Adherence to the 2008 Adult Physical Activity Guidelines and Mortality Risk

doi:10.1016/j.amepre.2010.12.029

American Journal of Preventive Medicine

Volume 40, Issue 5, May 2011, Pages 514-521

https://doi.org/10.1016/j.amepre.2010.12.029 Get rights and content

Background

Mortality differentials by level and intensity of physical activity have been widely documented. A comprehensive review of scientific evidence of the health benefits of physical activity led the USDHHS to issue new Federal Guidelines for physical activity in 2008. Reductions in mortality risk associated with adherence to these Guidelines among the general U.S. adult population have not yet been studied.

Purpose

This study compared the relative mortality risks of U.S. adults who met the 2008 Guidelines with adults who did not meet the recommendations.

Methods

Cox proportional hazards models were used to examine the relative mortality risks of U.S. adults aged ≥18 years, using data from the 1997–2004 National Health Interview Survey and linked mortality records for deaths occurring in 1997–2006 (analyzed in 2010). Risks for adults with and without chronic health conditions were examined separately.

Results

Meeting the recommendations for aerobic activity was associated with substantial survival benefits, especially among the population having chronic conditions, with estimated hazard ratios ranging from 0.65 to 0.75 (p<0.05). While strengthening activities by themselves did not appear to reduce mortality risks, they may provide added survival benefits to those already engaged in aerobic activities. The relative benefits of physical activity were greatest among adults who had at least one chronic condition.

Conclusions

Adherence to the 2008 Physical Activity Guidelines was associated with reduced all-cause mortality risks among U.S. adults, after controlling for sociodemographic characteristics, BMI, smoking, and alcohol use.

Section snippets

Background

Physical activity is associated with reduced risks of mortality as well as of serious chronic health conditions, such as cardiovascular disease, cancer, diabetes, depression, and functional limitations.1, 2, 3, 4 Early studies of the health benefits of physical activity suggested that only vigorous activity provided sufficient protection against many adverse health events.⁵ Vigorous activity remained the focus of health promotion efforts until 1995 when recommendations of the CDC and the

Study Design and Population

The current analysis, conducted in 2010, is based on data from the 1997–2004 NHIS, which were linked to the National Death Index (NDI), with mortality information available from January 1, 1997, through December 31, 2006. The NHIS is an ongoing multipurpose, in-person, health survey of the civilian, non-institutionalized U.S. population conducted by the National Center for Health Statistics, CDC.²⁸ The NHIS uses a multistage probability sample design, sampling households throughout the 50

Results

Among adults aged ≥18 years, nearly half (45.9%) had at least one chronic health condition (i.e., diabetes, cancer, circulatory conditions, respiratory conditions, or any functional limitation; see Appendix A, available online at www.ajpm-online.net). Demographic characteristics of adults with and without chronic conditions followed predictable patterns, with conditions more prevalent among women; older adults; non-Hispanic whites; adults with less education and lower incomes; those without

Discussion

The assessment of physical activity in the U.S. population is an evolving field of study. Efforts to identify levels of activity that promote health, prevent disease, and postpone death have been hampered by the difficulty of accurately assessing physical activity. No single measure of activity perfectly captures the behavior of the population at large. Still, the goal of promoting physical activity remains a priority, as evidence from around the world continues to point to its health benefits.

Conclusion

Adherence to the 2008 Physical Activity Guidelines at the time of the baseline interview was associated with reduced all-cause mortality risks over the follow-up period among a representative sample of U.S. adults, after controlling for sociodemographic characteristics, BMI, smoking, and alcohol use. Adults with comorbid conditions had greater reductions in relative mortality risks than adults without conditions. Longer follow-up is needed to confirm these findings, especially those related to

References (33)

S.A. Carlson et al.
Physical activity trend and prevalence estimates based on the 2008 Physical Activity Guidelines for Americans, National Health Interview Survey 1998–2008
Am J Prev Med
(2010)
K. Barber et al.
Cardiac rehabilitation for community-based patients with myocardial infarction: factors predicting discharge recommendation and participation in such programs
J Clin Epidemiol
(2001)
Physical Activity Guidelines Advisory Committee Report, 2008
(2008)
J.A. Laukkanen et al.
Intensity of leisure-time physical activity and cancer mortality in men
Br J Sports Med
(2011)
C.B. Eaton et al.
Self-reported physical activity predicts long-term coronary heart disease and all cause mortalities
Arch Fam Med
(1995)
M.F. Leitzmann et al.
Physical activity recommendations and decreased risk of mortality
Arch Intern Med
(2007)
J. Erlichman et al.
Physical activity and its impact on health outcomesPaper 1: the impact of physical activity on cardiovascular disease and all-cause mortality: an historical perspective
Obes Rev
(2002)
R.R. Pate et al.
Physical activity and public healthA recommendation from the CDC and the American College of Sports Medicine
JAMA
(1995)
Physical Activity and HealthA Report of the Surgeon General
(1996)
Healthy People 2010
With understanding and improving health and objectives for improving health. 2 vols
(2000)

W.L. Haskell et al.

Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association

Med Sci Sports Exerc

(2007)

Physical activity guidelines for Americans

Physical activity for everyone website

H. Lollgen et al.

Physical activity and all-cause mortality: an updated meta-analysis with different intensity categories

Int J Sports Med

(2009)

K.R. Fontaine et al.

Years of life lost due to obesity

JAMA

(2003)

C.P. Wen et al.

Are Asians at greater mortality risks for being overweight than Caucasians?Redefining obesity for Asians

Public Health Nutr

(2009)

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Current aerobic exercise guidelines recommend at least 150 min of moderate intensity or 75 min of vigorous intensity aerobic exercise per week (Piercy et al., 2018). However, depending on whether adherence is measured through accelerometry or self-report, as few as 5%–40% of midlife/older adults meet these guidelines (Schoenborn and Stommel, 2011; Troiano et al., 2008). The most common reported barrier to adherence to aerobic exercise guidelines is lack of time (El Ansari and Lovell, 2009; Kelly et al., 2016; Stutts, 2002).
Cardiovascular diseases (CVD) remain the leading cause of death in developed and developing societies and aging is the primary risk factor for CVD. Much of the increased risk of CVD in midlife/older adults (i.e., adults aged 50 years and older) is due to increases in blood pressure, vascular endothelial dysfunction and stiffening of the large elastic arteries. Aerobic exercise training is an effective lifestyle intervention to improve CV function and decrease CVD risk with aging. However, <40% of midlife/older adults meet guidelines for aerobic exercise, due to time availability-related barriers and other obstacles to adherence. Therefore, there is a need for new lifestyle interventions that not only improve CV function with aging but also promote adherence. High-resistance inspiratory muscle strength training (IMST) is an emerging, time-efficient (5 min/day) lifestyle intervention. Early research suggests high-resistance IMST may promote adherence, lower blood pressure and potentially improve vascular endothelial function. However, additional investigation will be required to more definitively establish high-resistance IMST as a healthy lifestyle intervention for CV aging. This review will summarize the current evidence on high-resistance IMST for improving CV function with aging and will identify key research gaps and future directions.
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There is strong scientific evidence that muscle-strengthening exercise (i.e. use of weight machines, push-ups, sit-ups) is independently associated with a reduced risk of multiple chronic diseases (e.g. diabetes, hypertension, cardiovascular disease). However, prevalence rates for meeting the muscle-strengthening exercise guideline (≥2 times/week) are significantly lower (~20%) than those reported to meet the aerobic physical activity guideline (e.g. walking, jogging, cycling) (~50%). It is therefore important to understand public health surveillance approaches to assess muscle-strengthening exercise. The aim of this review was to describe muscle-strengthening exercise assessment in public health surveillance. Informed by the PRISMA guidelines, an extensive keyword search was undertaken across 7 electronic data bases. We identified 86,672 possible articles and following screening (n = 1140 in full-text) against specific inclusion criteria (adults aged ≥18 years, English, studies containing <1000 participants), extracted data from 156 manuscripts. Fifty-eight different survey systems were identified across 17 countries. Muscle-strengthening exercise frequency (85.3%), duration (23.7%) and intensity (1.3%) were recorded. Muscle-strengthening exercise questions varied significantly, with some (11.5%) requiring a singular ‘yes’ vs ‘no’ response, while others (7.7%) sought specific details (e.g. muscle groups targeted). Assessments of duration and intensity were inconsistent. Very few studies measured the validity (0.6%) and reliability (1.3%) of muscle-strengthening exercise questions. Discrepancy exists within the current assessment systems/surveys used to assess muscle-strengthening exercise in public health surveillance. This is likely to impede efforts to identify at risk groups and trends within physical activity surveillance, and to accurately assess associations between muscle-strengthening exercise and health-related outcomes.

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Research articleAdherence to the 2008 Adult Physical Activity Guidelines and Mortality Risk

Background

Purpose

Methods

Results

Conclusions

Section snippets

Background

Study Design and Population

Results

Discussion

Conclusion

Am J Prev Med

J Clin Epidemiol

Physical Activity Guidelines Advisory Committee Report, 2008

Intensity of leisure-time physical activity and cancer mortality in men

Br J Sports Med

Self-reported physical activity predicts long-term coronary heart disease and all cause mortalities

Arch Fam Med

Physical activity recommendations and decreased risk of mortality

Arch Intern Med

Physical activity and its impact on health outcomesPaper 1: the impact of physical activity on cardiovascular disease and all-cause mortality: an historical perspective

Obes Rev

Physical activity and public healthA recommendation from the CDC and the American College of Sports Medicine

JAMA

Physical Activity and HealthA Report of the Surgeon General

Healthy People 2010

With understanding and improving health and objectives for improving health. 2 vols

Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association

Med Sci Sports Exerc

Physical activity guidelines for Americans

Physical activity for everyone website

Physical activity and all-cause mortality: an updated meta-analysis with different intensity categories

Int J Sports Med

Years of life lost due to obesity

JAMA

Are Asians at greater mortality risks for being overweight than Caucasians?Redefining obesity for Asians

Public Health Nutr

Research article
Adherence to the 2008 Adult Physical Activity Guidelines and Mortality Risk