title: Low-dose physical activity attenuates cardiovascular disease mortality in men and women with clustered metabolic risk factors.
abstract: BACKGROUND
  Physical activity may ameliorate the health hazards of metabolic disorders but evidence is inconclusive, and estimates of the minimal threshold for protection remain unknown.
  
  
  RESULTS
  The sample comprised 23 747 men and women (aged 54.1 ± 12.7 years [mean±SD], 45.2% men) without a known history of cardiovascular disease at baseline who were drawn from the Health Survey for England and the Scottish Health Survey. Based on blood pressure, high-density lipoprotein cholesterol, diabetes, waist circumference, and low-grade inflammation (C-reactive protein ≥ 3 mg/L), participants were classified as metabolically healthy (zero or one metabolic abnormality) or unhealthy (≥ 2 metabolic abnormalities). Self-reported physical activity was assessed at baseline. Cox proportional hazards models were used to examine the association of clustered metabolic risk and physical activity with mortality, controlling for age, sex, smoking, socioeconomic group, cardiovascular disease medication, and self-rated health. Over 7.0 ± 3.0 years follow-up, there were 2264 all-cause and 717 cardiovascular disease deaths, respectively. A physical activity threshold of at least one to 2 sessions per week was found to provide protection against mortality. Compared with active/metabolically healthy, the active with clustered metabolic abnormalities were not at elevated risk of cardiovascular disease (hazard ratio, 0.82; 95% CI, 0.54 -1.26) or all-cause mortality (hazard ratio, 1.11; 95% CI, 0.89 -1.39), although their inactive counterparts were at elevated risk of cardiovascular disease (hazard ratio, 1.41; 95% CI, 1.05 -1.91) and all-cause mortality (hazard ratio, 1.50; 95% CI, 1.27-1.78).
  
  
  CONCLUSIONS
  The risk of cardiovascular disease associated with poor metabolic health is substantially lower among those who are physically active. At minimum, a weekly bout of moderate to vigorous physical activity is protective in men and women with clustered metabolic abnormalities.
authors.affiliation: Department of Epidemiology and Public Health, University College, London, UK. m.hamer@ucl.ac.uk
authors.forename: Mark
authors.initials: M
authors.lastname: Hamer
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Stamatakis
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D015444:Exercise; D005260:Female; D006293:Health Promotion; D006306:Health Surveys; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008875:Middle Aged; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D057185:Sedentary Behavior; D057566:Self Report; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology