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Cited by 1,972Physical Activity and HealthCardiovascular Health and Risk FactorsHealth and Lifestyle Studies

The Association of Changes in Physical-Activity Level and Other Lifestyle Characteristics with Mortality among Men

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Paffenbarger, Ralph S., Hyde, Robert T., Wing, Alvin L., Lee, I-Min, Jung, Dexter L., Kampert, James B.·1993·New England Journal of Medicine
DOI 10.1056/nejm199302253280804
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Abstract

BACKGROUND: Recent trends toward increasing physical exercise, stopping cigarette smoking, and avoiding obesity may increase longevity. We analyzed changes in the lifestyles of Harvard College alumni and the associations of these changes with mortality. METHODS: Men who were 45 to 84 years of age in 1977 and who had reported no life-threatening disease on questionnaires completed in 1962 or 1966 and again in 1977 were classified according to changes in lifestyle characteristics between the first and second questionnaires. We analyzed changes in their level of physical activity, cigarette smoking, blood pressure, and body weight, and the relation of these factors to mortality between 1977 and 1985. RESULTS: Of the 10,269 men, 476 died during this period (which totaled 90,650 man-years of observation). Beginning moderately vigorous sports activity (at an intensity of 4.5 or more metabolic equivalents) was associated with a 23 percent lower risk of death (95 percent confidence interval, 4 to 42 percent; P = 0.015) than not taking up moderately vigorous sports. Quitting cigarette smoking was associated with a 41 percent lower risk (95 percent confidence interval, 20 to 57 percent; P = 0.001) than continuing smoking, but with a 23 percent higher risk than constant nonsmoking. Men with recently diagnosed hypertension had a lower risk of death than those with long-term hypertension (relative risk, 0.75; 95 percent confidence interval, 0.55 to 1.02; P = 0.057), as did men with consistently normal blood pressure (relative risk, 0.52; 95 percent confidence interval, 0.40 to 0.68; P < 0.001). Maintenance of lean body mass was associated with a lower mortality rate than long-term, recent, or previous obesity. The associations between changes in lifestyle and mortality were independent and were largely undiminished by age. Our findings on death from coronary heart disease mirrored those on death from all causes. CONCLUSIONS: Beginning moderately vigorous sports activity, quitting cigarette smoking, maintaining normal blood pressure, and avoiding obesity were separately associated with lower rates of death from all causes and from coronary heart disease among middle-aged and older men.

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  • Regular exercise is associated with a reduction in the long-term risk of coronary events.

    “numerous studies5,24-31 have found that regular exercise is associated with a reduction in the long-term risk of coronary events.”

    From Triggering of Acute Myocardial Infarction by Heavy Physical Exertion -- Protection against Triggering by Regular Exertion (1993) · cites this paper as [24]

    The Changes in Lifestyle and Mortality from Coronary Heart Disease section (p. 5) reports lower coronary-heart-disease death risk among men who took up moderately vigorous activity. The paper studied coronary mortality in men, not the broader category of coronary events, which can include nonfatal events. (LLM, conf=0.85)

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  • People who exercise regularly have a lower baseline risk of myocardial infarction.

    “People who exercise regularly not only have a lower base-line risk of myocardial infarction, but as demonstrated by this study, they also have a lower relative risk that an infarction will be triggered by heavy physical exertion.”

    From Triggering of Acute Myocardial Infarction by Heavy Physical Exertion -- Protection against Triggering by Regular Exertion (1993) · cites this paper as [24]

    The Lifestyle Characteristics and Mortality from Coronary Heart Disease section (p. 4) reports a lower risk of coronary heart disease death among active male alumni than among sedentary alumni. The paper does not establish a lower baseline risk of having a myocardial infarction: its outcome here is death from coronary heart disease, not infarction incidence. (LLM, conf=0.86)

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Cites

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Research works printed but not linked: 27

