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Papers by Steven Blair
Circulation, 2012
Introduction: There is little evidence on the association between resistance exercise and inciden... more Introduction: There is little evidence on the association between resistance exercise and incident metabolic syndrome. Hypothesis: We examined the hypothesis that resistance exercise reduces the risk of developing metabolic syndrome in men. Methods: Participants were 6,098 men aged 18 to 83 years (mean age, 46) who received an extensive preventive medical examination during 1987–2006, and were free of cardiovascular disease, cancer, and metabolic syndrome at baseline. Resistance exercise was assessed by self-reported muscle strengthening activities using either free weights or weight training machines. We used the frequency of resistance exercise (0, 1, 2, 3, 4, and ≥5 days/week) as our main exposure categories. Metabolic syndrome was defined as the presence of ≥3 of the following criteria: waist circumference >102 cm, triglycerides ≥150 mg/dL, high-density lipoprotein cholesterol <40 mg/dL, systolic/diastolic blood pressure ≥130/85 mm Hg or physician-diagnosed hypertension, a...
Circulation, 2012
Introduction: Although cigarette smoking, physical inactivity, obesity, and poor diet each have b... more Introduction: Although cigarette smoking, physical inactivity, obesity, and poor diet each have been linked to the risk of premature death, little is known about their relative individual and combined impact, adapted from the American Heart Association (AHA)’s new cardiovascular health construct, on mortality outcomes. We hypothesized that the individual and the combined health behaviors were inversely associated with all-cause mortality. The purpose of the study is to estimate the mortality effects of the 4 AHA defined cardiovascular health behaviors by examining the associated population attributable fractions (PAFs) of individual and combination factors. Methods: The study included 11240 (24% women) participants from the Aerobics Center Longitudinal Study (ACLS). Slightly modified AHA cardiovascular health behaviors (smoking, BMI, cardiorespiratory fitness and diet) were collected between 1987 and 1999 as part of the clinical examination. We used cardiorespiratory fitness as an o...
Nutrition, Metabolism and Cardiovascular Diseases, 2014
Background and Aim: The body adiposity index (BAI) has been recently proposed as a new method to ... more Background and Aim: The body adiposity index (BAI) has been recently proposed as a new method to estimate the percentage of body fat. The association between BAI and hypertension risk has not been investigated yet. The aim of our study was to evaluate the ability of BAI to predict hypertension in males and females compared with traditional body adiposity measures. Methods and Results: The present follow-up analysis comprised 10 309 individuals (2259 females) free of hypertension from the Aerobics Center Longitudinal Study, who completed a baseline examination during 1988-2003. Body adiposity measures included BAI, body mass index (BMI), waist circumference, hip circumference, percentage of body fat and waist to hip ratio (WHR). Incident hypertension was ascertained from responses to mail-back surveys between 1990 and 2004. During an average of 9.1 years of follow-up, 872 subjects (107 females) became hypertensive. Hazard ratios (HRs) and 95% confidence intervals (95% CI) showed that males in the highest categories of all body adiposity measures showed a higher incident risk of hypertension (HRs ranged from 1.37 to 2.09). Females showed a higher incident risk of hypertension only in the highest categories of BAI, BMI and WHR (HRs ranged from 1.84 to 3.36). Conclusion: Our results suggest that in order to predict incident hypertension BAI could be considered as an alternative to traditional body adiposity measures.
