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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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BackgroundCardiovascular benefits of exercise
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“43 Walking was associated with cardio-protection in the Nurses’ Health Study, 44 and moderate activity in post-menopausal women was similarly associated with a reduced risk of coronary disease in the Iowa Study.”
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“factors [5–13], joint flexibility [14] and quality of”
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Lee, I. (2008) · doi:10.1093/acprof:oso/9780195183009.001.0001 · Cited by 110
“With the 1995 CDC/ACSM recommendation focused on moderate-intensity physical activity, the Nurses’ Health Study became interested in examining whether walking, a common moderate-intensity activity undertaken by Americans, is associated with lower rates of CHD (Manson et al., 1999).”
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Colditz, G. A., Feskanich, D., Chen, W. Y., Hunter, D. J., & Willett, W. C. (2003) · British Journal of Cancer · doi:10.1038/sj.bjc.6601175 · Cited by 94
“…parallel studies among slightly older women we have shown that greater activity predicts reduced risk of diabetes (Hu et al, 1999), heart disease (Manson et al, 1999), stroke (Hu et al, 2000), colon cancer (Martinez et al, 1999), osteoporotic fractures (Feskanich et al, 2002), and reduced weight…”
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Boone‐Heinonen, J., Evenson, K. R., Taber, D. R., & Gordon‐Larsen, P. (2009) · Obesity Reviews · doi:10.1111/j.1467-789x.2008.00533.x · Cited by 96
“Walking is the most common PA among adults (8,9) and an accessible form of MPA particularly relevant for the obese, who are less likely to perform vigorous PA (VPA) (10).”
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JOSHIPURA, K. J., Pitiphat, W., & Douglass, C. W. (2002) · Journal of Public Health Dentistry · doi:10.1111/j.1752-7325.2002.tb03431.x · Cited by 95
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BackgroundInfluentialHealthy revolutions: promoting cycling among women
Garrard, J. (2003) · doi:10.1071/he03213 · Cited by 96
Effects of exercise training on 5 inflammatory markers associated with cardiovascular risk
Hammett, C. J. K., Prapavessis, H., Baldi, J. C., Varo, N., Schoenbeck, U., Ameratunga, R., French, J. K., White, H. D., & Stewart, R. A. H. (2006) · American Heart Journal · doi:10.1016/j.ahj.2005.08.009 · Cited by 95
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“This confirms previous studies that have shown health benefits with physical activities of low intensity (12,14) and is of interest for health promotion in older persons who do not enjoy high-intensity exercise or are unable to practice it.”
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From Exercise to Physical Activity
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Reducing Cardiovascular Risk Factors in Postmenopausal Women through a Lifestyle Change Intervention
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Relationship between regular walking, physical activity, and health-related quality of life.
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“The optimal intensity of activity has been discussed, but several studies indicate that even moderate activity is associated with reduced risk of both mortality and morbidity (Blair, Wells, Weathers, Paffenbarger, 1994; Lee & Paffenbarger, 2000; Manson et al., 1999; Rennie et al., 2003).”
BackgroundPhysical activity: the evidence of benefit in the prevention of coronary heart disease.
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“After a follow-up period of 8 years, researchers examined associations between total physical activity, walking and vigorous exercise and the incidence of coronary events.(14) There was a strong, graded inverse association between physical activity and CHD risk.”
BackgroundExercise in Aging: Its Important Role in Mortality, Obesity and Insulin Resistance
Ryan, A. S. (2010) · Aging Health · doi:10.2217/ahe.10.46 · Cited by 78
“Furthermore, brisk walking and vigorous exercise are associated with considerable and similar risk reductions in the incidence of coronary events among women [25].”
BackgroundComparison of the lipid profile and lipoprotein(a) between sedentary and highly trained subjects
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“In a recent study (13), walking and vigorous exercise were associated with substantial and similar reductions in the incidence of coronary events among women.”