  1. [1]1. Chave SPW, Morris JN, Moss S, Semmence AM. Vigorous exercise in leisure time and the death rate: a study of male civil servants. J Epidemiol Community Health 1978;32:239-43.
  2. [3]3. Salonen JT, Puska P, Tuomilehto J. Physical activity and risk of myocardial infarction, cerebral stroke and death: a longitudinal study in Eastern Finland. Am J Epidemiol 1982;115:526-37.
  3. [2]2. Paffenbarger RS Jr, Brand RJ, Sholtz RI, Jung DL. Energy expenditure, cigarette smoking, and blood pressure level as related to death from specific diseases. Am J Epidemiol 1978;108:12-8.
  4. [4]4. Paffenbarger RS Jr, Hyde RT, Wing AL, Hsieh C-c. Physical activity, allcause mortality, and longevity of college alumni. N Engl J Med 1986;314: 605-13.
  5. [5]5. Physical activity and longevity of college alumni. N Engl J Med 1986;315: 399-401.
  6. [7]7. Kaplan GA, Seeman TE, Cohen RD, Knudsen LP, Guralnik J. Mortality among the elderly in the Alameda County Study: behavioral and demographic risk factors. Am J Public Health 1987;77:307-12. [Erratum, Am J Public Health 1987;77:818.]
  7. [9]9. Karvonen MJ. Determinants of cardiovascular diseases in the elderly. Ann Med 1989;21:3-12.
  8. [8]8. Leon AS, Connett J, Jacobs DR Jr, Rauramaa R. Leisure-time physical activity levels and risk of coronary heart disease and death: the Multiple Risk Factor Intervention Trial. JAMA 1987;258:2388-95.
  9. [10]10. Benfante RJ, Reed DM, MacLean CJ, Yano K. Risk factors in middle age that predict early and late onset of coronary heart disease. J Clin Epidemiol 1989;42:95-104.
  10. [11]11. Slattery ML, Jacobs DR Jr, Nichaman MZ. Leisure time physical activity and coronary heart disease death: the US Railroad Study. Circulation 1989; 79:304-11.
  11. [12]12. Blair SN, Kohl HW III, Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW. Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA 1989;262:2395-401.
  12. [13]13. Morris JN, Clayton DG, Everitt MG, Semmence AM, Burgess EH. Exercise in leisure-time: coronary attack and death rates. Br Heart J 1990;63:32534.
  13. [15]15. Lindsted KD, Tonstad S, Kuzma JW. Self-report of physical activity and patterns of mortality in Seventh-Day Adventist men. J Clin Epidemiol 1991; 44:355-64.
  14. [14]14. Sytkowski PA, Kannel WB, D'Agostino RB. Changes in risk factors and the decline in mortality from cardiovascular disease: the Framingham Heart Study. N Engl J Med 1990;322:1635-41.
  15. [16]16. Arraiz GA, Wigle DT, Mao Y. Risk assessment of physical activity and physical fitness in the Canada Health Survey mortality follow-up study. J Clin Epidemiol 1992;45:419-28.
  16. [18]18. Wannamethee G, Shaper AG. Physical activity and stroke in British middle aged men. BMJ 1992;304:597-601.
  17. [17]17. Shaper AG, Wannamethee G. Physical activity and ischaemic heart disease in middle-aged British men. Br Heart J 1991;66:384-94.
  18. [19]19. Paffenbarger RS Jr, Notkin J, Krueger DE, et al. Chronic disease in former college students. II. Methods of study and observations on mortality from coronary heart disease. Am J Public Health Nations Health 1966;56:962-71.
  19. [21]21. Ainsworth BE, Haskell WL, Leon AS, et al. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 1993;25:71-80.
  20. [22]22. Lee I-M, Paffenbarger RS Jr, Hsieh C-c. Time trends in physical activity among college alumni, 1962-1988. Am J Epidemiol 1992;135:91525.
  21. [23]23. Frome EL. The analysis of rates using Poisson regression models. Biometrics 1983;39:665-74.
  22. [24]24. Mantel N. Chi-square tests with one degree of freedom: extensions of the Mantel-Haenszel procedure. J Am Stat Assoc 1963;58:690-700.
  23. [25]25. Hill AB. Principles of medical statistics. 9th ed. New York: Oxford University Press, 1971.
  24. [28]28. Manson JE, Tosteson H, Ridker PM, et al. The primary prevention of myocardial infarction. N Engl JMed 1992;326:1406-16.
  25. [30]30. Paffenbarger RS Jr, Hyde RT, Wing AL, Lee I-M, Kampert JB. Some interrelationships of physical activity, physiological fitness, health, and longevity. In: Bouchard C, Shephard RJ, Stephens T, McPherson BD, eds. Physical activity, fitness, and health. Champaign, Ill.: Human Kinetics Books (in press).
  26. [31]31. Morris JN. Physical activity, epidemiology, and the public's health: the role of exercise in the prevention of coronary heart disease. Med Sci Sports Exerc (in press). Yehliu Coral Rock Formations <!-- image --> Ira KirsCHENBaUM, M.D.
  27. [20]20. Caspersen CJ, Bloemberg BPM, Saris WHM, Merritt RK, Kromhout D. The prevalence of selected physical activities and their relation with coronary heart disease risk factors in elderly men: the Zutphen Study, 1985. Am JEpidemiol 1991;133:1078-92.

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Authors
Paffenbarger, R. S., Hyde, R. T., Wing, A. L., Lee, I.-M., Jung, D. L., & Kampert, J. B.
Affiliations
  • Stanford Medicine (US)
  • Harvard University (US)
ORCID
Lee, I-Min
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1993-02-25
Volume
328
Issue
8
Pages
538-545
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm199302253280804
OpenAlex
W2329993286
Cited by
1,972
References
3
Citations by year
2026: 5 · 2025: 16 · 2024: 21 · 2023: 17 · 2022: 38 · 2021: 39 · 2020: 35 · 2019: 50 · 2018: 50 · 2017: 43 · 2016: 55 · 2015: 50 · 2014: 61 · 2013: 89 · 2012: 83
FWCI
33.98
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Heart, Lung, and Blood Institute (R01HL034174)
  • National Cancer Institute (R01CA044854)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Health Professions › General Health Professions › Health and Lifestyle Studies
Keywords
physical activity, lifestyle modification, mortality, smoking cessation, hypertension, blood pressure, obesity, lean body mass, coronary artery disease, middle-aged and older men, longevity
MeSH terms
Aged, Aged, 80 and over, Blood Pressure, Body Weight, Coronary Disease, Humans, Hypertension, Life Style, Longevity, Male, Middle Aged, Mortality, Obesity, Surveys and Questionnaires, Smoking, Exercise

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