Original Article
Relation of Leisure-Time Physical Activity and Cardiorespiratory Fitness to the Risk of Acute Myocardial Infarction in Men
N Engl J Med 1994; 330:1549-1554June 2, 1994
- Abstract
Background
Previous studies have suggested that higher levels of regular physical activity and cardiorespiratory fitness are associated with a reduced risk of coronary heart disease. We investigated the independent associations of physical activity during leisure time and maximal oxygen uptake (a measure of cardiorespiratory fitness) with the risk of acute myocardial infarction.
Methods
During the period 1984 to 1989, we performed base-line examinations in 1453 men 42 to 60 years old who did not report having cardiovascular disease or cancer. Physical activity was assessed quantitatively with a detailed questionnaire, and maximal oxygen uptake was measured directly by exercise testing. During an average follow-up of 4.9 years, 42 of the 1166 men with normal electrocardiograms at base line had a first acute myocardial infarction.
Results
After adjustment for age and the year of examination, the relative hazard (risk) of myocardial infarction in the third of subjects with the highest level of physical activity (>2.2 hours per week) was 0.31 (95 percent confidence interval, 0.12 to 0.85; P = 0.02), as compared with the third with the lowest level (P = 0.04 for linear trend over all three groups). The relative hazard in the third with the highest maximal oxygen uptake (>2.7 liters per minute) was 0.26 (95 percent confidence interval, 0.10 to 0.68; P = 0.006) (P = 0.006 for linear trend), after adjustment for age, the year and season when the examination was performed, weight, height, and the type of respiratory-gas analyzer used. After up to 17 confounding variables were controlled for, the relative hazards for the third of subjects with the highest level of physical activity (0.34; 95 percent confidence interval, 0.12 to 0.94; P = 0.04) and maximal oxygen uptake (0.35; 95 percent confidence interval, 0.13 to 0.92; P = 0.03), as compared with the values in the lowest third, were significantly (P<0.05) less than 1.0.
Conclusions
Higher levels of both leisure-time physical activity and cardiorespiratory fitness had a strong, graded, inverse association with the risk of acute myocardial infarction, supporting the idea that lower levels of physical activity and cardiorespiratory fitness are independent risk factors for coronary heart disease in men.
Media in This Article
Table 1
Leisure-Time Physical Activity and Maximal Oxygen Uptake in 1453 Men in Eastern Finland Who Reported Having No Cardiovascular Disease or Cancer.Table 2
Risk Factors for a First Acute Myocardial Infarction in the Study Cohort.Article Activity
- Article
Higher levels of physical activity1-11 and cardiorespiratory fitness11-17 have been found to be associated with a decreased incidence of and mortality from coronary heart disease. However, only a few previous studies7,9,11,12,14,16 have simultaneously investigated the associations of physical activity and cardiorespiratory fitness with the risk of coronary disease.
Data on the type, duration, and intensity of physical activity needed to protect against coronary heart disease are limited and inconsistent. Some studies5 suggest that regular and vigorous exercise is necessary, whereas others7,9,10 indicate that exercise of moderate duration and intensity is sufficient to reduce the risk. Furthermore, little is known about the level of cardiorespiratory fitness required to protect against coronary heart disease.
Most studies of the association of physical activity with the risk of coronary heart disease have not used truly quantitative assessments of physical activity1. Furthermore, there is little or no information on the relation of direct measurements of maximal oxygen uptake, the most accurate method for assessing cardiorespiratory fitness,18 to risk. Few studies have adequately controlled for confounding variables1.
We investigated the associations of the type, duration, and intensity of leisure-time physical activity, assessed quantitatively by means of a detailed questionnaire, and directly measured maximal oxygen uptake with the risk of acute myocardial infarction in men from eastern Finland, after controlling for a number of potentially relevant confounders. We also attempted to estimate the “dose-response” relations of leisure-time physical activity and maximal oxygen uptake to the risk of coronary heart disease.
Methods
Subjects
The Kuopio Ischemic Heart Disease Risk Factor Study is a population-based study undertaken to investigate previously unestablished risk factors for acute myocardial infarction and extracoronary atherosclerosis19 among men in eastern Finland, a group with one of the highest recorded risks of coronary heart disease20. The study population is a random sample of men living in the town of Kuopio or neighboring rural communities, stratified and balanced according to age, who were 42, 48, 54, or 60 years old at the base-line examination. The base-line study was carried out between March 1984 and December 1989. Of 3235 eligible men, 2682 (83 percent) participated.
Men who reported that they had cardiovascular disease (including coronary disease21) or cancer (1042 men) were excluded. Complete data on physical activity and maximal oxygen uptake were available for 1453 of the remaining 1640 men. Men with hypertension (811 subjects) were not excluded from most analyses.
Data on the following factors were missing for some men: plasma fibrinogen level, 117 men; serum level of high-density lipoprotein-subfraction 2 (HDL2) cholesterol, 59; serum apolipoprotein B level, 51; serum copper level, 45; serum ferritin and insulin levels, 43; smoking, 33; serum triglyceride level, 33; serum low-density lipoprotein (LDL) cholesterol level, 30; blood glucose level, 15; blood leukocyte count, hemoglobin level, and diastolic blood pressure, 7; and systolic blood pressure, height, and body-mass index (the weight in kilograms divided by the square of the height in meters), 6. If a value was missing, the mean value for all 1453 men was substituted.
Assessment of Physical Activity
Leisure-time physical activity was assessed from a 12-month history22-24 modified from the Minnesota Leisure Time Physical Activity Questionnaire25. The checklist included the most common leisure-time physical activities of middle-aged Finnish men, selected on the basis of a previous population study in Finland26. For each activity performed, the subjects were asked to record the frequency (number of sessions per month), average duration (hours and minutes per session), and intensity (scored as 0 for recreational activity, 1 for conditioning activity, 2 for brisk conditioning activity, and 3 for competitive, strenuous exercise). A trained interviewer collected missing data.
The intensity of physical activity was expressed in metabolic units (MET, or metabolic equivalents of oxygen consumption). The four categories of intensity of activity (range of possible scores, 0 to 3) were assigned their own metabolic-unit values, revised on the basis of a synthesis of available empirical data26-28. The metabolic unit is the ratio of the metabolic rate during exercise to the metabolic rate at rest. One metabolic unit corresponds to an energy expenditure of approximately 1 kcal per kilogram of body weight per hour, or an oxygen uptake of 3.5 ml per kilogram per minute.
