Joint Associations of Physical Activity and Aerobic Fitness on the Development of Incident Hypertension: Coronary Artery Risk Development in Young Adults
Open accessAbstract
Fitness and physical activity are each inversely associated with the development of hypertension. We tested whether fitness and physical activity were independently associated with the 20-year incidence of hypertension in 4618 men and women. Hypertension was determined in participants who had systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or who reported antihypertensive medication use. Fitness was estimated based on the duration of a symptom-limited graded exercise treadmill test, and physical activity was self-reported. The incidence rate of hypertension was 13.8 per 1000 person-years (n=1022). Both baseline fitness (hazard ratio: 0.63 [95% CI: 0.56 to 0.70 per SD]; 2.9 minutes) and physical activity (hazard ratio: 0.86 [95% CI: 0.79 to 0.84 per SD]; 297 exercise units) were inversely associated with incident hypertension when included jointly in a model that also adjusted for age, sex, race, baseline smoking status, systolic blood pressure, alcohol intake, high-density lipoprotein cholesterol, dietary fiber, dietary sodium, fasting glucose, and body mass index. The magnitude of association between physical activity and hypertension was strongest among participants in the high fitness (hazard ratio: 0.80 [95% CI: 0.68 to 0.94]) category, whereas the magnitude of association between fitness and hypertension was similar across tertiles of physical activity. The estimated proportion of hypertension cases that could be prevented if participants moved to a higher fitness category (ie, preventive fraction) was 34% and varied by race and sex group. Fitness and physical activity are each associated with incident hypertension, and low fitness may account for a substantial proportion of hypertension incidence.
AI snapshot
Written from the paper’s full text.
TL;DR
In CARDIA, both baseline aerobic fitness and self-reported physical activity were inversely associated with 20-year incident hypertension, but fitness remained independently associated when both were modeled jointly. Low fitness may account for a substantial proportion of hypertension incidence, with an estimated preventive fraction of 34%.
Key findings
- Among 4618 participants followed for 20 years, 1022 developed hypertension, an incidence rate of 13.8 per 1000 person-years.
- Baseline fitness (HR=0.63, 95% CI: 0.56, 0.70 per SD [2.9 minutes]) and physical activity (HR=0.86, 95% CI: 0.79, 0.84 per SD [297 exercise units]) were each inversely associated with incident hypertension in a jointly adjusted model.
- Physical activity was most strongly associated with hypertension in the high fitness category (HR=0.80, 95% CI: 0.68, 0.94), whereas fitness was similarly associated across activity tertiles; there was no statistical interaction between activity and fitness (χ²=1.15, p=0.28).
- The estimated preventive fraction for moving to a higher fitness category was 34% and varied by race and sex; hypertension incidence rates were 20.7, 19.6, 10.6, and 6.1 per 1000 person-years in black women, black men, white men, and white women, respectively.
Methods
- Longitudinal analysis within the Coronary Artery Risk Development in Young Adults (CARDIA) study; 5115 adults initially aged 18–30 years in 1985–1986, with 4618 included after exclusions for baseline hypertension, missing baseline treadmill data, or loss to follow-up.
- Aerobic fitness was estimated from duration of a symptom-limited graded exercise treadmill test using a modified Balke protocol; physical activity was self-reported with the CARDIA physical activity questionnaire and expressed as exercise units.
- Hypertension was defined as SBP ≥140 mmHg, DBP ≥90 mmHg, or antihypertensive medication use; analyses used hazard ratios per SD, stratified models by fitness category and activity tertile, and preventive fraction estimates.
Limitations
- The paper states that self-reported activity may be under-reported, that non-exercise activity thermogenesis was not measured, and that the activity questionnaire did not query exercise duration, preventing caloric or MET estimates.
- The paper states that only baseline fitness and activity measures were used, that hypertension was defined from a single elevated blood pressure reading in the main analysis, and that preventive fractions assume causality and may be affected by residual confounding.
