Accelerometer measured physical activity and the incidence of cardiovascular disease: Evidence from the UK Biobank cohort study

Background Higher levels of physical activity (PA) are associated with a lower risk of cardiovascular disease (CVD). However, uncertainty exists on whether the inverse relationship between PA and incidence of CVD is greater at the highest levels of PA. Past studies have mostly relied on self-reported evidence from questionnaire-based PA, which is crude and cannot capture all PA undertaken. We investigated the association between accelerometer-measured moderate, vigorous, and total PA and incident CVD. Methods and findings We obtained accelerometer-measured moderate-intensity and vigorous-intensity physical activities and total volume of PA, over a 7-day period in 2013–2015, for 90,211 participants without prior or concurrent CVD in the UK Biobank cohort. Participants in the lowest category of total PA smoked more, had higher body mass index and C-reactive protein, and were diagnosed with hypertension. PA was associated with 3,617 incident CVD cases during 440,004 person-years of follow-up (median (interquartile range [IQR]): 5.2 (1.2) years) using Cox regression models. We found a linear dose–response relationship for PA, whether measured as moderate-intensity, vigorous-intensity, or as total volume, with risk of incident of CVD. Hazard ratios (HRs) and 95% confidence intervals for increasing quarters of the PA distribution relative to the lowest fourth were for moderate-intensity PA: 0.71 (0.65, 0.77), 0.59 (0.54, 0.65), and 0.46 (0.41, 0.51); for vigorous-intensity PA: 0.70 (0.64, 0.77), 0.54 (0.49,0.59), and 0.41 (0.37,0.46); and for total volume of PA: 0.73 (0.67, 0.79), 0.63 (0.57, 0.69), and 0.47 (0.43, 0.52). We took account of potential confounders but unmeasured confounding remains a possibility, and while removal of early deaths did not affect the estimated HRs, we cannot completely dismiss the likelihood that reverse causality has contributed to the findings. Another possible limitation of this work is the quantification of PA intensity-levels based on methods validated in relatively small studies. Conclusions In this study, we found no evidence of a threshold for the inverse association between objectively measured moderate, vigorous, and total PA with CVD. Our findings suggest that PA is not only associated with lower risk for of CVD, but the greatest benefit is seen for those who are active at the highest level.

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Associations of discretionary screen time with mortality, cardiovascular disease and cancer are attenuated by strength, fitness and physical activity: findings from the UK Biobank study

BMC Medicine ◽

10.1186/s12916-018-1063-1 ◽

2018 ◽

Vol 16 (1) ◽

Cited By ~ 20

Author(s):

Carlos A. Celis-Morales ◽

Donald M. Lyall ◽

Lewis Steell ◽

Stuart R. Gray ◽

Stamatina Iliodromiti ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Screen Time ◽

Uk Biobank ◽

The Uk

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P0694ALTERATION OF PHYSICAL ACTIVITY AND ITS ASSOCIATION WITH CARDIOVASCULAR OUTCOMES AMONG PRE-DIALYSIS CKD PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0694 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Soojin Lee ◽

