Original Article
A Prospective Study of Walking as Compared with Vigorous Exercise in the Prevention of Coronary Heart Disease in Women
N Engl J Med 1999; 341:650-658August 26, 1999
- Abstract
Background
The role of walking, as compared with vigorous exercise, in the prevention of coronary heart disease remains controversial, and data for women on this topic are sparse.
Methods
We prospectively examined the associations between the score for total physical activity, walking, and vigorous exercise and the incidence of coronary events among 72,488 female nurses who were 40 to 65 years old in 1986. Participants were free of diagnosed cardiovascular disease or cancer at the time of entry and completed serial detailed questionnaires about physical activity. During eight years of follow-up, we documented 645 incident coronary events (nonfatal myocardial infarction or death from coronary disease).
Results
There was a strong, graded inverse association between physical activity and the risk of coronary events. As compared with women in the lowest quintile group for energy expenditure (expressed as the metabolic-equivalent [MET] score), women in increasing quintile groups had age-adjusted relative risks of 0.77, 0.65, 0.54, and 0.46 for coronary events (P for trend <0.001). In multivariate analyses, the inverse gradient remained strong (relative risks, 0.88, 0.81, 0.74, and 0.66 for women in increasing quintile groups as compared with those in the lowest quintile group; P for trend=0.002). Walking was inversely associated with the risk of coronary events; women in the highest quintile group for walking, who walked the equivalent of three or more hours per week at a brisk pace, had a multivariate relative risk of 0.65 (95 percent confidence interval, 0.47 to 0.91) as compared with women who walked infrequently. Regular vigorous exercise (≥6 MET) was associated with similar risk reductions (30 to 40 percent). Sedentary women who became active in middle adulthood or later had a lower risk of coronary events than their counterparts who remained sedentary.
Conclusions
These prospective data indicate that brisk walking and vigorous exercise are associated with substantial and similar reductions in the incidence of coronary events among women.
Media in This Article
Figure 2
Age-Adjusted and Multivariate Relative Risks of Coronary Events (Nonfatal Myocardial Infarction or Death from Coronary Causes) According to Walking Pace.Figure 1
Multivariate Relative Risk of Coronary Events (Nonfatal Myocardial Infarction or Death from Coronary Causes) According to Quintile Group for Total Physical Activity within Subgroups Defined According to Smoking Status (Panel A), Body-Mass Index (Panel B), and Presence or Absence of a Parental History of Premature Myocardial Infarction (Panel C).Article Activity
- Article
In epidemiologic studies, physical activity has been associated with a decrease in the risk of coronary heart disease,1,2 but data on women have been sparse. Moreover, the specific role of walking, the most common form of exercise among women,3 has not been fully elucidated. The most recent federal guidelines from the Centers for Disease Control and Prevention and the American College of Sports Medicine,4 as well as the Surgeon General's report on physical activity and health,3 endorse at least 30 minutes of moderate-intensity physical activity on most, and preferably all, days of the week, whereas earlier guidelines recommended vigorous endurance exercise for at least 20 minutes three or more times per week.5 Although the current guidelines encourage a level of activity that is safe, achievable, and feasible for most Americans (60 percent of whom do not engage in regular physical activity),6,7 the potential benefits of moderate-intensity activity in preventing coronary heart disease remain unclear.
We therefore assessed the comparative roles of walking and vigorous exercise in the prevention of coronary events in a large cohort of women enrolled in the prospective Nurses' Health Study. Detailed and repeated assessments of physical activity were performed to examine the degree to which total physical activity, walking time and pace, vigorous exercise, and change in activity level were associated with the incidence of coronary events in this cohort.
Methods
Study Population
The Nurses' Health Study was initiated in 1976, when 121,700 female registered nurses 30 to 55 years old who were residing in 11 large U.S. states completed a mailed questionnaire on their medical history and lifestyle. Every two years, follow-up questionnaires have been sent to obtain updated information on potential risk factors and to identify newly diagnosed cases of coronary heart disease or other illnesses. For the primary analyses in the present study, the base-line data were those gathered in 1986, when detailed information on physical activity was first collected, and the duration of follow-up was eight years. After women who reported a diagnosis of cardiovascular disease or cancer at base line were excluded, the population for analysis was made up of 72,488 women 40 to 65 years old in 1986.
Assessment of Physical Activity
Detailed information on physical activity was first collected in 1986 and was updated in 1988 and 1992. Participants were asked to report the average amount of time spent per week during the previous year in walking or hiking outdoors (including walking to work or while playing golf), jogging (at a speed slower than 10 minutes per mile [6 minutes per kilometer]), running (at 10 minutes per mile or faster), bicycling (including the use of a stationary bicycle), swimming laps, playing tennis or squash, or participating in calisthenics, aerobics, or aerobic dance; in addition, the women were asked to report the average number of flights of stairs they climbed each week. Women also reported their usual walking pace: easy or casual (<2.0 miles per hour [mph] [3.2 km per hour]), average (2.0 to 2.9 mph [3.2 to 4.6 km per hour]), brisk (3.0 to 3.9 mph [4.8 to 6.2 km per hour]), or very brisk (≥4.0 mph [6.4 km per hour]). Using a standardized classification of the energy costs of physical activities,8 we calculated a weekly metabolic-equivalent (MET) score for total physical activity, vigorous activity (≥6 MET per hour), nonvigorous activity (<6 MET per hour), and walking (2.5 to 4.5 MET per hour, depending on the pace). One MET is the caloric need per kilogram of body weight per hour of activity, divided by the caloric need per kilogram per hour at rest. Physical-activity scores were expressed as MET-hours per week. Validation of the questionnaire for assessing physical activity has been described previously in a similar cohort9; the overall correlation between physical activities reported on the questionnaire and those recorded in four one-week diaries was 0.62, and the correlation was 0.79 for activities reported on the questionnaire and those recalled after one week.9
For secondary analyses, we used data from a shorter questionnaire about physical activity that was administered in 1980 and 1982. On the 1980 questionnaire, women were asked to report the average number of hours they spent each week during the previous year engaged in moderate or vigorous recreational activities, including vigorous sports, jogging, bicycling, brisk walking, heavy gardening, or heavy housework. On the 1982 questionnaire, women were asked the question: “For how many hours per week, on average, do you engage in activity strenuous enough to build up a sweat?” To analyze this information, we calculated the cumulative average number of hours per week spent in moderate or vigorous recreational activities (all the activities listed above except for walking at a casual or average pace), as assessed in 1980, and (with updated information) in 1982, 1986, 1988, and 1992.
Ascertainment of End Points
The primary end points for this study were coronary events (defined as nonfatal myocardial infarction or death due to coronary disease) that occurred after the return of the 1986 questionnaire and before June 1994. We requested permission to review the medical records of women who reported a nonfatal myocardial infarction on a follow-up questionnaire. Study physicians who had no knowledge of the women's self-reported risk factors reviewed the records. Nonfatal myocardial infarction was confirmed if data in the medical records met World Health Organization criteria for this condition — namely, symptoms and either diagnostic electrocardiographic changes or elevated cardiac-enzyme levels.10 Myocardial infarctions that required hospital admission and for which confirmatory information was obtained by interview or letter but for which no medical records were available were designated as probable infarctions (and constituted 17 percent of all reported nonfatal infarctions). We included all confirmed and probable cases of infarction in the analyses because the results were the same whether probable cases were included or excluded. Follow-up information for nonfatal infarction was obtained for more than 95 percent of the potential person-time of follow-up.
Deaths were reported by family members or the Postal Service or were ascertained through state registries or the National Death Index. We estimate that follow-up for deaths was more than 98 percent complete.11 Fatal coronary disease (codes 410 through 414 of the International Classification of Diseases , 8th Revision 12) was confirmed by review of the hospital or medical autopsy records or by review of the death certificate if coronary disease was the stated cause of death and evidence of previous coronary disease was available. We designated deaths for which coronary disease was listed as the underlying cause on the death certificate, but for which no records were available, as due to presumed fatal coronary disease. These cases constituted 14.7 percent of all fatal coronary events. We also included sudden deaths (12.3 percent of all fatal coronary events). Analyses limited to confirmed cases yielded results similar to those in which confirmed and presumed cases of fatal coronary disease were combined.
Statistical Analysis
For primary analyses, we used the detailed assessment of physical activity performed in 1986 as the base line. Person-time for each participant was calculated from the date of her return of the 1986 questionnaire to the date of an incident coronary event, death from any cause, or June 1, 1994, whichever came first. Data on women who had a coronary event or who died from any cause were censored with respect to subsequent analysis during follow-up. The relative risk of a coronary event was computed as the incidence of the event in each quintile group for MET score, divided by the incidence in the lowest quintile group, with adjustment for five-year age categories. Tests of linear trend for increasing quintiles of MET scores were performed by treating the score as a continuous variable and designating the median score for the category as its value. To represent long-term levels of physical activity for individual women as accurately as possible and to reduce measurement error, we calculated cumulative averages of the MET scores from all the questionnaires available up to the start of each two-year follow-up interval. A similar method for analyzing repeated dietary measurements has been described in detail elsewhere.13
For secondary analyses, we used data gathered in 1980 as the base line. We used the continuous values of hours of activity per week to compute the cumulative averages at the start of each interval and grouped the average hours per week of moderate or vigorous exercise into five categories (<1, 1 to 1.9, 2 to 3.9, 4 to 6.9, and ≥7 hours per week). To examine the association between a change in physical activity and the risk of coronary events, we related the change between 1980 and 1986 in hours spent engaged in moderate or vigorous activity to coronary events occurring between 1986 and 1994.
We used pooled logistic regression14 to adjust simultaneously for potential confounding variables, including age (in five-year categories), period during the study (four two-year periods), smoking status (never smoked, previously smoked, or currently smokes 1 to 14, 15 to 24, or ≥25 cigarettes per day), body-mass index (the weight in kilograms divided by the square of the height in meters, in five categories), alcohol consumption (0, 1 to 4, 5 to 14, or ≥15 g per day), menopausal status (premenopausal, postmenopausal without hormone-replacement therapy, postmenopausal with previous hormone-replacement therapy, or postmenopausal with current hormone-replacement therapy), history of diabetes, history of hypercholesterolemia, history of hypertension, parental history of myocardial infarction before the age of 60 years, use of multivitamin supplements, use of vitamin E supplements, and use of aspirin (none, one to six doses per week, or seven or more doses per week). Covariates were updated according to questionnaire information every two years. The population attributable risk was calculated from multivariate models with use of the following formula: ([1 – relative risk] ÷ relative risk) × (pro-portion of inactive cases) (×100).15
Results
The distribution at base line of several indicators of coronary risk varied according to quintile group for total physical-activity score (expressed as MET-hours per week) in this cohort (Table 1Table 1
Distribution of Indicators of Coronary Risk According to Quintile Group for Total Physical-Activity Score at Base Line (1986).). Women who were more physically active were less likely to be current smokers and, as expected, were leaner and had a lower prevalence of reported hypertension, diabetes, and hypercholesterolemia than less active women. More physically active women were also more likely to use postmenopausal hormone-replacement therapy, multivitamin and vitamin E supplements, and alcohol. In contrast, the activity level was not appreciably related to age, parental history of myocardial infarction, or dietary intake of fats or cholesterol.The eight years of follow-up, from 1986 to 1994, included 559,435 person-years. During this follow-up period we documented 645 coronary events (475 nonfatal myocardial infarctions and 170 deaths from coronary disease) among the 72,488 women who in 1986 were 40 to 65 years old, had neither cardiovascular disease nor cancer, and completed a detailed physical-activity questionnaire. The total physical-activity score (expressed as MET-hours per week) in 1986 was strongly inversely related to the risk of coronary events during the eight-year follow-up (Table 2Table 2
Relative Risk of Coronary Events According to Quintile Group for Total Physical-Activity Score.). In age-adjusted analyses from 1986 to 1994 (in which MET scores, first computed in 1986, were calculated as cumulative updated averages in 1988 and 1992), the risk of coronary events decreased monotonically with increasing quintiles for MET score (relative risks, 0.77, 0.65, 0.54, and 0.46 as compared with the risk in the lowest quintile group; P for trend <0.001). In multivariate analyses, after simultaneous control for age, smoking status, body-mass index, and other covariates (Table 2), the total physical-activity score remained a powerful predictor of the subsequent risk of coronary events; relative risks for increasing quintile groups for physical activity, as compared with the lowest quintile group, were 0.88, 0.81, 0.74, and 0.66 (P for trend=0.002). There was a significant risk reduction for the two highest quintile groups, with a total of 10.5 MET-hours per week or more (the equivalent of ≥3 hours per week of brisk walking or 1.5 hours per week of vigorous exercise). In a separate analysis in which data from the first two years of follow-up after completion of the activity questionnaires were excluded (to minimize potential bias due to the influence of subclinical disease on activity level), the results were not materially altered (Table 2). Exclusion of biologic variables that may have a role in mediating the effect of activity (e.g., body-mass index) strengthened the inverse association between physical-activity level and risk of a coronary event (relative risk, 0.60 [95 percent confidence interval, 0.46 to 0.77] for the highest vs. the lowest quintile group for total physical-activity score) (Table 2).To assess the potential modifying effects of cigarette-smoking status, body-mass index, and parental history with respect to premature myocardial infarction on the relation between physical activity and coronary events, analyses were repeated within subgroups defined by these variables (Figure 1Figure 1
