Coronary heart disease: decreased physical activity increased the risk of CHD death.

Clinical bottom line (level 1b)

  1. Patients in the general population were at an increased risk of coronary heart disease if they were sedentary, compared with those who take a high level of activity.
  2. Patients were at an increased risk of death from CHD if they were sedentary or take low or moderate levels of exercise, compared with high levels.
  3. Patients were at an increased risk of myocardial infarction if they took low levels of activity, compared with high.
  4. There was an increased risk of MI or sudden death in those who took low activity, compared with high.
Berlin and Colditz: American Journal of Epidemiology 1990; 132 (4): 612-628
Expires March 2003

The study

Systematic review of cohort studies of
  • Patients: general population
  • Intervention: physical activity- work or leisure-related activities compared with no physical activity
  • Outcome: incidence of coronary heart disease (CHD), death from CHD, myocardial infarction (MI), MI plus sudden death and angina pectoris


Articles found in ? languages using MEDLINE, dates not given (search terms: none given ) and data was taken from a previous meta-analysis by Powell at al, and added to by handsearching reference lists of studies already found.

Selection criteria: as above
Appraisal criteria: detailed in text
Articles excluded if: studies which did not report relative risks or a confidence interval or both

27 cohorts were included.
There was some heterogeneity between the studies.

The evidence

outcome time to outcome number of patients/total number %
(95% CI)
coronary heart disease ? / %
(% to %)
CHD death ? / %
(% to %)
myocardial infarction ? / %
(% to %)
MI and sudden death ? / %
(% to %)

prognostic factor for
coronary heart disease 		time to outcome adjusted RR
(95% CI)
sedentary versus high activity ? 1.40
(1.00 to 1.80)

prognostic factor for
CHD death 		time to outcome adjusted RR
(95% CI)
sedentary versus high activity ? 1.90
(1.60 to 2.20)
low activity versus high activity ? 1.50
(1.10 to 2.00)
moderate activity versus high activity ? 1.40
(1.20 to 1.80)

prognostic factor for
myocardial infarction 		time to outcome adjusted RR
(95% CI)
low activity versus high activity ? 2.40
(1.80 to 3.20)

prognostic factor for
MI and sudden death 		time to outcome adjusted RR
(95% CI)
low activity versus high activity ? 1.60
(1.00 to 2.40)

  • Physical activity is not clearly associated with angina pectoris.

Comments

  1. The Framingham Study (and the Puerto Rico Heart Health Program) was excluded because it did not report relative risks or confidence intervals.
  2. Logistic regression was used to adjust for at least age as a confounding factor.
  3. No description of each activity group (low, moderate or high activity) was given.
  4. Data was not available for all outcomes and all levels of intensity of activity.
  5. The authors noted that methodologically stronger studies tended to show a larger benefit of physical activity than less well designed ones.

Citation

  1. Berlin JA, and Colditz GA: A meta-analysis of physical activity in the prevention of coronary heart disease. American Journal of Epidemiology 1990; 132 (4): 612-628
Contributor: Clare Wotton and Musab Hayatli, February 2000
Reviewer:

Clinical Question.
    Patient general population
    Intervention or Exposure physical activity
    Comparison no physical activity
    Outcome risk of CHD and CHD death