Yeonhee Lee ◽

Sehoon Park ◽

Yaerim Kim ◽

Kyungdo Han ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

National Health ◽

Lower Risk ◽

Cox Regression ◽

Adverse Outcomes ◽

Health Examination ◽

National Health Insurance System ◽

Cox Regression Analysis ◽

Inactive Group

Abstract Background and Aims Cardiovascular disease is major cause of mortality among chronic kidney disease (CKD) patients, and it is fundamental to focus on reducing the potential risk factors. Regular physical activity is known to reduce the risk of cardiovascular disease in general population. However, whether the change of physical activity habits is beneficial for pre-dialysis CKD patients had not been examined thoroughly. Method We performed a nationwide population based cohort study using the database of Korean National Health Insurance System. Among adult patients who received national health screening program ≥2 times between 2012 and 2016, CKD patients were identified using the serum creatinine and dipstick albuminuria measurements. Those who previously underwent dialysis or diagnosed cardiovascular disease were excluded. The frequency and the intensity of the physical activity were obtained at least twice, from self-reported questionnaire during the health examination. The study groups were divided according to the status of physical activity habit alteration; active, quit exercise, start exercise, and inactive group. Then, the development of myocardial infarction (MI), stroke or death was assessed using the multivariate Cox regression analysis. Results During the median follow up of 3.18 years, 549,187 CKD patients were examined for adverse outcomes. Compared to those who remained inactive, the active group patients who consistently continued physical activity exhibited lower risk of MI (hazard ratio (HR); 0.76, 95% confidence interval (95% CI); 0.69-0.85), stroke (HR (95%CI) 0.69 (0.62-0.78)), and death (HR (95%CI) 0.62 (0.57-0.67)). Moreover, those who newly started physical activity also showed lower risk of adverse outcomes, compared to the inactive group (HR (95%CI) 0.83 (0.76-0.89)). Conclusion Continuation of physical activity in pre-dialysis CKD patients is beneficial to reduce the risk of cardiovascular disease development. Therefore, clinicians should encourage even mild intensity of physical activity to CKD patients.

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Prospective Association of the Portfolio Diet with All-Cause and Cause-Specific Mortality Risk in the Mr. OS and Ms. OS Study

Nutrients ◽

10.3390/nu13124360 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4360

Author(s):

Kenneth Lo ◽

Andrea J. Glenn ◽

Suey Yeung ◽

Cyril W. C. Kendall ◽

John L. Sievenpiper ◽

...

Keyword(s):

Cardiovascular Disease ◽

Mortality Risk ◽

Cancer Mortality ◽

Lower Risk ◽

Cox Regression ◽

Statistical Significance ◽

Food Sources ◽

Inverse Association ◽

Diet Adherence ◽

Specific Mortality

The Portfolio Diet has demonstrated its cardiovascular benefit from interventions, but the association between Portfolio Diet adherence and the risk of all-cause and cause-specific mortality has not been examined in Chinese population. The present study has collected Portfolio Diet adherence (assessed by food frequency questionnaire), lifestyle factors and mortality status of 3991 participants in the Mr. Osteoporosis (OS) and Ms. OS Study. Cox regression models were used to examine the association between the Portfolio Diet adherence and mortality risk (all-cause, cardiovascular disease or cancer). The highest quartile of the Portfolio Diet score was associated with a 28% lower risk of all-cause (hazard ratio, HR: 0.72) and cancer (HR: 0.72) mortality, respectively. The association between Portfolio Diet adherence and cardiovascular disease mortality did not reach statistical significance (HR: 0.90, 95% CI = 0.64, 1.26). Among male participants, the highest adherence to the Portfolio Diet was also associated with a lower risk of all-cause (HR: 0.63) and cancer mortality (HR: 0.59), and there was an inverse association between food sources of plant protein and the risk of cardiovascular mortality (HR: 0.50). However, most associations between the Portfolio Diet and mortality were not significant among females. The protection for cancer mortality risk might reach the plateau at the highest adherence to the Portfolio Diet for females. To conclude, greater adherence to the Portfolio Diet was significantly associated with a lower risk of mortality in Hong Kong older adults, and the associations appeared stronger among males.

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A model of lifetime health outcomes in cardiovascular disease based on clinical trials and large cohorts

European Heart Journal ◽

10.1093/eurheartj/ehab724.3149 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

R Wu ◽

C Williams ◽

I Schlackow ◽

J Zhou ◽

J Emberson ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Life Expectancy ◽