BackgroundCardiovascular Disease and Dyslipidemia in Women
Welty, F. K. (2001) · Archives of Internal Medicine · doi:10.1001/archinte.161.4.514 · Cited by 81
“Even brisk walking and other moderateintensity activities will substantially reduce CHD risk.(44) Exercise and dietarymodifications resulting inweight loss have beneficial effects on triglyceride levels even in persons with diabetes,(45) and HDL cholesterol levels have shown a dose-response relationship in female runn…”
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“exercise,(74) weight control(73) and blood pressure control.(74) Even if most of these recommendations have never been formally tested in RA patients,(75) one might agree that smoking cessation, a healthy diet or exercise will benefit the patients without adding any risk.”
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“The number of women (and cases) in the low and moderate/high CRF groups were 91 (6) and 317 (22) in controlled HTN; were 109 (9) and 590 (25) in stage 1 HTN; and were 35 (4) and 126 (5) in stage 2 HTN.”
BackgroundTobacco harm reduction strategies: The case for physical activity
deRuiter, W. K., & Faulkner, G. (2006) · Nicotine & Tobacco Research · doi:10.1080/14622200500494823 · Cited by 78
Aerobic Exercise Increases Peripheral and Hepatic Insulin Sensitivity in Sedentary Adolescents
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Arterial intima-media thickness: site-specific associations with HRT and habitual exercise
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“Indeed, habitual exercise has been associated with a reduced risk of CVD (10, 36, 40, 47).”
Risk factors for heart failure
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“This increased risk could be partially explained by the decreased risk of hypertension, obesity, diabetes mellitus, and coronary artery disease associated with higher level of physical activity [104–107].”
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The Association Between Physical Activity and the Risk of Incident Psoriasis
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“As previously described, women who reported greater amounts of physical activity were younger, had a lower BMI, consumed more alcohol, and were less likely to be current smokers.(10,17) The total physical activity score in MET-hours per week, which included vigorous activity and walking, was inversely related to the r…”
BackgroundAccuracy of physical activity monitors in pregnant women.
Connolly, C., Coe, D., Kendrick, J., Bassett, D., & Thompson, D. L. (2010) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3182058883 · Cited by 79
Maintaining regular physical activity in women: evidence to date.
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Healthy Lifestyle and Decreasing Risk of Heart Failure in Women
Agha, G., Loucks, E. B., Tinker, L. F., Waring, M. E., Michaud, D. S., Foraker, R. E., Li, W., Martin, L. W., Greenland, P., Manson, J. E., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.07.981 · Cited by 92
Self-citationThe Influence of Ethnicity and Length of Time since Immigration on Physical Activity
Dawson, A. J., Sundquist, J., & Johansson, S. (2005) · Ethnicity and Health · doi:10.1080/13557850500159965 · Cited by 67
Albright, C., & Thompson, D. L. (2006) · Journal of Women's Health · doi:10.1089/jwh.2006.15.271 · Cited by 75
“17 18–20 Manson et al. 19 found that higher walking volumes were associated with significant reductions in coronary events in women.”
Increasing Lifestyle Physical Activity in Patients with Depression or Other Serious Mental Illness
Richardson, C. R., Avripas, S. A., NEAL, D. L., & Marcus, S. M. (2005) · Journal of Psychiatric Practice · doi:10.1097/00131746-200511000-00004 · Cited by 63
Diet and lifestyle influences on risk of coronary heart disease
Hu, F. B. (2009) · Current Atherosclerosis Reports · doi:10.1007/s11883-009-0040-8 · Cited by 71
“For example, the Nurses’ Health Study showed a strong inverse association between total physical activity and CHD risk in women, independent of body mass index and other coronary risk factors [ 51 ].”
MethodSelf-citationPatterns of walking for transport and exercise: a novel application of time use data
Tudor-Locke, C., Bittman, M., Merom, D., & Bauman, A. (2005) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/1479-5868-2-5 · Cited by 74
“Regular walking for exercise has been associated with numerous health benefits including reduced risk of coronary heart disease[4,5] and diabetes[6], weight loss/weight maintenance[7], and lowered blood pressure[8].”
