Sedentary time, metabolic abnormalities, and all-cause mortality after myocardial infarction: A mediation analysis

Background Sedentary time was associated with myocardial infarction (MI) and metabolic diseases in previous studies. Purpose To investigate whether sedentary time measured before disease onset was associated with all-cause mortality among MI survivors and whether the sedentary time–mortality association was mediated by physical activity status and metabolic phenotypes. Methods In this prospective community-based cohort including 101,510 Chinese adults, we used sedentary time, evaluated at 2006 (baseline), to predict further all-cause mortality among individuals who then developed new onset MI from 2006 to December 2013 ( n = 989). The post-MI mortality was ascertained after the first non-fatal MI until December 2014. We assessed the mediating effects of physical inactivity and metabolic factors on the sedentary time-mortality association. Results During 7 years follow up, 180 deaths occurred among these participants with incident MI. Prolonged sedentary time was associated with a higher risk of mortality among MI survivors. The adjusted hazard ratio (HR) of mortality for sedentary time 4–8 hours/day versus <4 hours/day, was 1.62 (95% confidence interval (CI) 1.14–2.31). A high amount of sedentary time (>4 hours/day) and inactive physical activity had an increased risk of all-cause mortality (HR: 2.74, 95% CI 1.34–5.60), relative to those with sedentary time ≤4 hours/day and moderate/vigorous physical activity. Physical inactivity and metabolic factors mediated a small proportion (≤9.2 % for all) of the total association between sedentary time and post-MI mortality. Conclusion High sedentary time was significantly associated with all-cause mortality among MI survivors, independent of physical activity status and metabolic abnormalities.

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Associations of Objectively Measured Physical Activity and Sedentary Time with the Risk of Stroke, Myocardial Infarction or All-Cause Mortality in 70-Year-Old Men and Women: A Prospective Cohort Study

Sports Medicine ◽

10.1007/s40279-020-01356-y ◽

2020 ◽

Author(s):

Marcel Ballin ◽

Peter Nordström ◽

Johan Niklasson ◽

Anna Nordström

Keyword(s):

Physical Activity ◽

Myocardial Infarction ◽

Lower Risk ◽

Sedentary Time ◽

Moderate Intensity ◽

Men And Women ◽

All Cause Mortality ◽

Objectively Measured ◽

Incident Cases ◽

Objectively Measured Physical Activity

Abstract Objective To study the associations of objectively measured physical activity (PA) and sedentary time (ST) with the combined outcome of incident stroke, myocardial infarction (MI) or all-cause mortality in older adults. Methods N = 3343 men and women aged 70 who participated in a health survey between 2012 and 2017 were included. Actigraph GT3X+ accelerometers were used to measure light-intensity PA (LPA), moderate-intensity PA (MPA) and ST for 1 week. Incident cases of cardiovascular disease (CVD) in terms of stroke or MI, and all-cause mortality were identified using national registers. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using multivariable-adjusted Cox regressions. Results During a mean follow-up of 2.7 years (0.1–5.6), there were 124 events of CVD or all-cause mortality. After adjusting for potential confounders and mediators, every 30-min/day increment in LPA was associated with 11% lower risk of CVD or all-cause mortality (HR 0.89, 95% CI 0.82–0.97), and every 30-min/day increment in MPA was associated with 36% lower risk (HR 0.64, 95% CI 0.48–0.84). Every 1-h/day increment in ST increased the risk of the outcomes by 33% (HR 1.33, 95% CI 1.14–1.56), although there was no significant association among participants who performed ≥ 30 min/day MPA (HR 1.11, 95% CI 0.82–1.50, P = 0.034 for interaction). None of the associations were modified by sex (P > 0.4 for all). Conclusion Objectively measured LPA and MPA are each associated with lower risk of stroke, MI or all-cause mortality in 70-year-old individuals, while ST is associated with increased risk. The greatest risk reduction is observed for MPA, which also appears to attenuate some of the increased risks associated with ST.