- Evident from the text: the cohort included only black and white men and women, so findings may not generalize to other racial or ethnic groups.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 9 cited sources checked · 0 supported · 0 flagged
- Findingown data
The magnitude of association between physical activity and incident hypertension was strongest among participants in the high fitness category (HR=0.80, 95% CI: 0.68, 0.94).
“The magnitude of association between physical activity and hypertension was strongest among participants in the high fitness (HR= 0.80, 95% CI: 0.68, 0.94) category, whereas the magnitude of association between fitness and hypertension was similar across tertiles of physical activity.”
- Also stated in: § Results · plain
“Despite the absence of an interaction between activity and fitness, activity was only significantly inversely associated with the development of hypertension in the highest category of fitness.”
Quote in the paperSubstantial claim - Also stated in: § Results · plain
- Findingown data
The hazard ratio for developing hypertension ranged from 0.54 to 0.79 per 1 category higher fitness measure across race and sex groups.
“The HR for developing hypertension ranged from 0.54 to 0.79 per 1 category higher fitness measure across race and sex groups (Table 3).”
Quote in the paperSubstantial claim- Rests on an assumption: Treadmill test duration is directly correlated with VO2 max.
- Findingown data
The magnitude of association between fitness and incident hypertension was similar across tertiles of physical activity.
“The magnitude of association between physical activity and hypertension was strongest among participants in the high fitness (HR= 0.80, 95% CI: 0.68, 0.94) category, whereas the magnitude of association between fitness and hypertension was similar across tertiles of physical activity.”
Quote in the paperSubstantial claim - Findingown data
Our findings on the association of fitness or activity with incident hypertension were modestly attenuated when we included BMI in models and waist circumference (data not shown).
“A related observation is that our findings on the association of fitness or activity with incident hypertension were modestly attenuated when we included BMI in models and waist circumference (data not shown).”
Quote in the paperNot a substantial claim - Findingown data
Activity was only significantly inversely associated with the development of hypertension in the highest category of fitness.
“Despite the absence of an interaction between activity and fitness, activity was only significantly inversely associated with the development of hypertension in the highest category of fitness.”
- Also stated in: § Discussion · plain
“Activity was only significantly inversely associated with the development of hypertension among participants in the highest fitness category, although that heterogeneity was not statistically significant (i.e., no interaction).”
Quote in the paperSubstantial claim - Also stated in: § Discussion · plain
- Findingown data
There was no evidence of statistical interaction between activity and fitness in association with the development of hypertension (χ2=1.15, p=0.28).
“There was no evidence of statistical interaction between activity and fitness in association with the development of hypertension (χ2=1.15, p=0.28).”
Quote in the paperSubstantial claim - Findingown data
The estimated preventive fraction varied by race and sex group.
“The estimated proportion of hypertension cases that could be prevented if participants moved to a higher fitness category (i.e., preventive fraction) was 34% and varied by race and sex group.”
Quote in the paperNot a substantial claim- The authors state this as an assumption: The preventive fraction is appropriate when the hypothesized relationships are causal and when all competing causes have been accounted for using multivariable adjustment.
- Findingown data
According to our preventive fraction estimates, a smaller proportion of hypertension incidence would be prevented in black as compared with white participants if they moved into the high fitness category.
“According to our preventive fraction estimates, a smaller proportion of hypertension incidence would be prevented in black as compared with white participants if they were to move into the high fitness category.”
Quote in the paperNot a substantial claim- The authors state this as an assumption: The preventive fraction is appropriate when the hypothesized relationships are causal and when all competing causes have been accounted for using multivariable adjustment.
- Findingown data
There was an inverse, graded association between fitness category and the development of hypertension across race-sex groups.
“Across race-sex groups, there was an inverse, graded association between fitness category and the development of hypertension (Table 2).”
- Also stated in: § Results · plain
“The incidence of hypertension was inversely associated with fitness category in all race and sex groups, though the absolute rates varied by sex (Table 3).”
