title: Physical activity and the association with sporadic ALS.
abstract: OBJECTIVE
  To assess whether lifetime physical activity during work and leisure time is associated with an increased risk of developing ALS and to determine the association between physical activity and duration or age at onset of disease.
  
  
  METHODS
  Patients referred to our clinic during the 1-year period 2001 to 2002 who had definite, probable, or possible ALS according to El Escorial criteria, without a familial history of ALS, were asked to participate in the study. A case-control study was performed taking into account all occupational and leisure time activities of patients (n = 219) and controls (n = 254). Multivariate analysis included confounding factors (sex, age, level of education, body mass index, alcohol use, and smoking). Three quantitative measures of cumulative physical activity were calculated: until 1 year before the onset of disease (total physical activity), the last 10 years before the onset of disease (late physical activity), and until the age of 25 (early physical activity). In addition, a systematic review of all published data is presented.
  
  
  RESULTS
  Smoking and alcohol use were independently associated with ALS (current smoking increased risk, OR = 1.8, 95% CI = 1.0 to 3.0, p = 0.03, ever/current alcohol use decreased risk, OR = 0.6, 95% CI = 0.3 to 0.9, p = 0.04). No significant association with occupational or leisure time physical activity was found (all ORs < or = 1.7), which was in agreement with most studies with the highest level of evidence in the systematic review. Higher leisure time activities were associated with an earlier age at onset: activity levels before age of 25 (p < 0.001, 7 years earlier), and activity during the last 10 years (p < 0.001, 3 years earlier).
  
  
  CONCLUSIONS
  There is no association between physical activity and the risk of developing ALS.
authors.affiliation: Department of Neurology of the Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands.
authors.forename: J H
authors.initials: JH
authors.lastname: Veldink
authors.forename: S
authors.initials: S
authors.lastname: Kalmijn
authors.forename: G J
authors.initials: GJ
authors.lastname: Groeneveld
authors.forename: M J
authors.initials: MJ
authors.lastname: Titulaer
authors.forename: J H J
authors.initials: JH
authors.lastname: Wokke
authors.forename: L H
authors.initials: LH
authors.lastname: van den Berg
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D000690:Amyotrophic Lateral Sclerosis / Q000453:epidemiology*; D015992:Body Mass Index; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007899:Leisure Activities; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009426:Netherlands / Q000453:epidemiology; D009790:Occupations; D016017:Odds Ratio; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013177:Sports; D011795:Surveys and Questionnaires