Multivariate Relative Risk of Coronary Events (Nonfatal Myocardial Infarction or Death from Coronary Causes) According to Quintile Group for Total Physical Activity within Subgroups Defined According to Smoking Status (Panel A), Body-Mass Index (Panel B), and Presence or Absence of a Parental History of Premature Myocardial Infarction (Panel C).). Physical activity was inversely related to the risk of coronary events in all strata for smoking (never, previously, and currently), for both nonobese and obese women, and for women with and those without a parental history of premature myocardial infarction.We next used the 1980 questionnaire to assess the long-term association between moderate and vigorous recreational activity (from data updated in 1982, 1986, 1988, and 1992) and the incidence of coronary events from 1980 to 1994. The activities included were vigorous sports, jogging, bicycling, brisk walking, heavy gardening, heavy housework, and activities “strenuous enough to build up a sweat.” The number of hours per week of moderate or vigorous activity were strongly inversely related to the risk of coronary events. In multivariate analyses, averages of 4.0 to 6.9 and 7 or more hours per week spent in these activities were associated with risk reductions of 31 percent and 37 percent, respectively, as compared with an average of less than 1 hour per week (P for trend <0.001).
To assess the role of changes in activity level during the follow-up period, we categorized information from women according to their activity in 1980 relative to that in 1986. In an analysis restricted to women who were sedentary (exercised less than once per week) in 1980 (54 percent of the cohort at that time), women who remained sedentary in 1986 had substantially higher rates of coronary events than women who became active. As compared with the risk among women who remained sedentary, the multivariate risks of coronary events from 1986 to 1994 for women in increasing quintile groups for total physical activity (MET score) in 1986 were 0.85, 0.79, 0.67, and 0.71 (P for trend=0.03).
Detailed information about walking (duration and pace) was first obtained in 1986 and was updated in 1988 and 1992. Approximately 60 percent of the cohort of 72,488 women reported in 1986 that they walked for at least one hour per week, whereas only 26 percent engaged in vigorous exercise (≥6 MET) for at least one hour per week. To address the association between walking and the risk of coronary events while minimizing the potential confounding effect of vigorous activity, we restricted the study population to the women who reported no vigorous exercise (47 percent of the cohort). Women in the two highest quintile groups for walking score (a composite of walking time and pace) had a significantly reduced risk of coronary events as compared with the risk in the lowest quintile group (Table 3Table 3
Relative Risk of Coronary Events among Women Who Did Not Engage in Vigorous Exercise, According to Quintile Group for Walking.). As compared with sedentary women, women who had a walking score of 3.9 to 9.9 MET-hours per week — the equivalent of 1 to 2.9 hours of walking per week at a brisk pace ≥3 mph — had a multivariate relative risk of 0.70 (95 percent confidence interval, 0.51 to 0.95) for subsequent coronary events, and those with scores of 10 or more MET-hours per week — the equivalent of 3 or more hours of walking per week at a brisk pace — had a multivariate relative risk of 0.65 (95 percent confidence interval, 0.47 to 0.91) for subsequent coronary events (P for trend=0.02). For those who walked five or more hours per week, the risk reduction exceeded 40 percent (data not shown). Exclusion of the small number of women who reported that they were “unable to walk” on the 1990 or 1992 questionnaire (2 percent of the cohort) did not alter these results.Walking pace was also an important determinant of the risk of coronary events (Figure 2Figure 2
Age-Adjusted and Multivariate Relative Risks of Coronary Events (Nonfatal Myocardial Infarction or Death from Coronary Causes) According to Walking Pace.). In multivariate analyses that also included control for time spent walking (in MET-hours per week), walking pace emerged as an independent predictor of the risk of coronary events. As compared with women who walked at an easy or casual pace (<2.0 mph), women who usually walked at an average pace (2.0 to 2.9 mph) had a multivariate relative risk of 0.75 (95 percent confidence interval, 0.59 to 0.96), whereas those who walked briskly or very briskly (≥3.0 mph) had a relative risk of 0.64 (95 percent confidence interval, 0.47 to 0.88).To assess the comparative roles of walking and vigorous exercise in relation to coronary risk, we examined the incidence of coronary events according to the joint distribution of MET-hours per week spent in these activities (Table 4Table 4
Multivariate Relative Risks of Coronary Events According to Categories of Vigorous Exercise and Walking.). Women who engaged in both walking and vigorous exercise had greater reductions in coronary events than those who participated in either type of activity alone. When examined simultaneously in a multivariate model, walking and vigorous exercise were each associated with a risk reduction. For every 5 MET-hours per week spent walking (the equivalent of 1.5 hours of walking per week at a brisk pace), the multivariate relative risk of coronary events was 0.86 (95 percent confidence interval, 0.74 to 0.99; β coefficient, –0.157), and for every 5 MET-hours per week spent in vigorous exercise (the equivalent of jogging, bicycling, swimming laps, or playing tennis for 45 minutes per week), the multivariate risk was 0.94 (95 percent confidence interval, 0.89 to 0.99; β coefficient, –0.059). Thus, we did not observe a greater magnitude of risk reduction with vigorous exercise than with walking in this cohort when we compared those who walked with those who exercised vigorously a similar number of MET-hours per week. However, our ability to assess the role of vigorous exercise was limited because of the small number of women in this study population (26 percent of the cohort) who engaged regularly in vigorous exercise.Discussion
These prospective data from a large cohort of women indicate that both walking and vigorous exercise are associated with substantial reductions in the incidence of coronary events. We observed that in this cohort, the magnitudes of risk reduction associated with brisk walking and vigorous exercise were similar when total energy expenditures were similar. These findings lend further support to current federal exercise guidelines, which endorse moderate-intensity exercise for at least 30 minutes on most (preferably all) days of the week.3,4 Our results suggest that such a regimen (e.g., brisk walking for three or more hours per week) could reduce the risk of coronary events in women by 30 to 40 percent. Increasing walking time or combining walking with vigorous exercise appears to be associated with even greater risk reductions. Given the high prevalence in the United States of a sedentary lifestyle (78 percent of adults engage in less physical activity than currently recommended),3 we estimate, on the basis of our multivariate relative-risk analyses, that one third of coronary events among middle-aged women in the United States are attributable to physical inactivity.
The strengths of the current study include the prospective design, the large size of the cohort, the long-term follow-up, repeated measures of physical activity, and the uniform and strict criteria for coronary events. Women with diagnosed cardiovascular disease or cancer at base line were excluded from the analyses. These exclusions and the prospective design minimized any influence that underlying disease may have had on physical-activity levels and decreased the potential for biased reporting of activity. Moreover, in our secondary analyses, the first two years of follow-up were excluded in order to minimize bias related to subclinical disease. The repeated measures of physical activity enabled us to calculate more stable, cumulative, and updated classifications of activity status as well as to assess the role of changes in activity level over time. Other advantages include the level of detail of information gathered about walking time and pace on the survey first administered in 1986, the high rate of participation during follow-up, and the collection of information about a large number of potential confounders, including cigarette smoking, body-mass index, family history of myocardial infarction, postmenopausal hormone use, alcohol consumption, diet, and other coronary risk factors. The substantial reduction in the risk of coronary events among women who increased their activity level, as compared with women who remained sedentary, and the strong dose–response gradient observed in each analysis lend credence to the interpretation that there is a causal relation between physical activity and a reduced risk of coronary events and that the risk may be modified through increased activity, even when it is begun in later adulthood.
Because our multivariate analyses controlled for several factors that could be considered intermediate biologic variables (such as body-mass index and a history of hypertension, hypercholesterolemia, or diabetes),3 the analyses provide a conservative estimate of the relation between physical activity and coronary disease. In analyses that excluded these biologic intermediates, the inverse association between physical activity and coronary events was strengthened (Table 2).
Limitations of the current study must also be considered. Physical activity was assessed by a self-administered questionnaire and, despite the use of repeated measures, there was undoubtedly some misclassification. However, in a validation study, conducted in a separate cohort of nurses, the correlations between physical activity as reported on the questionnaire and as recorded in four one-week diaries or recalled after one week were reasonably high (r=0.62 and r=0.79, respectively).9 Random misclassifications would be expected to lead to underestimation of the true association and to bias the estimate of risk toward unity; therefore, misclassification cannot explain the strong inverse associations in our cohort between physical-activity level and the incidence of coronary events. Nevertheless, despite the control for many potential confounding variables in our multivariate analyses, residual confounding by lifestyle factors cannot be excluded. In this regard, it should be noted (Table 1) that the more active women had more favorable risk profiles. Finally, our study population, consisting of registered nurses, is not representative of the general population. The relative homogeneity of the cohort in educational attainment and socioeconomic status may actually serve to enhance the internal validity of this study; confounding by these factors has posed an important problem in many previous studies of physical activity and coronary disease.
More than 40 epidemiologic studies have addressed the relation between exercise and coronary disease,1,2 but few have included women and presented data on women separately.16-24 In those that did, results in women were generally similar to those in men, indicating that risk reductions were 30 to 50 percent in both sexes with regular physical activity. Most of these studies were small, however, and did not collect detailed information about walking or report repeated measures of activity. The evidence that moderate-intensity activity is associated with a reduction in the risk of coronary disease, however, has been mounting. In a recent report from the Iowa Women's Health Study, both moderate activity and vigorous activity were inversely related to overall mortality and mortality due to cardiovascular causes,20 although walking was not assessed separately. In two recent studies among elderly women24 and men,25 walking at least four hours per week was associated with substantial reductions in cardiovascular risk.
Even moderate levels of physical fitness (assessed by treadmill testing) have been associated with substantial reductions in mortality due to cardiovascular events and in total mortality.23 It is unlikely that genetic and constitutional differences in fitness levels and in the ability to exercise explain these findings: in a study of nearly 16,000 men and women in the Finnish Twin Cohort, leisure-time physical activity was associated with reduced mortality, even after the analyses had accounted for genetic, familial, and behavioral factors.26
It is also biologically plausible that both moderate exercise and vigorous exercise have an important role in reducing coronary risk. Increasing the intensity or duration of exercise has a graded relation to improvements in lipid concentrations3,27 and insulin sensitivity.28 Randomized trials of the effects of different intensities of exercise on blood pressure suggest that moderate- and vigorous-intensity activity may confer similar reductions in diastolic blood pressure and that moderate-intensity activity may confer even greater reductions in systolic blood pressure than vigorous-intensity exercise.3 In the Insulin Resistance Atherosclerosis Study, both vigorous and nonvigorous levels of physical activity were directly associated with insulin sensitivity.28 Moreover, equivalent expenditures of energy in moderate or vigorous exercise will lead to similar reductions in adipose mass.3 A recent study indicated that moderate-intensity exercise reduces the secretion of atherogenic cytokines.29 Finally, physical activity of all intensities has been linked to improvement in emotional well-being and reduction in anxiety and stress.3
In conclusion, these prospective data from a study of a large cohort of women indicate that both walking and vigorous exercise are associated with substantial reductions in the risk of coronary events. We observed a strong, graded inverse relation between energy expenditure in either walking or vigorous activity and the incidence of coronary disease. Among women who either walked briskly at least 3 hours per week or exercised vigorously for 1.5 hours per week, the risk was reduced by 30 to 40 percent. These findings lend support to current federal guidelines that endorse moderate-intensity exercise, which is safe, achievable, and feasible for the majority of the population. Although vigorous exercise should not be discouraged for those who choose a higher intensity of activity, our results indicate that enormous public health benefits would accrue from the adoption of regular moderate-intensity exercise by those who are currently sedentary.
