title: Estimating the effect of long-term physical activity on cardiovascular disease and mortality: evidence from the Framingham Heart Study.
abstract: OBJECTIVE
  In the majority of studies, the effect of physical activity (PA) on cardiovascular disease (CVD) and mortality is estimated at a single time point. The impact of long-term PA is likely to differ. Our study objective was to estimate the effect of long-term adult-life PA compared with long-term inactivity on the risk of incident CVD, all-cause mortality and CVD-attributable mortality.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Framingham, MA, USA.
  
  
  METHODS
  4729 Framingham Heart Study participants who were alive and CVD-free in 1956.
  
  
  METHODS
  PA was measured at three visits over 30 years along with a variety of risk factors for CVD. Cumulative PA was defined as long-term active versus long-term inactive.
  
  
  METHODS
  Incident CVD, all-cause mortality and CVD-attributable mortality.
  
  
  RESULTS
  During 40 years of follow-up there were 2594 cases of incident CVD, 1313 CVD-attributable deaths and 3521 deaths. Compared with long-term physical inactivity, the rate ratio of long-term PA was 0.95 (95% CI 0.84 to 1.07) for CVD, 0.81 (0.71 to 0.93) for all-cause mortality and 0.83 (0.72 to 0.97) for CVD-attributable mortality. Assessment of effect modification by sex suggests greater protective effect of long-term PA on CVD incidence (p value for interaction=0.004) in men (0.79 (0.66 to 0.93)) than in women (1.15 (0.97 to 1.37)).
  
  
  CONCLUSIONS
  Cumulative long-term PA has a protective effect on incidence of all-cause and CVD-attributable mortality compared with long-term physical inactivity. In men, but not women, long-term PA also appears to have a protective effect on incidence of CVD.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. shortreed.s@ghc.org
authors.forename: Susan M
authors.initials: SM
authors.lastname: Shortreed
authors.forename: Anna
authors.initials: A
authors.lastname: Peeters
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Forbes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D015331:Cohort Studies; D015444:Exercise; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D057185:Sedentary Behavior; D012737:Sex Factors; D014481:United States / Q000453:epidemiology