Remaining Life ◽

Uk Biobank ◽

Cvd Risk ◽

Micro Simulation ◽

History Of ◽

Remaining Life Expectancy ◽

The Uk

Abstract Background and purpose Cardiovascular disease (CVD) risk of individuals depends on their socio-demographic characteristics, clinical risk factors, and treatments, and strongly influences their quality of life and survival. Individual-based long-term disease models, which aim to more accurately calculate the lifetime consequences, can help to target treatments, develop disease management programmes, and assess the value of new therapies. We present a new micro-simulation CVD model. Methods This micro-simulation model was developed using individual participant data from the Cholesterol Treatment Trialists' collaboration (CTT: 118,000 participants; 15 trials) and calibrated (with added socioeconomic deprivation, ethnicity, physical activity, mental illness, cancer and incident diabetes) in the UK Biobank cohort (UKB: 502,000 participants). Parametric survival models estimated risks of key endpoints (myocardial infarction (MI), stroke, coronary revascularisation (CRV), diabetes, cancer and vascular (VD) and nonvascular death (NVD) using participants' age, sex, ethnicity, physical activity, socioeconomic deprivation, smoking history, lipids, blood pressure, creatinine, previous cardiovascular diseases, diabetes, mental illness and cancer at entry and non-fatal incidents of the key endpoints during follow-up. The model integrates the risk equations and enables annual projection of endpoints and survival over individuals' lifetimes. The model was used to project remaining life expectancy across UK Biobank participants. Results Nonfatal cardiovascular events and age were the major determinants of CVD risk and, together with incident diabetes and cancer, of individuals' survival. The cumulative incidence of the key endpoints predicted by the CTT-UKB model corresponded well to their observed incidence in the UK Biobank cohort, overall (Figure 1) and in categories of participants by age, sex, prior CVD and CVD risk. Predicted remaining life expectancy across UK Biobank participants without history of CVD ranged between 22 and 43 years in men and between 24 and 46 years in women, depending on their age and CVD risk (Figure 2). Among UK Biobank participants with history of CVD, depending on their age, predicted remaining life expectancy ranged from 20 to 32 years in men and from 26 to 38 years in women. Conclusion This new lifetime CVD model accurately predicts morbidity and mortality in a large UK population cohort. It will be made available to provide individualised projections of expected lifetime health outcomes and benefits of treatments. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme, UK Medical Research Council (MRC), British Heart Foundation Figure 1. Predicted (in black) versus observed (95% CI; in red) incidence of major clinical outcomes in the UK Biobank. Figure 2. Predicted remaining life expectancy of participants in UK Biobank cohort, by age and CVD risk or previous CVD at entry. QRISK, a 10-year CVD risk scoring algorithm for people without previous CVD, recommended for use in the UK National Health Service.

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The association of energy and macronutrient intake with all-cause mortality, cardiovascular disease, and dementia: findings from 120,963 women and men in the UK Biobank

British Journal Of Nutrition ◽

10.1017/s000711452100266x ◽

2021 ◽

pp. 1-24

Author(s):

Briar L McKenzie ◽

Katie Harris ◽

Sanne A E Peters ◽

Jacqui Webster ◽

Mark Woodward

Keyword(s):

Cardiovascular Disease ◽

Sex Differences ◽

Energy Intake ◽

Lower Risk ◽

Premature Death ◽

Uk Biobank ◽

Risk Of Death ◽

Hazard Ratios ◽

Reference Cluster ◽

The Uk

Abstract This study aimed to investigate the association between individual, and combinations of, macronutrients with premature death, cardiovascular disease (CVD) and dementia. Sex differences were investigated. Data were utilised from a prospective cohort of 120,963 individuals (57% female) within the UK Biobank, who completed ≥two 24-hour diet recalls. The associations of macronutrients, as percentages of total energy intake, with outcomes were investigated. Combinations of macronutrients were defined using k-means cluster analysis, with clusters explored in association with outcomes. There was a higher risk of death with high carbohydrate intake (Hazard ratios (HRs), 95% confidence intervals (95% CI) upper v lowest third 1.13 (1.03, 1.23)), yet a lower risk with higher intakes of protein (upper v lowest third 0.82 (0.76, 0.89)). There was a lower risk of CVD with moderate intakes (middle v lowest third) of energy and protein (sub distribution HRs (SHR), 0.87 (0.79, 0.97) and (0.87 (0.79, 0.96)) respectively). There was a lower risk of dementia with moderate energy intake (SHR 0.71 (0.52, 0.96)). Sex differences were identified. The dietary cluster characterised by low carbohydrate, low fat and high protein was associated with a lower risk of death (HR 0.84 (0.76, 0.93)) compared to the reference cluster, and a lower risk of CVD for men (SHR 0.83 (0.71, 0.97)). Given that associations were evident, both as single macronutrients and for combinations with other macronutrients for death, and for CVD in men, we suggest that the biggest benefit from diet-related policy and interventions will be when combinations of macronutrients are targeted.