Physical activity was categorized according to type: (1) conditioning physical activity -- walking (mean intensity, 4.2 MET), jogging (10.1 MET), skiing (9.6 MET), bicycling (5.8 MET), swimming (5.4 MET), rowing (5.4 MET), ball games (6.7 MET), and gymnastics, dancing, or weight lifting (5.0 MET); (2) nonconditioning physical activity -- crafts, repairs, or building (2.7 MET), yard work, gardening, farming, or snow shoveling (4.3 MET), hunting, picking berries, or gathering mushrooms (3.6 MET), fishing (2.4 MET), and forest activities (7.6 MET); and (3) walking (3.5 MET) or bicycling (5.1 MET) to work.
Assessment of Cardiorespiratory Fitness
Cardiorespiratory fitness was assessed with a maximal, symptom-limited exercise-tolerance test on an electrically braked bicycle ergometer. For 349 men examined before June 1986, the testing protocol comprised a three-minute warm-up at 50 W followed by a step-by-step increase in the workload by 20 W per minute (Tunturi EL 400 bicycle ergometer, Turku, Finland). The remaining 1104 men were tested with a linear increase in the workload by 20 W per minute (Medical Fitness Equipment 400 L bicycle ergometer, Mearn, the Netherlands).
Respiratory gas exchange was measured in the 349 men by the mixing-chamber method, with use of a Mijnhardt Oxycon 4 analyzer (Mijnhardt, Odijk, the Netherlands), and in the other 1104 men by the breath-by-breath method, with use of an MGC 2001 analyzer (Medical Graphics, St. Paul, Minn.). The Mijnhardt Oxycon 4 analyzer expressed the maximal oxygen uptake as the average of values recorded over a 30-second period, whereas the MGC 2001 analyzer expressed it as the average of values recorded over 8 seconds. Maximal oxygen uptake was defined as the highest value for or the plateau in oxygen uptake. The mean maximal oxygen uptake was 2.4 liters per minute when measured with the Mijnhardt Oxycon 4 analyzer and 2.6 liters per minute when measured with the MGC 2001 analyzer. Pearson's coefficient for the correlation between simultaneous Mijnhardt Oxycon 4 and MGC 2001 measurements in 13 men was 0.97, indicating a close correlation.
The most common reasons for stopping the exercise test were leg fatigue (813 men), exhaustion (223), breathlessness (146), and pain in the leg muscles, joints, or back (58). The test was discontinued because of cardiorespiratory symptoms or abnormalities in 138 men. These included dyspnea (44 men), arrhythmias (40), a marked change in systolic or diastolic blood pressure (35), dizziness (8), chest pain (7), and ischemic electrocardiographic changes (4).
One cardiologist coded the electrocardiograms manually, using the Minnesota code29. For resting electrocardiograms, coronary heart disease was indicated by the codes 1-1 to 1-3, 4-1 to 4-3, and 5-1 to 5-3, and arrhythmia by the codes 8-1 to 8-6. The criteria for evaluating ischemia on exercise electrocardiograms have been described elsewhere21. Evidence of coronary heart disease or arrhythmia on resting electrocardiograms was found in 72 men (5 percent) and evidence of ischemia on exercise electrocardiograms in 232 men (16 percent). Either or both of these electrocardiographic abnormalities were found in 287 men.
Assessment of Confounding Factors
Assessment of demographic variables,23 medical history, family history of diseases, smoking, blood pressure,21 and socioeconomic status30 was carried out as described previously. A pulmonary-disease index was calculated from scores for dichotomized disease variables (a score of 0 denoted the absence of chronic bronchitis, asthma, or pulmonary tuberculosis, and a score of 1 denoted the presence of any of them). The collection of blood specimens21 and the measurement of serum lipids,23,31 insulin,23 ferritin,21 copper,21 plasma fibrinogen,24 blood leukocytes,30 hemoglobin,21 and glucose21 have been described previously.
Ascertainment of Follow-up Events
The collection of data on myocardial infarction by the MONICA (Monitoring of Trends and Determinants of Cardiovascular Diseases) registry has been described previously32. A suspected fatal or nonfatal acute myocardial infarction occurring between March 1984 and December 1991 was recorded in 57 of the 1453 men at risk. If multiple events occurred during follow-up, the first event in each subject was considered the end point for the analyses in this study. There were 38 deaths due to causes other than coronary heart disease. Follow-up lasted up to 7.8 years and averaged 4.9 years.
Statistical Analysis
The associations of physical activity and maximal oxygen uptake with coronary risk factors were estimated with Pearson's correlation coefficients, with adjustment for age and year of examination (1985, 1986, 1987, 1988, and 1989 vs. other years). The level of physical activity and maximal oxygen uptake were entered as two dummy variables for the approximate upper two thirds of the sample (with the lowest third serving as the reference group) into forced Cox proportional-hazards models33,34. Risk factors were entered uncategorized into Cox models. Three different sets of fixed covariates were used. Acute myocardial infarction was defined as the outcome event, and deaths from other causes as losses to follow-up. Relative hazards adjusted for risk factors were estimated as antilogarithms of coefficients from multivariate models. Their confidence intervals were estimated under the assumption of asymptotic normality of the estimates. All tests for statistical significance were two-sided. The fit of the proportional-hazards models was examined by plotting the hazard functions in different categories of risk factors over time. The results indicated that the application of the models was appropriate.
Results
The subjects ranged in age from 42.0 to 61.2 years (mean, 52.0). They spent more of their leisure time in nonconditioning physical activity than in any other type (Table 1Table 1
Leisure-Time Physical Activity and Maximal Oxygen Uptake in 1453 Men in Eastern Finland Who Reported Having No Cardiovascular Disease or Cancer.). The mean intensity of conditioning physical activity was higher than that of other physical activities.The risk factors for acute myocardial infarction, adjusted for age and the year of examination, are shown in Table 2Table 2
Risk Factors for a First Acute Myocardial Infarction in the Study Cohort.. When all factors except those that correlated strongly with one another (height, weight, diastolic blood pressure, serum LDL cholesterol, and blood glucose) were entered simultaneously into the Cox model, the only factors found to be significantly associated with the risk of acute myocardial infarction were the number of pack-years of cigarette smoking (P = 0.001), a family history of coronary heart disease (P = 0.01), the maximal oxygen uptake (P = 0.02), and the duration of conditioning physical activity (P = 0.03).Although the duration of conditioning physical activity had no association with age, maximal oxygen uptake correlated inversely with age (r = -0.41) and decreased by 46 ml per minute per year of age. After adjustment for age and the year of examination, the duration of conditioning physical activity correlated directly with maximal oxygen uptake (r = 0.11) and inversely with the body-mass index, the serum level of triglycerides (r = -0.07), the LDL cholesterol level, and the apolipoprotein B level, the number of pack-years of cigarette smoking, weight (r = -0.06), and the serum ferritin level (r = -0.05). Maximal oxygen uptake correlated directly with height (r = 0.30), weight (r = 0.24), body-mass index (r = 0.14), and the serum HDL2 level (r = 0.11) and inversely with the number of pack-years of smoking (r = -0.23), the blood leukocyte count (r = -0.21), the plasma fibrinogen level (r = -0.19), socioeconomic status (r = -0.18), the serum levels of apolipoprotein B (r = -0.14), LDL cholesterol (r = -0.12), copper (r = -0.12), and triglycerides (r = -0.10), the blood glucose level (r = -0.07), and the serum insulin level (r = -0.05).
