Gary O’Donovan

Does Strength-Promoting Exercise Confer Unique Health Benefits? A Pooled Analysis of Data on 11 Population Cohorts With All-Cause, Cancer, and Cardiovascular Mortality Endpoints

Abstract Public health guidance includes recommendations to engage in strength‐promoting exercise (SPE), but there is little evidence on its links with mortality. Using data from the Health Survey for England and the Scottish Health Survey from 1994‐2008, we examined the associations between SPE (gym‐based and own‐body‐weight strength activities) and all‐cause, cancer, and cardiovascular disease mortality. Multivariable‐adjusted Cox regression was used to examine the associations between SPE (any, low‐/high‐volume, and adherence to the SPE guideline (≥2 sessions/week)) and mortality. The core sample comprised 80,306 adults aged ≥30 years, corresponding to 5,763 any‐cause deaths (736,463 person‐years). Following exclusions for prevalent disease/events occurring in the first 24 months, participation in any SPE was favorably associated with all‐cause (hazard ratio (HR) = 0.77, 95% confidence interval (CI): 0.69, 0.87) and cancer (HR = 0.69, 95% CI: 0.56, 0.86) mortality. Adhering only to the SPE guideline was associated with all‐cause (HR = 0.79, 95% CI: 0.66, 0.94) and cancer (HR = 0.66, 95% CI: 0.48, 0.92) mortality; adhering only to the aerobic activity guideline (equivalent to 150 minutes/week of moderate‐intensity activity) was associated with all‐cause (HR = 0.84, 95% CI: 0.78, 0.90) and cardiovascular disease (HR = 0.78, 95% CI: 0.68, 0.90) mortality. Adherence to both guidelines was associated with all‐cause (HR = 0.71, 95% CI: 0.57, 0.87) and cancer (HR = 0.70, 95% CI: 0.50, 0.98) mortality. Our results support promoting adherence to the strength exercise guidelines over and above the generic physical activity targets.

Sarcopenic obesity, weight loss, and mortality: the English Longitudinal Study of Ageing

Background: Age-related sarcopenia describes the loss of muscle strength and often accompanies an increase in adiposity in the elderly.Objective: We examined the association of sarcopenic obesity and changes in muscle strength and weight with the risk of mortality.Design: Participants (n = 6864) were community-dwelling men and women (45.6% men; 54.4% women; mean ± SD age: 66.2 ± 9.5 y) from the English Longitudinal Study of Ageing. Handgrip strength and body mass index (BMI; in kg/m2) were measured at baseline and at a 4-y follow-up. Individual participant data were linked with death records from National Health Service registries. Sarcopenic obesity was defined as obese individuals (BMI ≥30) in the lowest tertile of sex-specific grip strength (<35.3 kg for men and <19.6 kg for women).Results: There were 906 deaths over a mean follow-up of 8 y. Compared with the reference group (normal BMI and highest handgrip tertile), the risk of all-cause mortality increased as grip strength reduced within each BMI category. For participants in the lowest handgrip tertile, there was little difference in the risk between normal BMI (HR: 3.25; 95% CI: 1.86, 5.65), overweight (HR: 2.50; 95% CI: 1.44, 4.35), and obesity (HR: 2.66; 95% CI: 1.86, 3.80) after adjusting for covariates. The risk of all-cause mortality was significantly greater in participants who experienced weight loss over 4 y (HR: 2.21; 95% CI: 1.32, 3.71) and/or reduced hand grip strength (HR: 1.53; 95% CI: 10.07, 2.17) than in those with stable weight and grip strength, with the highest risk in those with both weight loss and reduced strength (HR: 3.77; 95% CI: 2.54, 5.60).Conclusions: Sarcopenic obesity did not confer any greater risk than sarcopenia alone. Weight loss combined with sarcopenia presented the greatest risk of mortality.

High-Density Lipoprotein Cholesterol and Mortality: Too Much of a Good Thing?