Quote in the paperSubstantial claim- Rests on an assumption: Treadmill test duration is directly correlated with VO2 max.
- Also stated in: § Results · plain
- Findingown data
Fitness was significantly and inversely associated with the development of hypertension within each tertile of physical activity.
“Fitness was significantly and inversely associated with the development of hypertension within each tertile of physical activity.”
Quote in the paperSubstantial claim- Rests on an assumption: Treadmill test duration is directly correlated with VO2 max.
- Findingown data
The estimated preventive fraction of incident hypertension cases that could be prevented if participants moved to a higher fitness category was 34%.
“The estimated proportion of hypertension cases that could be prevented if participants moved to a higher fitness category (i.e., preventive fraction) was 34% and varied by race and sex group.”
Quote in the paperSubstantial claim- The authors state this as an assumption: The preventive fraction is appropriate when the hypothesized relationships are causal and when all competing causes have been accounted for using multivariable adjustment.
- Interpretationreasoning
Under-reporting from these sources may bias the association of activity with incident hypertension toward the null.
“Under-reporting from these sources may bias the association of activity with incident hypertension toward the null.”
Quote in the paperSubstantial claim - Interpretationreasoning
The relatively stronger association of fitness as compared with activity in relation to incident hypertension may be attributable to under-reporting of activities not queried on the survey as well as non-purposeful movements.
“The relatively stronger association of fitness as compared with activity in relation to incident hypertension may be attributable to under-reporting of activities that participants may engage in that are not queried on the survey as well as non-purposeful movements.”
Quote in the paperSubstantial claim - Study design and conductown data
The proportional hazards assumption was valid.
“we tested and confirmed that the proportional hazards assumption was valid using log-log survival plots”
Quote in the paperSubstantial claim - Interpretationown data
Low fitness may account for a substantial proportion of hypertension incidence.
“Fitness and physical activity are each associated with incident hypertension, and low fitness may account for a substantial proportion of hypertension incidence.”
- Also stated in: § Discussion · hedged
“As estimated by the preventive fraction, achieving higher fitness by category could theoretically “prevent” more cases of incident hypertension.”
Quote in the paperSubstantial claim- The authors state this as an assumption: The preventive fraction is appropriate when the hypothesized relationships are causal and when all competing causes have been accounted for using multivariable adjustment.
- Also stated in: § Discussion · hedged
- Interpretationreasoning
The resulting misclassification bias has most likely shifted our estimates towards the null.
“The resulting misclassification bias has most likely shifted our estimates towards the null.”
Quote in the paperNot a substantial claim - Interpretationreasoning
A single elevated blood pressure reading may be an isolated event that has misclassified participants who were truly normotensive.
“A single elevated blood pressure reading may be an isolated event that has misclassified participants who were truly normotensive.”
Quote in the paperSubstantial claim- Rests on an assumption: A single elevated blood pressure reading is an acceptable definition of hypertension for epidemiologic studies.
- The quote only partly states this claim. 2
- May combine two claims. 14
- Classified as probably not a substantial claim. 9
The quote only partly states this claim.
Findingown dataBaseline fitness is inversely associated with incident hypertension when included jointly with physical activity in a model adjusted for age, sex, race, baseline smoking status, SBP, alcohol intake, HDL cholesterol, dietary fiber, dietary sodium, fasting glucose and BMI.
“When both were included in the same model, fitness remained significantly and independently associated with a lower likelihood of developing hypertension while activity attenuated to non-significance.”
Quote in the paperSubstantial claim- Rests on an assumption: Treadmill test duration is directly correlated with VO2 max.
May combine two claims.
Findingown dataThe proportion of hypertension that could theoretically be prevented was highest in white men and women, but all race-sex groups demonstrated the potential for a lower hazard with higher fitness.
“The proportion of hypertension that could theoretically be prevented was highest in white men and women but all race-sex groups demonstrated the potential for a lower hazard with higher fitness.”
Quote in the paperSubstantial claim- The authors state this as an assumption: The preventive fraction is appropriate when the hypothesized relationships are causal and when all competing causes have been accounted for using multivariable adjustment.