Of 1166 men without cardiovascular disease or cancer who had both normal resting and normal exercise electrocardiograms, 42 had initial myocardial infarctions during the follow-up period. The relative hazards of acute myocardial infarction among the men in the upper two thirds of the sample according to the duration of conditioning physical activity are shown in Table 3Table 3
Relative Hazards of a First Acute Myocardial Infarction in the Groups with Values in the Highest Two Thirds for Duration of Conditioning Physical Activity and Maximal Oxygen Uptake, According to Electrocardiographic Findings., with adjustment for age and the year of the examination. After additional adjustment for possible confounders (family history of coronary heart disease, the presence of pulmonary disease, diabetes, or disability, socioeconomic status, the number of pack-years of cigarette smoking, and blood leukocyte count), the relative hazards in these two groups were 1.19 in the middle third (95 percent confidence interval, 0.61 to 2.31) and 0.34 in the highest third (95 percent confidence interval, 0.12 to 0.94; P = 0.04) (P = 0.07 for linear trend). After further adjustment for other variables that might mediate the protective effect of physical activity (such as serum HDL2, triglyceride, apolipoprotein B, ferritin, and copper levels, plasma fibrinogen level, blood hemoglobin level, systolic blood pressure, height, and weight), the relative hazards in the two groups were 1.28 in the middle third (95 percent confidence interval, 0.65 to 2.51) and 0.38 in the highest third (95 percent confidence interval, 0.14 to 1.05) (P = 0.12 for linear trend).Table 3 also shows the relative hazards of acute myocardial infarction among the men in the upper two thirds of the sample according to maximal oxygen uptake, after adjustment for age, year and season of examination, height, weight, and the type of respiratory-gas analyzer. After additional adjustment for possible confounders, the relative hazards in the upper two thirds were 0.74 (95 percent confidence interval, 0.36 to 1.51) and 0.35 (95 percent confidence interval, 0.13 to 0.92; P = 0.03) (P = 0.04 for linear trend). After further adjustment for variables that might mediate the protective effect of physical activity, the respective relative hazards were 0.96 (95 percent confidence interval, 0.45 to 2.03) and 0.45 (95 percent confidence interval, 0.16 to 1.25) (P = 0.16 for linear trend).
When the 243 men with hypertension were excluded from the analysis, the numbers of men among the remaining 923 in the thirds of subjects defined by the duration of conditioning physical activity who had an acute myocardial infarction were 15 (4.9 percent), 13 (4.3 percent), and 2 (0.7 percent). The relative hazards of acute myocardial infarction in the upper two thirds of the sample according to the duration of conditioning physical activity, after adjustment for possible confounders, were 1.05 in the middle third (95 percent confidence interval, 0.48 to 2.28) and 0.15 in the highest third (95 percent confidence interval, 0.03 to 0.66; P = 0.01) (P = 0.01 for linear trend). After additional adjustment for variables that might mediate the protective effect of physical activity, the respective relative hazards were 1.22 (95 percent confidence interval, 0.54 to 2.78) and 0.14 (95 percent confidence interval, 0.03 to 0.70; P = 0.02) (P = 0.02 for linear trend).
Among the 923 men in this analysis, the numbers in the thirds of the sample according to maximal oxygen uptake who had an acute myocardial infarction were 13 (5.6 percent), 12 (3.9 percent), and 5 (1.3 percent). The relative hazards of acute myocardial infarction in the upper two thirds according to maximal oxygen uptake, after adjustment for possible confounders, were 0.55 in the middle third (95 percent confidence interval, 0.24 to 1.28) and 0.30 in the highest third (95 percent confidence interval, 0.10 to 0.92; P = 0.04) (P = 0.03 for linear trend). After further adjustment for variables that might mediate the protective effect of physical activity, the respective relative hazards were 0.69 (95 percent confidence interval, 0.28 to 1.73) and 0.37 (95 percent confidence interval, 0.11 to 1.24) (P = 0.11 for linear trend).
Table 3 shows the relative hazards of acute myocardial infarction in 287 men without cardiovascular disease or cancer who had abnormal resting or exercise electrocardiograms, with respect to the two upper thirds defined according to the duration of conditioning physical activity and maximal oxygen uptake.
Neither nonconditioning physical activity nor walking or bicycling to work was associated with any change in the risk of acute myocardial infarction.
Discussion
Conditioning leisure-time physical activity and maximal oxygen uptake had an inverse, graded, and independent association with the risk of acute myocardial infarction among men in eastern Finland who did not have cardiovascular disease or cancer. These findings are consistent with those of the U.S. Railroad Study, in which both leisure-time physical activity9 and heart rate during a submaximal exercise test16 were inversely associated with coronary mortality. Other studies have observed that either leisure-time physical activity7,11 or cardiorespiratory fitness12,14 alone had an inverse and significant relation to the risk of coronary heart disease. In the present study, conditioning physical activity and maximal oxygen uptake were inversely associated with the risk of acute myocardial infarction among both men with normal and men with abnormal resting or exercise electrocardiograms. Neither nonconditioning physical activity nor walking or bicycling to work was associated with coronary risk.
It has been recommended that the large muscles perform dynamic exercise three to four times a week for an average of 30 to 60 minutes to produce a cardiovascular benefit35. The present findings are consistent with those of the U.S. Railroad Study9 and the Multiple Risk Factor Intervention Trial,7 in which a low-to-moderate degree of leisure-time physical activity was associated with decreased mortality from coronary disease. We found that the risk of acute myocardial infarction was decreased by just two hours of conditioning physical activity a week.
The decrease in risk among the most active and fit men was greater than that observed in most previous studies7-12. After adjustment for a number of coronary risk factors, men who engaged in more than two hours of conditioning physical activity a week had a risk 60 percent lower than that of the least active men; men with a maximal oxygen uptake of at least 2.7 liters per minute, or 34 ml per kilogram per minute, had a risk 55 percent lower than that of the least fit men. Our data do not support earlier findings of a plateau2,7,9 or an increase6,10 in risk above a certain level of physical activity.
