title: Walking compared with vigorous exercise for the prevention of cardiovascular events in women.
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.
authors.affiliation: Division of Preventive Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston 02215, USA. jmanson@rics.bwh.harvard.edu
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Stefanick
authors.forename: Charles P
authors.initials: CP
authors.lastname: Mouton
authors.forename: Albert
authors.initials: A
authors.lastname: Oberman
authors.forename: Michael G
authors.initials: MG
authors.lastname: Perri
authors.forename: David S
authors.initials: DS
authors.lastname: Sheps
authors.forename: Mary B
authors.initials: MB
authors.lastname: Pettinger
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D003327:Coronary Disease / Q000401:mortality; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D017698:Postmenopause / Q000502:physiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015203:Reproducibility of Results; D012306:Risk; D011795:Surveys and Questionnaires; D016138:Walking / Q000502:physiology*