Higher physical activity associated with lower CVD risk in Chinese adults

Increased levels of physical activity were linked to a significantly lower risk for major CVD among Chinese adults, according to a study published in JAMA Cardiology.

The study from Derrick A. Bennett, PhD, from the clinical trial service unit, epidemiological studies and Nuffield Department of Population Health at the University of Oxford, and colleagues reinforces guidelines that promote any physical activity for CVD prevention.

“In recent decades, levels of physical activity have declined worldwide, including in China, mainly because of rapid urbanization, reduced physical activity in the workplace, changes in modes of transportation and other aspects of lifestyle,” the researchers wrote. “Previous studies of physical activity levels in China have been constrained by a small number of events that considered only fatal outcomes, covered a single geographic area, reported associations with CVD risk factors only, or had a combination of these constraints.”

Bennett and colleagues conducted a population-based, prospective cohort study at 10 areas across China consisting of 487,334 adults aged 30 to 79 years who had no prior history of CVD.

Participants were given a laptop-based questionnaire on demographic, socioeconomic and lifestyle factors and measured height, weight, waist and hip circumference, BP and lung function.

Researchers studied self-reported total, occupational and non-occupational physical activity, which were quantified as metabolic equivalent of task (MET) hours per day based on type, frequency and duration of specific activities.

Exercise beneficial

The primary outcomes of the study were major vascular events and the components thereof, including major coronary events, ischemic stroke, intracerebral hemorrhage and CVD death.

An inverse correlation between the risk for major vascular events and physical activity was found among the study participants (adjusted HR = 0.77; 95% CI, 0.74-0.8).

Each 4 MET hours per day higher usual total physical activity was associated with a 6% decreased risk for major vascular events (95% CI, 5-7), a 9% lower risk for major coronary events, a 5% lower risk for ischemic stroke, a 6% lower risk for intracerebral hemorrhage and a 12% lower risk for CVD death, according to the researchers.

Additionally, there was similar and independent strength of associations for occupational and non-occupational physical activity, the researchers reported.

Although they found that the associations of total physical activity with major vascular events were similar between men and women across different levels of sedentary leisure time, the associations were much weaker in patients with hypertension.

Infrastructure important

According to an accompanying editorial from Scott A. Lear, PhD, from the faculty of health sciences at Simon Fraser University in Burnaby, British Columbia, Canada, and the division of cardiology at Providence Health Care in Vancouver, and Salim Yusuf, DPhil, from the Population Health Research Institute, Hamilton Health Sciences and McMaster University in Hamilton, Ontario, Canada, the challenge for low- and middle-income countries such as China is how to mitigate decreasing levels of occupational physical activity.

“Over the past 2 decades, research into how the built environment ... affects behavior and health has indicated that access to parks, safe neighborhoods and walking or bicycle paths are associated with higher [physical activity],” they wrote. “For China in particular, supporting infrastructure for bike lanes can promote active transport and also have additional benefits, such as reduced traffic congestion and air pollution. If the entire population met the World Health Organization [physical activity] guidelines, whether through recreational, occupational, household or other obligatory activities, this would prevent about 1 in 12 ... premature deaths in adults worldwide.” by Dave Quaile

Disclosures: The authors report no relevant financial disclosures. Lear reports he holds the Pfizer/Heart and Stroke Foundation Chair in Cardiovascular Prevention at St. Paul’s Hospital. Yusuf reports he receives support from the Mary W. Burke endowed chair of the Heart and Stroke Foundation of Ontario.