Abstract
The benefits of leisure time physical activity (LTPA) in cardiovascular prevention are well established. While cardiac rehabilitation programmes have been demonstrated as improving myocardial infarction (MI) prognosis, the strength of the association between LTPA and post-MI survival has yet to be quantified. We evaluated long-term survival after MI of inactive, irregularly active, and regularly active patients and examined trajectories of LTPA and their relationship to mortality risk. Consecutive patients aged ≤65 years (n = 1,521), discharged from 8 hospitals in central Israel after first MI in 1992–1993, were followed through 2005. Extensive clinical and sociodemographic data, including self-reported LTPA habits, were obtained at baseline and at 4 subsequent interviews. Pre-MI inactive patients (54%) had lower socioeconomic status, higher prevalence of risk factors and comorbidities and more severe MI. The point prevalence rate of regular LTPA at all follow-up interviews was approximately 40% and 18% were regularly active throughout the entire follow-up. Over a median follow-up of 13.2 years, 427 deaths occurred. After multivariable adjustment, no association was observed between pre-MI LTPA and death. However, with LTPA categories modelled as time-dependent variables, providing an estimation of cumulative assessment and accounting for changes in LTPA post-MI, a strong inverse graded association was revealed (multivariable-adjusted hazard ratios, 0.56 [95% CI: 0.42–0.74] for regular and 0.71 [95% CI: 0.54–0.95] for irregular activity vs. none). Similar estimates were obtained among pre-MI sedentary patients. In summary, after MI, regularly active patients had about half the risk of dying compared with inactive patients, irrespective of pre-MI habits.
Similar content being viewed by others
Abbreviations
- ACS:
-
Acute coronary syndromes
- CABG:
-
Coronary artery bypass graft
- CHD:
-
Coronary heart disease
- CI:
-
Confidence interval
- CVD:
-
Cardiovascular disease
- HR:
-
Hazard ratio
- LTPA:
-
Leisure time physical activity
- MI:
-
Myocardial infarction
- PTCA:
-
Percutaneous transluminal coronary angioplasty
- SES:
-
Socioeconomic status
References
Paffenbarger RS Jr, Wing AL, Hyde RT. Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol. 1978;108(3):161–75.
Morris JN, Crawford MD. Coronary heart disease and physical activity of work: evidence of a national necropsy survey. BMJ. 1958;2(5111):1485–96.
Sofi F, Capalbo A, Cesari F, Abbate R, Gensini G. Physical activity during leisure time and primary prevention of coronary heart disease: an updated meta-analysis of cohort studies. Eur J Cardiovasc Prev Rehabil. 2008;15(3):247–57.
Jolliffe J, Rees K, Taylor RS, Thompson DR, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2004;1:CD001800.
Skinner JS, Cooper A, Feder GS. Secondary prevention for patients after a myocardial infarction: summary of NICE guidance. BMJ. 2007;334:1112–3.
Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004;116(10):682–92.
Blumenthal JA, Babyak MA, Carney RM, Huber M, Saab PG, Burg M, et al. Exercise, depression, and mortality after myocardial infarction in the ENRICHD trial. Med Sci Sports Exerc. 2004;36(5):746–55.
Apullan FJ, Bourassa MG, Tardif JC, Fortier A, Gayda M, Nigam A. Usefulness of self-reported leisure-time physical activity to predict long-term survival in patients with coronary heart disease. Am J Cardiol. 2008;102(4):375–9.
Al-Khalili F, Janszky I, Andersson A, Svane B, Schenk-Gustafsson K. Physical activity and exercise performance predict long-term prognosis in middle-aged women surviving acute coronary syndrome. J Intern Med. 2007;261(2):178–87.
Moholdt T, Wisloff U, Nilsen TI, Slordahl SA. Physical activity and mortality in men and women with coronary heart disease: a prospective population-based cohort study in Norway (the HUNT study). Eur J Cardiovasc Prev Rehabil. 2008;15(6):639–45.
Johansson S, Rosengren A, Tsipogianni A, Ulvenstam G, Wiklund I, Wilhelmsen L. Physical inactivity as a risk factor for primary and secondary coronary events in Goteborg, Sweden. Eur Heart J. 1988;9(Suppl L):8–19.
Pitsavos C, Kavouras SA, Panagiotakos DB, Arapi S, Anastasiou C, Zombolos S, et al. Physical activity status and acute coronary syndromes survival: the GREECS (Greek Study of Acute Coronary Syndromes) study. J Am Coll Cardiol. 2008;51(21):2034–9.
Steg PG, Lopez-Sendon J, Lopez de Sa E, Goodman SG, Gore JM, Anderson FA Jr, et al. External validity of clinical trials in acute myocardial infarction. Arch Intern Med. 2007;167(1):68–73.
Tu JV, Willison DJ, Silver FL, Fang J, Richards JA, Laupacis A, et al. Impracticability of informed consent in the Registry of the Canadian Stroke Network. N Engl J Med. 2004;350(14):1414–21.
Kaplan GA, Strawbridge WJ, Cohen RD, Hungerford LR. Natural history of leisure-time physical activity and its correlates: associations with mortality from all causes and cardiovascular disease over 28 years. Am J Epidemiol. 1996;144(8):793–7.
