Elsevier

Preventive Medicine

Volume 40, Issue 4, April 2005, Pages 432-437
Preventive Medicine

The associations between leisure-time physical activity and inflammatory and coagulation markers related to cardiovascular disease: the ATTICA Study

https://doi.org/10.1016/j.ypmed.2004.07.010Get rights and content

Abstract

Background

As coronary heart disease is increasingly seen as an inflammation process, we evaluated the hypothesis whether physical activity reduces coronary heart disease risk by modifying the levels of inflammatory and coagulation markers.

Methods

From May 2001 to December 2002, we randomly enrolled 1524 adult men and 1518 women, without any evidence of cardiovascular disease, stratified by age–gender (census 2001), from the greater area of Athens, Greece. We assessed the relationship between self-reported physical activity status and inflammation markers (high sensitivity C-reactive protein, serum amyloid-A, fibrinogen, interleukin-6, tumor necrosis factor-α, and white blood cell counts), after taking into account the effect of several confounders.

Results

Eight hundred seventy-four (57%) of men and 903 (59%) of women were classified as sedentary. Multivariate statistical analysis after adjustment for gender, age, smoking habits, body mass index, total cholesterol, blood glucose, and systolic and diastolic blood pressure levels showed that participants devoted to high physical activity (>7 kcal/min expended) had 29% lower levels of C-reactive protein, 19% of white blood cell counts, 22% lower concentrations of amyloid-A, 20% lower levels of tumor necrosis factor-α, 32% of interleukin-6, and 11% of fibrinogen (all P < 0.05) as compared to those who were devoted to sedentary life.

Conclusions

Our findings suggest that the adoption of a physically active lifestyle modifies the inflammation process in healthy individuals.

Introduction

In recent years, health care professionals have focus on prevention and therapy of the cardiovascular diseases through the evaluation and modification of several risk factors. Among the factors that may influence the occurrence of cardiovascular disease, the beneficial effect of physical activity on human health has been underlined in several studies, but the exact mechanisms are not well understood [1], [2], [3], [4], [5]. Recent findings support that inflammation plays a role in the pathogenesis of cardiovascular disease [6], [7], [8]. For example, some suggest that levels of C-reactive protein (CRP) in apparently healthy persons or patients with stable angina pectoris constitute an independent risk factor for cardiovascular events [9]. Moreover, since coronary heart disease (CHD) is increasingly seen as an inflammatory process, it is reasonable to hypothesize that physical activity reduces risk of coronary heart disease by reducing or preventing inflammation [10]. However, the strength of the association between several inflammation markers and physical activity is not fully investigated, since several potential confounders may influence it.

The aim of this work is to investigate the association between leisure-time physical activity and inflammation markers related to coronary heart disease [high sensitivity CRP, interleukin (IL)-6, tumor necrosis factor (TNF)-α, fibrinogen, serum amyloid-A (SAA), and white blood cell (WBC) counts], in a population-based sample of healthy adults.

Section snippets

Study's sample and design

The “ATTICA” study is a health and nutrition survey, carried out in the province of Attica (including 78% urban and 22% rural areas), where Athens is a major metropolis. The sampling was random, multistage, and on the city–gender–age distribution of the province of Attica provided by the National Statistical Service (census of 2001). The study's design anticipates enrolling only one participant per household. The number of the participants was determined by power analysis and chosen to evaluate

Results

Table 1 presents the investigated characteristics of the participants according to their physical activity status. From physically active participants, 5% of men and 2% of women reported only resistance training, while 7% of men and 12% of women reported only endurance training. Eight hundred seventy-four (57%) of men and 903 (59%) of women were classified as sedentary. Physically active participants were significantly younger and were less frequent to be active smokers, as compared to

Discussion

Our findings support that inflammatory markers are significantly lower in physically active individuals than those leading a sedentary lifestyle. More specifically, participants in the highest fitness tertile exhibited significantly lower concentrations of CRP, SAA, TNF-α, IL-6, WBC, and fibrinogen than the sedentary group.

The health benefits of a physically activity lifestyle are well recognized. In particular, the risk of coronary heart disease mortality or morbidity is inversely related to

Acknowledgments

The ATTICA Study is funded by research grants from the Hellenic Society of Cardiology.

The authors would like to thank the field investigators of “ATTICA” study: Dr. John Skoumas (principal field investigator), Dr. Natasa Katinioti (physical examination), Dr. Spiros Vellas (physical examination), Dr. Efi Tsetsekou (physical/psychological evaluation), Dr. Dina Masoura (physical examination), and Dr. Lambros Papadimitriou (physical examination); as well as the technical team: Dr. Marina Toutouza

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