Medicine & Science in Sports & Exercise, 2010
Chronic kidney disease (CKD) is a condition associated with excess morbidity and mortality. Much ... more Chronic kidney disease (CKD) is a condition associated with excess morbidity and mortality. Much of the excess risk occurs in later stages of the disease, highlighting the importance of examining risk factors, such as physical activity (PA), which may aid in slowing the progression of CKD. PURPOSE: To determine the association between all levels of PA intensity (sedentary (SA), light (LPA), moderate-vigorous (MVPA), and total PA (TPA)) and renal function. METHODS: NHANES is a cross-sectional observational study of non-institutionalized US individuals. The 2003 and 2005 study cycles assessed PA with an accelerometer. The intensity levels for each minute of PA were determined from previously validated cut points. Glomerular filtration rate was estimated (eGFR) using the Modification of Diet in Renal Disease study formula. Individuals were dichotomized into two groups based on eGFR according to the National Kidney Foundation criteria: normal and mild to moderate impairments (MMI) in renal function (CKD stages 1-3). Linear regression was used to determine the association between time spent in all levels of PA intensity and log transformed eGFR controlling for age, age squared, smoking status, race, BMI, HDL, total cholesterol, mean arterial pressure, and C-reactive protein. RESULTS: For the overall population, TPA and LPA were positively associated with eGFR for males and females (p<0.05). In females, SA was also negatively associated with eGFR (p<0.01). Stratifying by eGFR group, only TPA and LPA remained positively associated with eGFR in females with MMI (p<0.01). Stratifying the MMI group by diabetes status, TPA and LPA was positively associated with eGFR in men with MMI without diabetes (p<0.05). SA was also negatively associated with eGFR (p=0.04). In females with MMI without diabetes, TPA and LPA remained positively associated with eGFR (p<0.05). The association between PA and eGFR seem to break down when examining individuals with MMI and diabetes. CONCLUSION: TPA, LPA, and SA are associated with eGFR. These associations are strongest in individuals with MMI without diabetes.
Medicine & Science in Sports & Exercise, 2012
Although the effect of maternal exercise on low birthweight has been the focus of investigation, ... more Although the effect of maternal exercise on low birthweight has been the focus of investigation, there is a paucity of data regarding the association between exercise and macrosomic newborns. The authors investigated the effect of self-reported maternal physical activity on the outcome of macrosomia, defined as newborns weighing at least 4000 g, using a United States populationbased dataset. A case-control design was employed using data from the 1988 National Maternal and Infant Health Survey (NMIHS) that was restricted to non-anomalous, singleton infants who weighed 2500 g or more at birth. Cases (n = 524) and controls (n = 4639) were sampled on birthweight, and exposures to exercise and covariates were determined from sources available to the NMIHS. Associations were assessed with logistic regression adjusted for data-based confounders, with appropriate weighting for population inferences. Exercising women who were white, non-diabetic, or who gained less than 35 pounds were no more likely to deliver macrosomic infants than nonexercising women. A reduced risk of macrosomia was observed among black women (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.43-0.87), women with glucose intolerance (OR, 0.25; 95% CI, 0.07-0.88), and obese women (OR, 0.55, 95% CI 0.29-1.01) who reported leisure-time exercise. A positive association between exercise other than walking and macrosomia was found for activity through the second trimester. These associations suggest that a reduced risk of macrosomia among exercising women depends on racial, metabolic, nutritional, and anthropometric factors.
Medicine & Science in Sports & Exercise, 1997
Medicine & Science in Sports & Exercise, 2009
Mayo Clinic Proceedings, 2012
Objective: To analyze the relationship of ideal cardiovascular health to disease-specific death. ... more Objective: To analyze the relationship of ideal cardiovascular health to disease-specific death. Patients and Methods: We used data from the Aerobics Center Longitudinal Study from October 9, 1987, to March 3, 1999, to estimate the prevalence of ideal cardiovascular health in 11,993 individuals (24.3% women) and to examine its relationship with deaths from all causes, cardiovascular disease (CVD), and cancer. Results: During a mean follow-up of 11.6 years, 305 deaths occurred: 70 (23.0%) from CVD and 127 (41.6%) from cancer. In the entire cohort, only 29 individuals (0.2%) had 7 ideal metrics. After adjusting for age, sex, examination year, alcohol intake, and parental history of CVD, risk of death due to CVD was 55% lower in those participants who met 3 or 4 ideal metrics (hazard ratio, 0.45; 95% confidence interval, 0.27-0.77) and 63% lower in those with 5 to 7 ideal metrics (hazard ratio, 0.37; 95% confidence interval, 0.15-0.95), compared with those who met 0 to 2 ideal metrics. Although not significant, there was also a trend toward lower risk of death due to all causes across incremental numbers of ideal metrics. No association was observed for deaths due to cancer. Conclusion: The prevalence of ideal cardiovascular health was extremely low in a middle-aged cohort of men and women recruited between 1987 and 1999. The American Heart Association construct reflects well the subsequent risk of CVD, as reflected by graded CVD mortality in relation to the number of ideal metrics.