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Multimorbidity, mortality, and physical activity

Chronic Illness ◽

10.1177/1742395316644306 ◽

2016 ◽

Vol 12 (4) ◽

pp. 272-280 ◽

Cited By ~ 12

Author(s):

Paul D Loprinzi ◽

Ovuokerie Addoh ◽

Chelsea Joyner

Keyword(s):

Physical Activity ◽

Mortality Risk ◽

Physical Inactivity ◽

Self Report ◽

Minimal Effect ◽

Increased Risk ◽

All Cause Mortality ◽

The Government ◽

Physician Diagnosis

Objectives Multimorbidity and physical inactivity are individually associated with increased mortality risk, but the possibility for physical activity to moderate the multimorbidity–mortality relationship has yet to be investigated. Methods Data from the 1999–2006 NHANES were employed, with 16,091 participants constituting the analytic sample. Participants were followed through 2011, including a median follow-up of 99 months. Physical activity was assessed via self-report with multimorbidity assessed from physician diagnosis. Results After adjustment, for every 1 morbidity increase, participants had a 23% increased risk of all-cause mortality (HR = 1.23; 95% CI: 1.19–1.28; p < 0.001). Multimorbidity mostly remained associated with all-cause mortality across all levels of physical activity, with the exception of those achieving four times the dose of the government guidelines. Discussion With the exception of those who engaged in high levels of self-reported physical activity, physical activity had a minimal effect on the multimorbidity–mortality relationship.

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Abstract 047: Sedentary Behavior Increases Risk for Cardiovascular Disease in Older Women: The Objective Physical Activity and Cardiovascular Health (OPACH) Study

Circulation ◽

10.1161/circ.137.suppl_1.047 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

John Bellettiere ◽

Michael J LaMonte ◽

Eileen Rillamas-Sun ◽

Jacqueline Kerr ◽

Kelly R Evenson ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Sedentary Behavior ◽

Older Women ◽

Cardiovascular Health ◽

Sedentary Time ◽

Vigorous Physical Activity ◽

Cvd Risk ◽

Bout Duration ◽

Increased Risk

Background: Evidence on sedentary behavior and cardiovascular disease (CVD) is largely based on self-reported sedentary time. Furthermore, how sedentary time is accumulated (in longer vs. shorter bouts) may be related to CVD risk but has not been tested. Methods: Women (n=5638, mean age=79±7) with no history of myocardial infarction or stroke wore accelerometers for 4-7 days and were followed for up to 4 years for incident CVD. Hazard ratios (HR) and 95% confidence intervals (CIs) for CVD and coronary heart disease (CHD) events were estimated across quartiles of sedentary time and mean sedentary bout duration using Cox proportional hazard models adjusting for covariates. Separate models evaluated associations after adding moderate-to-vigorous physical activity (MVPA) and possible mediators: body mass index, diabetes, hypertension, systolic blood pressure, fasting glucose, HDL-cholesterol, and triglycerides. We then tested whether mean bout duration was associated with increased risk for CVD and CHD among women with above median sedentary time (≥10hr/day). Results: Covariate-adjusted HRs for CVD and CHD increased across quartiles of both sedentary time and mean bout duration (Table). All CHD associations remained significant but attenuated after adjustment for possible mediators. After adjustment for MVPA, highest vs. lowest quartile HRs (CI) for CHD were 1.6 (0.7-3.4; p-trend = .08) for sedentary time and 1.8 (0.9-3.5; p-trend = .047) for mean bout duration. Among women with high sedentary time, the HRs (CI) comparing the 75 th vs. 25 th percentile of mean bout duration were 1.05 (0.95-1.15) for CVD and 1.16 (1.01-1.34) for CHD. Conclusions: Both sedentary time and mean bout duration showed independent, dose-response associations with increased risk of CVD and CHD events in older women. Among women with high sedentary time, longer mean bout duration was associated with higher CHD risk. Taken together, this provides evidence that both total sedentary time and the way it is accumulated are predictive of incident CHD.

