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

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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Quantifying the Predictive Performance of Objectively Measured Physical Activity on Mortality in the UK Biobank

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa250 ◽

2020 ◽

Cited By ~ 1

Author(s):

Andrew Leroux ◽

Shiyao Xu ◽

Prosenjit Kundu ◽

John Muschelli ◽

Ekaterina Smirnova ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Cox Regression ◽

Predictive Performance ◽

Prediction Performance ◽

Objective Measures ◽

Uk Biobank ◽

All Cause Mortality ◽

Traditional Risk Factors ◽

The Uk

Abstract Background Objective measures of physical activity (PA) derived from wrist-worn accelerometers are compared with traditional risk factors in terms of mortality prediction performance in the UK Biobank. Method A subset of participants in the UK Biobank study wore a tri-axial wrist-worn accelerometer in a free-living environment for up to 7 days. A total of 82 304 individuals over the age of 50 (439 707 person-years of follow-up, 1959 deaths) had both accelerometry data that met specified quality criteria and complete data on a set of traditional mortality risk factors. Predictive performance was assessed using cross-validated Concordance (C) for Cox regression models. Forward selection was used to obtain a set of best predictors of mortality. Results In univariate Cox regression, age was the best predictor of all-cause mortality (C = 0.681) followed by 12 PA predictors, led by minutes of moderate-to-vigorous PA (C = 0.661) and total acceleration (C = 0.661). Overall, 16 of the top 20 predictors were objective PA measures (C = 0.578–0.661). Using a threshold of 0.001 improvement in Concordance, the Concordance for the best model that did not include PA measures was 0.735 (9 covariates) compared with 0.748 (12 covariates) for the best model with PA variables (p-value < .001). Conclusions Objective measures of PA derived from accelerometry outperform traditional predictors of all-cause mortality in the UK Biobank except age and substantially improve the prediction performance of mortality models based on traditional risk factors. Results confirm and complement previous findings in the National Health and Nutrition Examination Survey (NHANES).

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Distribution and association of cancer with mortality in end-stage renal disease patients receiving dialysis

Journal of Nephrology ◽

10.1007/s40620-019-00649-4 ◽

2019 ◽

Vol 32 (6) ◽

pp. 1003-1009

Author(s):

Rajkumar Chinnadurai ◽

Emma Flanagan ◽

Philip A. Kalra

Keyword(s):

Cox Regression ◽

Matched Sample ◽

Cancer History ◽

Cancer Group ◽

All Cause Mortality ◽

History Of ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Abstract Background and aims Cancer in end-stage renal disease (ESRD) patients is an important comorbidity to be taken into consideration while planning for renal replacement therapy (RRT) options due to its associated increased mortality. This study aims to investigate the natural history and association of cancer with all-cause mortality in an ESRD population receiving dialysis. Method The study was conducted on 1271 ESRD patients receiving dialysis between January 2012 and December 2017. A comparative analysis was carried out between 119 patients with and 1152 without cancer history at entry into this study (baseline). A 1:2 (119 cancer: 238 no cancer) propensity score matched sample of 357 patients was also used for analysis. Cox-regression analysis was used to study the strength of the association between cancer and all-cause mortality. Kaplan–Meier (KM) analysis was used to demonstrate the difference in cumulative survival between the groups. A competing risk analysis was also carried out to calculate the probability of competing events (death, transplant and incident cancer). Results At baseline, 10.1% of the cohort had a history of cancer (current and past) with the annual incident rate being 1.3%. Urological cancers were the leading site of cancer. The median age of our cohort was 63 years with a predominance of males (63%) and Caucasians (79%). The majority (69%) of the cohort were receiving haemodialysis. 47% had a history of diabetes with 88% being hypertensive. During a median follow-up of 28 months, the proportion of deaths observed was similar between the groups in the matched sample (cancer 49.6 versus no-cancer 52.1%, p value 0.77). In a univariable Cox-regression model, there was no significant association between cancer and all-cause mortality (HR 1.28; 95% CI 0.97–1.67; p = 0.07). The KM estimates showed similar observations in the cumulative survival between the groups (matched sample log-rank, p value 0.85). In competing risk analysis, the cumulative probability of death at 5 years was non-significantly higher in the cancer group (cancer group 64% vs no cancer group 51%, p value 0.16). Conclusions In our real-world multi-morbid dialysis cohort of 119 cancer patients, baseline cancer history did not prove to be an independent risk factor for all-cause mortality in the first 5 years of follow-up, suggesting the need for a case-by-case approach in provision of RRT options, including transplantation.