Mayo Clinic Proceedings, 2013
Objective-To study the protective role of lower resting heart rate (RHR) on cardiovascular diseas... more Objective-To study the protective role of lower resting heart rate (RHR) on cardiovascular disease (CVD) and all-cause mortality. Patients and Methods-Participants (n=51,936) who received a baseline medical examination between January 1, 1974 and December 31, 2002 were recruited from the Cooper Clinic, Dallas, Texas. They completed a medical questionnaire and underwent clinical evaluation. Participants with CVD or cancer, those who did not achieve at least 85% of their age-predicted maximal heart rate or who had <1 year of mortality follow-up were excluded from the study. SAS was used for statistical analysis. Relative risks and 95% confidence intervals of all-cause and CVD mortality across RHR categories were estimated using Cox proportional hazard models. Results-Highest cardiorespiratory fitness (CRF) with lower mortality was found in individuals with a RHR <60 bpm. Similarly, participants with a higher RHR, >80 bpm, were at greater risk for both CVD and all-cause mortality when compared with RHR <60 bpm. This analysis was followed by the stratification of the data by hypertension, where hypertensive individuals with high RHRs (≥80 bpm) were found at greater risk for CVD and all-cause mortality when compared to those with hypertension and lower RHRs (<60 bpm). Additionally unfit individuals with high RHR had the greatest risk for CVD and all-cause mortality. Interestingly, the unfit with low RHR group had a similar risk for both CVD and all-cause mortality as the fit with high RHR group. Conclusion-Lower levels of CRF and higher RHR are linked with greater CVD and all-cause mortality 1 .
Journal of the American College of Cardiology, 2012
Objectives-Our aim was to examine the independent and combined associations of changes in fitness... more Objectives-Our aim was to examine the independent and combined associations of changes in fitness and fatness with the subsequent incidence of the cardiovascular disease (CVD) risk factors of hypertension, metabolic syndrome, and hypercholesterolemia. Background-The relative and combined contributions of fitness and fatness to health are controversial, and few studies are available on the associations of changes in fitness and fatness with the development of CVD risk factors. Methods-We followed 3,148 healthy adults who received at least three medical examinations. Fitness was determined by a maximal treadmill test. Fatness was expressed by percent body fat and body mass index. Changes in fitness and fatness between the first and second examinations were categorized into loss, stable, or gain groups. Results-During the 6-year follow-up after the second examination, 752, 426, and 597 adults developed hypertension, metabolic syndrome, and hypercholesterolemia, respectively. Maintaining or improving fitness was associated with lower risk of developing each outcome, whereas increasing fatness was associated with higher risk of developing each outcome, after adjusting for possible confounders and fatness or fitness for each other (all p for trend <0.05). In the joint analyses, the increased risks associated with fat gain appeared to be attenuated, although
JAMA: The Journal of the American Medical Association, 2001
International Journal of Epidemiology, 2009
Background While dietary patterns that are both predictive of chronic disease and mortality have ... more Background While dietary patterns that are both predictive of chronic disease and mortality have been identified, the confounding effects of cardiorespiratory fitness have not been properly addressed. The primary objective was to assess the relation between dietary patterns with all-cause mortality, while controlling for the potentially confounding effects of fitness. Methods This was a prospective cohort study. Participants consisted of 13 621 men and women from the Aerobics Center Longitudinal Study (ACLS). Participants completed a clinical exam and 3-day diet record between 1987 and 1999. Participants were followed for mortality until 2003. Reduced rank regression (RRR) was used to identify dietary patterns that predicted unfavourable total and high-density lipoprotein-cholesterol, triglyceride, glucose, blood pressure, uric acid, white blood cell and body mass index values. Results One primary dietary pattern emerged and was labelled the Unhealthy Eating Index. This pattern was characterized by elevated consumption of processed and red meat, white potato products, nonwhole grains, added fat and reduced consumption of non-citrus fruits. The hazard ratio for all-cause mortality in the fifth vs the first quintile of the Unhealthy Eating Index was 1.40 (1.02-1.91). This risk estimate was reduced by 13.5 and 55.0% after controlling for self-reported physical activity and fitness, respectively. Conclusion In this study the association between diet and overall mortality was, in large part, confounded by fitness.