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Abstract P376: Associations Between Moderate To Vigorous Physical Activity And Sedentary Time On Cognitive Function In Older Adults With Cardiovascular Disease

Circulation ◽

10.1161/circ.141.suppl_1.p376 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Nicole M Hoffmann ◽

Megan E Petrov

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Cognitive Function ◽

Sedentary Time ◽

Reference Group ◽

Vigorous Physical Activity ◽

Cognitive Testing ◽

Digit Symbol Substitution Test ◽

Increased Risk ◽

History Of

Cardiovascular disease (CVD) is associated with increased risk for cognitive decline. Lifestyle behaviors such as moderate to vigorous physical activity (MVPA) and reduced sedentary time (ST) may mitigate this decline, but limited research exists. The aim of the study was to examine the joint association of MVPA and ST on cognitive function by CVD status. Adults (n=2844, ≥60yrs) from the 2011-2014 National Health and Nutrition Examination Survey underwent cognitive testing (Digit Symbol Substitution Test [DSST]; Animal Fluency [AF]). Participants reported minutes of MVPA per week (categorized by U.S. PA Guidelines: ≥ 150min MPA and/or ≥ 75min VPA PA vs <150min MPA and <75min VPA), and typical ST per day (≤7hrs vs >7hrs ) , and reported physician-diagnosed CVD (i.e., myocardial infarction, stroke, coronary heart disease, or heart failure). Weighted linear regression analyses assessed the joint association of MVPA and ST on cognitive function, and tested the modifying effect of CVD status (alpha level for interaction terms set at 0.1) after adjustment for demographics, hypertension, diabetes, body mass index, and depression symptomatology. See Table. There were significant main effects for combined MVPA-ST groups on DSST (Wald F (3,30)=4.92, p =.007) and AF (Wald F (3,30)=5.01, p =.006). Individuals who did not engage in MVPA regardless of ST had significantly worse scores on DSST compared to the reference group. There was a significant main effect for CVD on DSST (Wald F (1,32)=8.82, p =.006). There was a significant interaction between MVPA-ST groups and CVD status on DSST (Wald F (3,30)=3.691, p =.023). Stratified analyses indicated among individuals with CVD, the buffering effect of MVPA was maintained, but the interaction was not significant for those without CVD. In a sample of adults with a history of CVD, meeting recommendations for MVPA appeared to preserve executive functioning regardless of ST. This research highlights the added importance for people with a history of CVD to participate in the recommended amount of MVPA.

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Changes in Physical Activity and Sedentary Behaviour in Cardiovascular Disease Patients during the COVID-19 Lockdown

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182211929 ◽

2021 ◽

Vol 18 (22) ◽

pp. 11929

Author(s):

