A Prospective Study of Walking as Compared with Vigorous Exercise in the Prevention of Coronary Heart Disease in Women
Open accessAbstract
BACKGROUND: The role of walking, as compared with vigorous exercise, in the prevention of coronary heart disease remains controversial, and data for women on this topic are sparse. METHODS: We prospectively examined the associations between the score for total physical activity, walking, and vigorous exercise and the incidence of coronary events among 72,488 female nurses who were 40 to 65 years old in 1986. Participants were free of diagnosed cardiovascular disease or cancer at the time of entry and completed serial detailed questionnaires about physical activity. During eight years of follow-up, we documented 645 incident coronary events (nonfatal myocardial infarction or death from coronary disease). RESULTS: There was a strong, graded inverse association between physical activity and the risk of coronary events. As compared with women in the lowest quintile group for energy expenditure (expressed as the metabolic-equivalent [MET] score), women in increasing quintile groups had age-adjusted relative risks of 0.77, 0.65, 0.54, and 0.46 for coronary events (P for trend <0.001). In multivariate analyses, the inverse gradient remained strong (relative risks, 0.88, 0.81, 0.74, and 0.66 for women in increasing quintile groups as compared with those in the lowest quintile group; P for trend=0.002). Walking was inversely associated with the risk of coronary events; women in the highest quintile group for walking, who walked the equivalent of three or more hours per week at a brisk pace, had a multivariate relative risk of 0.65 (95 percent confidence interval, 0.47 to 0.91) as compared with women who walked infrequently. Regular vigorous exercise (> or =6 MET) was associated with similar risk reductions (30 to 40 percent). Sedentary women who became active in middle adulthood or later had a lower risk of coronary events than their counterparts who remained sedentary. CONCLUSIONS: These prospective data indicate that brisk walking and vigorous exercise are associated with substantial and similar reductions in the incidence of coronary events among women.
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Moderate physical activity is associated with a markedly reduced risk of coronary events and cardiac arrest.
“Moderate physical activity is associated with a markedly reduced risk of coronary events 32,36 and cardiac arrest, 37 and therefore it might also protect against sudden death.”
From Triggering of Sudden Death from Cardiac Causes by Vigorous Exertion (2000) · cites this paper as [32]
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Gregg, E., Cauley, J., Stone, K., Thompson, T., Bauer, D., Cummings, S., & Ensrud, K. (2003) · Journal of the American Medical Association (JAMA) · doi:10.1001/jama.289.18.2379 · Cited by 405 · see citing works
“PHYSICALLY ACTIVE LIFESTYLES have been consistently related to reduced mortality and morbidity from cardiovascular disease (CVD), diabetes, physical disability, and certain cancers.(1-9) Although primarily observed in middle-aged male populations,(1-4) these benefits have also been demonstrated among older men and wom…”
BackgroundExercise, affect, and adherence: an integrated model and a case for self-paced exercise
Williams, D. M. (2008) · Journal of Sport and Exercise Psychology · doi:10.1123/jsep.30.5.471 · Cited by 404 · see citing works
“…& Lind, 2006; Mattsson, Larsson, & Rossner, 1997), selfpaced exercise may eventually lead to greater energy expenditure, and associated health benefits (Hu et al., 1999; I. M. Lee et al., 2001; I. M. Lee & Skerrett, 2001; Manson et al., 1999), due to increased adherence to the exercise program.”
Aerobic exercise for women during pregnancy.
Kramer, M., & McDonald, S. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000180.pub2 · Cited by 399 · see citing works
Promoting physical activity in rural communities: walking trail access, use, and effects.
Brownson, R., Housemann, R., Brown, D. R., Jackson-Thompson, J., King, A., Malone, B., & Sallis, J. (2000) · American Journal of Preventive Medicine · doi:10.1016/s0749-3797(99)00165-8 · Cited by 399 · see citing works
“30 minutes per occasion (the algorithm commonly used to determine compliance with current public health recommendations for moderate-intensity physical activity10); (3) access to walking trails (defined by the question: “Are there any walking trails or paths in your area, not including those in state parks or national…”
BackgroundThe Role of the Built Environment in Healthy Aging
Kerr, J., Rosenberg, D. E., & Frank, L. D. (2012) · Journal of Planning Literature · doi:10.1177/0885412211415283 · Cited by 393 · see citing works
“Other prospective studies have shown decreases in the risk of coronary heart disease in men (Hakim et al. 1999) and women (Manson et al. 1999).”
ResultKistler, K., Brunt, E., Clark, J., Diehl, A., Sallis, J., & Schwimmer, J. (2011) · American Journal of Gastroenterology · doi:10.1038/ajg.2010.488 · Cited by 392 · see citing works
Recombinant erythropoietin in urine
Booth, F. W., Gordon, S. E., Carlson, C. J., & Hamilton, M. T. (2000) · Nature · doi:10.1111/j.1600-0838.2000.100509-2.x · Cited by 373
Murphy, M., Nevill, A., Murtagh, E., & Holder, R. (2007) · Preventive Medicine · doi:10.1016/j.ypmed.2006.12.008 · Cited by 366 · see citing works
“%) reduction in CHD (Manson et al., 1999).”
