title: Physical activity and risk of Amyotrophic Lateral Sclerosis in a prospective cohort study.
abstract: Previous case-control studies have suggested a possible increased risk of Amyotrophic Lateral Sclerosis (ALS) with physical activity (PA), but this association has never been studied in prospective cohort studies. We therefore assessed the association between PA and risk of death from ALS in the European Prospective Investigation into Cancer and Nutrition. A total of 472,100 individuals were included in the analysis, yielding 219 ALS deaths. At recruitment, information on PA was collected thorough standardised questionnaires. Total PA was expressed by the Cambridge Physical Activity Index (CPAI) and analysed in relation to ALS mortality, using Cox hazard models. Interactions with age, sex, and anthropometric measures were assessed. Total PA was weakly inversely associated with ALS mortality with a borderline statistically significant trend across categories (p = 0.042), with those physically active being 33% less likely to die from ALS compared to those inactive: HR = 0.67 (95% CI 0.42-1.06). Anthropometric measures, sex, and age did not modify the association with CPAI. The present study shows a slightly decreased-not increased like in case-control studies-risk of dying from ALS in those with high levels of total PA at enrolment. This association does not appear confounded by age, gender, anthropometry, smoking, and education. Ours was the first prospective cohort study on ALS and physical activity.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus - Norfolk Place, W2 1PG, London, UK. v.gallo@imperial.ac.uk.|Barts and the London School of Medicine, Centre for Primary Care and Public Health, Queen Mary, University of London, London, UK. v.gallo@imperial.ac.uk.
authors.forename: Valentina
authors.initials: V
authors.lastname: Gallo
authors.affiliation: Italian National Institute of Health, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Vanacore
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus - Norfolk Place, W2 1PG, London, UK.|National Institute for Public Health and the Environment, Bilthoven, The Netherlands.|Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.affiliation: Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands.
authors.forename: Roel
authors.initials: R
authors.lastname: Vermeulen
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Carol
authors.initials: C
authors.lastname: Brayne
authors.affiliation: Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Pearce
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus - Norfolk Place, W2 1PG, London, UK.
authors.forename: Petra A
authors.initials: PA
authors.lastname: Wark
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus - Norfolk Place, W2 1PG, London, UK.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Ward
authors.affiliation: International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ferrari
authors.affiliation: International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: Mazda
authors.initials: M
authors.lastname: Jenab
authors.affiliation: Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Andersen
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Patrik
authors.initials: P
authors.lastname: Wennberg
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Wareham
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Katzke
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, The Artic University of Norway, Tromsö, Norway.|Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|Folkhälsan Research Center, University of Helsinki, Helsinki, Finland.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus - Norfolk Place, W2 1PG, London, UK.|Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Petra H
authors.initials: PH
authors.lastname: Peeters
authors.affiliation: Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
authors.forename: Amalia
authors.initials: A
authors.lastname: Mattiello
authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Pala
authors.affiliation: Navarre Public Health Institute, Pamplona, Spain.|Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Barricante
authors.affiliation: Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.|Epidemiology Department, Murcia Regional Health Council, Murcia, Spain.
authors.forename: Maria-Dolores
authors.initials: MD
authors.lastname: Chirlaque
authors.affiliation: Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Noémie
authors.initials: N
authors.lastname: Travier
authors.affiliation: Cancer Epidemiological Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
authors.forename: Ruth C
authors.initials: RC
authors.lastname: Travis
authors.affiliation: Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain.|Andalusian School of Public Health, Granada, Spain.
authors.forename: Maria-Jose
authors.initials: MJ
authors.lastname: Sanchez
authors.affiliation: Department of Neurology, Skåne University Hospital, Lund University, Malmö, Sweden.
authors.forename: Hélène
authors.initials: H
authors.lastname: Pessah-Rasmussen
authors.affiliation: Department of Neurology, Skåne University Hospital, Lund University, Malmö, Sweden.
authors.forename: Jesper
authors.initials: J
authors.lastname: Petersson
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.affiliation: Ragusa Cancer Registry, Azienda Ospedaliera "Civile MP Arezzo", Ragusa, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.affiliation: Public Health Directorate, Asturias, Oviedo, Spain.
authors.forename: Jose Ramon
authors.initials: JR
authors.lastname: Quiros
authors.affiliation: Hellenic Health Foundation, Athens, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.affiliation: Hellenic Health Foundation, Athens, Greece.|First Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kyrozis
authors.affiliation: Hellenic Health Foundation, Athens, Greece.
authors.forename: Despoina
authors.initials: D
authors.lastname: Oikonomidou
authors.affiliation: Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Masala
authors.affiliation: Centre for Cancer Prevention (CPO-Piemonte), Turin, Italy.|Human Genetic Foundation (HuGeF), Turin, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Sacerdote
authors.affiliation: Public Health Division of Gipuzkoa, Donostia-San Sebastian, Spain.
authors.forename: Larraitz
authors.initials: L
authors.lastname: Arriola
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition, Potsdam, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition, Potsdam, Germany.
authors.forename: Matthaeus
authors.initials: M
authors.lastname: Vigl
authors.affiliation: Inserm, Centre for Research in Epidemiology and Population Health, Institut Gustave-Roussy, Villejuif, France.
authors.forename: Francoise
authors.initials: F
authors.lastname: Claver-Chapelon
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus - Norfolk Place, W2 1PG, London, UK.
authors.forename: Lefkos
authors.initials: L
authors.lastname: Middleton
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus - Norfolk Place, W2 1PG, London, UK.
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus - Norfolk Place, W2 1PG, London, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: Vineis
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000453:epidemiology* / Q000209:etiology; D000886:Anthropometry; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Amyotrophic Lateral Sclerosis; BMI; Cohort study; EPIC study; Physical activity; Vigorous physical activity