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Steven N. Blair Professor Departments of Exercise Science and Epidemiology/Biostatistics

Preserving Health and Function with Physical Activity SC Aging Research Confernece March 30, 2008. Steven N. Blair Professor Departments of Exercise Science and Epidemiology/Biostatistics Arnold School of Public Health University of South Carolina.

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Steven N. Blair Professor Departments of Exercise Science and Epidemiology/Biostatistics

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  1. Preserving Health and Function with Physical ActivitySC Aging Research Confernece March 30, 2008 Steven N. Blair Professor Departments of Exercise Science and Epidemiology/Biostatistics Arnold School of Public Health University of South Carolina

  2. Systematic Research on Physical Activity and Health Began in the Latter Half of the 20th Century

  3. Physical Activity at Work and Coronary Artery Disease, 31,000 London Transport Workers Rate/1000 *Within 3 days of MI Morris JN et al. Lancet 1953

  4. Articles/Period-Web of SciencePhysical Activity or Physical Fitness and Cardiovascular Disease # of Articles *Estimated from # Published 2005 to 11/7/06 Years

  5. Aerobics Center Longitudinal Study

  6. Design of the ACLS 1970 More than 80,000 patients 2005 Cooper Clinic examinations--including history and physical exam, clinical tests, body composition, EBT, and CRF Mortality surveillance to 2003 More than 4000 deaths 1982 ‘86 ‘90 ‘95 ’99 ‘04 Mail-back surveys for case finding and monitoring habits and other characteristics

  7. Activity, Fitness, and Mortality in Older Adults

  8. Risk of Death by Fitness Groups, 749 Women and 1758 Men 60 and Older, ACLS • Age, exam-year, BMI, cholesterol, high blood pressure, diabetes, smoking, CVD, parental CVD adjusted RR for all-cause mortality • Patients with cancer and failure to achieve at least 85% of predicted max HRwere excluded Blair & Wei. Am J Health Prom. 2000

  9. Amount of Specific Physical Activities for Moderately Fit Women and Men • Detailed physical activity assessments in women and men who also completed a maximal exercise test • Average min/week for the moderately fit who only reported each specific activity Mean Min/week N=3,972 13,444 Stofan JR et al. AJPH 1998; 88:1807

  10. Functional Capacity and Mortality in Older AdultsStudy Design & Population • Prospective observational study • At baseline: 4060 adults (24.7% women) aged 60 years or older, from the Aerobics Center Longitudinal Study (ACLS) examined from 1971 to 2001. • Outcomes: 989 deaths (453 CVD and 263 cancer) identified through the National Death Index during an average 14 years of follow up and 55,337 person-years of observation. Sui M et al. JAGS 2007; 55:1940-7..

  11. Adjusted Hazard Ratio for All-cause, CVD, and Cancer Mortality in Adults 60+ Adjusted HR* P trend<0.001 P trend<0.001 P trend=0.45 *Adj for age, sex, exam year, BMI, smoking, abnormal exercise ECG responses, MI, stroke, HTN, DM, cancer, or hypercholesterolemia, family history of CVD or cancer, and percent maximal heart rate achieved during exercise. Sui M et al. JAGS 2007; 55:1940-7.

  12. Cardiorespiratory Fitness and All-Cause Mortality, Women and Men ≥60 Years of Age All-cause deaths/10,000 person-years Sui M et al. JAGS 2007; 55:1940-7.

  13. CRF and CVD Mortality Rates across Age Groups in Adults 60+, ACLS participants Death rate/1,000 person-years Ptrend<0.001 Ptrend=0.001 Ptrend=0.04 Rates adjusted for age, sex and exam year Sui M et al. JAGS 2007; 55:1940-7.

  14. Walking and CVD Events, Women, 50-79 Years, WHI Adjusted RR for CVD Walking Pace among Walkers Adjusted for age, time walking, smoking, race, education, family income, BMI, WHR, alcohol intake, parental history of CHD, age at menopause, ERT, % kcal from saturated fat, # servings of fruit & vegetables, & dietary fiber 1,551 first CVD events in 232,971 woman-years of observation Manson et al. NEJM 2002; 347:716-25

  15. Time Spent Sitting and CVD, Women, 50-79 Years, WHI Adjusted RR Hours spent sitting/day Adjusted for age and total recreational physical activity 1551 first CVD events in 232,971 woman-years of observation Manson et al. NEJM 2002; 347:716-25

  16. 400 Meter Walk as a Predictor of Mortality, CVD, and Mobility Disability HR per minute* • 3075 women & men in HEALTH-ABC • 52% women • 42% African-American • 70-79 years of age • 400 m corridor walk on a 20 m long course • Follow-up for 4.9 y • 351 deaths • 308 incident CVD • 509 mobility disability Outcomes *Hazard Ratio per minute of walk time—adjusted for age, sex, race, smoking, SBP, ECG abnormalities, FPG, BMI, activity level, CVD, FEV, lower extremity function (SPPB)—All are significantly above 1.0 Newman AB et al. JAMA 2006; 295:2018

  17. Physical Activity, and Hip Fracture Risk, Nurses’ Health Study Adj RR* • Nurses’ Health Study cohort--61,200 postmenopausal women (40-77 yrs) • Followed for 12 years—415 incident hip fractures • *Adjusted for age, HRT use, smoking, BMI, and diet • MET-HRs/Week averaged over 1986-1996 P for trend<0.001 MET-Hours/Week Feskanich D et al. JAMA 2002; 288:2300

  18. Cardiorespiratory Fitness, Obesity, and CVD Outcomes—Can Activity or Fitness Reduce or Eliminate the Health Hazards of Obesity?

  19. Interrelationships Among Obesity, Fitness, and Mortality Obesity/Fat Distribution Morbidity or Mortality No grants should be awarded nor papers published on obesity and a health outcome unless carefully measured physical activity (accelerometry) or fitness is taken into account Activity/Fitness

  20. RR for All-cause and CVD Mortality in Fit and Unfit ACLS Men by Body Fat Categories Body Fat% Body Fat% All-cause Mortality CVD Mortality *adjusted for age, exam year, smoking, alcohol, & parental history Lee CD, Blair SN, & Jackson AS. Am J Clin Nurt 1999; 69:373-80

  21. Adjusted RR for All-Cause Mortality by Fitness and BMI, ACLS Women *adj for age, exam year, smoking, & health status Farrell et al. Obes Res. 2002; 10:417-423

  22. CVD Mortality Risk* by Fitness and BMI Categories, 2316 Men with Diabetes, 179 CVD Deaths p for trend <0.0001 p for trend <0.0001 p for trend <0.002 Church TS et al. Arch Int Med 2005; 165:2114 *Adj for age and examination year

  23. Fitness, Fatness, and Mortality in Older Women and Men

  24. Study Design & Population • Prospective observational study • At baseline: 2603 adults (19.8% women) aged 60 years or older, from the Aerobics Center Longitudinal Study (ACLS) examined from 1979 to 2001. • Exposure variables—CRF, BMI, %Body Fat, Waist Circumference • Outcomes: 450 deaths (198 CVD, 121 CHD, 40 stroke, 135 cancer, and 117 others) identified through the National Death Index during an average 12 years of follow up and 31,236 person-years of observation. Sui M et al. JAMA 2007; 298:2507-16

  25. Multivariate adjusted HR of All-Cause Mortality by Fitness Groups, ACLS, 2603 Adults 60+ Adjusted HR 106 deaths P for trend <0.001 98 deaths 95 deaths 90 deaths 61 deaths Cardiorespiratory Fitness *Adjusted for age, exam year, smoking, abnormal exercise ECG, baseline health conditions Sui M et al. JAMA 2007; 298:2507-16

  26. Multivariate + % Body Fat adjusted HR of All-Cause Mortality by Fitness Groups, ACLS, 2603 Adults 60+ Adjusted HR p for trend <0.001 106 deaths 98 deaths 95 deaths 90 deaths 61 deaths Cardiorespiratory Fitness *Adjusted for age, exam year, smoking, abnormal exercise ECG, baseline health conditions, and percent body fat Sui M et al. JAMA 2007; 298:2507-16

  27. Joint Associations of CRF and % Body Fat with All-cause Mortality, ACLS Adults 60+ Death rate/1,000 person-years Deaths 151190 29 72 Rates adjusted for age, sex and exam year Sui M et al. JAMA 2007; 298:2507-16

  28. Joint Associations of CRF and Waist Girth with All-cause Mortality, ACLS Adults 60+ Death rate/1,000 person-years Deaths 274 10 61 45 Rates adjusted for age, sex and exam year Sui M et al. JAMA 2007; 298:2507-16

  29. Percent of Older Adults Who Are Unfit or Fit, by BMI Categories Sui M et al. JAMA 2007; 298:2507-16

  30. We will all die eventually, but Who wants to spend their last years in a nursing home?

  31. Fitness and Functional Limitations, Women and Men, ACLS • Risk of self-reported functional limitation adjusted for age, follow-up, BMI, smoking, alcohol intake, baseline disease, & disease at follow-up Huang et al. MSSE 1998, 30:1430-5

