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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 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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BackgroundSelf-citationDietary fibre, lente carbohydrates and the insulin-resistant diseases
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“In addition, we have observed significant associations between this measure of physical activity and other chronic diseases, including diabetes, stroke, and coronary heart disease.(29-31) Given that the correlation between the questionnaire and four 7-day activity diaries was 0.”
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Self-citationPhysical activity and mortality: a prospective study among women
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“Walking is associated with many positive health outcomes, including reductions in cardiovascular and cancerrelated mortality risk (36, 37 ).”
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“In the NHS, physical activity was significantly associated with decreased risk of breast (28) and colorectal (29) cancers, coronary heart disease (30), and type 2 diabetes (31), while sedentary behaviors increased risk of type 2 diabetes and obesity (21).”
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“The frequency of activities requiring light or vigorous effort, or the question ‘‘For how many hours per week, on average, do you engage in activity strenuous enough to build up a sweat?’’ are examples of single-item questions [14, 16].”
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“It is possible that the CIAR volunteers (Welk et aI., 2000) may have been more active than typically sedentary individuals, such as those in our study. Our results suggest that the 10,00O-Step target may be challenging for some but too high for other sedentary women. The mean values for nonwalking days for women (know…”
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Working conditions and health behaviours among employed women and men: the Helsinki Health Study
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Predictors of physical activity in community-dwelling elderly white women
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Hu, G., Tuomilehto, J., Borodulin, K., & Jousilahti, P. (2007) · European Heart Journal · doi:10.1093/eurheartj/ehl475 · Cited by 138
“Since walking is highly accessible, readily adopted, and rarely associated with exercise-related injury, this activity is more available for elder subjects.(6,7,9,10) There are several strengths and limitations in our study.”
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“Yes 218 (51, 22) 3.2 (1.8–5.8) No 86 (7, 5 ) 1.4 (0.4–4.4)”
InfluentialCan Sedentary Adults Accurately Recall the Intensity of Their Physical Activity?
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“It has been shown that individuals who exercise more than the minimum recommendations offered by the CDC have a 30% reduced risk of coronary artery disease, stroke, and T2D (Hu et al., 1999; 2000; Manson et al., 1999).”
BackgroundPhysical activity and the prevention of cardiovascular disease
Bassuk, S. S., & Manson, J. E. (2003) · Current Atherosclerosis Reports · doi:10.1007/s11883-003-0053-7 · Cited by 136
“For example, walking is associated with a reduced incidence of CVD even after adjustment for changes in BMI over time [ 8 ], and clinical trials show that dieters who exercise develop a more favorable lipid profile than dieters who do not exercise, even when weight loss is equivalent between the two groups [31].”
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“Others (Manson et al., 1999; Brown, 1999) found that regular walking at a brisk pace reduced initial coronary events by one third in women who were free of cardiovascular disease.”
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“Exercise has long been recognized as an effective means to improve insulin sensitivity (12, 36) and prevent CVD; in fact, one-third of CVD-related deaths are attributable to physical inactivity (35).”
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“Some studies suggest that subjects could receive greater cardioprotective benefit from sport activities than from a high level of routine physical activity (15), but an important all-day activity level (61) or brisk walking (37) have also been shown to reduce cardiovascular risks.”
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Effects of Walking in Bamboo Forest and City Environments on Brainwave Activity in Young Adults
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Coronary atherogenic risk factors in women
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“Exercise in the form of walking between 2 and 3 miles per hour (mph) leads to a 25% reduction in coronary risk, and walking more than 3 mph, 36% [100] .”
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South American Guidelines for Cardiovascular Disease Prevention and Rehabilitation
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Metadata
- 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 › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Physiology (medical) › 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
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