Supported by research grants (HL34594 and CA40356) from the National Institutes of Health.
We are indebted to the participants in the Nurses' Health Study for their outstanding dedication and commitment; and to Karen Corsano, Gary Chase, Barbara Egan, Lisa Dunn, Sandra Melanson, Jeanne Grol, and Stefanie Parker for their unfailing assistance.
Source Information
From the Channing Laboratory (J.E.M., G.A.C., M.J.S., W.C.W., F.E.S.) and the Division of Preventive Medicine (J.E.M., C.H.H.), Department of Medicine, Harvard Medical School and Brigham and Women's Hospital; the Departments of Nutrition (F.B.H., M.J.S., W.C.W.) and Epidemiology (J.E.M., G.A.C., M.J.S., W.C.W., C.H.H.), Harvard School of Public Health; and the Department of Ambulatory Care and Prevention, Harvard Medical School (J.W.R.-E., C.H.H.) — all in Boston.
Address reprint requests to Dr. Manson at Brigham and Women's Hospital, 181 Longwood Ave., Boston, MA 02115, or at jmanson@rics.bwh.harvard.edu.
- References
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CrossRef | Web of Science | Medline
- Citing Articles (215)
Citing Articles
1
M. Du, J. Prescott, P. Kraft, J. Han, E. Giovannucci, S. E. Hankinson, I. De Vivo. (2012) Physical Activity, Sedentary Behavior, and Leukocyte Telomere Length in Women. American Journal of Epidemiology
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(2012) European Heart Journal
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Fiona C. Denison, Carolyn Chiswick. (2011) Improving pregnancy outcome in obese women. Proceedings of the Nutrition Society 70:04, 457-464
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R. Brion. (2011) L’activité physique : un élément clef de la prévention primaire cardiovasculaire. Archives des Maladies du Coeur et des Vaisseaux - Pratique 2011:200, 16-20
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Ester Cerin, Ka-wai Chan, Duncan J. Macfarlane, Ka-yiu Lee, Poh-chin Lai. (2011) Objective assessment of walking environments in ultra-dense cities: Development and reliability of the Environment in Asia Scan Tool—Hong Kong version (EAST-HK). Health & Place 17:4, 937-945
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Erin K. Kastenschmidt, Gary J. Kennedy. (2011) Depression and Anxiety in Late Life: Diagnostic Insights and Therapeutic Options. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine 78:4, 527-545
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Jaehee Kim, Sohee Oh, Haesook Min, Yeonjung Kim, Taesung Park. (2011) Practical issues in genome-wide association studies for physical activity. Annals of the New York Academy of Sciences 1229:1, 38-44
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Jeff K. Vallance, Terra C. Murray, Steven T. Johnson, Steriani Elavsky. (2011) Understanding Physical Activity Intentions and Behavior in Postmenopausal Women: An Application of the Theory of Planned Behavior. International Journal of Behavioral Medicine 18:2, 139-149
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Paul T. Williams. (2011) Dose-response relationship between walking and the attenuation of inherited weight. Preventive Medicine 52:5, 293-299
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Carl J. Lavie. (2011) Exercise and Cardiovascular Diseases—a Matter of Life or Death. Progress in Cardiovascular Diseases 53:6, 385-386
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Edward Archer, Steven N. Blair. (2011) Physical Activity and the Prevention of Cardiovascular Disease: From Evolution to Epidemiology. Progress in Cardiovascular Diseases 53:6, 387-396
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Kristin D Kistler, Elizabeth M Brunt, Jeanne M Clark, Anna Mae Diehl, James F Sallis, Jeffrey B Schwimmer. (2011) Physical Activity Recommendations, Exercise Intensity, and Histological Severity of Nonalcoholic Fatty Liver Disease. The American Journal of Gastroenterology 106:3, 460-468
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H. Pieringer, M. Pichler. (2011) Cardiovascular morbidity and mortality in patients with rheumatoid arthritis: vascular alterations and possible clinical implications. QJM 104:1, 13-26
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Peter Kitchen, Allison Williams, James Chowhan. (2011) Walking to work in Canada: health benefits, socio-economic characteristics and urban-regional variations. BMC Public Health 11:1, 212
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Claudio R. Nigg, Karly S. Geller, Rob W. Motl, Caroline C. Horwath, Kristin K. Wertin, Rodney K. Dishman. (2011) A research agenda to examine the efficacy and relevance of the Transtheoretical Model for physical activity behavior. Psychology of Sport and Exercise 12:1, 7-12
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Megan Teychenne, Kylie Ball, Jo Salmon. (2010) Sedentary Behavior and Depression Among Adults: A Review. International Journal of Behavioral Medicine 17:4, 246-254
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Cynthia A. Stuenkel. (2010) Taking steps (literally) toward a healthier heart. Menopause 17:6, 1111-1113
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Alice S Ryan. (2010) Exercise in aging: its important role in mortality, obesity and insulin resistance. Aging Health 6:5, 551-563
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J. Pucher, R. Buehler, D. R. Bassett, A. L. Dannenberg. (2010) Walking and Cycling to Health: A Comparative Analysis of City, State, and International Data. American Journal of Public Health 100:10, 1986-1992
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P. Diehr, C. Hirsch. (2010) Health Benefits of Increased Walking for Sedentary, Generally Healthy Older Adults: Using Longitudinal Data to Approximate an Intervention Trial. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 65A:9, 982-989
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S.S. Bassuk, J.E. Manson. (2010) Physical activity and cardiovascular disease prevention in women: A review of the epidemiologic evidence. Nutrition, Metabolism and Cardiovascular Diseases 20:6, 467-473
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Roy J. Shephard, Yukitoshi Aoyagi. (2010) Objective monitoring of physical activity in older adults: clinical and practical implications. Physical Therapy Reviews 15:3, 170-182
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R. Todd Hurst, Robert F. Burke, Erik Wissner, Arthur Roberts, Christopher B. Kendall, Steven J. Lester, Virend Somers, Martin E. Goldman, Qing Wu, Bijoy Khandheria. (2010) Incidence of Subclinical Atherosclerosis as a Marker of Cardiovascular Risk in Retired Professional Football Players. The American Journal of Cardiology 105:8, 1107-1111
