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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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“Walking has been shown in many studies to have inverse correlation with body mass index (a measure of obesity) and to generally improve health [9, 13].”
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“In Australia and elsewhere, a number of research papers have established the relationships between environment and behaviours (link A—see figure 1) or behaviours and health outcomes (link B—see figure 1).(19) 20 It logically follows that the environment is related to health out-”
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“[4–7] Findings from this longitudinal, observational study demonstrated that a woman was able to decrease the incidence of a coronary event by more than 80% through not smoking, maintaining normal body weight (body mass index or BMI < 25 kg/m2), consuming a healthy diet, participating in moderate to vigorous exercise…”
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Akhtar, M., Hoellwarth, J., Tetsworth, K., Oomatia, A., & Muderis, M. A. (2022) · Arthroplasty Today · doi:10.1016/j.artd.2022.04.008 · Cited by 19
Association Between Walking Pace and Stroke Incidence
Hayes, S., Forbes, J. F., Celis-Morales, C. A., Anderson, J. J., Ferguson, L. D., Gill, J. M. R., Gray, S. R., Hastie, C. E., Iliodromoti, S., Lyall, D. M., et al. (2020) · Stroke · doi:10.1161/strokeaha.119.028064 · Cited by 23
[Physical exercise and sport activities in patients with and without coronary heart disease].
Francavilla, G., Abrignani, M., Braschi, A., Sciacca, R., Francavilla, V. C., Caracciolo, M. M., Renda, N., Riccio, C., Scaglione, A., & Braschi, G. (2016) · Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace · doi:10.4081/monaldi.2007.457 · Cited by 19
“Sin dai primi lavori di Morris sui British Civil Servants [1, 2] e di Paffenbarger (Harvard Alumni Health Study) [3-6], numerosi studi prospettici a lungo termine hanno valutato il rischio relativo di morte totale e per cause specifiche, in particolare cardiovascolare, associate alla sedentarietà [7-30].”
BackgroundInfluentialPractical issues in genome‐wide association studies for physical activity
Kim, J., Oh, S., Min, H., Kim, Y., & Park, T. (2011) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2011.06102.x · Cited by 19
Lipid profile in men and women with different levels of sports participation and physical activity
Scheers, T., Philippaerts, R., Langendonck, L. V., Duquet, W., Duvigneaud, N., Matton, L., Thomis, M., Wijndaele, K., & Lefevre, J. (2008) · Public Health Nutrition · doi:10.1017/s1368980007001425 · Cited by 19
“even walking has beneficial effects on the lipid profile and lowers the risk of coronary events, especially in older participants((37,43,44)).”
BackgroundCriteria for the Evaluation of Large Cohort Studies: An Application to the Nurses’ Health Study
Colditz, G. A., & Winn, D. M. (2008) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djn193 · Cited by 18
Self-citationAssociation between walking distance and percentiles of body mass index in older and younger men
Williams, P. (2008) · British Journal of Sports Medicine · doi:10.1136/bjsm.2007.041822 · Cited by 19
“As with other large epidemiological prospective studies (for example, the Nurses’ Health Study [36], Women’s Health Initiative Observational Study [37]), our results necessarily rely on self-reported walking distance and weight measures, pedometers and direct clinical measurements being impractical in large epidemiolo…”
ResultFransson, E., de Faire, U., Ahlbom, A., Reuterwall, C., Hallqvist, J., & Alfredsson, L. (2006) · BMC Public Health · doi:10.1186/1471-2458-6-296 · Cited by 19
“Background Both excess body weight and lack of leisure-time physical activity have been identified as important risk factors for cardiovascular mortality, as well as coronary heart disease [1-13].”
BackgroundRelationships Among Health Behaviors, Health, and Mortality
Himes, C. L. (2011) · International handbooks of population · doi:10.1007/978-90-481-9996-9_14 · Cited by 23
Phase angle and metabolic equivalents as predictors of frailty transitions in advanced age.
Zanforlini, B. M., Trevisan, C., Bertocco, A., Piovesan, F., Dianin, M., Mazzochin, M., Alessi, A., Zoccarato, F., Manzato, E., & Sergi, G. (2019) · Experimental Gerontology · doi:10.1016/j.exger.2019.04.016 · Cited by 18
Hamer, M., O’Donovan, G., & MURPHY, M. H. (2017) · Advances in experimental medicine and biology · doi:10.1007/978-981-10-4307-9_1 · Cited by 24
Joint Identification of Genetic Variants for Physical Activity in Korean Population
Kim, J., Kim, J., Min, H., Oh, S., Kim, Y., Lee, A. H., & Park, T. (2014) · International Journal of Molecular Sciences · doi:10.3390/ijms150712407 · Cited by 18
“Previous genetic studies have focused on the relationship between PA and health (or fitness) [37,42–44].”
