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Independent associations of physical activity and cardiovascular fitness with cardiovascular risk in adults.
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
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.
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2010 (English)In: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 17, no 2, 175-80 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Uncertainty still exists whether physical activity (PA) and cardiovascular fitness (CF) contribute separately to cardiovascular disease (CVD) risk. This study examined the associations of PA and CF on individual as well as clustered CVD risk factors. DESIGN: Cross-sectional. METHODS: Seven hundred and eighty-one men and 890 women, aged 20-65 years, from two random population-based samples of Swedish women and men were included. PA was assessed by questionnaire and CF was predicted by a submaximal cycle ergometry test. Waist circumference, blood pressure, and fasting levels of blood lipids were assessed and dichotomized by conventional cut-off points. RESULTS: Participants reporting high PA level benefited from lower triglycerides and atherogenic cholesterol levels, regardless of CF. Higher CF level was, regardless of PA, associated with lower risk for all risk factors. With regard to clustering of risk factors, each higher CF level was associated with a gradually reduced risk by half or more, independent of PA. Furthermore, being unfit but reporting high PA was associated with a 50% lower risk compared with being unfit and inactive. Furthermore, high reported PA was associated with an additional reduced risk among fit participants. In addition, an excess risk of interaction was found for waist circumference, triglycerides, and the clustered CVD risk between neither being sufficiently active nor being fit. CONCLUSION: This study suggests that both PA and CF are independently associated with lower cardiovascular risk, and that both variables should be taken into account when CVD risk is estimated.

Place, publisher, year, edition, pages
2010. Vol. 17, no 2, 175-80 p.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medicine/Technology
Identifiers
URN: urn:nbn:se:gih:diva-1430DOI: 10.1097/HJR.0b013e32833254f2PubMedID: 19809331OAI: oai:DiVA.org:gih-1430DiVA: diva2:360151
Available from: 2010-11-02 Created: 2010-11-02 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)
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Available from: 2013-10-25 Created: 2013-10-25 Last updated: 2015-09-18Bibliographically approved

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Ekblom-Bak, ElinEkblom, ÖrjanEngström, Lars-MagnusEkblom, Björn

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Public Health, Global Health, Social Medicine and Epidemiology

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