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Review
. 2016 Sep 14;5(9):e002495.
doi: 10.1161/JAHA.115.002495.

Quantifying the Association Between Physical Activity and Cardiovascular Disease and Diabetes: A Systematic Review and Meta-Analysis

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Free PMC article
Review

Quantifying the Association Between Physical Activity and Cardiovascular Disease and Diabetes: A Systematic Review and Meta-Analysis

Ahad Wahid et al. J Am Heart Assoc. .
Free PMC article

Abstract

Background: The relationships between physical activity (PA) and both cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) have predominantly been estimated using categorical measures of PA, masking the shape of the dose-response relationship. In this systematic review and meta-analysis, for the very first time we are able to derive a single continuous PA metric to compare the association between PA and CVD/T2DM, both before and after adjustment for a measure of body weight.

Methods and results: The search was applied to MEDLINE and EMBASE electronic databases for all studies published from January 1981 to March 2014. A total of 36 studies (3 439 874 participants and 179 393 events, during an average follow-up period of 12.3 years) were included in the analysis (33 pertaining to CVD and 3 to T2DM). An increase from being inactive to achieving recommended PA levels (150 minutes of moderate-intensity aerobic activity per week) was associated with lower risk of CVD mortality by 23%, CVD incidence by 17%, and T2DM incidence by 26% (relative risk [RR], 0.77 [0.71-0.84]), (RR, 0.83 [0.77-0.89]), and (RR, 0.74 [0.72-0.77]), respectively, after adjustment for body weight.

Conclusions: By using a single continuous metric for PA levels, we were able to make a comparison of the effect of PA on CVD incidence and mortality including myocardial infarct (MI), stroke, and heart failure, as well as T2DM. Effect sizes were generally similar for CVD and T2DM, and suggested that the greatest gain in health is associated with moving from inactivity to small amounts of PA.

Keywords: cardiovascular diseases; meta‐analysis; physical activity; systematic review.

Figures

Figure 1
Figure 1
Flow chart for inclusion of studies. CVD indicates cardiovascular disease; diabetes, diabetes mellitus.
Figure 2
Figure 2
Relative risk for CVD mortality against MET hours per day. Results from 14 studies, including the 0.25 power transformation fit line as well as linear, log‐linear, 0.375, 0.5, and 0.750 power transformations. Relative risk estimates are weighted by the inverse of the reported SE, with larger circles for results with greater weighting. The red line represents a log‐linear transformation, and the orange line represents a 0.25 power transformation. CVD indicates cardiovascular disease; MET, metabolic equivalent of task; RR, relative risk.
Figure 3
Figure 3
Meta‐analysis of 11.25 MET h/week increase in physical activity on CVD mortality, with a 0.25 power transformation, adjusted for body weight. CVD indicates cardiovascular disease; MET, metabolic equivalent of task; RR, relative risk.
Figure 4
Figure 4
Funnel plot for meta‐analyses of 11.25 MET h/week increase in physical activity, with a 0.25 power transformation, for CVD mortality, adjusted for body weight. CVD indicates cardiovascular disease; MET, metabolic equivalent of task.

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