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Cited by 162Physical Activity and HealthCardiovascular Health and Risk FactorsCardiovascular and exercise physiology

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Association of Light Physical Activity Measured by Accelerometry and Incidence of Coronary Heart Disease and Cardiovascular Disease in Older Women

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LaCroix, Andrea Z., Bellettiere, John, Rillamas-Sun, Eileen, Di, Chongzhi, Evenson, Kelly R., Lewis, Cora E., Buchner, David M., Stefanick, Marcia L., Lee, I-Min, Rosenberg, Dori E., LaMonte, Michael J., for the Women’s Health Initiative (WHI)·2019·JAMA Network Open
DOI 10.1001/jamanetworkopen.2019.0419PMC PMC6484645
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Abstract

Importance: To our knowledge, no studies have examined light physical activity (PA) measured by accelerometry and heart disease in older women. Objective: To investigate whether higher levels of light PA were associated with reduced risks of coronary heart disease (CHD) or cardiovascular disease (CVD) in older women. Design, Setting, and Participants: Prospective cohort study of older women from baseline (March 2012 to April 2014) through February 28, 2017, for up to 4.91 years. The setting was community-dwelling participants from the Women's Health Initiative. Participants were ambulatory women with no history of myocardial infarction or stroke. Exposures: Data from accelerometers worn for a requested 7 days were used to measure light PA. Main Outcomes and Measures: Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% CIs for physician-adjudicated CHD and CVD events across light PA quartiles adjusting for possible confounders. Light PA was also analyzed as a continuous variable with and without adjustment for moderate to vigorous PA (MVPA). Results: Among 5861 women (mean [SD] age, 78.5 [6.7] years), 143 CHD events and 570 CVD events were observed. The HRs for CHD in the highest vs lowest quartiles of light PA were 0.42 (95% CI, 0.25-0.70; P for trend <.001) adjusted for age and race/ethnicity and 0.58 (95% CI, 0.34-0.99; P for trend = .004) after additional adjustment for education, current smoking, alcohol consumption, physical functioning, comorbidity, and self-rated health. Corresponding HRs for CVD in the highest vs lowest quartiles of light PA were 0.63 (95% CI, 0.49-0.81; P for trend <.001) and 0.78 (95% CI, 0.60-1.00; P for trend = .004). The HRs for a 1-hour/day increment in light PA after additional adjustment for MVPA were 0.86 (95% CI, 0.73-1.00; P for trend = .05) for CHD and 0.92 (95% CI, 0.85-0.99; P for trend = .03) for CVD. Conclusions and Relevance: The present findings support the conclusion that all movement counts for the prevention of CHD and CVD in older women. Large, pragmatic randomized trials are needed to test whether increasing light PA among older women reduces cardiovascular risk.