Health Education & Behavior, 2011
This study examined the relationship between emotional outlook on life and change in physical act... more This study examined the relationship between emotional outlook on life and change in physical activity among inactive adults in the Aerobics Center Longitudinal Study. A total of 2,132 sedentary adults completed a baseline medical examination and returned for a follow-up examination at least 6 months later. Participants self-reported physical activity level and emotional outlook on life. Emotional outlook on life was significantly and positively related to physical activity participation at the follow-up visit in men but not women. Men who were usually very happy and optimistic at baseline had significantly greater increases in physical activity compared to men who were not happy. Men with a more positive outlook on life (e.g., happier) may be more likely to increase physical activity levels. Physical activity interventions targeting men may be more successful if they first increase happiness.
British Journal of Sports Medicine, 2012
British Journal of Sports Medicine, 2008
British Journal of Sports Medicine, 2011
Self-rated health (SRH) and cardiorespiratory fitness (fitness) are independent risk factors for ... more Self-rated health (SRH) and cardiorespiratory fitness (fitness) are independent risk factors for allcause mortality. The purpose of this report is to examine the single and joint effects of these exposures on mortality risk. The study included 18,488 men who completed a health survey, clinical examination, and a maximal exercise treadmill test during 1987-2003. Cox regression analysis was used to quantify the associations of SRH and fitness with all-cause mortality. There were 262 deaths during 17 years of follow-up. There was a significant inverse trend (P trend < 0.05) for mortality across SRH categories after adjustment for age, examination year, body mass index, physical activity, smoking, alcohol consumption, abnormal ECG, hypertension, and hypercholesterolemia, cardiovascular disease, diabetes, and cancer. Adjustment for fitness attenuated the association (P value =0.09). We also observed an inverse association between fitness and mortality after controlling for the same covariates and SRH (P trend = 0.006). The combined analysis of SRH and fitness showed that fit men with good or excellent SRH had a 58% lower risk of mortality than their counterparts. SRH and fitness were both associated with allcause mortality in men. Fit men with good or excellent SRH live longer than unfit men with poor or fair SRH.
American Journal of Preventive Medicine, 2010
Background-Falls are a major cause of deaths, hospitalizations, and emergency room visits in the ... more Background-Falls are a major cause of deaths, hospitalizations, and emergency room visits in the U.S., but circumstances surrounding falls are not well described. Among the elderly, balance and gait disorders and muscle weakness are associated with increased risk for falling, but the relationship of cardiorespiratory fitness and physical activity with falls is unclear. Purpose-This purpose of this study is to describe characteristics of falls among adults and assess the association of cardiorespiratory fitness and physical activity with walking-related falls. Methods-Data on participants enrolled in the Aerobics Center Longitudinal Study (ACLS) from 1970 through 1989 who responded to questions on falls on the 1990 follow-up survey were analyzed in 2008-2009. The percentage of participants reporting at least one fall during the year before the follow-up survey was calculated and the activities at the time of falling were described. The relative risk and 95% CIs for the association of baseline fitness and physical activity with walking-related falls were calculated and logistic regression models for walking-related falls were developed. Results-Of 10,615 participants aged 20-87 years, 20% (95% CI 19%, 21%) reported falling during the past year. Of those falling, 54% (95% CI 52%, 56%) fell during sports or exercise, 15% (95% CI 14%,17%) while walking, and 4% (95% CI 3%,5%) from a stool or ladder. People aged ≥65 years were no more likely than younger people to report falling in general, but they were more likely than people aged <45 years to report falling while walking (RR 1.9; 95% CI 1.2, 3.0 for men; RR 2.2; 95% CI 1.3, 3.9 for women). Men with a low level of fitness were more likely to fall while walking than men who were highly fit (RR 2.2; 95% CI 1.5,3.3). In the multivariate analysis, walking-related falls were associated with low levels of fitness (AOR 1.8; 95% CI 1.1,2.8) and with physical inactivity (AOR 1.7; 95% CI 1.1-2.7) in men but not in women. Conclusions-Falls are common throughout adulthood but activities at time of falls differ by age. Low fitness levels and physical inactivity may increase risk for walking-related falls.
