title: Leisure-Time Physical Activity and Cardiovascular Mortality in an Elderly Population in Northern Manhattan: A Prospective Cohort Study.
abstract: BACKGROUND
  Previous studies of exercise have focused on measuring physical activity in totality using summary statistics such as metabolic equivalent score for total intensity or total energy count.
  
  
  OBJECTIVE
  We aimed to examine the multidimensionality of leisure-time physical activity (LTPA) and to identify the specific LTPA components that were associated with cardiovascular mortality in the elderly.
  
  
  METHODS
  The Northern Manhattan Study (NOMAS) is a multiethnic prospective cohort of elderly stroke-free individuals consisting of a total of 3298 participants recruited between 1993 and 2001, with a median follow-up of 17 years.
  
  
  METHODS
  Physical activity questionnaire data were available in 3293 NOMAS participants, who were categorized into subgroups with similar exercise patterns by model-based cluster analysis. Three subgroup-defining LTPA features were identified and were considered as primary exposures in Cox proportional hazard models: frequency of activity, number of activity types (variety), and energy-to-duration ratio (EDR). We considered cardiovascular mortality and non-cardiovascular mortality as outcomes in Cox cause-specific proportional hazard models, and all-cause mortality as outcome in Cox models.
  
  
  RESULTS
  A high activity frequency was associated with reduced cardiovascular mortality (hazard ratio, HR = 0.93, P = 0.03), but demonstrated no effect on non-cardiovascular death. A high EDR was associated with increased risk of cardiovascular death (HR = 1.30, P = 0.01). A high number of activity types was beneficial in reducing all-cause mortality (HR = 0.87, P = 0.01).
  
  
  CONCLUSIONS
  Exercise frequency was protective against cardiovascular mortality, and a high variety of activity was protective against all-cause mortality. The performance of frequent and varied non-intense exercise in an elderly population such as ours is achievable and can reduce the risk of death.
authors.affiliation: Department of Biostatistics, Columbia University, New York, NY, USA.
authors.forename: Ying Kuen
authors.initials: YK
authors.lastname: Cheung
authors.affiliation: Department of Neurology, Columbia University, 710 West 168th street, New York, NY, 10032, USA.
authors.forename: Yeseon P
authors.initials: YP
authors.lastname: Moon
authors.affiliation: Department of Neurology, Columbia University, 710 West 168th street, New York, NY, 10032, USA.
authors.forename: Erin R
authors.initials: ER
authors.lastname: Kulick
authors.affiliation: Department of Neurology, University of Miami, New York, NY, USA.
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.affiliation: Department of Neurology, Columbia University, 710 West 168th street, New York, NY, 10032, USA.|Department of Epidemiology, Columbia University, New York, NY, USA.
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.affiliation: Department of Neurology, Columbia University, 710 West 168th street, New York, NY, 10032, USA. jzw2@columbia.edu.
authors.forename: Joshua Z
authors.initials: JZ
authors.lastname: Willey
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D015897:Comorbidity; D015444:Exercise; D005260:Female; D006801:Humans; D007899:Leisure Activities; D008137:Longitudinal Studies; D008297:Male; D009519:New York City / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: cardiovascular; exercise; mortality