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P3823Body mass index or waist and hip circumference as predictors of outcome in the UK biobank

European Heart Journal ◽

10.1093/eurheartj/ehz745.0665 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P Pellicori ◽

B Stanley ◽

S Iliodromiti ◽

C A Celis-Morales ◽

D M Lyall ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Heart Failure ◽

Body Fat ◽

Uk Biobank ◽

Anthropometric Indices ◽

All Cause Mortality ◽

History Of ◽

Cv Disease ◽

The Uk

Abstract Background Controversies exist about the relationship between body habitus and mortality, especially for patients with cardiovascular disease. Purpose We evaluated the relations between different anthropometric indices and mortality amongst participants with and without cardiovascular (CV) risk factors, or established CV disease (stroke, myocardial infarction and/or heart failure), enrolled in the UK Biobank. Methods The UK Biobank is a large prospective study which, between 2006 and 2010, enrolled 502,620 participants aged 38–73 years. Participants filled questionnaires and had a medical history recorded, physical measurements done and biological samples taken. The UK Biobank is routinely linked to national death registries and updated on a quarterly basis. Data on death were coded according to the International Classification of Diseases, 10th Revision (ICD-10). The primary end-point was all-cause mortality (ACM) across three subgroups of men and women: those with, or without, one or more CV risk factors (smoking, diabetes and/or hypertension), and those with CV disease (history of stroke, myocardial infarction and/or heart failure) at recruitment. Presence, or absence, of CV risk factors and diagnoses of CV disease were self-reported by participants at enrolment. Associations between anthropometric indices (body mass index (BMI), waist circumference (WC), waist to hip ratio (WHiR), and waist to height ratio (WHeR)) and the risk of all-cause mortality were analysed using Cox regression models. Results After excluding those with history of cancer at baseline (n=45,222), 453,046 participants were included (median age: 58 (interquartile range: 50 - 63) years; 53% women), of whom 150,732 had at least one CV risk factor, and 17,884 established CV disease. During a median follow-up of 5 years, 6,319 participants died. Baseline BMI had a U-shaped relationship with ACM, with higher nadir-values for those with CV risk factors or CV disease, for both sexes (figure). WC, WHiR and WHeR (measures of central distribution of body fat) had more linear associations with ACM, regardless of CV risk factors, CV disease and sex. Conclusions For adults with or without CV risk factors or established CV disease, measures of central distribution of body fat are more strongly and more linearly associated with ACM than BMI. WC, or WHiR, rather than BMI, appear to be more appropriate variables for risk stratification.

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Fitness, Fatness, and Mortality in Men and Women From the UK Biobank: Prospective Cohort Study

Journal of the American Heart Association ◽

10.1161/jaha.120.019605 ◽

2021 ◽

Author(s):

Jakob Tarp ◽

Anders Grøntved ◽

Miguel A. Sanchez‐Lastra ◽

Knut Eirik Dalene ◽

Ding Ding ◽

...