Circulation, 2012
Introduction: There is little evidence on the association between resistance exercise and inciden... more Introduction: There is little evidence on the association between resistance exercise and incident metabolic syndrome. Hypothesis: We examined the hypothesis that resistance exercise reduces the risk of developing metabolic syndrome in men. Methods: Participants were 6,098 men aged 18 to 83 years (mean age, 46) who received an extensive preventive medical examination during 1987–2006, and were free of cardiovascular disease, cancer, and metabolic syndrome at baseline. Resistance exercise was assessed by self-reported muscle strengthening activities using either free weights or weight training machines. We used the frequency of resistance exercise (0, 1, 2, 3, 4, and ≥5 days/week) as our main exposure categories. Metabolic syndrome was defined as the presence of ≥3 of the following criteria: waist circumference >102 cm, triglycerides ≥150 mg/dL, high-density lipoprotein cholesterol <40 mg/dL, systolic/diastolic blood pressure ≥130/85 mm Hg or physician-diagnosed hypertension, a...
Circulation, 2012
Introduction: Although cigarette smoking, physical inactivity, obesity, and poor diet each have b... more Introduction: Although cigarette smoking, physical inactivity, obesity, and poor diet each have been linked to the risk of premature death, little is known about their relative individual and combined impact, adapted from the American Heart Association (AHA)’s new cardiovascular health construct, on mortality outcomes. We hypothesized that the individual and the combined health behaviors were inversely associated with all-cause mortality. The purpose of the study is to estimate the mortality effects of the 4 AHA defined cardiovascular health behaviors by examining the associated population attributable fractions (PAFs) of individual and combination factors. Methods: The study included 11240 (24% women) participants from the Aerobics Center Longitudinal Study (ACLS). Slightly modified AHA cardiovascular health behaviors (smoking, BMI, cardiorespiratory fitness and diet) were collected between 1987 and 1999 as part of the clinical examination. We used cardiorespiratory fitness as an o...
Nutrition, Metabolism and Cardiovascular Diseases, 2014
Background and Aim: The body adiposity index (BAI) has been recently proposed as a new method to ... more Background and Aim: The body adiposity index (BAI) has been recently proposed as a new method to estimate the percentage of body fat. The association between BAI and hypertension risk has not been investigated yet. The aim of our study was to evaluate the ability of BAI to predict hypertension in males and females compared with traditional body adiposity measures. Methods and Results: The present follow-up analysis comprised 10 309 individuals (2259 females) free of hypertension from the Aerobics Center Longitudinal Study, who completed a baseline examination during 1988-2003. Body adiposity measures included BAI, body mass index (BMI), waist circumference, hip circumference, percentage of body fat and waist to hip ratio (WHR). Incident hypertension was ascertained from responses to mail-back surveys between 1990 and 2004. During an average of 9.1 years of follow-up, 872 subjects (107 females) became hypertensive. Hazard ratios (HRs) and 95% confidence intervals (95% CI) showed that males in the highest categories of all body adiposity measures showed a higher incident risk of hypertension (HRs ranged from 1.37 to 2.09). Females showed a higher incident risk of hypertension only in the highest categories of BAI, BMI and WHR (HRs ranged from 1.84 to 3.36). Conclusion: Our results suggest that in order to predict incident hypertension BAI could be considered as an alternative to traditional body adiposity measures.
