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Running, regardless of speed or duration, reduced risk for CV death
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Researchers found that running, no matter how long or how fast, is associated with a 45% lower risk for CV mortality and a 30% lower risk for all-cause mortality.
The mortality benefits were the same in runners who ran less than 1 hour per week as in those who ran more than 3 hours per week, the researchers found.
Attainable health goal
“Since time is one of the strongest barriers to participate in physical activity, the study may motivate more people to start running and continue to run as an attainable health goal for mortality benefits,” researcher Duck-chul Lee, PhD, said in a press release. “Running may be a better exercise option than more moderate-intensity exercises for healthy but sedentary people since it produces similar, if not greater, mortality benefits in 5 to 10 minutes compared to the 15 to 20 minutes per day of moderate-intensity activity that many find too time-consuming.”
Lee, of the department of kinesiology at the College of Human Sciences, Iowa State University, Ames, Iowa, analyzed participants in the Aerobics Center Longitudinal Study (n=55,137; mean age, 44 years; 26% women) who received at least one extensive medical examination between 1974 and 2002 and had no history of MI, stroke or cancer at baseline.
Participants were questioned about duration, distance, speed and frequency of running and were classified into nonrunners and five quintiles of runners. They were followed for mortality through date of death or Dec. 31, 2003.
There were 3,413 all-cause deaths and 1,217 CVD deaths during the study period, the researchers found.
Compared with nonrunners, runners were at lower risk for all-cause mortality (HR=0.7; 95% CI, 0.64-0.77) and for CV mortality (HR=0.55; 95% CI, 0.46-0.65), Lee and colleagues found. The findings were consistent regardless of sex, age, BMI, general health status, smoking or alcohol use, they found.
After adjustment for other mortality predictors, nonrunners had 3 years’ lower life expectancy compared with runners, the researchers wrote. Not running accounted for 16% of all-cause mortality and 25% of CV mortality, making it almost as important a factor as hypertension, they wrote.
Runners in all quintiles of running time, distance, frequency, amount and speed had similar mortality benefits compared with each other and superior mortality benefits compared with nonrunners, Lee and colleagues found. Therefore, they concluded, even weekly running of less than 51 minutes, less than 6 miles, one or two times per week, less than 506 metabolic equivalent-minutes and less than 6 miles per hour was sufficient to reduce mortality risk compared with nonrunning.
Persistent runners over a mean of 5.9 years had the greatest mortality benefits, with a 29% lower risk for all-cause mortality and a 50% lower risk for CV mortality compared with never-runners, the researchers found.
Virtuous cycle
In a related editorial, Chi Pang Wen, MD, DrPH, and colleagues wrote that although “the causality associated with [the] conclusion is not clear” because runners in the study had fewer risk factors such as smoking or obesity and nonrunners had more comorbidities such as diabetes and hypertension, the findings are consistent with randomized clinical trials that have shown a mortality benefit from regular exercise. “The reality is that a virtuous cycle exists for an iterative process of incremental exercise promoting incremental health, and the healthier individuals in turn being more likely to exercise, blurring the simple cause-and-effect relationship,” they wrote.
However, Wen, of the Institutes of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan, and colleagues wrote that running takes less time than walking, but it is associated with a higher rate of injuries compared with walking and is less conducive to social networking, so doctors should encourage their patients toward whichever activity they are more comfortable with.
For more information:
Lee DC. J Am Coll Cardiol. 2014;64:472-481.
Wen CP. J Am Coll Cardiol. 2014;64:482-484.
Disclosure: The study was funded by the NIH and the Coca-Cola Co. One researcher reports financial ties with BodyMedia, Clarity, the Coca-Cola Co., Santech and Technogym. Wen and colleagues report no relevant financial disclosures.
Perspective
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Alfred A. Bove, MD, PhD, MACC
The study by Lee et al confirms long-held beliefs that a commitment to regular exercise has significant positive effects on CV mortality. Prior studies support this conclusion, but the current study provides more detail on the levels of activity that reduce mortality. The data counter recent data suggesting that high-intensity exercise may increase mortality; their data show positive value to exercise intensities ranging from <6 miles/hour (slower than 10 minutes per mile) to >7.6 miles/hour (faster than 8 minutes/mile). Other measures, such as total distance run/week, also show persistent positive effects between ≤6 miles/week and >20 miles/week. Of importance for providing advice to patients is the finding that a commitment of 75 minutes/week of running time (about 11 minutes/day) is enough to have a positive benefit on mortality.
The study reinforces the importance of exercise in maintaining CV health. While the benefits were greatest on improving mortality from CVD, there was a smaller but significant benefit on all-cause mortality as well. Lee et al also provide useful information for patients regarding BMI, where benefit was found for those with BMI ≥25 as well as for those with BMI <25, in women and in individuals aged at least 50 years. Even smokers benefited from lower mortality risk if they were runners.
It is clear from their data that those who ran for exercise were generally healthier than the nonrunners when examining smoking status, incidence of diabetes, hypertension and hypercholesterolemia. One could argue that these findings indicate that runners are generally healthier due to overall lifestyle differences, and this commitment to a healthier lifestyle was the cause of the improved mortality. Lee et al, however, examined overall mortality accounting for lifestyle differences and were able to show that running had an independent effect on overall and CV mortality. The findings provide strong support for advising patients to initiate a program of aerobic exercise. While running might be stressful due to orthopedic or mobility limitations, those who can initiate a jogging program, even at slow speed, for 75 minutes per week, will gain significant benefit in longevity.
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