The Relationship between Daily Steps and Body Composition in Postmenopausal Women
Krumm, E. M., Dessieux, O., Andrews, P., & Thompson, D. L. (2006) · Journal of Women's Health · doi:10.1089/jwh.2006.15.202 · Cited by 73
Leisure time physical activity and early atherosclerosis: the Los Angeles Atherosclerosis Study.
Nordstrom, C., Dwyer, K., Merz, C., Shircore, A., & Dwyer, J. (2003) · American Journal of Medicine · doi:10.1016/s0002-9343(03)00242-0 · Cited by 73
Pitta, F. D. O., Troosters, T., Probst, V. S., Lucas, S. J., Decramer, M., & Gosselink, R. (2006) · Jornal Brasileiro de Pneumologia · doi:10.1590/s1806-37132006001100008 · Cited by 51
“2006;32(4):301-8 the best predictor of mortality in COPD patients so far.”
BackgroundInfluentialCurrent Understanding of the Genetic Basis for Physical Activity
Lightfoot, J. T. (2011) · Journal of Nutrition · doi:10.3945/jn.110.127290 · Cited by 64
“With this amount of regular moderate activity, there are decreases of all-cause mortality rates (2), a decrease in rates of cardiovascular disease (3), a decrease in diabetes (4), a decrease in several forms of cancer (5), a decrease in risk of stroke (6), an increase in mitochondrial function (7), an association with…”
BackgroundMetabolic and anti‐inflammatory benefits of eccentric endurance exercise – a pilot study
Drexel, H., Saely, C., Langer, P., Loruenser, G., Marte, T., Risch, L., Hoefle, G., & Aczél, S. (2008) · European Journal of Clinical Investigation · doi:10.1111/j.1365-2362.2008.01937.x · Cited by 72
Deutsche Leitlinie zur Rehabilitation von Patienten mit Herz-Kreislauferkrankungen (DLL-KardReha)
Bjarnason‐Wehrens, B., Held, K., Hoberg, E., Karoff, M., & Rauch, B. (2007) · Clinical Research in Cardiology Supplements · doi:10.1007/s11789-007-0001-0 · Cited by 64
An evolving perspective on physical activity counselling by medical professionals
McPhail, S., & Schippers, M. (2012) · BMC Family Practice · doi:10.1186/1471-2296-13-31 · Cited by 90
“There are a range of benefits associated with increasing physical activity [1,4-7,18-20].”
BackgroundInfluentialObesity in women of childbearing age: risks, prevention, and treatment
Cogswell, M. E., Perry, G. S., Schieve, L. A., & Dietz, W. H. (2001) · Primary Care Update for OB/GYNS · doi:10.1016/s1068-607x(00)00087-1 · Cited by 67
Physical Activity and Cardiovascular Disease
Wannamethee, S. G., & Shaper, A. G. (2002) · Seminars in Vascular Medicine · doi:10.1055/s-2002-35400 · Cited by 70
Schuler, G. (2005) · Zeitschrift für Kardiologie · doi:10.1007/s00392-005-1303-1 · Cited by 70
“In den letzten Jahren wurden noch mehrere Studien an großen Patientenkollektiven publiziert, die ohne Ausnahme eine negative, lineare Korrelation zwischen körperlicher Aktivität oder Leistungsfähigkeit auf der einen und kardiovaskulärer Mortalität auf der anderen Seite zeigten [4, 10].”
