Walking Compared with Vigorous Exercise for the Prevention of Cardiovascular Events in Women

[Guest guest]

Walking Compared with Vigorous Exercise for the Prevention of

Cardiovascular Events in Women

JoAnn E. Manson, M.D., Dr.P.H., Philip Greenland, M.D., Z.

LaCroix, Ph.D., Marcia L. Stefanick, Ph.D., P. Mouton, M.D.,

Albert Oberman, M.D., M.P.H., G. Perri, Ph.D., S. Sheps,

M.D., B. Pettinger, M.S., and S. Siscovick, M.D., M.P.H.

ABSTRACT

Background The role of walking, as compared with vigorous exercise, in

the prevention of cardiovascular disease remains controversial. Data for

women who are members of minority racial or ethnic groups are

particularly sparse.

Methods We prospectively examined the total physical-activity score,

walking, vigorous exercise, and hours spent sitting as predictors of the

incidence of coronary events and total cardiovascular events among

73,743 postmenopausal women 50 to 79 years of age in the Women's Health

Initiative Observational Study. At base line, participants were free of

diagnosed cardiovascular disease and cancer, and all participants

completed detailed questionnaires about physical activity. We documented

345 newly diagnosed cases of coronary heart disease and 1551 total

cardiovascular events.

Results An increasing physical-activity score had a strong, graded,

inverse association with the risk of both coronary events and total

cardiovascular events. There were similar findings among white women and

black women. Women in increasing quintiles of energy expenditure

measured in metabolic equivalents (the MET score) had age-adjusted

relative risks of coronary events of 1.00, 0.73, 0.69, 0.68, and 0.47,

respectively (P for trend, <0.001). In multivariate analyses, the

inverse gradient between the total MET score and the risk of

cardiovascular events remained strong (adjusted relative risks for

increasing quintiles, 1.00, 0.89, 0.81, 0.78, and 0.72, respectively; P

for trend <0.001). Walking and vigorous exercise were associated with

similar risk reductions, and the results did not vary substantially

according to race, age, or body-mass index. A brisker walking pace and

fewer hours spent sitting daily also predicted lower risk.

Conclusions These prospective data indicate that both walking and

vigorous exercise are associated with substantial reductions in the

incidence of cardiovascular events among postmenopausal women,

irrespective of race or ethnic group, age, and body-mass index.

Prolonged sitting predicts increased cardiovascular risk.

Source Information

From the Division of Preventive Medicine, Harvard Medical School and

Brigham and Women's Hospital, Boston (J.E.M.); the Department of

Preventive Medicine, Northwestern University Medical School, Chicago

(P.G.); the Fred Hutchinson Cancer Research Center (A.Z.L., M.B.P.) and

the Departments of Medicine and Epidemiology (D.S.S.), University of

Washington, Seattle; Stanford Center for Research in Disease Prevention,

Stanford, Calif. (M.L.S.); the University of Texas Health Science

Center, San (C.P.M.); the Division of Preventive Medicine,

University of Alabama at Birmingham, Birmingham (A.O.); and the

Department of Clinical and Health Psychology (M.G.P.) and Division of

Cardiology (D.S.S.), University of Florida, Gainesville.

Address reprint requests to Dr. Manson at the Division of Preventive

Medicine, Brigham and Women's Hospital, 900 Commonwealth Ave., Boston,

MA 02215, or at jmanson@....