 0.
21, spline 2 = 0.
061, spline 3 = 0.
048)
.
Education of healthy individuals There are also different dose-response correlations at different levels.
Healthy individuals with low education have a U-shaped dose-response relationship, and high MVPA levels lead to reduced health benefits (Figure S2)
.
Age and gender do not affect the dose-response correlation of MVPA
.

5.
The dose-response relationship of scene-specific MVPA

The total amount of MVPA largely depends on recreational PA (Table 1)
.
Consistent with total MVPA, participation in leisure time MVPA is associated with a gradual decrease in adverse outcomes, and more leisure time MVPA is associated with a greater reduction in all-cause mortality and accident MACE in healthy individuals and CVRF patients (Figures 2 and 3, S5- S7 table)
.
The total amount of MVPA largely depends on recreational PA (Table 1)
.
Consistent with total MVPA, participation in leisure time MVPA is associated with a gradual decrease in adverse outcomes, and more leisure time MVPA is associated with a greater reduction in all-cause mortality and accident MACE in healthy individuals and CVRF patients (Figures 2 and 3, S5- S7 table)
.
Consistent with total MVPA, participation in leisure time MVPA is associated with a gradual decrease in adverse outcomes, and more leisure time MVPA is associated with a greater reduction in all-cause mortality and accident MACE in healthy individuals and CVRF patients (Figures 2 and 3, S5- S7 table)
.
However, in CVD patients, leisure time MVPA has nothing to do with all-cause mortality and MACE
.
In CVD patients, the association between leisure time and non- leisure time MVPA and adverse outcomes is not consistent (Figures 2 and 3, S8-S10 tables)
.
Leisure time In healthy individuals, the non- leisure MVPA quartile risk estimate is < 1, but it does not reach statistical significance
.
Leisure < In CVRF patients, non- leisure MVPA is associated with the event in Q1 (HR 0.
86 [95% CI 0.
77; 0.
97], P = 0.
02) and Q2 (HR 0.
84 [95% CI 0.
74; Leisure 0.
95], P = 0.
006) Rate reduction is related, but in 3 and Q4, there is no risk reduction
.
Among CVD patients, compared with inactive individuals, only non- leisure MVPA Q2 (HR 0.
76 [95% CI 0.
62-0.
93], P = 0.
008) was associated with a lower event rate
.
Leisure leisure or leisure time MVPA, cardiovascular mortality and MACE comparable results
.
Leisure leisure time leisure MVPA strong all-cause mortality, non- spare MVPA weaker all-cause mortality (S7 and S10 table)
.
Leisure and leisure When separating the working time MVPA from the non- leisure time MVPA, it is found that there is no correlation between the working time MVPA and the primary and secondary results (Figures 2 and 3, S11-S13 tables)
.
free time

In general, in all groups, higher MVPA levels were associated with a significantly lower risk of cardiovascular disease and death, but in healthy individuals and CVRF patients, the benefit stabilized when the amount of PA was high
.
Cardiovascular health affects the dose-response correlation between PA and MACE and all-cause mortality
.
Specifically, compared with healthy people and CVRF patients, the greater the amount of MVPA in CVD patients, the greater the health benefits
.
Healthy people and CVRF patients have a curvilinear relationship, while CVD patients have a linear relationship
.
In addition, we have also observed important differences in risk reduction in different scenarios of MVPA
.
Leisure time MVPA brings the most health benefits, non-leisure MVPA brings few health benefits, and working time MVPA has no health benefits
.

Original source:

Esme´e A.
Bakker,et al.
Dose--response association between moderate to vigorous physical activity and incident morbidity and mortality for individuals with a different cardiovascular health status: A cohort study among 142,493
adults from the Netherlands.
PLOS Medicine | https:/ /doi.
org/10.
1371/journal.
pmed.
1003845 December 2, 2021

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