Keyword(s):

Body Composition ◽

Cardiorespiratory Fitness ◽

Cox Regression ◽

World Health ◽

Uk Biobank ◽

Men And Women ◽

Increased Risk ◽

All Cause Mortality ◽

The Uk

Background Cardiorespiratory fitness may moderate the association between obesity and all‐cause mortality (ie, the “fat‐but‐fit” hypothesis), but unaddressed sources of bias are a concern. Methods and Results Cardiorespiratory fitness was estimated as watts per kilogram from a submaximal bicycle test in 77 169 men and women from the UK Biobank cohort and combined with World Health Organization standard body mass index categories, yielding 9 unique fitness‐fatness combinations. We also formed fitness‐fatness combinations based on bioimpedance as a direct measure of body composition. All‐cause mortality was ascertained from death registries. Multivariable‐adjusted Cox regression models were used to estimate hazard ratios and 95% CIs. We examined the association between fitness‐fatness combinations and all‐cause mortality in models with progressively more conservative approaches for accounting for reverse causation, misclassification of body composition, and confounding. Over a median follow‐up of 7.7 years, 1731 participants died. In our base model, unfit men and women had higher risk of premature mortality irrespective of levels of adiposity, compared with the normal weight–fit reference. This pattern was attenuated but maintained with more conservative approaches in men, but not in women. In analysis stratified by sex and excluding individuals with prevalent major chronic disease and short follow‐up and using direct measures of body composition, mortality risk was 1.78 (95% CI, 1.17–2.71) times higher in unfit‐obese men but not higher in obese‐fit men (0.94 [95% CI, 0.60–1.48]). In contrast, there was no increased risk in obese‐unfit women (1.09 [95% CI, 0.44–1.05]) as compared with the reference. Conclusions Cardiorespiratory fitness modified the association between obesity and mortality in men, but this pattern appeared susceptible to biases in women.

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

PLoS Medicine ◽

10.1371/journal.pmed.1003487 ◽

2021 ◽

Vol 18 (1) ◽

pp. e1003487

Author(s):

Rema Ramakrishnan ◽

Aiden Doherty ◽

Karl Smith-Byrne ◽

Kazem Rahimi ◽

Derrick Bennett ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Lower Risk ◽

Cox Regression ◽

Moderate Intensity ◽

Inverse Association ◽

Uk Biobank ◽

Reverse Causality ◽

Vigorous Intensity ◽

The Uk

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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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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Educational differentials in key domains of physical activity by ethnicity, age and sex: a cross-sectional study of over 40 000 participants in the UK household longitudinal study (2013–2015)

BMJ Open ◽

10.1136/bmjopen-2019-033318 ◽

2020 ◽

Vol 10 (1) ◽

pp. e033318

Author(s):

Meg E Fluharty ◽

Snehal M Pinto Pereira ◽

Michaela Benzeval ◽

Mark Hamer ◽

Barbara Jefferis ◽

...

Keyword(s):

Physical Activity ◽

Longitudinal Study ◽

Leisure Time Physical Activity ◽

Cross Sectional Study ◽

Occupational Activity ◽

Activity Levels ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The Difference ◽

The Uk

ObjectivesTo assess whether educational differentials in three key physical activity (PA) domains vary by age, sex and ethnicity.DesignNational cross-sectional survey.SettingUK.ParticipantsAltogether 40 270 participants, aged 20 years and over, from the UK Household Longitudinal Study with information on education, PA and demographics collected in 2013–2015.Outcome measuresParticipation in active travel (AT), occupational activity (OA) and leisure time physical activity (LTPA) at the time of assessment.ResultsLower educational attainment was associated with higher AT and OA, but lower weekly LTPA activity; these associations were modified by sex, ethnicity and age. Education-related differences in AT were larger for women—the difference in predicted probability of activity between the highest and the lowest education groups was −10% in women (95% CI: −11.9% to 7.9%) and −3% in men (−4.8% to –0.4%). Education-related differences in OA were larger among men −35% (-36.9% to –32.4%) than women −17% (-19.4% to –15.0%). Finally, education-related differences in moderate-to-vigorous LTPA varied by ethnicity; for example, differences were 17% (16.2% to 18.7%) for white individuals compared with 6% (0.6% to 11.6%) for black individuals.ConclusionsEducational differences in PA vary by domain and are modified by age, sex and ethnicity. A better understanding of physically inactive subgroups may aid development of interventions to both increase activity levels and reduce health inequalities.