Bram M.A. van Bakel ◽

Esmée A. Bakker ◽

Femke de Vries ◽

Dick H.J. Thijssen ◽

Thijs M.H. Eijsvogels

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Physical Inactivity ◽

Mixed Model ◽

Sedentary Time ◽

Vigorous Physical Activity ◽

Social Contact ◽

Younger Age ◽

Artery Disease ◽

Mental Health Factors

The COVID-19 lockdown has been associated with physical inactivity. We prospectively evaluated changes in moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) among 1565 cardiovascular disease (CVD) patients using validated questionnaires at 5 weeks after lockdown initiation (i.e., baseline, April 2020) and at every 4 subsequent weeks, until July 2020. Multivariate mixed model analyses were performed to identify whether age, sex, CVD-subtype, lockdown adherence and mental health factors impacted changes in physical (in)activity. Patients were 67 (interquartile range: 60–73) years and primarily diagnosed with coronary artery disease. Time spent in MVPA was 143 min/day (95% confidence interval (CI) 137; 148) at baseline. Female sex, heart-failure, fear of COVID-19 infection and limited possibilities for physical activity were independently associated with lower levels of MVPA across time. After adjusting for confounders, overall MVPA did not change. ST was 567 (95% CI 555; 578) min/day at baseline. Lack of social contact, limited possibilities for physical activity and younger age were independently associated with higher levels of ST. After adjusting for confounders, ST progressively increased following 8 (Δ+19.7 (95% CI 0.4; 39.0)) and 12 weeks (Δ+25.2 (95% CI 5.4; 47.1) min/day) of lockdown. Despite a phased relaxation of the lockdown, CVD patients progressively increased ST and reported no change in MVPA. This highlights the need to target physical inactivity during and beyond the COVID-19 pandemic.

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Physical Activity, Sedentary Behavior and the Risk of Overweight and Obesity in School-Aged Children

Pediatric Exercise Science ◽

10.1123/pes.2016-0234 ◽

2017 ◽

Vol 29 (3) ◽

pp. 408-418 ◽

Cited By ~ 23

Author(s):

Eimear Keane ◽

Xia Li ◽

Janas M. Harrington ◽

Anthony P. Fitzgerald ◽

Ivan J. Perry ◽

...

Keyword(s):

Physical Activity ◽

Sedentary Behavior ◽

Screen Time ◽

Sedentary Time ◽

Vigorous Physical Activity ◽

Overweight And Obesity ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Increased Risk ◽

Independent Association

Purpose:Globally, public health policies are targeting modifiable lifestyle behaviors. We explore the independent association of moderate-to-vigorous physical activity (MVPA) and sedentary behavior on the risk of childhood overweight/obesity.Method:A cross-sectional survey of children aged 8–11 years (N = 826). Objective body mass index was used to classify children as normal weight or overweight/obese. Children wore wrist-worn Geneactiv accelerometers for 7-days and thresholds were applied to categorize MVPA and sedentary time. Screen time (ST) was parent reported. Poisson regression examined the independent association of (1) MVPA (2), objective sedentary time and (3) ST on the risk of overweight/obesity.Results:Overall, 23.7% (95% CI, 20.8–26.6%) of children were overweight/obese. On average, children spent 10.8% of waking time at MVPA and 61.3% sedentary. One-fifth (22.1%, 95% CI, 19.3–25.0%) of children achieved MVPA recommendations (≥ 60 min each day) and 17.5% (95% CI, 14.9–20.1%) met ST recommendations (<2 hr per day). Time spent at MVPA was inversely associated with the risk of overweight/obese independent of total sedentary time. Total time spent sedentary was not associated with overweight/obese independent of MVPA. ST was associated with an increased risk of overweight/obese independent of physical activity.Conclusion:Few schoolchildren met physical activity and screen time recommendations suggesting population based measures are needed.

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The Relationship of Accelerometer-Assessed Standing Time With and Without Ambulation and Mortality: The WHI OPACH Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa227 ◽

2020 ◽

Vol 76 (1) ◽

pp. 77-84

Author(s):

Purva Jain ◽

John Bellettiere ◽

Nicole Glass ◽

Michael J LaMonte ◽

Chongzhi Di ◽

...

Keyword(s):