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E. A. Beverly, L. A. Wray. (2010) The role of collective efficacy in exercise adherence: a qualitative study of spousal support and Type 2 diabetes management. Health Education Research 25:2, 211-223
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Dick H. J. Thijssen, Andrew J. Maiorana, Gerry O’Driscoll, Nigel T. Cable, Maria T. E. Hopman, Daniel J. Green. (2010) Impact of inactivity and exercise on the vasculature in humans. European Journal of Applied Physiology 108:5, 845-875
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Samuel T. Creavin, Kate M. Dunn, Christian D. Mallen, Iris Nijrolder, Daniëlle A.W.M. van der Windt. (2010) Co-occurrence and associations of pain and fatigue in a community sample of Dutch adults. European Journal of Pain 14:3, 327-334
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Giuseppe Sergi, Alessandra Coin, Silvia Sarti, Egle Perissinotto, Marina Peloso, Silvana Mulone, Manola Trolese, Emine Meral Inelmen, Giuliano Enzi, Enzo Manzato. (2010) Resting VO2, maximal VO2 and metabolic equivalents in free-living healthy elderly women. Clinical Nutrition 29:1, 84-88
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Jeff K. Vallance, Terra C. Murray, Steven T. Johnson, Steriani Elavsky. (2010) Quality of life and psychosocial health in postmenopausal women achieving public health guidelines for physical activity. Menopause 17:1, 64-71
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Parvin Abedi, Mary Huang Soo Lee, Mirnalini Kandiah, Zaitun Yassin, Davood Shojaeezade, Mostafa Hosseini, Reza Malihi. (2010) Diet intervention to improve cardiovascular risk factors among Iranian postmenopausal women. Nutrition Research and Practice 4:6, 522
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Shari S. Bassuk, JoAnn E. Manson. 2010. Gender-Specific Aspects of Selected Coronary Heart Disease Risk FactorsA Summary of the Epidemiologic Evidence. , 162-174.
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Allison E. Aiello, George A. Kaplan. (2009) Socioeconomic Position and Inflammatory and Immune Biomarkers of Cardiovascular Disease: Applications to the Panel Study of Income Dynamics. Biodemography and Social Biology 55:2, 178-205
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D. Schaeffer, A. Büscher. (2009) Möglichkeiten der Gesundheitsförderung in der Langzeitversorgung. Zeitschrift für Gerontologie und Geriatrie 42:6, 441-451
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Barbara Sassen, Véronique A. Cornelissen, Henri Kiers, Harriet Wittink, Gerjo Kok, Luc Vanhees. (2009) Physical fitness matters more than physical activity in controlling cardiovascular disease risk factors. European Journal of Cardiovascular Prevention & Rehabilitation 16:6, 677-683
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S. L Taubman, J. M Robins, M. A Mittleman, M. A Hernan. (2009) Intervening on risk factors for coronary heart disease: an application of the parametric g-formula. International Journal of Epidemiology 38:6, 1599-1611
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David M. Buchner. (2009) Physical Activity and Prevention of Cardiovascular Disease in Older Adults. Clinics in Geriatric Medicine 25:4, 661-675
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Jacob R. Sattelmair, Jeremy H. Pertman, Daniel E. Forman. (2009) Effects of Physical Activity on Cardiovascular and Noncardiovascular Outcomes in Older Adults. Clinics in Geriatric Medicine 25:4, 677-702
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Carl J. Lavie, Richard Milani. (2009) Secondary Coronary Prevention in Women: It Starts with Cardiac Rehabilitation, Exercise, and Fitness. Journal of Women's Health 18:8, 1115-1117
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Satvinder S. Dhaliwal, Timothy A. Welborn. (2009) Central obesity and cigarette smoking are key determinants of cardiovascular disease deaths in Australia: A public health perspective. Preventive Medicine 49:2-3, 153-157
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Karin Schenck-Gustafsson. (2009) Risk factors for cardiovascular disease in women. Maturitas 63:3, 186-190
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Frank B. Hu. (2009) Diet and lifestyle influences on risk of coronary heart disease. Current Atherosclerosis Reports 11:4, 257-263
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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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Kuo-Liong Chien, Ming-Fong Chen, Hsiu-Ching Hsu, Ta-Chen Su, Yuan-Teh Lee. (2009) Sports activity and risk of type 2 diabetes in Chinese. Diabetes Research and Clinical Practice 84:3, 311-318
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MARK HAMER, EMMANUEL STAMATAKIS. (2009) Physical Activity and Risk of Cardiovascular Disease Events. Medicine & Science in Sports & Exercise 41:6, 1206-1211
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Leon D. Sanchez, Jayson Pereira, David J. Berkoff. (2009) The Evaluation of Cardiac Complaints in Marathon Runners. The Journal of Emergency Medicine 36:4, 369-376
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Roseann M. Chesler, Nieca Goldberg, Richard A. Stein. (2009) Physiologic considerations and pragmatic issues in the design and implementation of lifetime exercise programs to prevent and treat coronary artery disease in women. Current Cardiovascular Risk Reports 3:3, 211-218
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Mark Hamer, Emmanuel Stamatakis. (2009) Physical activity and mortality in men and women with diagnosed cardiovascular disease. European Journal of Cardiovascular Prevention & Rehabilitation 16:2, 156-160
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Henry Zheng, Nicola Orsini, Janaki Amin, Alicja Wolk, Van Thi Thuy Nguyen, Fred Ehrlich. (2009) Quantifying the dose-response of walking in reducing coronary heart disease risk: meta-analysis. European Journal of Epidemiology 24:4, 181-192
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Carl J. Lavie, Randal J. Thomas, Ray W. Squires, Thomas G. Allison, Richard V. Milani. (2009) Exercise Training and Cardiac Rehabilitation in Primary and Secondary Prevention of Coronary Heart Disease. Mayo Clinic Proceedings 84:4, 373-383
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C. J. Lavie, R. J. Thomas, R. W. Squires, T. G. Allison, R. V. Milani. (2009) Exercise Training and Cardiac Rehabilitation in Primary and Secondary Prevention of Coronary Heart Disease. Mayo Clinic Proceedings 84:4, 373-383