Only vigorous physical activity was associated with a decreased risk of coronary heart disease in the British Civil Servant Study,5 whereas activity of low-to-moderate intensity was associated with reduced mortality from coronary disease in the Multiple Risk Factor Intervention Trial7. Both low-to-moderate and vigorous physical activity were inversely associated with mortality from coronary disease in the U.S. Railroad Study9. Our data indicate that physical activity with a mean intensity of 6 MET (or six times higher than resting metabolic requirements) may be required to decrease the risk. The inconsistency among previous studies in the level of physical activity necessary to reduce risk may be partly due to differences in the classification of physical activity.
In the Seven Countries Study, Keys20 found no association between habitual physical activity and coronary risk among Finnish men. Karvonen,36 however, observed an inverse relation that disappeared when he evaluated only men who had no coronary heart disease at entry. These findings have been used to argue that physical inactivity is not an important coronary risk factor. Our data support the majority of previous studies, which have shown an inverse association between the level of physical activity and coronary risk1-11.
It is difficult to distinguish an increased risk of coronary disease related to physical inactivity or poor cardiorespiratory fitness from an increased risk due to a prevalent asymptomatic or preexisting cardiovascular disease in sedentary or unfit persons19. Therefore, it is possible that self-selection bias exaggerated the strength of the associations observed in our study. On the other hand, we assessed asymptomatic coronary heart disease with a maximal exercise test and used very sensitive diagnostic criteria to reduce the probability of this bias.
Conditioning physical activity and maximal oxygen uptake were associated with several variables that might mediate the cardioprotective effects of physical activity. These included increased serum HDL2 cholesterol levels and decreased serum levels of triglycerides, LDL cholesterol, apolipoprotein B, copper, and ferritin, blood hemoglobin levels, plasma fibrinogen levels, and body-mass index. We have reported some of these findings previously23,24,37. The present data and our earlier studies21,31,38 also indicate that these variables are risk factors for acute myocardial infarction in men in eastern Finland. However, these factors account for only some of the observed relations between physical activity and fitness and coronary risk.
The quantitative methods enabled us to investigate the dose-response relations of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infarction. The 12-month history gives a more accurate estimate of the past level of physical activity than shorter-term measurements22. The reproducibility and validity of the Minnesota Leisure Time Physical Activity Questionnaire and our 12-month history have been previously confirmed in the United States,25,39 Belgium,40 and Finland22-24. Cardiorespiratory fitness as determined by exercise testing was one of the criteria used for validation in these studies.
In conclusion, our findings are consistent with the notion that lower levels of both conditioning leisure-time physical activity and cardiorespiratory fitness are important, independent coronary risk factors. Both men with more than two hours of conditioning physical activity a week and men with a maximal oxygen uptake of at least 2.7 liters per minute, or 34 ml per kilogram per minute, had less than half the risk of acute myocardial infarction of the least active or the least fit men. On the basis of the present study, physical activity of predominantly moderate-to-high intensity may be needed to decrease coronary risk.
Supported by grants from the Finnish Academy and the Ministry of Education of Finland and by the town of Kuopio. Dr. Lakka received grants from the Finnish Academy and the Yrjo Jahnsson Foundation.
We are indebted to Dr. Esko Taskinen, Dr. Hannu Litmanen, and Dr. Arno Heikela for their participation in the supervision of exercise tests, to Kari Seppanen, M.Sc., and Kristiina Nyyssonen, M.Sc., for supervising laboratory measurements, to Dr. Jaakko Eranen for coding the resting and exercise electrocardiography, and to Kimmo Ronkainen, M.Sc., for carrying out the data analyses.
Source Information
From the Research Institute of Public Health, University of Kuopio (T.A.L., R.S., J.T.S.), and the Kuopio Research Institute of Exercise Medicine (J.M.V., R.R., R.S.), Kuopio, Finland; and the Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland (J.T.).
Address reprint requests to Professor J.T. Salonen at the University of Kuopio, P.O. Box 1627, 70211 Kuopio, Finland.
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Nicole S. Coverdale, Deborah D. O’Leary, Brent E. Faught, Daniele Chirico, John Hay, John Cairney. (2012) Baroreflex sensitivity is reduced in adolescents with probable developmental coordination disorder. Research in Developmental Disabilities 33:1, 251-257
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I Reinders, J K Virtanen, I A Brouwer, T-P Tuomainen. (2011) Association of serum n-3 polyunsaturated fatty acids with C-reactive protein in men. European Journal of Clinical Nutrition
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L. Hakola, P. Komulainen, M. Hassinen, K. Savonen, H. Litmanen, T. A. Lakka, R. Rauramaa. (2011) Cardiorespiratory fitness in aging men and women: the DR's EXTRA study. Scandinavian Journal of Medicine & Science in Sports 21:5, 679-687
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STIAN THORESEN ASPENES, JAVAID NAUMAN, TOM IVAR LUND NILSEN, LARS JOHAN VATTEN, ULRIK WISLØFF. (2011) Physical Activity as a Long-Term Predictor of Peak Oxygen Uptake. Medicine & Science in Sports & Exercise 43:9, 1675-1679
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Jyrki K. Virtanen, Tarja Nurmi, Sari Voutilainen, Jaakko Mursu, Tomi-Pekka Tuomainen. (2011) Association of serum 25-hydroxyvitamin D with the risk of death in a general older population in Finland. European Journal of Nutrition 50:5, 305-312
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STIAN THORESEN ASPENES, TOM IVAR LUND NILSEN, ELI-ANNE SKAUG, GRO F. BERTHEUSSEN, ØYVIND ELLINGSEN, LARS VATTEN, ULRIK WISLØFF. (2011) Peak Oxygen Uptake and Cardiovascular Risk Factors in 4631 Healthy Women and Men. Medicine & Science in Sports & Exercise 43:8, 1465-1473
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K. P. Savonen, V. Kiviniemi, D. E. Laaksonen, T. A. Lakka, J. A. Laukkanen, T.-P. Tuomainen, R. Rauramaa. (2011) Two-minute heart rate recovery after cycle ergometer exercise and all-cause mortality in middle-aged men. Journal of Internal Medicineno-no