Medicine & Science in Sports & Exercise, 2010
Chronic kidney disease (CKD) is a condition associated with excess morbidity and mortality. Much ... more Chronic kidney disease (CKD) is a condition associated with excess morbidity and mortality. Much of the excess risk occurs in later stages of the disease, highlighting the importance of examining risk factors, such as physical activity (PA), which may aid in slowing the progression of CKD. PURPOSE: To determine the association between all levels of PA intensity (sedentary (SA), light (LPA), moderate-vigorous (MVPA), and total PA (TPA)) and renal function. METHODS: NHANES is a cross-sectional observational study of non-institutionalized US individuals. The 2003 and 2005 study cycles assessed PA with an accelerometer. The intensity levels for each minute of PA were determined from previously validated cut points. Glomerular filtration rate was estimated (eGFR) using the Modification of Diet in Renal Disease study formula. Individuals were dichotomized into two groups based on eGFR according to the National Kidney Foundation criteria: normal and mild to moderate impairments (MMI) in renal function (CKD stages 1-3). Linear regression was used to determine the association between time spent in all levels of PA intensity and log transformed eGFR controlling for age, age squared, smoking status, race, BMI, HDL, total cholesterol, mean arterial pressure, and C-reactive protein. RESULTS: For the overall population, TPA and LPA were positively associated with eGFR for males and females (p<0.05). In females, SA was also negatively associated with eGFR (p<0.01). Stratifying by eGFR group, only TPA and LPA remained positively associated with eGFR in females with MMI (p<0.01). Stratifying the MMI group by diabetes status, TPA and LPA was positively associated with eGFR in men with MMI without diabetes (p<0.05). SA was also negatively associated with eGFR (p=0.04). In females with MMI without diabetes, TPA and LPA remained positively associated with eGFR (p<0.05). The association between PA and eGFR seem to break down when examining individuals with MMI and diabetes. CONCLUSION: TPA, LPA, and SA are associated with eGFR. These associations are strongest in individuals with MMI without diabetes.
Medicine & Science in Sports & Exercise, 2012
Although the effect of maternal exercise on low birthweight has been the focus of investigation, ... more Although the effect of maternal exercise on low birthweight has been the focus of investigation, there is a paucity of data regarding the association between exercise and macrosomic newborns. The authors investigated the effect of self-reported maternal physical activity on the outcome of macrosomia, defined as newborns weighing at least 4000 g, using a United States populationbased dataset. A case-control design was employed using data from the 1988 National Maternal and Infant Health Survey (NMIHS) that was restricted to non-anomalous, singleton infants who weighed 2500 g or more at birth. Cases (n = 524) and controls (n = 4639) were sampled on birthweight, and exposures to exercise and covariates were determined from sources available to the NMIHS. Associations were assessed with logistic regression adjusted for data-based confounders, with appropriate weighting for population inferences. Exercising women who were white, non-diabetic, or who gained less than 35 pounds were no more likely to deliver macrosomic infants than nonexercising women. A reduced risk of macrosomia was observed among black women (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.43-0.87), women with glucose intolerance (OR, 0.25; 95% CI, 0.07-0.88), and obese women (OR, 0.55, 95% CI 0.29-1.01) who reported leisure-time exercise. A positive association between exercise other than walking and macrosomia was found for activity through the second trimester. These associations suggest that a reduced risk of macrosomia among exercising women depends on racial, metabolic, nutritional, and anthropometric factors.
Medicine & Science in Sports & Exercise, 1997
Medicine & Science in Sports & Exercise, 2009
Mayo Clinic Proceedings, 2012
Objective: To analyze the relationship of ideal cardiovascular health to disease-specific death. ... more Objective: To analyze the relationship of ideal cardiovascular health to disease-specific death. Patients and Methods: We used data from the Aerobics Center Longitudinal Study from October 9, 1987, to March 3, 1999, to estimate the prevalence of ideal cardiovascular health in 11,993 individuals (24.3% women) and to examine its relationship with deaths from all causes, cardiovascular disease (CVD), and cancer. Results: During a mean follow-up of 11.6 years, 305 deaths occurred: 70 (23.0%) from CVD and 127 (41.6%) from cancer. In the entire cohort, only 29 individuals (0.2%) had 7 ideal metrics. After adjusting for age, sex, examination year, alcohol intake, and parental history of CVD, risk of death due to CVD was 55% lower in those participants who met 3 or 4 ideal metrics (hazard ratio, 0.45; 95% confidence interval, 0.27-0.77) and 63% lower in those with 5 to 7 ideal metrics (hazard ratio, 0.37; 95% confidence interval, 0.15-0.95), compared with those who met 0 to 2 ideal metrics. Although not significant, there was also a trend toward lower risk of death due to all causes across incremental numbers of ideal metrics. No association was observed for deaths due to cancer. Conclusion: The prevalence of ideal cardiovascular health was extremely low in a middle-aged cohort of men and women recruited between 1987 and 1999. The American Heart Association construct reflects well the subsequent risk of CVD, as reflected by graded CVD mortality in relation to the number of ideal metrics.