A descriptive epidemiology of leisure-time physical activity in Brazil, 1996-1997.
Monteiro, C., Conde, W., Matsudo, S., Matsudo, V., Bonsenor, I. J. M., & Lotufo, P. (2003) · Revista Panamericana De Salud Publica-pan American Journal of Public Health · doi:10.1590/s1020-49892003000900005 · Cited by 365 · see citing works
Matthews, C., Jurj, A. L., Shu, X., Li, H.-L., Yang, G., Li, Q., Gao, Y.-T., & Zheng, W. (2007) · American Journal of Epidemiology · doi:10.1093/aje/kwm088 · Cited by 362 · see citing works
Intervening on risk factors for coronary heart disease: an application of the parametric g-formula.
Taubman, S., Robins, J., Mittleman, M., & Hernán, M. (2009) · International Journal of Epidemiology · doi:10.1093/ije/dyp192 · Cited by 359 · see citing works
Wearable-device-measured physical activity and future health risk
Strain, T., Wijndaele, K., Dempsey, P. C., Sharp, S. J., Pearce, M., Jeon, J., Lindsay, T., Wareham, N., & Brage, S. (2020) · Nature Medicine · doi:10.1038/s41591-020-1012-3 · Cited by 355 · see citing works
Impact of inactivity and exercise on the vasculature in humans
Thijssen, D., Maiorana, A., O'Driscoll, G., Cable, N. T., Hopman, M., & Green, D. (2009) · European Journal of Applied Physiology · doi:10.1007/s00421-009-1260-x · Cited by 344 · see citing works
“Physical inactivity is an independent risk factor for atherosclerosis, cardiovascular diseases and diabetes (Blair et al. 1995; LaMonte et al. 2005; Manson et al. 1999) and low cardiopulmonary fitness is a strong independent predictor of all-cause mortality (Wei et al.”
BackgroundChristakis, N., & Iwashyna, T. (2003) · Social Science & Medicine (1967) · doi:10.1016/s0277-9536(02)00370-2 · Cited by 340 · see citing works
“Indeed, the end-of-life care a woman's husband receives has an impact on the woman similar in magnitude to that of various other modifiable diet and exercise risk factors (Stampfer, Hu, Manson, Rimm, & Willett, 2000; Manson et al., 1999; Grodstein et al., 1997 ).”
BackgroundDestinations that matter: associations with walking for transport.
Cerin, E., Leslie, E., du Toit, L., Owen, N., & Frank, L. (2007) · Health and Place · doi:10.1016/j.healthplace.2006.11.002 · Cited by 339 · see citing works
“Regular walking has been associated with health benefits (Manson et al., 1999).”
BackgroundHu, G., Tuomilehto, J., Silventoinen, K., Barengo, N., & Jousilahti, P. (2004) · European Heart Journal · doi:10.1016/j.ehj.2004.10.020 · Cited by 338 · see citing works
“Walking also reduced the incidence of CHD among men and women.(5,8) However, occupational physical activity has been largely ignored in these surveys.”
BackgroundQuantifying energy expenditure and physical activity in the context of dose response
LaMonte, M. J., & Ainsworth, B. E. (2001) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-200106001-00006 · Cited by 298 · see citing works
Caloric imbalance and public health policy.
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Exercise Capacity and Mortality in Older Men: A 20-Year Follow-Up Study
Kokkinos, P., Myers, J., Faselis, C., Panagiotakos, D. B., Doumas, M., Pittaras, A., Manolis, A., Kokkinos;, J. P., Karasik, P., Greenberg, M., et al. (2010) · Circulation · doi:10.1161/circulationaha.110.938852 · Cited by 328 · see citing works
“In addition to age ( 65 years), we excluded the following subjects: (1) those with a history of an implanted pacemaker; (2) those who developed left bundle branch block during the test; (3) those with heart failure classified as New York Heart Association class II or higher and those unable to complete the test second…”
Physical activity decreases cardiovascular disease risk in women
Oguma, Y., & Shinoda-Tagawa, T. (2004) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2004.02.007 · Cited by 323 · see citing works
Tudor-Locke, C., Bell, R. C., Myers, A. M., Harris, S. B., Ecclestone, N. A., Lauzon, N., & Rodger, N. W. (2004) · International Journal of Obesity · doi:10.1038/sj.ijo.0802485 · Cited by 321 · see citing works
Association of the metabolic syndrome with both vigorous and moderate physical activity.