Objective— The objective of this study was to examine the shape of the association between high-density lipoprotein cholesterol (HDL-C) and mortality in a large general population sample. Approach and Results— Adult participants (n=37 059; age=57.7±11.9 years; 46.8% men) were recruited from general population household-based surveys (Health Survey for England and Scottish Health Survey). Individual participant data were linked with the British National Health Service Central Registry to record mortality. There were 2250 deaths from all causes during 326 016 person-years of follow-up. When compared with the reference category (HDL-C=1.5–1.99 mmol/L), a U-shaped association was apparent for all-cause mortality, with elevated risk in participants with the lowest (hazard ratio=1.23; 95% confidence interval, 1.06, 1.44) and highest (1.25; 0.97, 1.62) HDL-C concentration. Associations for cardiovascular disease were linear, and elevated risk was observed in those with the lowest HDL-C concentration (1.49; 1.15, 1.94). Conclusions— A U-shaped association was observed between HDL-C and mortality in a large general population sample.

Associations between alcohol and obesity in more than 100 000 adults in England and Scotland

The objective of this cross-sectional study was to clarify the association between alcohol and obesity using data from 106 182 adults in England and Scotland (46·7 % male; mean 46·9 (sd 16·9) years). Trained interviewers asked participants about alcohol intake. Obesity was defined as BMI≥30 kg/m2. Potential confounders included age, sex, smoking, physical activity, longstanding illness, psychological distress and socioeconomic status. Compared with those who drank at least five times a week, obesity risk was 1·21 (95 % CI 1·15, 1·27) in those who drank one to four times a week, 1·53 (95 % CI 1·43, 1·62) in those who drank one to two times a month, 1·61 (95 % CI 1·52, 1·71) in those who drank less than once every couple of months, 1·34 (95 % CI 1·23, 1·47) in those who were former drinkers, and 1·03 (95 % CI 0·95, 1·11) in those who were never drinkers. Compared with those who drank a harmful volume, obesity risk was 0·78 (95 % CI 0·68, 0·90) in those who drank within guidelines, 0·69 (95 % CI 0·54, 0·88) in former drinkers and 0·50 (95 % CI 0·40, 0·63) in never drinkers; and, these associations were biased away from the null after adjustment for drinking volume. Abstinence was associated with increased risk of obesity in women. These data suggest that the association between drinking frequency and obesity is bell-shaped, with obesity risk not significantly different in those who drink most often and never drinkers. Drinking volume has a positive confounding effect on the association between drinking frequency and obesity, which may help explain the conflicting findings of other studies.

Physical Inactivity and the Economic and Health Burdens Due to Cardiovascular Disease: Exercise as Medicine

Leisure time physical activity, or exercise, has been described as todays best buy in public health. Physical inactivity is responsible for around 10% of all deaths and physical inactivity costs global healthcare systems billions of dollars each year. Here, we describe the human and economic costs of cardiovascular disease. Then, we explain that physical inactivity is a major modifiable risk factor for cardiovascular disease. The evidence of the role of physical activity in the primary prevention of cardiovascular disease is reviewed and we make the case that exercise is medicine.

Infographic: The ‘weekend warrior’ physical activity pattern and mortality

Our study about the ‘weekend warrior’ physical activity pattern and mortality1 was one of the most talked about studies of 2017.2 Here we offer an infographic summarising the results of our study. The English and Spanish versions of the infographic were created in collaboration with Yann Le Meur of YLMSportScience (www.ylmsportscience.com). Those who choose to do all their exercise on 1 or 2 days of the week have been termed ‘weekend warriors’.3 Data from the Harvard Alumni Health Study suggest that all-cause mortality risk might be lower in weekend warriors than …

Is Weekend-Only Physical Activity Enough to Compensate for a Sedentary Lifestyle?—Reply

This paper was accepted for publication in the journal JAMA Internal Medicine and the definitive published version is available at http://dx.doi.org/10.1001/jamainternmed.2017.2386