Mayo Clinic Proceedings, 2013
Objective-To study the protective role of lower resting heart rate (RHR) on cardiovascular diseas... more Objective-To study the protective role of lower resting heart rate (RHR) on cardiovascular disease (CVD) and all-cause mortality. Patients and Methods-Participants (n=51,936) who received a baseline medical examination between January 1, 1974 and December 31, 2002 were recruited from the Cooper Clinic, Dallas, Texas. They completed a medical questionnaire and underwent clinical evaluation. Participants with CVD or cancer, those who did not achieve at least 85% of their age-predicted maximal heart rate or who had <1 year of mortality follow-up were excluded from the study. SAS was used for statistical analysis. Relative risks and 95% confidence intervals of all-cause and CVD mortality across RHR categories were estimated using Cox proportional hazard models. Results-Highest cardiorespiratory fitness (CRF) with lower mortality was found in individuals with a RHR <60 bpm. Similarly, participants with a higher RHR, >80 bpm, were at greater risk for both CVD and all-cause mortality when compared with RHR <60 bpm. This analysis was followed by the stratification of the data by hypertension, where hypertensive individuals with high RHRs (≥80 bpm) were found at greater risk for CVD and all-cause mortality when compared to those with hypertension and lower RHRs (<60 bpm). Additionally unfit individuals with high RHR had the greatest risk for CVD and all-cause mortality. Interestingly, the unfit with low RHR group had a similar risk for both CVD and all-cause mortality as the fit with high RHR group. Conclusion-Lower levels of CRF and higher RHR are linked with greater CVD and all-cause mortality 1 .
Journal of the American College of Cardiology, 2012
Objectives-Our aim was to examine the independent and combined associations of changes in fitness... more Objectives-Our aim was to examine the independent and combined associations of changes in fitness and fatness with the subsequent incidence of the cardiovascular disease (CVD) risk factors of hypertension, metabolic syndrome, and hypercholesterolemia. Background-The relative and combined contributions of fitness and fatness to health are controversial, and few studies are available on the associations of changes in fitness and fatness with the development of CVD risk factors. Methods-We followed 3,148 healthy adults who received at least three medical examinations. Fitness was determined by a maximal treadmill test. Fatness was expressed by percent body fat and body mass index. Changes in fitness and fatness between the first and second examinations were categorized into loss, stable, or gain groups. Results-During the 6-year follow-up after the second examination, 752, 426, and 597 adults developed hypertension, metabolic syndrome, and hypercholesterolemia, respectively. Maintaining or improving fitness was associated with lower risk of developing each outcome, whereas increasing fatness was associated with higher risk of developing each outcome, after adjusting for possible confounders and fatness or fitness for each other (all p for trend <0.05). In the joint analyses, the increased risks associated with fat gain appeared to be attenuated, although
JAMA: The Journal of the American Medical Association, 2001
International Journal of Epidemiology, 2009
Background While dietary patterns that are both predictive of chronic disease and mortality have ... more Background While dietary patterns that are both predictive of chronic disease and mortality have been identified, the confounding effects of cardiorespiratory fitness have not been properly addressed. The primary objective was to assess the relation between dietary patterns with all-cause mortality, while controlling for the potentially confounding effects of fitness. Methods This was a prospective cohort study. Participants consisted of 13 621 men and women from the Aerobics Center Longitudinal Study (ACLS). Participants completed a clinical exam and 3-day diet record between 1987 and 1999. Participants were followed for mortality until 2003. Reduced rank regression (RRR) was used to identify dietary patterns that predicted unfavourable total and high-density lipoprotein-cholesterol, triglyceride, glucose, blood pressure, uric acid, white blood cell and body mass index values. Results One primary dietary pattern emerged and was labelled the Unhealthy Eating Index. This pattern was characterized by elevated consumption of processed and red meat, white potato products, nonwhole grains, added fat and reduced consumption of non-citrus fruits. The hazard ratio for all-cause mortality in the fifth vs the first quintile of the Unhealthy Eating Index was 1.40 (1.02-1.91). This risk estimate was reduced by 13.5 and 55.0% after controlling for self-reported physical activity and fitness, respectively. Conclusion In this study the association between diet and overall mortality was, in large part, confounded by fitness.
