Marc Nocon

Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis:

Background Over the past several decades, numerous large cohort studies have attempted to quantify the protective effect of physical activity on cardiovascular and all-cause mortality. The aim of the authors’ review was to provide an up-to-date overview of the study results. Methods In a systematic MEDLINE search conducted in May 2007, the authors included cohort studies that assessed the primary preventive impact of physical activity on all-cause and cardiovascular mortality. The authors reported risk reductions on the basis of comparison between the least active and the most active population subgroups, with the least active population subgroup as the reference group. Random-effect models were used for meta-analysis. Results A total of 33 studies with 883372 participants were included. Follow-up ranged from 4 years to over 20 years. The majority of studies reported significant risk reductions for physically active participants. Concerning cardiovascular mortality, physical activity was associated with a risk reduction of 35% (95% confidence interval, 30–40%). All-cause mortality was reduced by 33% (95% confidence interval, 28–37%). Studies that used patient questionnaires to assess physical activity reported lower risk reductions than studies that used more objective measures of fitness. Conclusions Physical activity is associated with a marked decrease in cardiovascular and all-cause mortality in both men and women, even after adjusting for other relevant risk factors.

Long-term effectiveness of interventions promoting physical activity: A systematic review

BACKGROUND This systematic review aims to evaluate the long-term effectiveness of physical activity interventions targeted at healthy adults and to identify effective intervention components. METHODS The systematic search in Pubmed, Embase, the Cochrane Library and Psycinfo identified literature published in English and German between January 2001 and June 2007. We included randomised controlled trials investigating physical activity interventions for healthy adults with a minimum study duration of 12 months. Two researchers independently assessed publications according to pre-defined inclusion criteria and methodological quality was rated according to the SIGN criteria. Study characteristics and outcome measures were extracted, and pooled effect estimates with 95% confidence intervals calculated. RESULTS Of 5508 identified publications 25 studies met the inclusion criteria. There was substantial heterogeneity in study quality, intervention strategies and intervention effects. Compared to no-intervention and minimal-intervention control, gains in weekly energy expenditure and physical fitness of up to 975 kcal and 11% were achieved, respectively. Booster interventions were used in 16 studies. CONCLUSIONS There is evidence for long-term increases in physical activity behaviour and physical fitness. To improve uptake of physical activity additional tailored exercise prescription strategies seem promising. Booster interventions such as phone, mail or internet can help to facilitate long-term effectiveness.

Lifestyle factors and symptoms of gastro‐oesophageal reflux – a population‐based study

Although the symptoms of gastro‐oesophageal reflux disease are common in the general adult population, the aetiology of gastro‐oesophageal reflux disease is still largely unknown. Lifestyle factors such as diet, body mass index, and smoking have been frequently suggested as possible risk factors.

Prospective Follow-Up Data from the ProGERD Study Suggest that GERD Is Not a Categorial Disease

OBJECTIVES:There is a controversy as to whether gastroesophageal reflux disease (GERD) exists as a spectrum of disease severity or as a categorial disease in three distinct groups: nonerosive (NERD) and erosive reflux disease (ERD) and Barretts esophagus (BE). Aim of the study was to assess progression or regression of GERD over 2 yr in a large cohort of patients (N = 3,894) under routine clinical care in Germany, Austria, and Switzerland (ProGERD study).METHOD:Patients with predominant heartburn, with or without esophagitis, were recruited and classified according to endoscopic status at baseline, i.e., NERD, erosive reflux disease-Los Angeles (ERD-LA) grade A/B and ERD-LA grade C/D, and BE. After an initial treatment with esomeprazole, they were followed, regardless of their response. Medical therapy or endoscopy was initiated at the discretion of their primary care physician, in line with routine care. At 2 yr, endoscopy with biopsy was performed according to the protocol.RESULTS:After 2 yr, 25% of patients who had NERD at baseline progressed to LA A/B and 0.6% to LA C/D; 1.6% of patients who had LA A/B progressed to LA C/D and 61% regressed to NERD; 42% of patients who had LA C/D regressed to LA A/B and 50% regressed to NERD (all figures exclude patients with confirmed BE at baseline). At 2 yr, 22% of patients had been off medication for at least 3 months. Patients with ERD-LA grade C/D were at greatest risk of developing BE: 5.8% compared with 1.4% for ERD-LA grade A/B and 0.5% for NERD.CONCLUSION:GERD does not seem to be a categorial disease. Progression and regression between grades was observed in this large cohort of patients under routine clinical care.