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J. Boone-Heinonen, K. R. Evenson, D. R. Taber, P. Gordon-Larsen. (2009) Walking for prevention of cardiovascular disease in men and women: a systematic review of observational studies. Obesity Reviews 10:2, 204-217
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Gert-Jan de Bruijn, Stef P.J. Kremers, Amika Singh, Bas van den Putte, Willem van Mechelen. (2009) Adult Active Transportation. American Journal of Preventive Medicine 36:3, 189-194
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Elsa-Grace V. Giardina, Melissa Laudano, Emily Hurstak, Alan Saroff, Elaine Fleck, Robert Sciacca, Bernadette Boden-Albala, Julia Cassetta. (2009) Physical Activity Participation among Caribbean Hispanic Women Living in New York: Relation to Education, Income, and Age. Journal of Women's Health 18:2, 187-193
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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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Lai Ming Yung, Ismail Laher, Xiaoqiang Yao, Zhen Yu Chen, Yu Huang, Fung Ping Leung. (2009) Exercise, Vascular Wall and Cardiovascular Diseases. Sports Medicine 39:1, 45-63
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A. G. Bertoni, M. C. Whitt-Glover, H. Chung, K. Y. Le, R. G. Barr, M. Mahesh, N. S. Jenny, G. L. Burke, D. R. Jacobs. (2008) The Association Between Physical Activity and Subclinical Atherosclerosis: The Multi-Ethnic Study of Atherosclerosis. American Journal of Epidemiology 169:4, 444-454
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Mohamad Sidani, Carol Ziegler. (2008) Preventing Heart Disease: Who Needs to be Concerned and What to Do. Primary Care: Clinics in Office Practice 35:4, 589-607
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Catherine L. Carpenter. (2008) Motivation to Exercise: Translating Our Best Intentions into Action. Obesity Management 4:6, 329-332
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M. Hamer, A. Steptoe. (2008) Walking, vigorous physical activity, and markers of hemostasis and inflammation in healthy men and women. Scandinavian Journal of Medicine & Science in Sports 18:6, 736-741
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Tineke Scheers, Renaat Philippaerts, Leen Van Langendonck, William Duquet, Nathalie Duvigneaud, Lynn Matton, Martine Thomis, Katrien Wijndaele, Johan Lefevre. (2008) Lipid profile in men and women with different levels of sports participation and physical activity. Public Health Nutrition 11:11,
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PAUL T. WILLIAMS. (2008) Relationship of Running Intensity to Hypertension, Hypercholesterolemia, and Diabetes. Medicine & Science in Sports & Exercise 40:10, 1740-1748
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Jo Ellen Vrazel, Ruth P. Saunders, Sara Wilcox. (2008) An Overview and Proposed Framework of Social-Environmental Influences on the Physical-Activity Behavior of Women. American Journal of Health Promotion 23:1, 2-12
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Francisco Javier Apullan, Martial G. Bourassa, Jean-Claude Tardif, Annik Fortier, Mathieu Gayda, Anil Nigam. (2008) Usefulness of Self-Reported Leisure-Time Physical Activity to Predict Long-Term Survival in Patients With Coronary Heart Disease. The American Journal of Cardiology 102:4, 375-379
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Christoph Handschin, Bruce M. Spiegelman. (2008) The role of exercise and PGC1α in inflammation and chronic disease. Nature 454:7203, 463-469
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G. A. Colditz, D. M. Winn. (2008) Criteria for the Evaluation of Large Cohort Studies: An Application to the Nurses' Health Study. JNCI Journal of the National Cancer Institute 100:13, 918-925
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DAVID R. BASSETT, MATTHEW T. MAHAR, DAVID A. ROWE, JAMES R. MORROW. (2008) Walking and Measurement. Medicine & Science in Sports & Exercise 40:Supplement, S529-S536
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BRIAN E. SAELENS, SUSAN L. HANDY. (2008) Built Environment Correlates of Walking. Medicine & Science in Sports & Exercise 40:Supplement, S550-S566
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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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S E Crouter, J R Churilla, D R Bassett. (2008) Accuracy of the Actiheart for the assessment of energy expenditure in adults. European Journal of Clinical Nutrition 62:6, 704-711
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Yi-Sub Kwak, Duk-Jung Kim. (2008) The Effects of the Complex Training Program on Cardiovascular Disease Risk Factors and Rate of Changes in the Elderly Women with Cardiovascular Disease.. Journal of Life Science 18:5, 715-723
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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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H. Drexel, C. H. Saely, P. Langer, G. Loruenser, T. Marte, L. Risch, G. Hoefle, S. Aczel. (2008) Metabolic and anti-inflammatory benefits of eccentric endurance exercise – a pilot study. European Journal of Clinical Investigation 38:4, 218-226
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I. Chung, D. Goyal, R. J. MacFadyen, G. Y. H. Lip. (2008) The effects of maximal treadmill graded exercise testing on haemorheological, haemodynamic and flow cytometry platelet markers in patients with systolic or diastolic heart failure. European Journal of Clinical Investigation 38:3, 150-158
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S. Patel, M. R. Adams. (2008) Prevention of cardiac disease: lifestyle modification or pharmacotherapy?. Internal Medicine Journal 38:3, 199-203
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George A. Bray. (2008) The Expert Weighs In: How Much Exercise Do We Need?: Interview with Timothy Church, M.D., Ph.D., M.P.H., Professor, John S. McIlhenny Endowed Chair of Health Wisdom and Director of the Laboratory of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana. Obesity Management 4:1, 8-10
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Conrad Earnest. (2008) Exercise: How to Begin. Obesity Management 4:1, 14-16
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Jillian Davis, Marie Murphy, Tom Trinick, Ellie Duly, Alan Nevill, Gareth Davison. (2008) Acute effects of walking on inflammatory and cardiovascular risk in sedentary post-menopausal women. Journal of Sports Sciences 26:3, 303-309
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Alice Lichtenstein, Nirupa Matthan. 2007. Cardiovascular Disease. .