May combine two claims.
Findingown dataOver 20 years, 1022 participants developed hypertension at a rate of 13.8 per 1000 person-years.
“Over 20 years, 1022 participants developed hypertension at a rate of 13.8 per 1000 person-years.”
- Also stated in: § Abstract · plain
“The incidence rate of hypertension was 13.8 per 1000 person-years (n=1022).”
Quote in the paperNot a substantial claim- Also stated in: § Abstract · plain
May combine two claims.
Findingown dataNeither race nor sex modified the association between fitness and hypertension.
“Neither race nor sex modified the association between fitness and hypertension.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataBoth BMI and waist circumference are significantly inversely associated with categories of fitness and activity.
“Both BMI and waist circumference are significantly inversely associated with categories of fitness and activity.”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
Findingown dataThe rate of hypertension was 20.7, 19.6, 10.6, and 6.1 per 1000 person-years in black women, black men, white men and white women, respectively.
“The rate of hypertension was 20.7, 19.6, 10.6, and 6.1 in black women, black men, white men and white women, respectively.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataBaseline activity category was inversely associated with incident hypertension, but the hazard ratio was only statistically significant in black men.
“Although baseline activity category was inversely associated with incident hypertension, the HR was only statistically significant in black men.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataWhen both fitness and activity were included in the same model, fitness remained significantly and independently associated with a lower likelihood of developing hypertension while activity attenuated to non-significance.
“When both were included in the same model, fitness remained significantly and independently associated with a lower likelihood of developing hypertension while activity attenuated to non-significance.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataFitness and physical activity are each inversely associated with the development of incident hypertension.
“Fitness and physical activity are each inversely associated with the development of hypertension.”
- Also stated in: § Discussion · boosted
“Findings from our longitudinal study demonstrate that both fitness and activity are inversely associated with the development of hypertension over 20 years.”
- Also stated in: § Abstract · plain
“Fitness and physical activity are each associated with incident hypertension, and low fitness may account for a substantial proportion of hypertension incidence.”
Quote in the paperSubstantial claim- Also stated in: § Discussion · boosted
May combine two claims.
PremisecitationThe CARDIA physical activity history does not query duration of exercise session and so neither caloric expenditure nor metabolic-equivalents (MET) of exercise can be estimated.
“The CARDIA physical activity history does not query duration of exercise session and so neither caloric expenditure nor metabolic-equivalents (MET) of exercise can be estimated.12”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [12] Jacobs DR Hahn L Haskell WL Pirie P Sidney S Validity and reliability of short physical activityhistory: CARDIA Study and the Minnesota Heart Health Program Journal of Cardiopulmonary Rehabilitation 1989 9 448 459 PMC5894828 29657358
Not checked in the free run.
May combine two claims.
Interpretationown dataLow fitness demonstrates a more robust association with the development of hypertension than low self-reported physical activity, yet the two appear to exert independent effects.
“In conclusion, low fitness demonstrates a more robust association with the development of hypertension than low self-reported physical activity, yet the two appear to exert independent effects.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe disparity in hypertension incidence between black and white adults in CARDIA is consistent with patterns in other US samples.
“The disparity in hypertension incidence between black and white adults in CARDIA is consistent with patterns in other US samples.19”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] Lloyd-Jones D Adams R Carnethon M De Simone G Ferguson TB Flegal K Ford E Furie K Go A Greenlund K Haase N Hailpern S Ho M Howard V Kissela B Kittner S Lackland D Lisabeth L Marelli A McDermott M Meigs J Mozaffarian D Nichol G O’Donnell C Roger V Rosamond W Sacco R Sorlie P Stafford R Steinberger J Thom T Wasserthiel-Smoller S Wong N Wylie-Rosett J Hong Y Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation 2009 119 e21 181 19075105
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenStandardized protocols for data collection were used across study centers and examinations.
