Death, Cardiovascular Events Reduced by Nonrecreational Activity

Increased rates of physical activity, recreational or otherwise, has been shown to lower the risk of death and cardiovascular events, according to the results of the PURE study.

Led by Scott Lear (pictured), PhD, of Simon Fraser University in Vancouver, British Columbia, Canada, the study compared low physical activity (defined as less than 150 minutes per week), moderate activity (150 to 750 minutes per week), and high activity (more than 750 minutes per week) in more than 130800 individuals without preexisting cardiovascular disease.

Participants were required to complete the International Physical Activity Questionnaire (IPQA), with an average of 6.9 years follow-up. Since the participant population was global, adjustments were made for effects that the sociodemographic and other risk factors, such as household, community, and country clustering, had on mortality and cardiovascular disease.

Overall, 18% of the study population did not meet the activity guidelines. Despite that, 44% were considered highly active. According to Lear, the highly physically active achieved their status by incorporating their physical activity into their jobs or housework.

The results showed a graded reduction in mortality when comparing low activity with moderate and high activity (HR 0.80 [95% CI, 0.74-0.87] and 0.65 [95% CI, 0.60-0.71], respectively; P < 0.0001 for trend) and major cardiovascular events (HR 0.86; 95% CI, 0.78-0.93; P < 0.001 for trend). For those who did not meet the recommended amount of activity, the risk of death was 6.4% compared to 4.2% for those who did.

Physical activity guidelines recommend 30 minutes of moderate exercise at least 5 days per week. If this was met by the population, 8% of deaths and 4.6% of cardiovascular disease events could be prevented, according to Lear. The 5-year adjusted population attributable fraction for those not meeting the guidelines was 8.0% for mortality and 4.6% for major cardiovascular events.

Higher physical activity is also associated with a lower risk for diabetes, heart failure, and other conditions. Mandeep Mehra, the medical director of the heart and vascular center at Brigham and Women's Hospital in Boston, and president of the Heart Failure Society of America, told MD Magazine that the best prevention for cardiovascular events was primordial care, beginning with diet and physical activity.

"Primordial care is actually doing things that don't allow risk factors to be generated," Mehra said. "So it's even before risk markers become manifested. Our ability to think through cardiovascular disease starts at the inception point of detection of risk markers - like tobacco smoke, obesity, hypertension, cholesterol, and things like that."

Shifalika Goenka, of the Indian Institute of Public Health in New Delhi, and I-Min Lee of Brigham and Women's Hospital, echoed the sentiment in an editorial that accompanied the PURE study. "Creating a physical, social, and political environment where physical activity in daily living is desirable, accessible, and safe should be a developmental imperative; a planning, economic, social, and equity imperative; and a public health imperative," they said.