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Fitness and abdominal obesity are independently associated with cardiovascular risk.
Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Björn Ekblom's research group.ORCID iD: 0000-0002-3901-7833
Karolinska institutet.
Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Björn Ekblom's research group.ORCID iD: 0000-0001-6058-4982
Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Forskningsgruppen för pedagogik, idrott och fritidskultur. (Lärarhögskolan i Stockholm)
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2009 (English)In: Journal of internal medicine, ISSN 1365-2796, no 21 MayArticle in journal (Refereed) Published
Abstract [en]

Objectives. To examine the relationship between cardiovascular fitness (VO(2)max) and abdominal obesity (waist circumference) and individual cardiovascular disease (CVD) risk factors, as well as a clustered risk factor profile, and to study the impact of gender, age and smoking on these relationships. Design. Cross-sectional. Setting. Astrand Laboratory of Work Physiology, Swedish School of Sport and Health Sciences, Stockholm, Sweden. Subjects. Men (n = 781) and women (n = 890) from two random population-based samples of Swedish women and men aged 20 to 65 years. Main outcomes. Odds ratios. Results. Each unit of higher fitness was associated with a decrease in all individual risk factors ranging from 2% to 4% independent of waist circumference, each unit of higher waist circumference was associated with an increased risk ranging from 2% to 5% independent of fitness. For clustering of three or more of the risk factors, each unit of fitness was associated with a 5% decrease in risk and each unit of waist circumference with a 5% increase in risk. The clustered risk was higher in unfit participants who were older or smoked daily, regardless of waist circumference. Obese participants were at higher risk if they were men or older, regardless of fitness level. However, neither a higher fitness level nor lean status reduced the risk associated with smoking. Conclusions. Higher fitness and lower waist circumference are each independently associated to a similar extent with a lower CVD risk. Simultaneous evaluation of both fitness and abdominal obesity status in clinical practice is important.

Place, publisher, year, edition, pages
2009. no 21 May
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:gih:diva-965DOI: 10.1111/j.1365-2796.2009.02131.xPubMedID: 19563391OAI: oai:DiVA.org:gih-965DiVA: diva2:236648
Available from: 2009-09-24 Created: 2009-09-24 Last updated: 2017-03-31Bibliographically approved
In thesis
1. Physical activity, cardiorespiratory fitness, and abdominal obesity in relation to cardiovascular disease risk: epidemiological studies
Open this publication in new window or tab >>Physical activity, cardiorespiratory fitness, and abdominal obesity in relation to cardiovascular disease risk: epidemiological studies
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Although Sweden saw a decline in death rates related to cardiovascular disease (CVD) between 1987 and 2011, it is still the most common cause of death for both women and men. Lifestyle-related factors such as inadequate physical activity (PA), poor cardiorespiratory fitness (CF), and excess body fat are all recognised as important predictors of CVD morbidity and mortality. More recently, studies have highlighted the possible detrimental effects of prolonged sitting, which mainly substitutes for daily non-exercise PA (NEPA). Conversely, more preferable levels of these lifestyle factors are associated with lower CVD risk and increased life expectancy. Despite the extensive research performed within this field, there is still no consensus.

The main objective of this thesis was therefore to examine the interrelationship between different levels of PA, CF, and abdominal adiposity and their association with CVD risk factors, CVD morbidity, and longevity in population-based samples of Swedish men and women of different ages. A second objective was to develop a new and more precise method for estimation of CF in a mixed, healthy, population.

The main findings were

- In a cross-sectional population based random sample of Swedish men (n=781) and women (n=890) aged 20 to 65 years were CF and abdominal obesity each independently and strongly beneficially associated with individual CVD risk factors, as well as to a clustered CVD risk factor profile. For the clustered risk, each unit of fitness (ml·kg-1·min-1) was associated with a 5% decrease in risk and each unit of waist circumference (cm) with a 5% increase in risk. This was seen in women as well as men, younger as well as older people, and daily smokers as well as non-smokers; however, there were some differences within the subgroups.

- In the same population, higher levels of self-reported PA and CF, but mainly the latter, were independently associated in a beneficial way with both individual and clustered CVD risk factors. Furthermore, a notable interaction of excess clustered CVD risk was shown for being insufficiently physical active according to general guidelines in combination with not being fit.

- In a representative cohort of 60-year-old men (n=2039) and women (n=2193) in Stockholm County, a generally active daily life was associated with beneficial metabolic health at baseline and an approximately 30% lower risk for a first-time cardiovascular event and all-cause mortality, respectively, after 12.5 years. These relationships were independent of regular exercise.

- A new submaximal cycle ergometer test for estimation of maximal oxygen uptake was developed. The test is simple, low-risk, and easily administered, and does not require laboratory equipment or expertise. In a mixed population (in terms of age, activity status, and gender), the test showed a significantly increased precision compared with one of the most commonly used submaximal exercise tests today.

In conclusion, these results indicate that in clinical practice it is important to evaluate both PA and CF as well as abdominal obesity status. Regarding PA, it is important to highlight the separate beneficial associations of a daily active life including NEPA on the one hand, and intentional regular exercise on the other.

Place, publisher, year, edition, pages
Karolinska Institutet, 2013
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-2989 (URN)978-91-7549-309-1 (ISBN)
Public defence
2013-11-15, Aulan, GIH, Lidingövägen 1, Stockholm, 09:00 (English)
Opponent
Supervisors
Available from: 2013-10-25 Created: 2013-10-25 Last updated: 2015-09-18Bibliographically approved

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