“Standardized protocols for data collection were used across study centers and examinations”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationown dataIt is plausible that the mechanism by which fitness and activity are associated with a lower rate of developing hypertension is through lowered BMI.
“It is plausible that the mechanism by which fitness and activity are associated with a lower rate of developing hypertension is through lowered BMI.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationnone givenIn our observational study, it is possible that residual confounders are influencing our hazard ratio estimates and biasing our estimates away from the null.
“In our observational study, it is possible that residual confounders are influencing our hazard ratio estimates and biasing our estimates away from the null.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataThe findings were robust: they persisted with adjustment for family history, in the subset who exercised to at least 85% of age-predicted maximum heart rate, in participants without hospitalized CVD during follow-up, and when incident hypertension was determined among those with it at more than 1 follow-up examination.
“Our findings were robust as they were persisted with adjustment for family history, were present in the subset of participants who exercised to at least 85% of their age-predicted maximum heart rate, participants who did not experience hospitalized CVD during follow-up, and when incident hypertension was determined among those participants who had it at more than 1 follow-up examination.”
- Also stated in: § Limitations · boosted
“However, a secondary analysis restricting the definition of incidence to hypertension at two or more examinations demonstrated that our findings were robust.”
Quote in the paperSubstantial claim- Also stated in: § Limitations · boosted
Classified as probably not a substantial claim.
Study design and conductown dataThe Omron automated blood pressure device used at year 20 was calibrated against the random-zero device for comparability.
“At year 20, an Omron automated blood pressure device was used and calibrated against the random-zero device for comparability”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationIn a prior CARDIA study, Parker et al. showed that young adults who were the most physically active had a decreased risk of developing hypertension, and that the risk was attenuated after adjustment for fasting insulin level and waist circumference.
“In a prior CARDIA study, Parker et al showed that young adults who were the most physically active had a decreased risk of developing hypertension, and that the risk was attenuated after adjustment for fasting insulin level and waist circumference.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2] Parker ED Schmitz KH Jacobs DR Jr Dengel DR Schreiner PJ Physical Activity in Young Adults and Incident Hypertension Over 15 Years of Follow-Up: The CARDIA Study Am J Public Health 2007 97 703 709 17329668 PMC1829365
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPrior research in CARDIA demonstrates that the associations of activity with the development of hypertension and metabolic syndrome are in the expected direction.
“Prior research in CARDIA demonstrates that the associations of activity with the development of hypertension2 and metabolic syndrome23, are in the expected direction.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [2] Parker ED Schmitz KH Jacobs DR Jr Dengel DR Schreiner PJ Physical Activity in Young Adults and Incident Hypertension Over 15 Years of Follow-Up: The CARDIA Study Am J Public Health 2007 97 703 709 17329668 PMC1829365
Not checked in the free run.
- cites [23] Carnethon MR Loria CM Hill JO Sidney S Savage PJ Liu K Risk Factors for the Metabolic Syndrome: The Coronary Artery Risk Development in Young Adults (CARDIA) study, 1985–2001 Diabetes Care 2004 27 2707 2715 15505009
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataRetention rates across examinations were 90%, 86%, 81%, 79%, 74%, and 72%.
“retention rates across examinations were 90%, 86%, 81%, 79%, 74%, and 72%, respectively.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataBecause the incidence of hypertension is 2-3 times higher in black men and women as compared with their counterparts, those proportions represent a large number of cases and a substantial reduction in the public health burden of hypertension.
“However, because the incidence of hypertension is 2–3 times higher in black men and women as compared with their counterparts, those proportions represent a large number of cases and a substantial reduction in the public health burden of hypertension.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationIn NHANES III, the prevalence of hypertension was higher among black as compared with white and Mexican-American adults, and within each group hypertension prevalence was inversely associated with the number of bouts per week of leisure time physical activity.