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Norma J. Stumbo, Yawei Wang, Shane Pegg. (2011) Issues of access: what matters to people with disabilities as they seek leisure experiences. World Leisure Journal 53:2, 91-103
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Francesco Cipollini, Gualberto Gussoni, Roberta Pacifici, Silvia Rossi, Erminio Bonizzoni, Antonella Valerio, Adolfo Iacopino, Audenzio D’Angelo, Domenico Panuccio, Ido Iori, Antonino Mazzone, Piergiorgio Zuccaro. (2011) The influence of physical activity performed at 20-40 years of age on cardiovascular outcomes in medical patients aged 65-75. Italian Journal of Medicine 5:2, 114-119
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Jatin G Burniston, Eric P Hoffman. (2011) Proteomic responses of skeletal and cardiac muscle to exercise. Expert Review of Proteomics 8:3, 361-377
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J. Mursu, J.K. Virtanen, T.H. Rissanen, T.-P. Tuomainen, I. Nykänen, J.A. Laukkanen, R. Kortelainen, S. Voutilainen. (2011) Glycemic index, glycemic load, and the risk of acute myocardial infarction in Finnish men: The Kuopio Ischaemic Heart Disease Risk Factor Study. Nutrition, Metabolism and Cardiovascular Diseases 21:2, 144-149
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Laura Kauhanen, Janne Leino, Hanna-Maaria Lakka, John W. Lynch, Jussi Kauhanen. (2011) Adverse Childhood Experiences and Risk of Binge Drinking and Drunkenness in Middle-Aged Finnish Men. Advances in Preventive Medicine 2011, 1-12
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Peter Kokkinos, Helen Sheriff, Raya Kheirbek. (2011) Physical Inactivity and Mortality Risk. Cardiology Research and Practice 2011, 1-10
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Chiaki Yagura, Noboru Takamura, Yoshinobu Goto, Hajime Sugihara, Takeshi Sota, Shinichiro Oka, Takeyoshi Shimoda, Kohei Yoshizumi. (2011) Cardiorespiratory Fitness and Metabolic Markers in Healthy Young Adult Men. Journal of Physical Therapy Science 23:6, 845-849
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Katja Borodulin, Catherine Zimmer, Risto Sippola, Tomi E. Mäkinen, Tiina Laatikainen, Ritva Prättälä. (2010) Health Behaviours as Mediating Pathways between Socioeconomic Position and Body Mass Index. International Journal of Behavioral Medicine
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M. K. Salonen, E. Kajantie, C. Osmond, T. Forsen, H. Yliharsila, M. Paile-Hyvarinen, D. J. P. Barker, J. G. Eriksson. (2010) Prenatal and childhood growth and leisure time physical activity in adult life. The European Journal of Public Health
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Jari A. Laukkanen, Timo H. Mäkikallio, Rainer Rauramaa, Vesa Kiviniemi, Kimmo Ronkainen, Sudhir Kurl. (2010) Cardiorespiratory Fitness Is Related to the Risk of Sudden Cardiac Death. Journal of the American College of Cardiology 56:18, 1476-1483
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Maarit Valtonen, David E. Laaksonen, Jari Laukkanen, Tommi Tolmunen, Rainer Rauramaa, Heimo Viinamäki, Jaakko Mursu, Kai Savonen, Timo A. Lakka, Leo Niskanen, Jussi Kauhanen. (2010) Sedentary lifestyle and emergence of hopelessness in middle-aged men. European Journal of Cardiovascular Prevention & Rehabilitation 17:5, 524-529
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Catriona O'Dwyer, Susan Coote. (2010) A guide for clinicians – physical activity and energy expenditure explained. Physical Therapy Reviews 15:5, 382-390
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Aila J. AHOLA, Sari MÄKIMATTILA, Markku SARAHEIMO, Vera MIKKILÄ, Carol FORSBLOM, Riitta FREESE, Per-Henrik GROOP, . (2010) Many patients with Type 1 diabetes estimate their prandial insulin need inappropriately. Journal of Diabetes 2:3, 194-202
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Bilal Aijaz, Todd M. Brown, Bonnie K. Sanderson, Vera Bittner. (2010) Exercise as a Treatment for the Risk of Cardiovascular Disease. Current Treatment Options in Cardiovascular Medicine 12:4, 329-341
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M. F. Burke, R. L. Dunbar, D. J. Rader. (2010) Could Exercise Metabolomics Pave the Way for Gymnomimetics?. Science Translational Medicine 2:41, 41ps35-41ps35
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Patrick E. McKnight, Alex Afram, Todd B. Kashdan, Shelley Kasle, Alex Zautra. (2010) Coping self-efficacy as a mediator between catastrophizing and physical functioning: treatment target selection in an osteoarthritis sample. Journal of Behavioral Medicine 33:3, 239-249
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Zhaoqing Sun, Liqiang Zheng, Robert Detrano, Xingang Zhang, Changlu Xu, Jue Li, Dayi Hu, Yingxian Sun. (2010) Risk of Progression to Hypertension in a Rural Chinese Women Population with Prehypertension and Normal Blood Pressure. American Journal of Hypertension 23:6, 627-632
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Taeko MIYAJIMA, Kazuyoshi ISHIDA, Mitsuko SATO, Zentaro YAMAGATA. (2010) Pilot study to test the safety of an exercise machine on healthy adult females. Japan Journal of Nursing Science 7:1, 37-46
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Giuseppe Maio, Salim Saraeb, Antonio Marchiori. (2010) Physical Activity and PDE5 Inhibitors in the Treatment of Erectile Dysfunction: Results of a Randomized Controlled Study. Journal of Sexual Medicine
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Elin Ekblom-Bak, Mai-Lis Hellénius, Örjan Ekblom, Lars-Magnus Engström, Björn Ekblom. (2010) Independent associations of physical activity and cardiovascular fitness with cardiovascular risk in adults. European Journal of Cardiovascular Prevention & Rehabilitation 17:2, 175-180
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Jari A. Laukkanen, Eero Pukkala, Rainer Rauramaa, Timo H. Mäkikallio, Adetunji T. Toriola, Sudhir Kurl. (2010) Cardiorespiratory fitness, lifestyle factors and cancer risk and mortality in Finnish men. European Journal of Cancer 46:2, 355-363
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Eo Rin Cho, Aesun Shin, Jeongseon Kim, Sun Ha Jee, Joohon Sung. (2009) Leisure-Time Physical Activity is Associated with a Reduced Risk for Metabolic Syndrome. Annals of Epidemiology 19:11, 784-792
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RL Thomson, JD Buckley, LJ Moran, M Noakes, PM Clifton, RJ Norman, GD Brinkworth. (2009) Comparison of aerobic exercise capacity and muscle strength in overweight women with and without polycystic ovary syndrome. BJOG: An International Journal of Obstetrics & Gynaecology 116:9, 1242-1250
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A. T. Toriola, S. Kurl, J. A. Laukkanen, J. Kauhanen. (2009) Does binge drinking increase the risk of lung cancer: results from the Findrink study. The European Journal of Public Health 19:4, 389-393