  32. Prevalence of Self-reported Functional Limitations by Fitness and Age Groups *Prevalence (%) Huang et al. MSSE 1998, 30:1430-5

  33. Adjusted OR for Functional Limitations OR adjusted for exam year and all variables in table Brill PA et al. MSSE 2000; 32:412-6

  34. Exercise and Incident Dementia Age- & sex-adj Hazard Ratio • 1740 persons >65 years of age • Free of cognitive impairment • Frequency of exercise/week during past year • <3 (bottom quarter) • ≥3 • 158 developed dementia in 6.2 years of follow-up • Risk reduction was greater in those with lower physical performance scores Weekly Exercise Larsen EB et al. Ann Int Med 2006; 144:73-81

  35. Cardiorespiratory Fitness and Risk of Dementia, ACLS • 59,960 women and men • Followed for 16.9 years after clinic exam • 4,108 individuals died • 161 with dementia listed on the death certificate • Hazard ratio adjusted for age, sex, exam yr, BMI, smoking, alcohol, abnormal ECG, history of hypertension, diabetes, abnormal lipids, and health status Hazard Ratio P for trend=0.002 Fitness Categories Laditka J et al. Research in progress

  36. HR of Total Dementia per 1-MET Increment within Strata of Other Conditions P >0.05 for all Current Smoker Alcohol Intake Chronic Conditions (>=5 drinks/week) Multivariate: age, exam year, BMI, abnormal exercise ECG responses, hypercholesterolemia, and each of the other variables in the figure. Laditka J et al. Research in progress

  37. Lifestyle Factors and Risk of Nursing Home Admission • NHANES I—6462 adults (aged 45-74 years at baseline in 1971-75) • Followed through 1992 (93% of cohort) for nursing home admissions • Modifiable risk factors were common • Only 8.5% (45-64 y) and 4.9% (65-74 y) had no risk factors • 51.2% (45-64 y) & 64.2% (65-74 y) were inactive • 14.8% had at least 1 nursing home admission • 6.5% (45-64 y) and 24.7% (65-74 y) had more than one admission Valiyeva E et al. Arch Int Med 2006; 166:985

  38. Hazard Ratios* for Nursing Home Admissions for Lifestyle Risk Factors *HR adjusted for age, sex, race, underweight, & baseline chronic disease Valiyeva E et al. Arch Int Med 2006; 166:985

  39. LIFE Pilot study CA PA NC TX FL N=424 – FU 1-1.5 yrs

  40. LIFE-P Inclusion criteria • 70-89 years • Sedentary lifestyle (<20 min per week spent in structured PA during the past month) • Able to walk 400 m • SPPB score <9 • Completed a behavioral run-in related to logging health behavior • Gives informed consent, lives in the study area and does not plan to move

  41. LIFE-P change in minutes of > moderate intensity physical activity (CHAMPS) Transition P<0.001 Maintenance P<0.001 Change from baseline

  42. LIFE-P SPPB score P<0.001 mo mo Means estimated from repeated measures ANCOVA adjusted for gender, field center and baseline values J Gerontol Biol Sci Med Sci 2006;61:1157

  43. LIFE-P Serious adverse events J Gerontol Biol Sci Med Sci 2006;61:1157

  44. My son has stopped talking about nursing homes since I participated in Active Living Every Day!

  45. Exercise Is Medicine

  46. Age and exam year adjusted rates of total CVD events by levels of CRF and severity of HTN in 8147 hypertensive men CVD incidence/1000 man-years P <.001 P <.001 P =.048 CRF: Controlled HTN Stage 1 HTN Stage 2 HTN Severity of HTN Sui X et al. Am J Hyptertension. 2007

  47. Physical Activity and Survival2987 Women with Breast Cancer Nurses’ Health Study Multivariable adjusted relative risk Similar findings for breast cancer recurrance Physical Activity in MET-hours/Week Holmes MD et al. JAMA 2005; 293:2479

  48. Yes, But Those Are Observational Studies, and We Require Randomized Clinical Trial Evidence

  49. Exercise Training and Angioplasty, 101 Men with Stable CAD Event-free survival (%) Per unit change in angina-CCS Exercise was 20 minutes/day on a cycle ergometer Hambrecht R et al. Circulation 2004; 109:1371

  50. Attributable Fractions of Health Outcomes For Low Cardiorespiratory Fitness and Other Predictors, ACLS • Attributable fraction (%) is the estimated number of deaths due to a specific characteristic • Based on strength of association • Prevalence of the condition Aerobics Center Longitudinal Study, 1970-2004. In progress

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