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Figure 1. Continuous Dose-Response Association of Light Physical Activity (PA) With Coronary Heart Disease (CHD) and Cardiovascular Disease (CVD) Events A, Association with incident CHD events. B, Association with incident CVD events. C, Distribution of daily light PA for the Objectively Measured Physical Activity and Cardiovascular Health (OPACH) cohort. All associations were estimated using multivariable linear Cox proportional hazards regression models adjusted for age, race/ethnicity, highest education, current smoking, alcohol consumption, physical functioning, comorbidity, and self-rated health (blue lines). Orange lines show results after additional adjustment for moderate to vigorous PA (MVPA). The reference category was set to the 10th percentile of light PA (3.3 hours per day). Respective hazard ratios (HRs) and 95% CIs for 4, 5, and 6 hours per day of light PA (compared with the reference) were for CHD: not adjusted for MVPA 0.84 (0.75-0.95), 0.68 (0.52-0.88), 0.54 (0.36-0.82); adjusted for MVPA 0.89 (0.79-1.00), 0.76 (0.58-1.00), 0.65 (0.42-1.01). For CVD: not adjusted for MVPA 0.92 (0.87-0.97), 0.83 (0.73-0.94), 0.74 (0.61-0.91); adjusted for MVPA 0.94 (0.88-1.00), 0.86 (0.75-0.99), 0.79 (0.64-0.98). Results were trimmed at the 1st and 99th percentiles.
Figure 1. Continuous Dose-Response Association of Light Physical Activity (PA) With Coronary Heart Disease (CHD) and Cardiovascular Disease (CVD) Events A, Association with incident CHD events. B, Association with incident CVD events. C, Distribution of daily light PA for the Objectively Measured Physical Activity and Cardiovascular Health (OPACH) cohort. All associations were estimated using multivariable linear Cox proportional hazards regression models adjusted for age, race/ethnicity, highest education, current smoking, alcohol consumption, physical functioning, comorbidity, and self-rated health (blue lines). Orange lines show results after additional adjustment for moderate to vigorous PA (MVPA). The reference category was set to the 10th percentile of light PA (3.3 hours per day). Respective hazard ratios (HRs) and 95% CIs for 4, 5, and 6 hours per day of light PA (compared with the reference) were for CHD: not adjusted for MVPA 0.84 (0.75-0.95), 0.68 (0.52-0.88), 0.54 (0.36-0.82); adjusted for MVPA 0.89 (0.79-1.00), 0.76 (0.58-1.00), 0.65 (0.42-1.01). For CVD: not adjusted for MVPA 0.92 (0.87-0.97), 0.83 (0.73-0.94), 0.74 (0.61-0.91); adjusted for MVPA 0.94 (0.88-1.00), 0.86 (0.75-0.99), 0.79 (0.64-0.98). Results were trimmed at the 1st and 99th percentiles.CC BY · PubMed Central
Figure 2. Associations of Physical Activity (PA) With Coronary Heart Disease (CHD) and Cardiovascular Disease (CVD) Events, by Selected Participant Characteristics A, Associations comparing the 75th vs 25th percentiles of light PA (difference of 1.6 hours per day) with incident CHD and CVD events. B, Associations comparing the 75th vs 25th quartiles of moderate to vigorous PA (MVPA) (difference of 42 minutes per day) with incident CHD and CVD events. Hazard ratios (HR) were adjusted for age, race/ethnicity, highest education, current smoking, alcohol consumption, physical functioning, comorbidity, and self-rated health (where appropriate). Reynolds Risk Score, MVPA, physical functioning, and light PA were split at the median. Hazard ratios below 1 indicate favorable associations (ie, lower risk), whereas those above 1 indicate harmful associations (ie, higher risk). NA indicates not applicable; error bars, 95% CIs. The n values for subanalyses stratified by Reynolds Risk Score do not sum to 5750 because of missing biomarker data.
Figure 2. Associations of Physical Activity (PA) With Coronary Heart Disease (CHD) and Cardiovascular Disease (CVD) Events, by Selected Participant Characteristics A, Associations comparing the 75th vs 25th percentiles of light PA (difference of 1.6 hours per day) with incident CHD and CVD events. B, Associations comparing the 75th vs 25th quartiles of moderate to vigorous PA (MVPA) (difference of 42 minutes per day) with incident CHD and CVD events. Hazard ratios (HR) were adjusted for age, race/ethnicity, highest education, current smoking, alcohol consumption, physical functioning, comorbidity, and self-rated health (where appropriate). Reynolds Risk Score, MVPA, physical functioning, and light PA were split at the median. Hazard ratios below 1 indicate favorable associations (ie, lower risk), whereas those above 1 indicate harmful associations (ie, higher risk). NA indicates not applicable; error bars, 95% CIs. The n values for subanalyses stratified by Reynolds Risk Score do not sum to 5750 because of missing biomarker data.CC BY · PubMed Central

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  1. National Center for Health Statistics, Health, United States, 2016: With Chartbook on Long-term Trends in Health

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Metadata

Authors
LaCroix, A. Z., Bellettiere, J., Rillamas-Sun, E., Di, C., Evenson, K. R., Lewis, C. E., Buchner, D. M., Stefanick, M. L., Lee, I.-M., Rosenberg, D. E., LaMonte, M. J., & (WHI), F. T. W. H. I.
Affiliations
  • University of California San Diego (US)
  • San Diego State University (US)
  • Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
  • Fred Hutch Cancer Center (US)
  • University of North Carolina at Chapel Hill (US)
  • University of Alabama at Birmingham (US)
  • University of Illinois at Urbana-Champaign, Champaign
  • Stanford Medicine (US)
  • Brigham and Women's Hospital (US)
  • Kaiser Permanente Washington Health Research Institute (US)
  • University at Buffalo, State University of New York (US)
Corresponding author
LaCroix, Andrea Z.
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2019-03-15
Volume
2
Issue
3
Pages
e190419
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2019.0419
PMC
PMC6484645
OpenAlex
W2921167015
Cited by
162
References
43
Citations by year
2026: 10 · 2025: 18 · 2024: 22 · 2023: 15 · 2022: 27 · 2021: 30 · 2020: 28 · 2019: 11
FWCI
16.45
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UA Campus Repository (The University of Arizona) (acceptedVersion, cc-by)
  • Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
  • UNC Libraries
Funders
  • U.S. Department of Health and Human Services
  • Women's Health Initiative
  • National Institutes of Health
  • National Heart, Lung, and Blood Institute (HHSN268201600018C, HHSN268201600004C, HHSN268201600001C, HHSN268201600003C, HHSN268201600002C, R01HL130483, T32HL079891)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK079626)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
Keywords
light physical activity, accelerometry, coronary artery disease, cardiovascular disease, older women, moderate-to-vigorous physical activity, heart disease risk, Women's Health Initiative, community-dwelling women, physical activity measurement
MeSH terms
Aged, Cardiovascular Diseases, Coronary Disease, Female, Humans, Prospective Studies, Risk Factors, United States, Cohort Studies, Exercise, Proportional Hazards Models, Risk Reduction Behavior, Independent Living, Accelerometry

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