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Theodore Chimonas, Irene Fanouraki, Evangelos N. Liberopoulos, Elias Chimonas, Moses Elisaf. (2009) Diverging trends in cardiovascular morbidity and mortality in a low risk population. European Journal of Epidemiology 24:8, 415-423
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Sanna H. Rantakömi, Jari A. Laukkanen, Sudhir Kurl, Jussi Kauhanen. (2009) Binge drinking and the progression of atherosclerosis in middle-aged men: An 11-year follow-up. Atherosclerosis 205:1, 266-271
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A. Jonsson, F. Renström, V. Lyssenko, E. C. Brito, B. Isomaa, G. Berglund, P. M. Nilsson, L. Groop, P. W. Franks. (2009) Assessing the effect of interaction between an FTO variant (rs9939609) and physical activity on obesity in 15,925 Swedish and 2,511 Finnish adults. Diabetologia 52:7, 1334-1338
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Birna Bjarnason-Wehrens, Olaf Schulz, Stephan Gielen, Martin Halle, Martin Dürsch, Rainer Hambrecht, Heinz Lowis, Wilfried Kindermann, Robin Schulze, Bernhard Rauch. (2009) Leitlinie körperliche Aktivität zur Sekundärprävention und Therapie kardiovaskulärer Erkrankungen. Clinical Research in Cardiology Supplements 4:S3, 1-44
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Jaime S Rosa, Pietro R Galassetti. (2009) Altered molecular adaptation to exercise in children with type 1 diabetes: beyond hypoglycemia. Pediatric Diabetes 10:3, 213-226
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Giorgos S. Metsios, Antonios Stavropoulos-Kalinoglou, Vasileios F. Panoulas, Mat Wilson, Alan M. Nevill, Yiannis Koutedakis, George D. Kitas. (2009) Association of physical inactivity with increased cardiovascular risk in patients with rheumatoid arthritis. European Journal of Cardiovascular Prevention & Rehabilitation 16:2, 188-194
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C. Herder, M. Peltonen, W. Koenig, K. Sütfels, J. Lindström, S. Martin, P. Ilanne-Parikka, J. G. Eriksson, S. Aunola, S. Keinänen-Kiukaanniemi, T. T. Valle, M. Uusitupa, H. Kolb, J. Tuomilehto, . (2009) Anti-inflammatory effect of lifestyle changes in the Finnish Diabetes Prevention Study. Diabetologia 52:3, 433-442
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J. A. Laukkanen, T. H. Makikallio, R. Rauramaa, S. Kurl. (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men: a population-based follow-up study. European Heart Journal 30:5, 558-565
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Tuija Leskinen, Katja Waller, Sara Mutikainen, Sari Aaltonen, Paula H. A Ronkainen, Markku Alén, Sarianna Sipilä, Vuokko Kovanen, Merja Perhonen, Kirsi H Pietiläinen, Sulin Cheng, Harri Suominen, Heikki Kainulainen, Jaakko Kaprio, Urho M Kujala. (2009) Effects of 32-Year Leisure Time Physical Activity Discordance in Twin Pairs on Health (TWINACTIVE Study): Aims, Design and Results for Physical Fitness. Twin Research and Human Genetics 12:1, 108-117
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S. Kurl, J. Sivenius, T. H. Mäkikallio, R. Rauramaa, J. A. Laukkanen. (2009) Exercise workload, cardiovascular risk factor evaluation and the risk of stroke in middle-aged men. Journal of Internal Medicine 265:2, 229-237
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Helmut Gohlke, Christian Albus, Detlef Bernd Gysan, Harry W. Hahmann, Peter Mathes. (2009) Cardiovascular Prevention in Clinical Practice (ESC and German Guidelines 2007). Herz 34:1, 4-14
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Min-Seon Park, So-Yeon Chung, Yoosoo Chang, Kyungwoo Kim. (2009) Physical Activity and Physical Fitness as Predictors of All-Cause Mortality in Korean Men. Journal of Korean Medical Science 24:1, 13
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Tuomas Liikavainio, Tarja Lyytinen, Erja Tyrväinen, Sarianna Sipilä, Jari P. Arokoski. (2008) Physical Function and Properties of Quadriceps Femoris Muscle in Men With Knee Osteoarthritis. Archives of Physical Medicine and Rehabilitation 89:11, 2185-2194
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K. P. Savonen, V. Kiviniemi, J. A. Laukkanen, T. A. Lakka, T. H. Rauramaa, J. T. Salonen, R. Rauramaa. (2008) Chronotropic incompetence and mortality in middle-aged men with known or suspected coronary heart disease. European Heart Journal 29:15, 1896-1902
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Francesco Sofi, Andrea Capalbo, Francesca Cesari, Rosanna Abbate, Gian Franco Gensini. (2008) Physical activity during leisure time and primary prevention of coronary heart disease: an updated meta-analysis of cohort studies. European Journal of Cardiovascular Prevention & Rehabilitation 15:3, 247-257
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V. Gremeaux, Y. Lemoine, A. Fargeot, P. D’Athis, J.-C. Beer, Y. Laurent, Y. Cottin, D. Antoine, J.-M. Casillas. (2008) The Dijon Physical Activity Score: Reproducibility and correlations with physical fitness in patients with coronary artery disease. Annales de Réadaptation et de Médecine Physique 51:5, 366-378
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Jari A. Laukkanen, Rainer Rauramaa, Sudhir Kurl. (2008) Exercise workload, coronary risk evaluation and the risk of cardiovascular and all-cause death in middle-aged men. European Journal of Cardiovascular Prevention & Rehabilitation 15:3, 285-292
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Adetunji T. Toriola, Sudhir Kurl, Jari A. Laukanen, Charles Mazengo, Jussi Kauhanen. (2008) Alcohol consumption and risk of colorectal cancer: the Findrink study. European Journal of Epidemiology 23:6, 395-401
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Araceli Boraita Pérez. (2008) Ejercicio, piedra angular de la prevención cardiovascular. Revista Española de Cardiología 61:5, 514-528
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P. L. Kristensen, N. C. Møller, L. Korsholm, N. Wedderkopp, L. B. Andersen, K. Froberg. (2008) Tracking of objectively measured physical activity from childhood to adolescence: The European youth heart study. Scandinavian Journal of Medicine & Science in Sports 18:2, 171-178
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Antony D. Karelis, Marie-Ève Lavoie, Virginie Messier, Diane Mignault, Dominique Garrel, Denis Prud’homme, Rémi Rabasa-Lhoret. (2008) Relationship between the metabolic syndrome and physical activity energy expenditure: a MONET study. Applied Physiology, Nutrition, and Metabolism 33:2, 309-314
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K Waller, J Kaprio, U M Kujala. (2008) Associations between long-term physical activity, waist circumference and weight gain: a 30-year longitudinal twin study. International Journal of Obesity 32:2, 353-361