Health Education & Behavior, 2011
This study examined the relationship between emotional outlook on life and change in physical act... more This study examined the relationship between emotional outlook on life and change in physical activity among inactive adults in the Aerobics Center Longitudinal Study. A total of 2,132 sedentary adults completed a baseline medical examination and returned for a follow-up examination at least 6 months later. Participants self-reported physical activity level and emotional outlook on life. Emotional outlook on life was significantly and positively related to physical activity participation at the follow-up visit in men but not women. Men who were usually very happy and optimistic at baseline had significantly greater increases in physical activity compared to men who were not happy. Men with a more positive outlook on life (e.g., happier) may be more likely to increase physical activity levels. Physical activity interventions targeting men may be more successful if they first increase happiness.
British Journal of Sports Medicine, 2012
British Journal of Sports Medicine, 2008
British Journal of Sports Medicine, 2011
Self-rated health (SRH) and cardiorespiratory fitness (fitness) are independent risk factors for ... more Self-rated health (SRH) and cardiorespiratory fitness (fitness) are independent risk factors for allcause mortality. The purpose of this report is to examine the single and joint effects of these exposures on mortality risk. The study included 18,488 men who completed a health survey, clinical examination, and a maximal exercise treadmill test during 1987-2003. Cox regression analysis was used to quantify the associations of SRH and fitness with all-cause mortality. There were 262 deaths during 17 years of follow-up. There was a significant inverse trend (P trend < 0.05) for mortality across SRH categories after adjustment for age, examination year, body mass index, physical activity, smoking, alcohol consumption, abnormal ECG, hypertension, and hypercholesterolemia, cardiovascular disease, diabetes, and cancer. Adjustment for fitness attenuated the association (P value =0.09). We also observed an inverse association between fitness and mortality after controlling for the same covariates and SRH (P trend = 0.006). The combined analysis of SRH and fitness showed that fit men with good or excellent SRH had a 58% lower risk of mortality than their counterparts. SRH and fitness were both associated with allcause mortality in men. Fit men with good or excellent SRH live longer than unfit men with poor or fair SRH.
American Journal of Preventive Medicine, 2010
Background-Falls are a major cause of deaths, hospitalizations, and emergency room visits in the ... more Background-Falls are a major cause of deaths, hospitalizations, and emergency room visits in the U.S., but circumstances surrounding falls are not well described. Among the elderly, balance and gait disorders and muscle weakness are associated with increased risk for falling, but the relationship of cardiorespiratory fitness and physical activity with falls is unclear. Purpose-This purpose of this study is to describe characteristics of falls among adults and assess the association of cardiorespiratory fitness and physical activity with walking-related falls. Methods-Data on participants enrolled in the Aerobics Center Longitudinal Study (ACLS) from 1970 through 1989 who responded to questions on falls on the 1990 follow-up survey were analyzed in 2008-2009. The percentage of participants reporting at least one fall during the year before the follow-up survey was calculated and the activities at the time of falling were described. The relative risk and 95% CIs for the association of baseline fitness and physical activity with walking-related falls were calculated and logistic regression models for walking-related falls were developed. Results-Of 10,615 participants aged 20-87 years, 20% (95% CI 19%, 21%) reported falling during the past year. Of those falling, 54% (95% CI 52%, 56%) fell during sports or exercise, 15% (95% CI 14%,17%) while walking, and 4% (95% CI 3%,5%) from a stool or ladder. People aged ≥65 years were no more likely than younger people to report falling in general, but they were more likely than people aged <45 years to report falling while walking (RR 1.9; 95% CI 1.2, 3.0 for men; RR 2.2; 95% CI 1.3, 3.9 for women). Men with a low level of fitness were more likely to fall while walking than men who were highly fit (RR 2.2; 95% CI 1.5,3.3). In the multivariate analysis, walking-related falls were associated with low levels of fitness (AOR 1.8; 95% CI 1.1,2.8) and with physical inactivity (AOR 1.7; 95% CI 1.1-2.7) in men but not in women. Conclusions-Falls are common throughout adulthood but activities at time of falls differ by age. Low fitness levels and physical inactivity may increase risk for walking-related falls.