“In NHANES III, the prevalence of hypertension was higher among black as compared with white and Mexican-American adults, and within each group hypertension prevalence was inversely associated with the number of bouts per week of leisure time physical activity.20”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [20] Matthews CE Ainsworth BE Thompson RW Bassett DR Jr Sources of variance in daily physical activity levels as measured by an accelerometer Med Sci Sports Exerc 2002 34 1376 1381 12165695
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe CARDIA physical activity questionnaire has reliability and validity comparable to other activity questionnaires.
“The reliability and validity of the instrument is comparable to other activity questionnaires.11, 12”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [11] Jacobs DR Jr Ainsworth BE Hartman TJ Leon AS A simultaneous evaluation of 10 commonly used physical activity questionnaires Med Sci Sports Exerc 1993 25 81 91 8423759
Not checked in the free run.
- cites [12] Jacobs DR Hahn L Haskell WL Pirie P Sidney S Validity and reliability of short physical activityhistory: CARDIA Study and the Minnesota Heart Health Program Journal of Cardiopulmonary Rehabilitation 1989 9 448 459 PMC5894828 29657358
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe CARDIA activity history instrument was reliable over a 1 month interval and was correlated with estimates of body fatness and treadmill test performance.
“However, in a review of the CARDIA activity history the instrument was reliable over a 1 month interval and was correlated with estimates of body fatness and treadmill test performance.11”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [11] Jacobs DR Jr Ainsworth BE Hartman TJ Leon AS A simultaneous evaluation of 10 commonly used physical activity questionnaires Med Sci Sports Exerc 1993 25 81 91 8423759
Not checked in the free run.
The paper relies on this without support.
Treadmill test duration is directly correlated with VO2 max.
“Fitness was estimated based on the duration of the treadmill test, which is directly correlated with VO2 max.”
The paper relies on this without support.
Baseline fitness and activity commonly track over time in the CARDIA sample.
“We chose to use the baseline measure because baseline fitness and activity commonly “track” over time in the CARDIA sample.”
The paper relies on this without support.
Baseline risk factors are more strongly associated with incident disease outcomes in CARDIA and in other longitudinal studies than are measures that are updated over time.
“Further, baseline risk factors are more strongly associated with incident disease outcomes in CARDIA and in other longitudinal studies than are measures that are updated over time.”
The paper relies on this without support.
A single elevated blood pressure reading is an acceptable definition of hypertension for epidemiologic studies.
“Despite clinical recommendations to diagnose hypertension based on multiple readings and across many days,14 we classified participants as having hypertension based on a single elevated blood pressure reading—a definition shared by most epidemiologic studies.”
The authors state this as an assumption.
The preventive fraction is appropriate when the hypothesized relationships are causal and when all competing causes have been accounted for using multivariable adjustment.
“They are appropriate when the hypothesized relationships are causal and when all competing causes have been accounted for using multivariable adjustment.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Graded inverse associations between activity and fitness level with the risk for developing high blood pressure have been shown in young adults, men, and women.
“Graded inverse associations between activity and fitness level with the risk for developing high BP have been shown in young adults,168 men,169 and women.170”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [168]
Both reduced physical activity and lower physical fitness are independent risk factors for hypertension.
“Both reduced physical activity and lower physical fitness are independent risk factors for hypertension.166–171”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [168]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Physical activity is described as independently associated but becomes non-significant in the joint model
MajorThe abstract says physical activity was inversely associated with hypertension when included jointly with fitness, and gives a confidence interval excluding 1. The results say activity became non-significant when both were included in the same model.
“Both baseline fitness (hazard ratio [HR]=0.63, 95% confidence interval [CI]: 0.56, 0.70 per standard deviation [SD; 2.9 minutes]) and physical activity (HR=0.86, 95% CI: 0.79, 0.84 per SD [297 exercise units]) were inversely associated with incident hypertension when included jointly in a model”
“When both were included in the same model, fitness remained significantly and independently associated with a lower likelihood of developing hypertension while activity attenuated to non-significance.”