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Robert S. McKelvie. (2008) Exercise training in patients with heart failure: clinical outcomes, safety, and indications. Heart Failure Reviews 13:1, 3-11
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Linda Van Horn, Mikelle McCoin, Penny M. Kris-Etherton, Frances Burke, Jo Ann S. Carson, Catherine M. Champagne, Wahida Karmally, Geeta Sikand. (2008) The Evidence for Dietary Prevention and Treatment of Cardiovascular Disease. Journal of the American Dietetic Association 108:2, 287-331
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F. Sofi, A. Capalbo, R. Marcucci, A. M. Gori, S. Fedi, C. Macchi, A. Casini, C. Surrenti, R. Abbate, G. F. Gensini. (2007) Leisure time but not occupational physical activity significantly affects cardiovascular risk factors in an adult population. European Journal of Clinical Investigation 37:12, 947-953
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Donald H. Paterson, Gareth R. Jones, Charles L. Rice. (2007) Ageing and physical activity: evidence to develop exercise recommendations for older adultsThis article is part of a supplement entitled Advancing physical activity measurement and guidelines in Canada: a scientific review and evidence-based foundation for the future of Canadian physical activity guidelines co-published by Applied Physiology, Nutrition, and Metabolism and the Canadian Journal of Public Health . It may be cited as Appl. Physiol. Nutr. Metab. 32(Suppl. 2E) or as Can. J. Public Health 98(Suppl. 2).. Applied Physiology, Nutrition, and Metabolism 32:S2E, S69-S108
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U. Ekelund, S. A. Anderssen, K. Froberg, L. B. Sardinha, L. B. Andersen, S. Brage, . (2007) Independent associations of physical activity and cardiorespiratory fitness with metabolic risk factors in children: the European youth heart study. Diabetologia 50:9, 1832-1840
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J. A. Laukkanen, R. Rauramaa, J. T. Salonen, S. Kurl. (2007) The predictive value of cardiorespiratory fitness combined with coronary risk evaluation and the risk of cardiovascular and all-cause death. Journal of Internal Medicine 262:2, 263-272
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Kai P. Savonen, Timo A. Lakka, Jari A. Laukkanen, Tuomas H. Rauramaa, Jukka T. Salonen, Rainer Rauramaa. (2007) Effectiveness of Workload at the Heart Rate of 100 Beats/Min in Predicting Cardiovascular Mortality in Men Aged 42, 48, 54, or 60 Years at Baseline. The American Journal of Cardiology 100:4, 563-568
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J.-M. Casillas, V. Gremeaux, S. Damak, A. Feki, D. Pérennou. (2007) Entraînement à l'effort au cours des pathologies cardiovasculaires. Annales de Réadaptation et de Médecine Physique 50:6, 386-402
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H.-H. Osterhues (federführend), F.M. Baer, M. Kelm, M. Irmer (BNK), K. Ivens, M. Leschke (ALKK), A. Meißner (DGAI), M. Pauschinger, B. Ritter (BNK), J. Röther (DGN). (2007) Kommentar zu den Leitlinien zur perioperativen kardiovaskulären Evaluation bei nichtkardialer Chirurgie der ACC/AHA. Der Kardiologe 1:1, 18-30
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J.M. Casillas, V. Gremeaux, S. Damak, A. Feki, D. Pérennou. (2007) Exercise training for patients with cardiovascular disease. Annales de Réadaptation et de Médecine Physique 50:6, 403-418
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Mette Aadahl, Michael Kj??r, Jens H. Kristensen, Birgit Mollerup, Torben J??rgensen. (2007) Self-reported physical activity compared with maximal oxygen uptake in adults. European Journal of Cardiovascular Prevention & Rehabilitation 14:3, 422-428
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DAVID E. LAAKSONEN, NIINA SIITONEN, JAANA LINDSTR??M, JOHAN G. ERIKSSON, PIRITTA REUNANEN, JAAKKO TUOMILEHTO, MATTI UUSITUPA. (2007) Physical Activity, Diet, and Incident Diabetes in Relation to an ADRA2B Polymorphism. Medicine & Science in Sports & Exercise 39:2, 227-232
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Helmut Gohlke, Moritz Winter, Marthin Karoff, Klaus Held. (2007) CARRISMA: a new tool to improve risk stratification and guidance of patients in cardiovascular risk management in primary prevention. European Journal of Cardiovascular Prevention & Rehabilitation 14:1, 141-148
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Timo A. Lakka, David E. Laaksonen. (2007) Physical activity in prevention and treatment of the metabolic syndrome. Applied Physiology, Nutrition, and Metabolism 32:1, 76-88
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Hsu-Ko Kuo, Chung-Jen Yen, Jen-Hau Chen, Yau-Hua Yu, Jonathan F. Bean. (2007) Association of cardiorespiratory fitness and levels of C-reactive protein: Data from the National Health and Nutrition Examination Survey 1999–2002. International Journal of Cardiology 114:1, 28-33
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T. Tolmunen, J. A. Laukkanen, J. Hintikka, S. Kurl, H. Viinamäki, R. Salonen, J. Kauhanen, G. A. Kaplan, J. T. Salonen. (2006) Low maximal oxygen uptake is associated with elevated depressive symptoms in middle-aged men. European Journal of Epidemiology 21:9, 701-706
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M. Kallinen, M. Kauppinen, P. Era, E. Heikkinen. (2006) The predictive value of exercise testing for survival among 75-year-old men and women. Scandinavian Journal of Medicine and Science in Sports 16:4, 237-244
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Jari A. Laukkanen, Sudhir Kurl, Rainer Rauramaa, Timo A. Lakka, Juha M. Ven??l??inen, Jukka T. Salonen. (2006) Systolic blood pressure response to exercise testing is related to the risk of acute myocardial infarction in middle-aged men. European Journal of Cardiovascular Prevention & Rehabilitation 13:3, 421-428
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Raza H. Orakzai, Sarwar H. Orakzai, Khurram Nasir, Ariel Roguin, Izabel Pimentel, Jose A.M. Carvalho, Romeu Meneghello, Roger S. Blumenthal, Raul D. Santos. (2006) Association of Increased Cardiorespiratory Fitness with Low Risk for Clustering of Metabolic Syndrome Components in Asymptomatic Men. Archives of Medical Research 37:4, 522-528
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Michael R. Le Grande, Barbara M. Murphy, Rosemary O. Higgins, Marian U.C. Worcester, Anne Parkinson, Stephen L. Brown, Peter C. Elliott, Alan J. Goble. (2006) Physical activity and negative emotional response after percutaneous coronary intervention. European Journal of Cardiovascular Prevention & Rehabilitation 13:2, 254-260