Gerber Y, Benyamini Y, Goldbourt U, Drory Y. Neighborhood socioeconomic context and long-term survival after myocardial infarction. Circulation. 2010;121:375–83.
Gerber Y, Rosen LJ, Goldbourt U, Benyamini Y, Drory Y. Smoking status and long-term survival after first acute myocardial infarction. J Am Coll Cardiol. 2009;54:2382–7.
Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273(5):402–7.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.
Gerber Y, Benyamini Y, Goldbourt U, Drory Y. Prognostic importance and long-term determinants of self-rated health after initial acute myocardial infarction. Med Care. 2009;47(3):342–9.
Gerber Y, Goldbourt U, Drory Y. Interaction between income and education in predicting long-term survival after acute myocardial infarction. Eur J Cardiovasc Prev Rehabil. 2008;15(5):526–32.
Modan M, Karp M, Bauman B, Gordon O, Danon YL, Laron Z. Mortality in Israeli Jewish patients with Type 1 (insulin-dependent) diabetes mellitus diagnosed prior to 18 years of age: a population based study. Diabetologia. 1991;34(7):515–20.
Cox DR. Regression models and life-tables (with discussion). J R Stat Soc (Ser B Methodol). 1972;34(2):187–220.
Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15(4):361–87.
Sesso HD, Paffenbarger RS, Lee IM. Physical activity and coronary heart disease in men: the Harvard Alumni Health Study. Circulation. 2000;102(9):975–80.
Berlin JA, Colditz GA. A meta-analysis of physical activity in the prevention of coronary heart disease. Am J Epidemiol. 1990;132(4):612–28.
Boraita PA. Exercise as the cornerstone of cardiovascular prevention. Rev Esp Cardiol. 2008;61(5):514–28. (Spanish).
Lee IM, Paffenbarger RS. Associations of light, moderate, and vigorous intensity physical activity with longevity. The Harvard Alumni Health Study. Am J Epidemiol. 2000;151(3):293–9.
Kolovou GD, Mihas C, Kotanidou A, Dimoula Y, Karkouli G, Kadda O, et al. Mortality after first myocardial infarction in Greek patients: a 4-year follow-up study. Angiology. 2009;60(5):582–7.
NICE: clinical guideline 48. MI: secondary prevention in primary and secondary care for patients following a myocardial infarction. London: National Institute for Health and Clinical Excellence, 2007.
Iestra JA, Kromhout D, van der Schouw YT, Grobbee DE, Boshuizen HC, van Staveren WA. Effect size estimates of lifestyle and dietary changes on all-cause mortality in coronary artery disease patients: a systematic review. Circulation. 2005;112(6):924–34.
Paffenbarger RS Jr, Blair SN, Lee IM. A history of physical activity, cardiovascular health and longevity: the scientific contributions of Jeremy N Morris, DSc, DPH, FRCP. Int J Epidemiol. 2001;30(5):1184–92.
Brandstrom Y, Brink E, Grankvist G, Alsen P, Herlitz J, Karlson BW. Physical activity six months after a myocardial infarction. Int J Nurs Pract. 2009;15(3):191–7.
Acknowledgments
This work was supported in part by the Israel National Institute for Health Policy and Health Services Research (grant number r/89/2008 to Drs. Drory and Gerber); the Environment and Health Fund (grant number RGA0904 to Dr. Gerber); and the Marguerite Stolz Research Fund, Sackler Faculty of Medicine, Tel Aviv University.
Author information
Authors and Affiliations
Corresponding author
Additional information
This study is conducted for the Israel Study Group on First Acute Myocardial Infarction. See the “Appendix” for a list of participating medical centres and investigators.
Appendix
Appendix
The following investigators and institutions took part in the Israel Study Group on First Acute Myocardial Infarction: Yaacov Drory, MD, Principal Investigator, Department of Rehabilitation, Sackler Medical School, Tel Aviv University, Tel Aviv; Yeheskiel Kishon, MD, Michael Kriwisky, MD, and Yoseph Rosenman, MD, Wolfson Medical Center, Holon; Uri Goldbourt, PhD, Hanoch Hod, MD, Eliezer Kaplinsky, MD, and Michael Eldar, MD, Sheba Medical Center, Tel Hashomer; Itzhak Shapira, MD, Amos Pines, MD, Margalit Drory, MSW, Arie Roth, MD, Shlomo Laniado, MD, and Gad Keren, MD, Tel-Aviv Sourasky Medical Center, Tel-Aviv; Daniel David, MD, Morton Leibowitz, MD, and Hana Pausner, MD, Meir Medical Center, Kfar Sava; Zvi Schlesinger, MD, and Zvi Vered, MD, Assaf Harofeh Medical Center, Zerifin; Alexander Battler, MD, Alejandro Solodky, MD, and Samuel Sclarovsky, MD, Beilinson Medical Center, Petach Tikvah; Izhar Zehavi, MD, and Rachel Marom-Klibansky, MD, Hasharon Medical Center, Petah Tikvah; and Ron Leor, MD, Laniado Medical Center, Netanya.
Rights and permissions
About this article
Cite this article
Gerber, Y., Myers, V., Goldbourt, U. et al. Long-term trajectory of leisure time physical activity and survival after first myocardial infarction: a population-based cohort study. Eur J Epidemiol 26, 109–116 (2011). https://doi.org/10.1007/s10654-010-9523-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10654-010-9523-8