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Comparison of accelerometer-derived physical activity levels between individuals with and without cancer: a UK Biobank study

Future Oncology ◽

10.2217/fon-2019-0443 ◽

2019 ◽

Vol 15 (33) ◽

pp. 3763-3774 ◽

Cited By ~ 1

Author(s):

Laura McDonald ◽

Mustafa Oguz ◽

Robert Carroll ◽

Pratik Thakkar ◽

Fei Yang ◽

...

Keyword(s):

Physical Activity ◽

Cox Regression ◽

Activity Levels ◽

Uk Biobank ◽

Cancer Group ◽

All Cause Mortality ◽

History Of ◽

The Difference ◽

The Uk ◽

History Of Cancer

Aim: To identify the difference in physical activity (PA) levels between individuals with and without cancer, and to estimate all-cause mortality associated with this difference. Methods: Current cancer, cancer survivor and cancer-free groups were identified from the UK Biobank. We used multivariate and Cox regression to estimate PA differences and association of PA with all-cause mortality. Results: Compared with the cancer-free individuals, participants in the two cancer groups had fewer minutes in moderate-to-vigorous PA per day in adjusted analyses. The PA difference was associated with higher mortality in the current cancer group. Conclusion: Patients with a history of cancer were less active than those without cancer, and PA is associated with increased mortality. PA improvement strategies in cancer patients must be explored.

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Abstract P264: Meeting 2008 Physical Activity Guidelines for Americans Reduces Risk of Recurrent CVD Events in MI Survivors: The Western New York Acute MI Study (1996–2006)

Circulation ◽

10.1161/circ.125.suppl_10.ap264 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Joan M Dorn ◽

Kathleen Hovey ◽

Maurizio Trevisan

Keyword(s):

Physical Activity ◽

Recurrent Events ◽

Clinical Medicine ◽

Cox Regression ◽

Smoking Status ◽

Moderate Intensity ◽

Occupational Activity ◽

Physical Activity Guidelines ◽

Cox Regression Analysis ◽

Vigorous Intensity

Introduction: The 2008 Physical Activity Guidelines for Americans (PAG) recommend adults perform at least 150 minutes/week of moderate intensity physical activity or 75 minutes/week of vigorous intensity activity or an equivalent combination of both in order to obtain important health benefits, including lower CHD risk. Despite advances in clinical medicine, survivors of MI remain at substantial risk of recurrent cardiovascular events and death. The aim of our prospective study was to examine whether meeting the PAG reduced risk of recurrent CVD events in MI patients. Hypothesis: We hypothesized that MI survivors who met the current PAG had a more favorable prognosis than those who did not meet the guidelines. Methods: Incident MI cases (933 men, 354 women, 35–69 years old) recruited from 12 of 15 Western NY hospitals completed an interviewer-administered survey and clinic exam. Physical activity (PA) in the previous seven days was assessed using the Stanford 7-day PA recall. Minutes reported in moderate and vigorous intensity recreational, household and occupational activity (MVPA) were summed and participants were categorized as follows (min/week): inactive (0), insufficiently active (>0–<150), met (150–300), and exceeded the guideline goal (>300). Participant surveys, medical records and a search of the National Death Index Plus were used to determine fatal and non-fatal recurrent CVD (ICD9 390–450) events. Cox regression analysis adjusting for age (in years), gender, education (in years), race, BMI, smoking status, hypertension and use of diabetes and lipid medication was conducted to examine the association between PA and recurrent events. Results: During a mean follow up of 4.1 years, 301 recurrent CVD events occurred. At baseline, 174 (13.5%) participants reported no MVPA, 216 (16.8%) were insufficiently active, whereas 259 (20.1%) met and 638 (49.6%) exceeded the PAG, respectively. Multivariate adjusted hazard ratios (95% CI) for recurrent CVD events were Inactive [Ref (1.00)], insufficiently active [0.68 (0.46–1.01)], met [0.63 (0.43–0.92)], and exceeded the guideline goal [0.63 (0.45–0.87)], p-trend =0.019. Conclusion: In this prospective population-based study, there is evidence to support that meeting the 2008 Physical Activity Guidelines for Americans has significant benefits on fatal and non-fatal recurrent CVD events in men and women following myocardial infarction.