Physical activity hazard ratio falls outside its reported confidence interval
MajorThe reported hazard ratio is 0.86, but its reported 95% confidence interval runs from 0.79 to 0.84. The point estimate cannot lie above both bounds of its own interval.
“physical activity (HR=0.86, 95% CI: 0.79, 0.84 per SD [297 exercise units])”
“HR=0.86, 95% CI: 0.79, 0.84”
Hypertension thresholds differ between the abstract and methods
MinorThe abstract includes blood pressure readings equal to 140/90 mmHg, while the methods require readings greater than 140/90 mmHg.
“Hypertension was determined in participants who had systolic blood pressure (SBP)≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg or who reported antihypertensive medication use.”
“Hypertension was defined if any of the following criteria was met at a single examination: systolic blood pressure > 140 mmHg or a diastolic blood pressure > 90 mmHg on, or use of antihypertensive medications.”
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A simple field test for the assessment of physical fitness.
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Dwyer, T., Magnussen, C. G., Schmidt, M. D., Ukoumunne, O. C., Ponsonby, A., Raitakari, O. T., Zimmet, P., Blair, S. N., Thomson, R. J., Cleland, V. J., et al. (2008) · Diabetes Care · doi:10.2337/dc08-1638 · Cited by 164 · see citing works
A SIMPLE FIELD TEST FOR THE ASSESSMENT OF PHYSICAL FITNESS. REP 63-6.
Balke, B. (1963) · PubMed · Cited by 160 · see citing works
Parker, E. D., Schmitz, K. H., Jacobs, D. R., Dengel, D. R., & Schreiner, P. J. (2007) · American Journal of Public Health · doi:10.2105/ajph.2004.055889 · Cited by 144 · see citing works
Self-citationSymptom-limited graded treadmill exercise testing in young adults in the CARDIA study
Sidney, S., Haskell, W. L., Crow, R. S., Sternfeld, B., Oberman, A., Armstrong, M. A., Cutter, G., Jacobs, D. R., Savage, P. J., & Horn, L. V. (1992) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-199202000-00004 · Cited by 112 · see citing works
Self-citationAssociation of 20-Year Changes in Cardiorespiratory Fitness With Incident Type 2 Diabetes
Carnethon, M. R., Sternfeld, B., Schreiner, P. J., Jacobs, D. R., Lewis, C. E., Liu, K., & Sidney, S. (2009) · Diabetes Care · doi:10.2337/dc08-1971 · Cited by 99 · see citing works
Self-citationHozawa, A., Jacobs, D. R., Steffes, M. W., Gross, M. D., Steffen, L. M., & Lee, D. (2009) · Journal of Hypertension · doi:10.1097/hjh.0b013e32832258c9 · Cited by 91 · see citing works
Self-citationDesign of Posture and Activity Detector (PAD)
Bliley, K. E., Schwab, D., Zahn, S. K., Rowley, K. L., Kane, P. H., Levine, J. A., Daniel, E. S., & Gilbert, B. K. (2007) · Conference proceedings · doi:10.1109/iembs.2007.4352876 · Cited by 9 · see citing works
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Fletcher, G. F., Ades, P. A., Kligfield, P., Arena, R., Balady, G. J., Bittner, V. A., Coke, L. A., Fleg, J. L., Forman, D. E., Gerber, T. C., et al. (2013) · Circulation · doi:10.1161/cir.0b013e31829b5b44 · Cited by 2,235 · see citing works
Carey, R. M., Calhoun, D. A., Bakris, G. L., Brook, R. D., Daugherty, S. L., Dennison-Himmelfarb, C. R., Egan, B. M., Flack, J. M., Gidding, S. S., Judd, E., et al. (2018) · Hypertension · doi:10.1161/hyp.0000000000000084 · Cited by 1,153 · see citing works
Physical Activity and the Prevention of Hypertension
Diaz, K. M., & Shimbo, D. (2013) · Current Hypertension Reports · doi:10.1007/s11906-013-0386-8 · Cited by 528 · see citing works