BackgroundVaquero-Cristóbal, R., Martínez-González-Moro, I., Cárceles, F. A., & Simón, E. R. (2013) · Revista Española de Geriatría y Gerontología · doi:10.1016/j.regg.2012.11.003 · Cited by 18
Physical Activity and Cardiovascular Disease Prevention: Current Recommendations
Kokkinos, P. (2008) · Angiology · doi:10.1177/0003319708318582 · Cited by 18
Actividad física y factores de riesgo cardiovascular y metabólico en la población general
Soriguer, F., Martínez, G. R., Esteva, I., de Adana, M. R. D., Catalá, M., Merelo, M., Tinahones, F., Cardona, F., Dobarganes, C., Cuesta, A. L., et al. (2003) · Medicina Clínica · doi:10.1016/s0025-7753(03)74018-4 · Cited by 18
Physical exercise and coronary artery disease
Fagard, R. (2002) · Acta Cardiologica · doi:10.2143/ac.57.2.2005379 · Cited by 18
Metabolic, endocrine and haemodynamic risk factors in the patient with peripheral arterial disease
Belch, J. (2002) · Diabetes, obesity and metabolism · doi:10.1046/j.1463-1326.2002.0040s20s7.x · Cited by 18
[Options for health care promotion in long-term care: empirical evidence and conceptual approaches].
Schaeffer, D., & Büscher, A. (2009) · Zeitschrift für Gerontologie und Geriatrie (Print) · doi:10.1007/s00391-009-0071-3 · Cited by 17
Yu, A. F., & Jones, L. W. (2015) · Future Cardiology · doi:10.2217/fca.15.29 · Cited by 16
Lammers, G., van Duijnhoven, N. V., Hoenderop, J., Horstman, A., de Haan, A. D., Janssen, T., de Graaf, M., Pardoel, E. M., Verwiel, E., Thijssen, D., et al. (2013) · Experimental Physiology · doi:10.1113/expphysiol.2012.068726 · Cited by 17
“Physical inactivity is an independent risk factor for the development of cardiovascular diseases (Blair et al. 1995; Manson et al. 1999), while regular exercise reduces this risk (Paffenbarger et al.”
BackgroundBarton, M. (2001) · Expert Opinion on Investigational Drugs · doi:10.1517/13543784.10.5.789 · Cited by 13
“Thus in order to minimise the risk, it appears of paramount importance that other cardiovascular risk factors are treated in potential users of HRT, including modifications of diet [256] and lifestyle [256-258].”
BackgroundModerate-intensity stepping in older adults: insights from treadmill walking and daily living
Yates, T., Henson, J., Mcbride, P., Maylor, B., Herring, L., Sargeant, J., Davies, M., Dempsey, P., Rowlands, A., & Edwardson, C. (2023) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-023-01429-x · Cited by 16
Physical distancing ≠ physical inactivity.
Meyer, S. M., Landry, M. J., Gustat, J., Lemon, S., & Webster, C. (2021) · Translational Behavioral Medicine · doi:10.1093/tbm/ibaa134 · Cited by 16
Noh, E., Kim, J., Kim, M., & Yi, E.-S. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17186935 · Cited by 23
“Looking at the results of prior studies on the effectiveness of exercise mediation on post-menopausal women, weight, body fat percentage and BMI decreased in the obese women who participated in the 12-week circulation exercise program without using any tools that combined aerobic and resistance exercise [47], and the…”
ResultMakino, K., Ihira, H., Mizumoto, A., Shimizu, K., Ishida, T., & Furuna, T. (2015) · Journal of Physical Therapy Science · doi:10.1589/jpts.27.2207 · Cited by 16
Relationship between body composition and level of physical activity among university students
Mialich, M., Covolo, N., Vettori, J. C., & Jordão, A. A. (2014) · Revista chilena de nutrición · doi:10.4067/s0717-75182014000100006 · Cited by 16
“[35] observed that a decline in performing physical activity mainly occurs during adolescence among individuals aged 15 to 18 years, and among young adults aged about 20 to 25 years, a period coinciding with an increased tendency to the onset and installation of this disease.”
BackgroundEffect of unilateral forearm inactivity on endothelium-dependent vasodilator function in humans
Birk, G., Dawson, E., Cable, N., Green, D. J., & Thijssen, D. (2012) · European Journal of Applied Physiology · doi:10.1007/s00421-012-2505-7 · Cited by 16
Diet and lifestyle measures to protect the ageing heart.
Stanner, S. (2009) · British Journal of Community Nursing · doi:10.12968/bjcn.2009.14.5.42080 · Cited by 16
Walking may be related to less vascular stiffness in the Activity Counseling Trial (ACT).
Havlik, R., Phillips, C., Brock, D., Lohman, K., Haskell, W., Snell, P., O'Toole, M., Ribisl, P., Vaitkevicius, P., Spurgeon, H., et al. (2005) · American Heart Journal · doi:10.1016/j.ahj.2004.09.006 · Cited by 16
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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