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Reallocating time from device-measured sleep, sedentary behaviour or light physical activity to moderate-to-vigorous physical activity is associated with lower cardiovascular disease risk

10.1101/2020.11.10.20227769 ◽

2020 ◽

Author(s):

Rosemary Walmsley ◽

Shing Chan ◽

Karl Smith-Byrne ◽

Rema Ramakrishnan ◽

Mark Woodward ◽

...

Keyword(s):

Physical Activity ◽

Machine Learning ◽

Cardiovascular Disease ◽

Sedentary Behaviour ◽

Lower Risk ◽

Vigorous Physical Activity ◽

Accelerometer Data ◽

Uk Biobank ◽

Light Physical Activity ◽

Machine Learning Model

AbstractBackgroundModerate-to-vigorous physical activity (MVPA), light physical activity, sedentary behaviour and sleep have all been associated with cardiovascular disease (CVD). Due to challenges in measuring and analysing movement behaviours, there is uncertainty about how the association with incident CVD varies with the time spent in these different movement behaviours.MethodsWe developed a machine-learning model (Random Forest smoothed by a Hidden Markov model) to classify sleep, sedentary behaviour, light physical activity and MVPA from accelerometer data. The model was developed using data from a free-living study of 152 participants who wore an Axivity AX3 accelerometer on the wrist while also wearing a camera and completing a time use diary. Participants in UK Biobank, a prospective cohort study, were asked to wear an accelerometer (of the same type) for seven days, and we applied our machine-learning model to classify their movement behaviours. Using Compositional Data Analysis Cox regression, we investigated how reallocating time between movement behaviours was associated with CVD incidence.FindingsWe classified accelerometer data as sleep, sedentary behaviour, light physical activity or MVPA with a mean accuracy of 88% (95% CI: 87, 89) and Cohen’s kappa of 0·80 (95% CI: 0·79, 0·82). Among 87,509 UK Biobank participants, there were 3,424 incident CVD events. Reallocating time from any behaviour to MVPA, or reallocating time from sedentary behaviour to any behaviour, was associated with a lower risk of CVD. For example, for a hypothetical average individual, reallocating 20 minutes/day to MVPA from all other behaviours proportionally was associated with 9% (7%, 10%) lower risk of incident CVD, while reallocating 1 hour/day to sedentary behaviour was associated with 5% (3%, 7%) higher risk.InterpretationReallocating time from light physical activity, sedentary behaviour or sleep to MVPA, or reallocating time from sedentary behaviour to other behaviours, was associated with lower risk of incident CVD. Accurate classification of movement behaviours using machine-learning and statistical methods to address the compositional nature of movement behaviours enabled these insights. Public health interventions and guidelines should promote reallocating time to MVPA from other behaviours, as well as reallocating time from sedentary behaviour to light physical activity.FundingMedical Research Council.

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Fitness, Physical Activity, and Cardiovascular Disease: Longitudinal and Genetic Analyses in the UK Biobank Study

10.1101/136192 ◽

2017 ◽

Cited By ~ 1

Author(s):