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Association between physical activity and risk of incident arrhythmias in 402 406 individuals: evidence from the UK Biobank cohort

European Heart Journal ◽

10.1093/eurheartj/ehz897 ◽

2020 ◽

Vol 41 (15) ◽

pp. 1479-1486 ◽

Cited By ~ 8

Author(s):

Adrian D Elliott ◽

Dominik Linz ◽

Ricardo Mishima ◽

Kadhim Kadhim ◽

Celine Gallagher ◽

...

Keyword(s):

Physical Activity ◽

Ventricular Arrhythmias ◽

Hospital Admissions ◽

Vigorous Physical Activity ◽

Activity Levels ◽

Uk Biobank ◽

Physically Active ◽

Activity Assessment ◽

The Uk

Abstract Aims Physical activity reduces cardiovascular disease burden and mortality, although its relationship with cardiac arrhythmias is less certain. The aim of this study was to assess the association between self-reported physical activity and atrial fibrillation (AF), ventricular arrhythmias and bradyarrhythmias, across the UK Biobank cohort. Methods and results We included 402 406 individuals (52.5% female), aged 40–69 years, with over 2.8 million person-years of follow-up who underwent self-reported physical activity assessment computed in metabolic equivalent-minutes per week (MET-min/wk) at baseline, detailed physical assessment and medical history evaluation. Arrhythmia episodes were diagnosed through hospital admissions and death reports. Incident AF risk was lower amongst physically active participants, with a more pronounced reduction amongst female participants [hazard ratio (HR) for 1500 vs. 0 MET-min/wk: 0.85, 95% confidence interval (CI) 0.74–0.98] than males (HR for 1500 vs. 0 MET-min/wk: 0.90, 95% CI 0.82–1.0). Similarly, we observed a significantly lower risk of ventricular arrhythmias amongst physically active participants (HR for 1500 MET-min/wk 0.78, 95% CI 0.64–0.96) that remained relatively stable over a broad range of physical activity levels between 0 and 2500 MET-min/wk. A lower AF risk amongst female participants who engaged in moderate levels of vigorous physical activity was observed (up to 2500 MET-min/wk). Vigorous physical activity was also associated with reduced ventricular arrhythmia risk. Total or vigorous physical activity was not associated with bradyarrhythmias. Conclusion The risk of AF and ventricular arrhythmias is lower amongst physically active individuals. These findings provide observational support that physical activity is associated with reduced risk of atrial and ventricular arrhythmias.

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Cancer patterns and association with mortality and renal outcomes in non-dialysis dependent chronic kidney disease: a matched cohort study

BMC Nephrology ◽

10.1186/s12882-019-1578-5 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Rajkumar Chinnadurai ◽

Emma Flanagan ◽

Gordon C. Jayson ◽

Philip A. Kalra

Keyword(s):