Effects of physical activity and sedentary time on the risk of heart failure
Young, D. R., Reynolds, K., Sidell, M., Brar, S., Ghai, N. R., Sternfeld, B., Jacobsen, S. J., Slezak, J. M., Caan, B., & Quinn, V. P. (2014) · Circulation: Heart Failure · doi:10.1161/circheartfailure.113.000529 · Cited by 125 · see citing works
Self-citationHealth-promoting lifestyle and quality of life among Chinese nursing students
Mak, Y. W., Kao, A. H. F., Tam, L. W. Y., Tse, V. W. C., Tse, D. T. H., & Leung, D. Y. P. (2018) · Primary Health Care Research & Development · doi:10.1017/s1463423618000208 · Cited by 120 · see citing works
Lamoureux, N. R., Fitzgerald, J. S., Norton, K. I., Sabato, T., Tremblay, M. S., & Tomkinson, G. R. (2019) · Sports Medicine · doi:10.1007/s40279-018-1017-y · Cited by 111 · see citing works
Juraschek, S. P., Blaha, M. J., Whelton, S. P., Blumenthal, R., Jones, S. R., Keteyian, S. J., Schairer, J., Brawner, C. A., & Al‐Mallah, M. H. (2014) · Journal of the American Heart Association · doi:10.1161/jaha.114.001268 · Cited by 97 · see citing works
Pathophysiological mechanisms underlying the beneficial effects of physical activity in hypertension
Gambardella, J., Morelli, M. B., Wang, X., & Santulli, G. (2020) · The Journal of Clinical Hypertension · doi:10.1111/jch.13804 · Cited by 54 · see citing works
Cheng, C., Zhang, D., Chen, S., & Duan, G. (2022) · Journal of Human Hypertension · doi:10.1038/s41371-021-00567-8 · Cited by 28 · see citing works
Prepregnancy Fitness and Risk of Gestational Diabetes: A Longitudinal Analysis
WHITAKER, K. M., INGRAM, K. H., APPIAH, D., NICHOLSON, W. K., BENNETT, W. L., LEWIS, C. E., REIS, J. P., SCHREINER, P. J., & GUNDERSON, E. P. (2018) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001600 · Cited by 24 · see citing works
Self-citation
- Authors
- Carnethon, M. R., Evans, N. S., Church, T. S., Lewis, C. E., Schreiner, P. J., Jacobs, D. R., Sternfeld, B., & Sidney, S.
- Affiliations
- Pennington Biomedical Research Center (US)
- ORCID
- Venue
- Hypertension
- Published
- 2010-07
- Volume
- 56
- Issue
- 1
- Pages
- 49-55
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC2909350
- OpenAlex
- W2139355291
- Cited by
- 168
- References
- 25
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 17 · 2023: 12 · 2022: 14 · 2021: 11 · 2020: 13 · 2019: 7 · 2018: 8 · 2017: 12 · 2016: 11 · 2015: 12 · 2014: 11 · 2013: 13 · 2012: 10
- FWCI
- 6.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01hc95095-66-0-1, n01hc48050-59-0-1, n01hc48048-58-0-1, 5k12hl083790-03, n01hc48047-55-0-1, n01hc48049-61-0-1)
- National Heart, Lung, and Blood Institute (N01HC48050, K12-HL083790, N01 HC 95095, N01 HC048048, N01-HC-048049, N01 HC095095, N01 HC048050, N01-HC48048, N01-HC-48-049, N01 HC048047, N01-HC-480-47, 512HL083790, R01HL078972)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- hypertension incidence, cardiorespiratory fitness, physical activity, blood pressure, racial differences, sex differences, cardiovascular risk factors
- MeSH terms
- Adolescent, Adult, Age Factors, Blood Pressure, Coronary Artery Disease, Female, Follow-Up Studies, Humans, Hypertension, Male, Motor Activity, Physical Fitness, Prognosis, Retrospective Studies, Risk Factors, Sex Factors, United States, Incidence, Disease Progression, Risk Assessment, Young Adult
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.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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