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Maria Penco, Renata Petroni, Francesca Pastori, Simona Fratini, Silvio Romano. (2006) Should sports activity be encouraged or contraindicated in hypertensive subjects?. Journal of Cardiovascular Medicine 7:4, 288-295
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Carolyn S. Rabin, Bernardine M. Pinto, Joseph J. Trunzo, Georita M. Frierson, Lynn M. Bucknam. (2006) Physical activity among breast cancer survivors: regular exercisers vs participants in a physical activity intervention. Psycho-Oncology 15:4, 344-354
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Borodulin Katja, Tiina Laatikainen, Veikko Salomaa, Pekka Jousilahti. (2006) Associations of leisure time physical activity, self-rated physical fitness, and estimated aerobic fitness with serum C-reactive protein among 3803 adults. Atherosclerosis 185:2, 381-387
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Jyrki K. Virtanen, Sari Voutilainen, Tiina H. Rissanen, Pertti Happonen, Jaakko Mursu, Jari A. Laukkanen, Henrik Poulsen, Timo A. Lakka, Jukka T. Salonen. (2006) High dietary methionine intake increases the risk of acute coronary events in middle-aged men. Nutrition, Metabolism and Cardiovascular Diseases 16:2, 113-120
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No??l C. Barengo, Mika Kastarinen, Timo Lakka, Aulikki Nissinen, Jaakko Tuomilehto. (2006) Different forms of physical activity and cardiovascular risk factors among 24???64-year-old men and women in Finland. European Journal of Cardiovascular Prevention & Rehabilitation 13:1, 51-59
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Francesca Giovannelli, Speranza Rubattu. (2006) The Role of Cardiac Rehabilitation in the Treatment and Secondary Prevention of Cardiovascular Disease. High Blood Pressure & Cardiovascular Prevention 13:1, 21-27
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Hidenari SAKUTA, Takashi SUZUKI. (2006) Physical Activity and Selected Cardiovascular Risk Factors in Middle-Aged Male Personnel of Self-Defense Forces. Industrial Health 44:1, 184-189
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A V Kurpad, R Raj, K N Maruthy, M Vaz. (2006) A simple method of measuring total daily energy expenditure and physical activity level from the heart rate in adult men. European Journal of Clinical Nutrition 60:1, 32-40
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H.-K. KUO, C.-J. YEN, J. F. Bean. (2005) Levels of homocysteine are inversely associated with cardiovascular fitness in women, but not in men: data from the National Health and Nutrition Examination Survey 1999-2002. Journal of Internal Medicine 258:4, 328-335
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Jyrki K. Virtanen, Sari Voutilainen, Pertti Happonen, Georg Alfthan, Jari Kaikkonen, Jaakko Mursu, Tiina H. Rissanen, George A. Kaplan, Maarit J. Korhonen, Juhani Sivenius, Jukka T. Salonen. (2005) Serum homocysteine, folate and risk of stroke: Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. European Journal of Cardiovascular Prevention & Rehabilitation 12:4, 369-375
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J.M. Casillas, G. Deley, S. Salmi-Belmihoub. (2005) Indices de mesure de l'activité physique dans le domaine des affections cardiovasculaires. Annales de Réadaptation et de Médecine Physique 48:6, 404-410
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Katja Borodulin, Tiina Laatikainen, Marjaana Lahti-Koski, Timo A. Lakka, Raija Laukkanen, Seppo Sarna, Pekka Jousilahti. (2005) Associations between estimated aerobic fitness and cardiovascular risk factors in adults with different levels of abdominal obesity. European Journal of Cardiovascular Prevention & Rehabilitation 12:2, 126-131
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Demosthenes B. Panagiotakos, Christos Pitsavos, Christina Chrysohoou, Stavros Kavouras, Christodoulos Stefanadis. (2005) The associations between leisure-time physical activity and inflammatory and coagulation markers related to cardiovascular disease: the ATTICA Study. Preventive Medicine 40:4, 432-437
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No??l C Barengo, Gang Hu, Mika Kastarinen, Timo A Lakka, Heikki Pekkarinen, Aulikki Nissinen, Jaakko Tuomilehto. (2005) Low physical activity as a predictor for antihypertensive drug treatment in 25-64-year-old populations in Eastern and south-western Finland. Journal of Hypertension 23:2, 293-299
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H. Robert, J.M. Casillas, M. Iskandar, P. D'Athis, D. Antoine, S. Taha, V. Didier, G. Scaglioni, B.X. Caillaux, J. Van Hoecke. (2004) Le Score d'activité physique de Dijon : reproductibilité et corrélations avec l'aptitude physique de sujets sains âgés. Annales de Réadaptation et de Médecine Physique 47:8, 546-554
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David E. Laaksonen, Jari A. Laukkanen, Leo Niskanen, Kristiina Nyyss
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Jonathan F Bean, Ariana Vora, Walter R Frontera. (2004) Benefits of exercise for community-dwelling older adults. Archives of Physical Medicine and Rehabilitation 85, 31-42
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Matthew S Kerner, Anthony B Kurrant, Michael I Kalinski. (2004) Leisure-time physical activity, sedentary behavior, and fitness of high school girls. European Journal of Sport Science 4:2, 1-17
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Merja H Arokoski, Mikko Haara, Heikki J Helminen, Jari P Arokoski. (2004) Physical function in men with and without hip osteoarthritis. Archives of Physical Medicine and Rehabilitation 85:4, 574-581
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Christos H Pitsavos, Christina Chrysohoou, Demosthenes B Panagiotakos, Peter Kokkinos, John Skoumas, Ioanna Papaioannou, Andreas P Michaelides, Steven Singh, Christodoulos I Stefanadis. (2004) Exercise capacity and heart rate recovery as predictors of coronary heart disease events, in patients with heterozygous Familial Hypercholesterolemia. Atherosclerosis 173:2, 345-350
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Sean Carroll, Mike Dudfield. (2004) What is the Relationship Between Exercise and Metabolic Abnormalities?. Sports Medicine 34:6, 371-418
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Demosthenes B. Panagiotakos, Christos Pitsavos, Christina Chrysohoou, John Skoumas, Akis Zeimbekis, Ioanna Papaioannou, Christodoulos Stefanadis. (2003) Effect of leisure time physical activity on blood lipid levels: the ATTICA study. Coronary Artery Disease 14:8, 533-539
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Milton Hollenberg, Tad Haight, Ira B. Tager. (2003) Depression decreases cardiorespiratory fitness in older women. Journal of Clinical Epidemiology 56:11, 1111-1117
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