End Stage Renal Disease ◽

Cox Regression ◽

Matched Cohort ◽

All Cause Mortality ◽

History Of ◽

Renal Progression ◽

Rate Of Decline ◽

Stage Renal Disease ◽

End Stage ◽

History Of Cancer

Abstract Background Cancer in patients with chronic kidney disease (CKD) is an added burden to their overall morbidity and mortality. Cancer can be a cause or an effect of CKD. In CKD patients, a better understanding of cancer distribution and associations can aid in the proper planning of renal replacement therapy (RRT) and in the choice of chemotherapeutic agents, many of which are precluded in more advanced CKD. This study aims to investigate the distribution and the association of cancer with mortality, renal progression and RRT assignment in a non-dialysis dependent CKD cohort, few studies have investigated this in the past. Methods The study was carried out on 2952 patients registered in the Salford Kidney Study (SKS) between October 2002 and December 2016. A comparative analysis was performed between 339 patients with a history of cancer (previous and current) and 2613 patients without cancer at recruitment. A propensity score matched cohort of 337 patients was derived from each group and used for analysis. Cox-regression models and Kaplan-Meier estimates were used to compare the association of cancer with mortality and end-stage renal disease (ESRD) outcomes. Linear regression analysis was applied to generate the annual rate of decline in estimated glomerular filtration rate (delta eGFR). Results Of our cohort, 13.3% had a history of cancer at recruitment and the annual rate of de novo cancers in the non-cancer patients was 1.6%. Urogenital cancers including kidney and bladder, and prostate and testicle in males, ovary and uterus in females, were the most prevalent cancers (46%), as expected from the anatomical or physiological roles of these organs and relationship to nephrology. Over a median follow-up of 48 months, 1084 (36.7%) of patients died. All-cause mortality was higher in the previous and current cancer group (49.6% vs 35%, p < 0.001), primarily because of cancer-specific mortality. Multivariate Cox regression analysis showed a strong association of cancer with all-cause mortality (HR:1.41; 95%CI: 1.12–1.78; p = 0.004). There was no difference between the groups regarding reaching end-stage renal disease (26% in both groups) or the rate of decline in eGFR (− 0.97 for cancer vs − 0.93 mL/min/year for non-cancer, p = 0.93). RRT uptake was similar between the groups (17.2% vs 19.3%, p = 0.49). Conclusions Cancer status proved to be an added burden and an independent risk factor for all-cause mortality but not for renal progression. CKD patients with a previous or current history of cancer should be assessed on a case by case basis in planning for renal replacement therapy options, and the presence of cancer should not be a limitation for RRT provision including transplantation.

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Abstract 172: Baseline Physical Activity and Clinical Outcomes in Patients with Diabetes Mellitus and Stable Ischemic Heart Disease: Analysis From BARI-2D Trial.

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.8.suppl_2.172 ◽

2015 ◽

Vol 8 (suppl_2) ◽

Author(s):

Lynda Otalvaro Orozco ◽

Abdulla Damluji ◽

Christopher Hawk ◽

George Marzouka ◽

Italo Novoa ◽

...

Keyword(s):

Physical Activity ◽

Cox Regression ◽

Activity Levels ◽

Cox Regression Analysis ◽

Strenuous Activity ◽

All Cause Mortality ◽

Strenuous Physical Activity ◽

Sedentary Life ◽

Sedentary Life Style ◽

Baseline Physical Activity

Introduction: We aimed to evaluate the differences in clinical outcomes among patients with DM and coronary heart disease according to their baseline physical activity status. Methods: We evaluated 2,343 patients with CHD and DM who underwent either prompt revascularization (PR) and intensive medical therapy (IMT) or IMT alone in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. Patients were categorized according to their baseline physical activity status to sedentary, mild physical activity or moderate/strenuous activity. Primary end points were all cause mortality. Cox Regression analysis was used to evaluate the effects of baseline physical activity on all-cause-mortality. Results: Of 2,343 patients, 858 (37%) were able to achieve moderate/strenuous physical activity prior to randomization. Patients with sedentary life style and mild physical activity at baseline had worse survival compared to those with higher activity levels (Figure). In a Cox regression analysis, in patients randomized to IMT alone, there were no differences in mortality across physical activity levels. In the PR arm, sedentary and mild physical activity carried high risk of mortality compared to strenuous activity levels. Furthermore, patients in the low physical activity categories carried an increased risk of death if they were randomized to the insulin sensitizing arm of the trial. Conclusions: In this study, patients with DM and CHD, moderate/strenuous physical activity at baseline had improved survival compared to mild physical activity or sedentary life-style.

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