Physical Activity ◽

Mortality Risk ◽

Sedentary Time ◽

Vigorous Physical Activity ◽

Community Dwelling ◽

Machine Learning Algorithms ◽

Cardiovascular Health Study ◽

Accelerometer Data ◽

All Cause Mortality

Abstract Background Self-reported time spent standing has been associated with lower risk of mortality. No previous studies have examined this association using device-measured standing. Method This was a prospective cohort study of 5878 older (median age = 80 years), racial/ethnically diverse, community-dwelling women in the WHI Objective Physical Activity and Cardiovascular Health Study (OPACH). Women wore accelerometers for 1 week and were followed for mortality. The study applied previously validated machine learning algorithms to ActiGraph GT3X+ accelerometer data to separately measure time spent standing with and without ambulation. Cox proportional hazards models were used to estimate mortality risk adjusting for potential confounders. Effect modification by age, body mass index, moderate-to-vigorous physical activity, sedentary time, physical functioning, and race/ethnicity was evaluated. Results There were 691 deaths during 26 649 person-years of follow-up through March 31, 2018 (mean follow-up = 4.8 years). In fully adjusted models, all-cause mortality risk was lower among those with more standing without ambulation (quartile [Q] 4 vs Q1 HR = 0.63; 95% CI = 0.49–0.81, p-trend = .003) and more standing with ambulation (Q4 vs Q1 HR = 0.50; 95% CI = 0.35–0.71, p-trend < .001). Associations of standing with ambulation and mortality were stronger among women with above-median sedentary time (HR = 0.51; 95% CI = 0.38–0.68) compared to women with below-median sedentary time (HR = 0.80; 95% CI = 0.59–1.07; p-interaction = .02). Conclusions In this prospective study among older women, higher levels of accelerometer-measured standing were associated with lower risks of all-cause mortality. Standing is an achievable approach to interrupting prolonged sedentary time, and if not contraindicated, is a safe and feasible behavior that appears to benefit health in older ages.

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Meeting Canadian 24-Hour Movement Guideline recommendations and risk of all-cause mortality

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2021-0010 ◽

2021 ◽

Author(s):

Anna E Clarke ◽

Valerie Carson ◽

Jean-Philippe Chaput ◽

Rachel C Colley ◽

Karen C Roberts ◽

...

Keyword(s):

Physical Activity ◽

Sedentary Behavior ◽

Sedentary Behaviour ◽

Mortality Risk ◽

Sedentary Time ◽

Vigorous Physical Activity ◽

Nutrition Examination Survey ◽

Health And Nutrition ◽

All Cause Mortality ◽

New Guidelines

This study determined if meeting the Canadian 24-Hour Movement Guidelines recommendations are associated with all-cause mortality. Participants were 3,471 adults from the 2005-2006 U.S. National Health and Nutrition Examination Survey followed for mortality over 11 years. They were classified as meeting or not meeting recommendations for sleep duration, sedentary behaviour, and moderate-to-vigorous physical activity (MVPA). A total of 63.8%, 35.3%, and 41.5% of participants met recommendations for sleep, sedentary behavior, and physical activity while 12.3% met all three recommendations. The hazard ratio (HR) for all-cause mortality in participants meeting the recommendations relative to those not meeting the recommendations were 0.91 (0.72, 1.16) for sleep, 0.92 (0.61, 1.40) for sedentary behavior, and 0.42 (0.24, 0.74) for MVPA. The HR for meeting none, any one, any two, and all three recommendations were 1.00, 0.86 (0.65, 1.14), 0.49 (0.28, 0.86), and 0.72 (0.34, 1.50). When the cut-point used to denote acceptable sedentary time was changed from ≤8 to ≤10 hours/day, the HR for meeting none, any one, any two, and all three recommendations were 1.00, 0.83 (0.59, 1.15), 0.57 (0.34, 0.96), and 0.43 (0.20, 0.93). These findings provide some support for the ability of the 24-hour movement guidelines to predict mortality risk. NOVELTY - The 24-Hour Movement Guidelines provide recommendations for sleep, sedentary behavior, and physical activity. - The findings of this study provide some support of the ability of these new guidelines to predict mortality risk.