Emmi Tikkanen ◽

Stefan Gustafsson ◽

Erik Ingelsson

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Grip Strength ◽

Cardiorespiratory Fitness ◽

Genetic Risk ◽

Cardiovascular Events ◽

Large Scale ◽

Mendelian Randomization ◽

Uk Biobank ◽

The Uk

AbstractBackgroundExercise is inversely related with cardiovascular disease (CVD), but large-scale studies of incident CVD events are lacking. Moreover, little is known about genetic determinants of fitness and physical activity, and modifiable effects of exercise in individuals with elevated genetic risk of CVD. Finally, causal analyses of exercise traits are limited.MethodsWe estimated associations of grip strength, physical activity, and cardiorespiratory fitness with CVD and all-cause death in up to 502,635 individuals from the UK Biobank. We also examined these associations in individuals with different genetic burden on coronary heart disease (CHD) and atrial fibrillation (AF). Finally, we performed genome-wide association study (GWAS) of grip strength and physical activity, as well as Mendelian randomization analysis to assess the causal role of grip strength in CHD.FindingsGrip strength, physical activity, and cardiorespiratory fitness showed strong inverse associations with incident cardiovascular events and all-cause death (for composite CVD; HR, 0.78, 95% CI, 0.77-0.80; HR, 0.94, 95% CI, 0.93-0.95, and HR, 0.67, 95% CI, 0.63-0.71, per SD change, respectively). We observed stronger associations of grip strength with CHD and AF for individuals in the lowest tertile of genetic risk (Pinteraction = 0.006, Pinteraction = 0.03, respectively), but the inverse associations were present in each category of genetic risk. We report 27 novel genetic loci associated with grip strength and 2 loci with physical activity, with the strongest associations in FTO (rs56094641, P=3.8×10-24) and SMIM2 (rs9316077, P=1.4×10-8), respectively. By use of Mendelian randomization, we provide evidence that grip strength is causally related to CHD.InterpretationMaintaining physical strength is likely to prevent future cardiovascular events, also in individuals with elevated genetic risk for CVD.FundingNational Institutes of Health (1 R01 HL135313-01), Knut and Alice Wallenberg Foundation (2013.0126), and the Finnish Cultural Foundation.

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Vitamin D Status and Risk of All-Cause and Cause-Specific Mortality in a Large Cohort: Results From the UK Biobank

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa432 ◽

2020 ◽

Vol 105 (10) ◽

pp. e3606-e3619 ◽

Cited By ~ 3

Author(s):

Xikang Fan ◽

Jiayu Wang ◽

Mingyang Song ◽

Edward L Giovannucci ◽

Hongxia Ma ◽

...

Keyword(s):

Vitamin D ◽

Cancer Mortality ◽

Lower Risk ◽

Premature Death ◽

Inverse Association ◽

Vitamin D Status ◽

Uk Biobank ◽

Hydroxyvitamin D ◽

Specific Mortality ◽

The Uk

Abstract Context Although an inverse association between vitamin D status and mortality has been reported in observational studies, the precise association shape and optimal vitamin D status remain undetermined. Objective To investigate the association between vitamin D status and risk of all-cause and cause-specific mortality and estimate optimal serum 25-hydroxyvitamin D [25(OH)D] concentrations. Design Prospective cohort study. Setting UK Biobank. Participants 365 530 participants who had serum 25(OH)D measurements and no history of cardiovascular disease (CVD), cancer, or diabetes at baseline (2006-2010). Main outcome measures All-cause and cause-specific mortality. Results During a median follow-up of 8.9 (interquartile range: 8.3-9.5) years, 10 175 deaths occurred, including 1841 (18.1%) due to CVD and 5737 (56.4%) due to cancer. The multivariate analyses revealed nonlinear inverse associations, with a decrease in mortality risk appearing to level off at 60 nmol/L of 25(OH)D for all-cause and CVD deaths and at 45 nmol/L for cancer deaths. Compared to participants with 25(OH)D concentrations below the cutoffs, those with higher concentrations had a 17% lower risk for all-cause mortality (hazard ratio [HR]: 0.83, 95% confidence interval [CI]: 0.79-0.86), 23% lower risk for CVD mortality (HR: 0.77, 95% CI: 0.68-0.86), and 11% lower risk for cancer mortality (HR: 0.89, 95% CI: 0.84-0.95). Conclusions Higher 25(OH)D concentrations are nonlinearly associated with lower risk of all-cause, CVD, and cancer mortality. The thresholds of 45 to 60 nmol/L might represent an intervention target to reduce the overall risk of premature death, which needs further confirmation in large clinical trials.

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