Evolution of gastro-oesophageal reflux disease over 5 years under routine medical care - the ProGERD study

Aliment Pharmacol Ther 2012; 35: 154–164

Association of body mass index with heartburn, regurgitation and esophagitis: Results of the Progression of Gastroesophageal Reflux Disease study

Background:  Overweight and obesity are believed to be risk factors for gastroesophageal reflux disease (GERD). The aim of the present study was to analyze the impact of body mass index (BMI) on the severity and frequency of reflux symptoms and esophagitis in a large cohort of reflux patients.

Increasing physical activity with point-of-choice prompts - a systematic review.

Aims: Stair climbing is an activity that can easily be integrated into everyday life and has positive health effects. Point-of-choice prompts are informational or motivational signs near stairs and elevators/escalators aimed at increased stair climbing. The aim of this review was to assess the effectiveness of point-of-choice prompts for the promotion of stair climbing. Methods: In a systematic search of the literature, studies that assessed the effectiveness of point-of-choice prompts to increase the rate of stair climbing in the general population were identified. No restrictions were made regarding the setting, the duration of the intervention, or the kind of message. Results: A total of 25 studies were identified. Point-of-choice prompts were predominantly posters or stair-riser banners in public traffic stations, shopping malls or office buildings. The 25 studies reported 42 results. Of 10 results for elevator settings, only three reported a significant increase in stair climbing, whereas 28 of 32 results for escalator settings reported a significant increase in stair climbing. Conclusions: Overall, point-of-choice prompts are able to increase the rate of stair climbing, especially in escalator settings. In elevator settings, point-of-choice prompts seem less effective. The long-term efficacy and the most efficient message format have yet to be determined in methodologically rigorous studies.

Education, income, occupational status and health risk behaviour

AimSocio-economic status is associated with a variety of health-related behaviours. In our study, we determined the independent effects of income, educational attainment and occupational status on overweight, smoking and physical activity in the German population.Subjects and methodsThe German National Health Interview and Examination Survey is a representative sample of the German adult population and includes 7,124 men and women. Prevalences of obesity, smoking and physical inactivity stratified for education, income and occupational status were calculated. Multiple logistic regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (CI) for education, income, occupational status and health-related behaviour, adjusted for age and gender.ResultsHealth risk behaviours were more prevalent in subjects with lower education, income or occupational status. After mutual adjustment, education, income and occupation were independently associated with physical inactivity. Low education was strongly associated with both obesity (OR: 2.58, 95% CI: 1.99–3.34) and smoking (OR: 2.09, 95% CI: 1.71–2.54). Low income was associated with smoking (OR: 1.40, 95% CI: 1.07–1.83), but not with obesity, and low occupational status was associated with obesity (OR: 1.42, 95% CI: 1.05–1.92), but not with smoking. High income or occupation could not compensate for the impact of low education on obesity and smoking.ConclusionLow socio-economic status is associated with health risk behaviours. Concerning obesity and smoking, education was more important than income or occupational status. Public health programmes to reduce these risk factors should focus on early-life health education.

Prevalence and sociodemographics of reflux symptoms in Germany--results from a national survey.

Although gastro‐oesophageal reflux disease is a common gastrointestinal disorder, the prevalence rates differ depending on the population studied.

Cost‐of‐disease analysis in patients with gastro‐oesophageal reflux disease and Barrett's mucosa

Gastro‐oesophageal reflux disease (GERD) is a common and frequently chronic condition that causes considerable costs.