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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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“In the present study, we focused only on walking because walking is the most typical human physical activity and has been reported to be a key activity to achieve health benefits [2,3,4,5].”
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Exercise as the Cornerstone of Cardiovascular Prevention
Pérez, A. B. (2008) · Revista Española de Cardiología (English Edition) · doi:10.1016/s1885-5857(08)60166-8 · Cited by 52
“Although moderate levels of physical activity have been shown to be beneficial to health, higher levels appear to provide increased protection.(26) Progressive increases in activity have been shown to reduce total mortality.”
BackgroundThe Effects of a Brief, Water-Based Exercise Intervention on Cognitive Function in Older Adults
Fedor, A., Garcia, S., & Gunstad, J. (2015) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acv001 · Cited by 44
Predel, H., Mainka, W., Schillings, W. J., Knigge, H., Montiel, J., von Fallois, J., Agrawal, R., Schramm, T. K., Graf, C., Giannetti, B., et al. (2001) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1001257 · Cited by 36
Iijima, K., Iimuro, S., Shinozaki, T., Ohashi, Y., Sakurai, T., Umegaki, H., Araki, A., Ouchi, Y., Ito, H., & the Japanese Elderly Diabetes Intervention Trial Investigator Group (2012) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/j.1447-0594.2011.00815.x · Cited by 42
Chomistek, A. K., Cook, N. R., Rimm, E. B., Ridker, P. M., Buring, J. E., & Lee, I. ‐. (2018) · Journal of the American Heart Association · doi:10.1161/jaha.117.008234 · Cited by 36
Reduced walking speed and distance as harbingers of the approaching grim reaper.
Franklin, B., Brinks, J., Sacks, R., Trivax, J., & Friedman, H. (2015) · American Journal of Cardiology · doi:10.1016/j.amjcard.2015.04.024 · Cited by 35
Resting VO2, maximal VO2 and metabolic equivalents in free-living healthy elderly women
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Walking Activity, Body Composition and Blood Pressure in Adults with Intellectual Disabilities
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Reducing global risk for cardiovascular disease: Using lifestyle changes and pharmacotherapy
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Self‐Reported Physical Activity Validated by Pedometer: A Pilot Study
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Olympic Textbook of Science in Sport
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“For example, the multivariable adjusted risk of CVD was, on average, 14% and 6% lower (P < 0.05 each) for each 5 MET-hour increment of energy expenditure in walking and vigorous activity, respectively (Manson et al. 1999).”
BackgroundInfluentialLiu, D.-W., Lu, Y., & Yang, L.-C. (2024) · Travel Behaviour & Society · doi:10.1016/j.tbs.2024.100814 · Cited by 33
“…an individual halts the trends of sedentary lifestyle and private automobile dependence, manifesting considerable health (Aune et al., 2016; Boyle et al., 2012; Manson et al., 1999; Smith et al., 2007; Wu et al., 2013) and environmental benefits (Maioli et al., 2019; Pellicer-Chenoll et al., 2021).”
BackgroundDempsey, P. C., Musicha, C., Rowlands, A. V., Davies, M. J., Khunti, K., Razieh, C., Timmins, I. R., Zaccardi, F., Codd, V., Nelson, C. P., et al. (2022) · Communications Biology · doi:10.1038/s42003-022-03323-x · Cited by 47
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Walking and Walkability: Is Wayfinding a Missing Link? Implications for Public Health Practice
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Development and initial validation of the Brunel lifestyle physical activity questionnaire
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Walking: the best medicine for diabetes?
Hu, F., & Manson, J. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.12.1397 · Cited by 33
Self-citationExercise Behavior among Female Occupational Health Nurses
Piazza, J., Conrad, K., & Wilbur, J. (2001) · AAOHN Journal · doi:10.1177/216507990104900204 · Cited by 33
Winett, R. A., & Carpinelli, R. N. (2000) · Annals of Behavioral Medicine · doi:10.1007/bf02895119 · Cited by 29
“Thus, to derive their volume indicator, Manson et al. ( 30 ) combined the MET level, which is a measure of intensity relative to resting oxygen consumption, with duration.”
BackgroundMethodInfluentialGao, H., Gao, H.-X., Sun, F., & Zhang, L. (2016) · Menopause · doi:10.1097/gme.0000000000000627 · Cited by 32
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Physical Activity, Genes for Physical Fitness, and Risk of Coronary Heart Disease
Chomistek, A. K., Chasman, D. I., Cook, N. R., Rimm, E. B., & Lee, I.-M. M. (2013) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3182784e9f · Cited by 33
“Active individuals have approximately 30% lower risk of coronary heart disease (CHD) than inactive individuals(12, 19, 27).”
BackgroundHamer, M., & Steptoe, A. (2008) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/j.1600-0838.2007.00747.x · Cited by 32
“In large scale prospective epidemiological studies, walking has been inversely associated with risk of coronary events in men and women (Manson et al., 1999; Tanasescu et al., 2002), although more vigorous physical activity tends to be associated with greater risk reduction (Tanasescu et al., 2002).”
BackgroundAcute effects of walking on inflammatory and cardiovascular risk in sedentary post-menopausal women
Davis, J., Murphy, M., Trinick, T., Duly, E., Nevill, A., & Davison, G. (2008) · Jurnal sport science · doi:10.1080/02640410701552906 · Cited by 32
“Moderate-intensity physical activity, however, has been shown to be cardioprotective as it lowers inflammatory CRP, even when the duration of exercise is relatively low (Manson et al., 1999).”
BackgroundWomen and cardiovascular disease.
McFetridge, J. F., Hanley, J., Allen, D. M., Cheek, A., Kelly, A., & Cheek, D. (2000) · The Nursing Clinics of North America · doi:10.1016/s0029-6465(22)02641-x · Cited by 32
Impact of walking on life expectancy and lifetime medical expenditure: the Ohsaki Cohort Study
Nagai, M., Kuriyama, S., Kakizaki, M., Ohmori‐Matsuda, K., Sone, T., Hozawa, A., Kawado, M., Hashimoto, S., & Tsuji, I. (2011) · BMJ Open · doi:10.1136/bmjopen-2011-000240 · Cited by 41
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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