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Changes in the Frequency of Moderate-to-Vigorous Physical Activity and Subsequent Risk of All-Cause and Cardiovascular Disease Mortality

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19010504 ◽

2022 ◽

Vol 19 (1) ◽

pp. 504

Author(s):

Young Choi ◽

Jae Woo Choi

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Physical Inactivity ◽

Vigorous Physical Activity ◽

National Sample ◽

Increased Risk ◽

Nationally Representative ◽

Cox Proportional Hazard Regression ◽

Cvd Mortality ◽

Physically Inactive

We investigated the association of changes in the frequency of moderate-to-vigorous physical activity (MVPA) and the risks of all-cause and cardiovascular disease (CVD) mortality. This study used the nationally representative National Health Insurance Service-National Sample Cohort database. We included 286,402 individuals aged ≥20 years and estimated changes in the frequency of MVPA over a two-year period. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard regression models. The HRs (95% CIs) for the risk of all-cause and CVD mortality for an increased frequency of MVPA from physical inactivity compared with continual physical inactivity were 0.82 and 0.68 (0.73–0.92 and 0.51–0.91) for 1–2, 0.72 and 0.48 (0.62–0.84 and 0.31–0.74) for 3–4, and 0.73 and 0.70 (0.63–0.85 and 0.50–0.98) for ≥5 sessions of MVPA/week. The HRs (95% CIs) for the risk of all-cause and CVD mortality were 1.28 and 1.58 (1.07–1.53 and 1.01–2.46), 1.25 and 2.17 (1.01–1.57 and 1.14–4.12), and 1.43 and 1.44 (1.15–1.77 and 0.84–2.47) for changes from 1–2, 3–4, and ≥5 sessions of MVPA/week to physical inactivity, respectively. This study showed the beneficial effect of increasing physical activity, particularly for those who were physically inactive at baseline, as well as the increased risk of all-cause and CVD mortality after adapting a physically inactive lifestyle regardless of their baseline physical activity status.

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Joint association between accelerometry-measured daily combination of time spent in physical activity, sedentary behaviour and sleep and all-cause mortality: a pooled analysis of six prospective cohorts using compositional analysis

British Journal of Sports Medicine ◽

10.1136/bjsports-2020-102345 ◽

2021 ◽

pp. bjsports-2020-102345

Author(s):

Sebastien Chastin ◽

Duncan McGregor ◽

Javier Palarea-Albaladejo ◽

Keith M Diaz ◽

Maria Hagströmer ◽

...

Keyword(s):

Physical Activity ◽

Sedentary Behaviour ◽

Sedentary Time ◽

Cox Regression ◽

Vigorous Physical Activity ◽

Pooled Analysis ◽

Light Physical Activity ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Prospective Cohorts

ObjectiveTo examine the joint associations of daily time spent in different intensities of physical activity, sedentary behaviour and sleep with all-cause mortality.MethodsFederated pooled analysis of six prospective cohorts with device-measured time spent in different intensities of physical activity, sedentary behaviour and sleep following a standardised compositional Cox regression analysis.Participants130 239 people from general population samples of adults (average age 54 years) from the UK, USA and Sweden.Main outcomeAll-cause mortality (follow-up 4.3–14.5 years).ResultsStudies using wrist and hip accelerometer provided statistically different results (I2=92.2%, Q-test p<0.001). There was no association between duration of sleep and all-cause mortality, HR=0.96 (95% CI 0.67 to 1.12). The proportion of time spent in moderate to vigorous physical activity was significantly associated with lower risk of all-cause mortality (HR=0.63 (95% CI 0.55 to 0.71) wrist; HR=0.93 (95% CI 0.87 to 0.98) hip). A significant association for the ratio of time spent in light physical activity and sedentary time was only found in hip accelerometer-based studies (HR=0.5, 95% CI 0.42 to 0.62). In studies based on hip accelerometer, the association between moderate to vigorous physical activity and mortality was modified by the balance of time spent in light physical activity and sedentary time.ConclusionThis federated analysis shows a joint dose–response association between the daily balance of time spent in physical activity of different intensities and sedentary behaviour with all-cause mortality, while sleep duration does not appear to be significant. The strongest association is with time spent in moderate to vigorous physical activity, but it is modified by the balance of time spent in light physical activity relative to sedentary behaviour.

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