Rennie, K., McCarthy, N., Yazdgerdi, S., Marmot, M., & Brunner, E. (2003) · International Journal of Epidemiology · doi:10.1093/ije/dyg179 · Cited by 320 · see citing works
Physical Activity, Function, and Longevity Among the Very Old
Stessman, J. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.248 · Cited by 316 · see citing works
Adiposity as Compared with Physical Activity in Predicting Mortality among Women
Hu, F. B., Willett, W. C., Li, T., Stampfer, M. J., Colditz, G. A., & Manson, J. E. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa042135 · Cited by 798 · see citing works
Self-citationActive Commuting and Cardiovascular Disease Risk
Gordon‐Larsen, P., Boone‐Heinonen, J., Sidney, S., Sternfeld, B., Jacobs, D. R., & Lewis, C. E. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.163 · Cited by 269 · see citing works
“5)d 10 (5-20)d 5 (1-10)d Minutes to work, median (IQR)c 20.”
Is it Safe to Walk?1 Neighborhood Safety and Security Considerations and Their Effects on Walking
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Kromhout, D., Menotti, A., Kesteloot, H., & Sans, S. (2002) · Circulation · doi:10.1161/hc0702.103728 · Cited by 297 · see citing works
Influence of forest therapy on cardiovascular relaxation in young adults
Lee, J., Tsunetsugu, Y., Takayama, N., Park, B.-J., Li, Q., Song, C., Komatsu, M., Ikei, H., Tyrväinen, L., Kagawa, T., et al. (2014) · Evidence-Based Complementary and Alternative Medicine · doi:10.1155/2014/834360 · Cited by 294 · see citing works
“Moreover, walking, the most common form of physical activity, is becoming increasingly important in the prevention of cardiovascular diseases [26– 28].”
BackgroundFrederiksen, H., Hjelmborg, J., Mortensen, J., McGue, M., Vaupel, J., & Christensen, K. (2006) · Annals of Epidemiology · doi:10.1016/j.annepidem.2005.10.006 · Cited by 294 · see citing works
“, more active individuals have a stronger grip) (2, 36, 37), which in itself predicts better survival (38, 39), less disability (40), and less morbidity (41, 42).”
BackgroundSimonsick, E., Guralnik, J., Volpato, S., Balfour, J., & Fried, L. P. (2005) · Journal of The American Geriatrics Society · doi:10.1111/j.1532-5415.2005.53103.x · Cited by 290 · see citing works
Physical Activity, Health Benefits, and Mortality Risk
Kokkinos, P. F. (2012) · ISRN Cardiology · doi:10.5402/2012/718789 · Cited by 294 · see citing works
“The findings of recent large cohort studies in women, including the Women’s Health Study, the Lipid Research Clinics Research Prevalence Study, and the Women Take Heart Project also support an inverse and graded association between increased physical activity and mortality in women [7, 8, 13–15].”
ResultSchutz, Y., Weinsier, R., & Hunter, G. R. (2001) · Obesity Research · doi:10.1038/oby.2001.48 · Cited by 282 · see citing works
Exercise and gene expression: physiological regulation of the human genome through physical activity
Booth, F. W., Chakravarthy, M. V., & Spangenburg, E. E. (2002) · The Journal of Physiology · doi:10.1113/jphysiol.2002.019265 · Cited by 277 · see citing works
Trends in the incidence of coronary heart disease and changes in diet and lifestyle in women.
Hu, F., Stampfer, M., Manson, J., Grodstein, F., Colditz, G. A., Speizer, F., & Willett, W. (2000) · New England Journal of Medicine · doi:10.1097/00006254-200101000-00019 · Cited by 271
Self-citationMeasurement of daily walking distance-questionnaire versus pedometer
BASSETT, D. R. (2000) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-200005000-00021 · Cited by 260 · see citing works
- Authors
- Manson, J. E., Hu, F. B., Rich-Edwards, J. W., Colditz, G. A., Stampfer, M. J., Willett, W. C., Speizer, F. E., & Hennekens, C. H.
- Affiliations
- Brigham and Women's Hospital (US)
- Harvard University (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1999-08-26
- Volume
- 341
- Issue
- 9
- Pages
- 650-658
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2330716957
- Cited by
- 1,005
- References
- 0
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 14 · 2023: 21 · 2022: 16 · 2021: 20 · 2020: 24 · 2019: 25 · 2018: 31 · 2017: 33 · 2016: 28 · 2015: 32 · 2014: 41 · 2013: 40 · 2012: 48
- FWCI
- 26.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL34594, R01HL034594)
- National Cancer Institute (CA-40356)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- walking, high-intensity exercise, coronary heart disease prevention, women, physical activity, energy expenditure, myocardial infarction, coronary events, sedentary lifestyle, midlife
- MeSH terms
- Adult, Aged, Coronary Disease, Energy Metabolism, Female, Humans, Middle Aged, Prospective Studies, Risk, Exercise, Incidence, Multivariate Analysis, Walking
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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