Objectively measured physical activity, cardiorespiratory fitness and cardiometabolic risk factors in the Health Survey for England
Introduction
Physical activity and cardiorespiratory fitness are associated with reductions in the risks of type 2 diabetes (Gill and Cooper, 2008, Sieverdes et al., 2010) and cardiovascular disease (CVD) (Shiroma and Lee, 2010, Williams, 2001). Physical activity improves cardiorespiratory fitness in most adults (Skinner et al., 2000) and vigorous-intensity activity produces greater improvements in cardiorespiratory fitness than the same volume of moderate-intensity activity (Kraus et al., 2002, O'Donovan et al., 2005). Nonetheless, it has been suggested that the pursuit of cardiorespiratory fitness is unnecessary or unrealistic (Després and Lamarche, 1994, Lee et al., 2001, Pate et al., 1995). It is also suggested that the observed association between cardiorespiratory fitness and health is greater than that between physical activity and health because fitness has been measured with greater accuracy (Shiroma and Lee, 2010). Objective measures of physical activity are now more readily available (Warren et al., 2010), but there have been few reports on the associations between objectively measured physical activity, objectively measured cardiorespiratory fitness, and cardiometabolic risk factors (Franks et al., 2004, Schmidt et al., 2008). Physical activity (Chaudhury and Esliger, 2010) and cardiorespiratory fitness (Aresu et al., 2010) were objectively measured in the 2008 Health Survey for England and the purpose of the present study was to investigate the relationship between physical activity and cardiorespiratory fitness (predictors) and cardiometabolic risk factors (outcomes). Some authors have used linear regression to investigate the independent effects of activity and fitness on cardiometabolic risk factors (Ekblom-Bak et al., 2010, Franks et al., 2004, Lakka and Salonen, 1993, Sassen et al., 2009, Schmidt et al., 2008); however, activity and fitness are not independent predictors: physical activity improves (Skinner et al., 2000) and can explain much of the variance (Lakoski et al., 2011) in cardiorespiratory fitness. Franks et al. (2004) investigated the interaction of objectively measured physical activity and objectively measured cardiorespiratory fitness on the metabolic syndrome in white men and women in the UK, but participants were not drawn from a nationally representative sample. Ekblom-Bak et al. (2010) investigated the interaction of physical activity and cardiorespiratory fitness on the clustering of CVD risk factors in a representative sample of men and women in Sweden, but physical activity was not objectively measured. Participants in the present study were drawn from a survey that was designed to be representative of the national population, and physical activity and cardiorespiratory fitness were objectively measured. We tested the hypothesis that both physical activity and cardiorespiratory fitness are associated with cardiometabolic risk factors. We also tested the hypothesis that cardiorespiratory fitness modifies (changes the direction and/or strength of) the associations between physical activity and cardiometabolic risk factors.
Section snippets
Health Survey for England
The sample design (Craig et al., 2010a) and data weighting (Craig et al., 2010b) of the 2008 Health Survey for England are described in detail elsewhere. The core sample was designed to be representative of the population living in private households in England and comprised 16,056 addresses selected at random in 1176 postcode sectors. Fifteen thousand, one hundred and two (15,102) adults from 9191 households took part in the study; 88% of participants were interviewed, 63% saw a nurse and 44%
Results
Table 1 presents participants' characteristics. Participants in the present study who had valid data for both MVPA and VO2 max had a mean (± SD) age of 46 ± 14 years compared to participants in the core sample who had a mean age of 49 ± 19 years. Forty eight per cent of adults in the present study and 45% of adults in the core sample were male. Sixteen per cent of participants in the present study and 20% of participants in the core sample were smokers. Forty two per cent of participants in the
Discussion
Physical activity and cardiorespiratory fitness were objectively measured in the 2008 Health Survey for England and the present study supports the hypothesis that both physical activity and cardiorespiratory fitness are associated with cardiometabolic risk factors: physical activity was associated with HDL-C, TC:HDL-C, HbA1C and BMI after adjusting for potential confounders; and cardiorespiratory fitness was associated with HDL-C, TC:HDL-C, HbA1C, systolic blood pressure and BMI after adjusting
Conclusions
These data suggest that objectively measured physical activity and objectively measured cardiorespiratory fitness are associated with cardiometabolic risk factors after adjusting for potential confounders. A larger sample is required to determine whether cardiorespiratory fitness modifies associations between physical activity and cardiometabolic risk factors or, alternatively, to rule out modification effects of a size that would be clinically important if real.
Conflict of interest statement
The authors declare that there are no conflicts of interest.
Acknowledgments
The Health Survey for England is part of a programme of surveys commissioned by the UK National Health Service Information Centre for health and social care, carried out since 1994 by the Joint Health Surveys Unit of the National Centre for Social Research (NatCen) and the Department of Epidemiology and Public Health at the University College London Medical School. Hamer is supported by the British Heart Foundation (RG 05/006). Stamatakis is a National Institute of Health Research Career
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