Elsevier

The Lancet

Volume 351, Issue 9116, 30 May 1998, Pages 1603-1608
The Lancet

Articles
Changes in physical activity, mortality, and incidence of coronary heart disease in older men

https://doi.org/10.1016/S0140-6736(97)12355-8Get rights and content

Summary

Background

We studied the relations between physical activity and changes in physical activity, all-cause mortality, and incidence of major coronary-heart-disease events in older men.

Methods

In 1978–80 (Q1), 7735 men aged 40–59 were selected from general practices in 24 British towns, and enrolled in a prospective study of cardiovascular disease, which included physical activity data. In 1992 (Q92), 12–14 years later, 5934 of the men (91% of available survivors, mean age 63 years) gave further information on physical activity and were then followed up for a further 4 years. The main endpoints were all-cause mortality during 4 years of follow-up from Q92, and major fatal and non-fatal coronary-heart-disease events during 3 years of follow-up from Q92.

Findings

Among 4311 men with no history of coronary heart disease, stroke, or “other heart trouble” by Q92 and who did not report “poor health”, there were 219 deaths. In the inactive/occasionally active, light, moderate, and moderately vigorous/vigorous activity groups there were 101 (18·5/1000 person-years) 48 (11·4), 23 (7·3), and 47 (9·1) deaths, respectively (adjusted risk ratios 1·00, 0·61 [95% CI 0·48-0·86], 0·50 [0·31-0·79], 0·65 [0·45-0·94]). Men who were sedentary at Q1 and who began at least light activity by Q92 had significantly lower all-cause mortality than those who remained sedentary, even after adjustment for potential confounders (risk ratio=0·55 [0·36-0·84]). Physical activity improved both cardiovascular mortality (0·66 [0·35-1·23]) and non-cardiovascular mortality (0·48 [0·27-0·85]). The relation between physical activity at Q92, changes in physical activity, and mortality were similar for men with pre-existing cardiovascular disease.

Interpretation

Maintaining or taking up light or moderate physical activity reduces mortality and heart attacks in older men with and without diagnosed cardiovascular disease. Our results support public-health recommendations for older sedentary people to increase physical activity, and for active middle-aged people to continue their activity into old age.

Introduction

For middle-aged men, regular leisure-time physical activity is associated with lower all-cause mortality and with lower morbidity and mortality from cardiovascular disease.1, 2, 3, 4, 5, 6, 7 There is also evidence that older people benefit from physical activity.8, 9 However, despite the benefits of physical activity, many middle-aged adults in the UK and the USA do little or no regular physical activity in their leisure time.10, 11 There has been little investigation of whether adoption of regular physical activity in later adult life is beneficial. Two US studies have suggested that adoption of physical activity or improved fitness even in later life improves mortality outcome.12, 13 However, in a study of Danish men,14 increased physical activity by men aged over 64 was associated with increased risk of coronary heart disease, and in a study of Swedish women aged 38–60 increased physical activity was associated with a slight excess mortality.15

We used data from the British Regional Heart Study to find out whether middle-aged or elderly men should be advised to begin or to increase physical activity in later life. We studied the association between physical activity in older men, all-cause mortality, and the incidence of coronary heart disease. We also assessed the relation between changes in physical activity in these men during the preceding 12–14 years and subsequent mortality outcome.

Section snippets

Data collection

The British Regional Heart Study is a large prospective study of cardiovascular disease, which began in 1978. At this time, 7735 men aged 40–59 were selected from the age-sex registers of one group general practice in each of 24 towns in England, Wales, and Scotland. The criteria for selection of the town, the general practice, and the participants, and the data collection methods, are described elsewhere.16 In 1978–80 (Q1) research nurses completed for each man a standard questionnaire that

Background data

The mean age of the 5567 men who completed the physical-activity questionnaire at Q92 was 63 years (range 52–72 years). 1256 men (22·6%) had a history of coronary heart disease, stroke, or other heart trouble, or reported “poor health”. In this group 198 men died (121 from cardiovascular, 77 from other causes) during the 4-year follow-up period-a mortality rate of 40·0 per 1000 person-years. Since coronary heart disease, stroke, other heart trouble, and self-reported “poor health” may influence

Discussion

The benefits of regular leisure-time physical activity on health are widely recognised. Reports from the British Regional Heart Study have studied the links between physical activity at baseline and health outcome, and have confirmed the benefits to health of regular physical activity for middle-aged men.6, 7, 22 We have shown that sporting (vigorous) activity is not essential for reduction of cardiovascular risk, that regular physical activity for men over 60 brings a significant decrease in

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