Bassett, D. R., Mahar, M. T., Rowe, D. A., & Morrow, J. R. (2008) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31817c699c · Cited by 65
Age-Specific Exercise Capacity Threshold for Mortality Risk Assessment in Male Veterans
Kokkinos, P. F., Faselis, C. J., MYERS, J. N., Sui, X., Zhang, J., & Blair, S. N. (2014) · Circulation · doi:10.1161/circulationaha.114.009666 · Cited by 76
Leitlinie körperliche Aktivität zur Sekundärprävention und Therapie kardiovaskulärer Erkrankungen
Bjarnason‐Wehrens, B., Schulz, O., Gielen, S., Halle, M., Dürsch, M., Hambrecht, R., Lowis, H., Kindermann, W., Schulze, R., & Rauch, B. (2009) · Clinical Research in Cardiology Supplements · doi:10.1007/s11789-009-0078-8 · Cited by 58
Keller, C. S., & Treviño, R. P. (2001) · Research in Nursing & Health · doi:10.1002/nur.1039 · Cited by 54
Physical activity of moderate intensity in leisure time and the risk of all cause mortality
Bucksch, J. (2005) · British Journal of Sports Medicine · doi:10.1136/bjsm.2004.015768 · Cited by 67
Dyck, D. V., Veitch, J., Bourdeaudhuij, I. D., Thornton, L. E., & Ball, K. (2013) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/1479-5868-10-108 · Cited by 68
“The current study focused on walking, because this is the most common and accessible type of physical activity in adults having documented health benefits [20] and because the impact of the neighbourhood environment is supposed to be strongest for walking [4].”
BackgroundPhysical activity and mortality in men and women with diagnosed cardiovascular disease
Hamer, M., & Stamatakis, E. (2009) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/hjr.0b013e32831f1b77 · Cited by 67
Rebecchi, A., Buffoli, M., Dettori, M., Appolloni, L., Azara, A., Castiglia, P., D'Alessandro, D., & Capolongo, S. (2019) · Sustainability · doi:10.3390/su11102778 · Cited by 66
Health, medical risk factors, and bicycle use in everyday life in the over-50 population.
Huy, C., Becker, S., Gomolinsky, U., Klein, T., & Thiel, A. (2008) · Journal of Aging and Physical Activity · doi:10.1123/japa.16.4.454 · Cited by 66
“going for walks on a regular basis is enough to have a positive impact on health (Hakim et al., 1999; Manson et al., 1999).”
BackgroundSartorelli, D. S., Sciarra, E. C., Franco, L., & Cardoso, M. (2005) · Public Health Nutrition · doi:10.1079/phn2005737 · Cited by 66
“Mean walking time for the intervention group was 25 min day 2 1 , which is enough to reduce the risk to develop cardiovascular diseases 16 .”
Clinical Characteristics of Unexpected Death Among Young Enlisted Military Personnel
Amital, H., Glikson, M., Burstein, M., Afek, A. B., Sinnreich, R., Weiss, Y., & Israeli, V. (2004) · CHEST Journal · doi:10.1378/chest.126.2.528 · Cited by 57
Harch, S., Reeve, D. M., & Reeve, C. (2008) · Handbook of Diabetes · doi:10.1002/9780470760277.ch7 · Cited by 65
Colditz, G. A., Samplin‐Salgado, M., Ryan, C. T., Dart, H., Fisher, L. B., Tokuda, A., & Rockhill, B. (2002) · Cancer Causes & Control · doi:10.1023/a:1015040702565 · Cited by 58
Self-citationExercise as an adjunct to nicotine gum in treating tobacco dependence among women
Kinnunen, T., Leeman, R. F., Korhonen, T., Quiles, Z. N., Terwal, D. M., Garvey, A. J., & Hartley, H. L. (2008) · Nicotine & Tobacco Research · doi:10.1080/14622200801979043 · Cited by 72
“…intensity exercise may promote better adherence (Blair & Connelly, 1996), has a higher feasibility of adoption (as even walking can be considered as exercise) (Manson et al., 1999), requires less need for supervision and has lower risk of injury (Asikainen, Kukkonen-Harjula, & Miilunpalo, 2004).”
BackgroundLiu, D., Wang, R., Grekousis, G., Liu, Y., & Lü, Y. (2023) · Computers Environment and Urban Systems · doi:10.1016/j.compenvurbsys.2023.102027 · Cited by 63
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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