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L. Miles. (2007) Physical activity and health. Nutrition Bulletin 32:4, 314-363
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Christa Meisinger, Hannelore Löwel, Margit Heier, Ulla Kandler, Angela Döring. (2007) Association of sports activities in leisure time and incident myocardial infarction in middle-aged men and women from the general population: the MONICA/KORA Augsburg cohort study. European Journal of Cardiovascular Prevention & Rehabilitation 14:6, 788-792
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Neville Owen, Ester Cerin, Eva Leslie, Lorinne duToit, Neil Coffee, Lawrence D. Frank, Adrian E. Bauman, Graeme Hugo, Brian E. Saelens, James F. Sallis. (2007) Neighborhood Walkability and the Walking Behavior of Australian Adults. American Journal of Preventive Medicine 33:5, 387-395
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Wendy J. Brown, Nicola W. Burton, Paul J. Rowan. (2007) Updating the Evidence on Physical Activity and Health in Women. American Journal of Preventive Medicine 33:5, 404-411.e25
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Lisa von Huth Smith, Knut Borch-Johnsen, Torben Jørgensen. (2007) Commuting physical activity is favourably associated with biological risk factors for cardiovascular disease. European Journal of Epidemiology 22:11, 771-779
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E. Fossum, G. W. Gleim, S. E. Kjeldsen, J. R. Kizer, S. Julius, R. B. Devereux, W. E. Brady, D. A. Hille, P. A. Lyle, B. Dahlöf. (2007) The effect of baseline physical activity on cardiovascular outcomes and new-onset diabetes in patients treated for hypertension and left ventricular hypertrophy: the LIFE study. Journal of Internal Medicine 262:4, 439-448
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Gang Hu, Pekka Jousilahti, Katja Borodulin, Noël C. Barengo, Timo A. Lakka, Aulikki Nissinen, Jaakko Tuomilehto. (2007) Occupational, commuting and leisure-time physical activity in relation to coronary heart disease among middle-aged Finnish men and women. Atherosclerosis 194:2, 490-497
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Hideko Takahashi, Shinichi Kuriyama, Yoshitaka Tsubono, Naoki Nakaya, Kazuki Fujita, Yoshikazu Nishino, Daisuke Shibuya, Ichiro Tsuji. (2007) Time spent walking and risk of colorectal cancer in Japan: The Miyagi Cohort Study. European Journal of Cancer Prevention 16:5, 403-408
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WILLIAM L. HASKELL, I-MIN LEE, RUSSELL R. PATE, KENNETH E. POWELL, STEVEN N. BLAIR, BARRY A. FRANKLIN, CAROLINE A. MACERA, GREGORY W. HEATH, PAUL D. THOMPSON, ADRIAN BAUMAN. (2007) Physical Activity and Public Health. Medicine & Science in Sports & Exercise 39:8, 1423-1434
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Ylva Trolle Lagerros, Pagona Lagiou. (2007) Assessment of physical activity and energy expenditure in epidemiological research of chronic diseases. European Journal of Epidemiology 22:6, 353-362
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Birna Bjarnason-Wehrens, Klaus Held, Eike Hoberg, Marthin Karoff, Bernhard Rauch. (2007) Deutsche Leitlinie zur Rehabilitation von Patienten mit Herz-Kreislauferkrankungen (DLL-KardReha). Clinical Research in Cardiology Supplements 2:3, 1-54
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Kenneth H. Pitetti, Andrew D. Rendoff, Travis Grover, Michael W. Beets. (2007) The Efficacy of a 9-Month Treadmill Walking Program on the Exercise Capacity and Weight Reduction for Adolescents with Severe Autism. Journal of Autism and Developmental Disorders 37:6, 997-1006
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Carol A. Mancuso, Melina Rincon, Wendy Sayles, Stephen A. Paget. (2007) Comparison of energy expenditure from lifestyle physical activities between patients with rheumatoid arthritis and healthy controls. Arthritis & Rheumatism 57:4, 672-678
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Heidi I. Stanish, Christopher C. Draheim. (2007) Walking Activity, Body Composition and Blood Pressure in Adults with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities 20:3, 183-190
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Marie H. Murphy, Alan M. Nevill, Elaine M. Murtagh, Roger L. Holder. (2007) The effect of walking on fitness, fatness and resting blood pressure: A meta-analysis of randomised, controlled trials. Preventive Medicine 44:5, 377-385
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Tyler C. Smith, Deborah L. Wingard, Besa Smith, Donna Kritz-Silverstein, Elizabeth Barrett-Connor. (2007) Walking decreased risk of cardiovascular disease mortality in older adults with diabetes. Journal of Clinical Epidemiology 60:3, 309-317
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Kathleen M. McCauley. (2007) Modifying Women’s Risk for Cardiovascular Disease. Journal of Obstetric, Gynecologic, & Neonatal Nursing 36:2, 116-124
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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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Toshiyuki Saito, Yoshihiro Shimazaki. (2007) Metabolic disorders related to obesity and periodontal disease. Periodontology 2000 43:1, 254-266
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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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Nihal Gelecek, Nursen Teoman, Mehtap Ozdirenc, Lamia Pınar, Pınar Akan, Cem Bediz, Omer Kozan. (2007) Influences of Acute and Chronic Aerobic Exercise on the Plasma Homocysteine Level. Annals of Nutrition and Metabolism 51:1, 53-58
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Melissa A. Napolitano, Jessica A. Whiteley, George Papandonatos, Gareth Dutton, Nancy C. Farrell, Anna Albrecht, Beth Bock, Terry Bazzarre, Christopher Sciamanna, Andrea L. Dunn, Bess H. Marcus. (2006) Outcomes from the women's wellness project: A community-focused physical activity trial for women. Preventive Medicine 43:6, 447-453
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Cindy K Perry, Jill A. Bennett. (2006) Heart disease prevention in women: Promoting exercise. Journal of the American Academy of Nurse Practitioners 18:12, 568-573
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Sandra D??Amore, Samia Mora. (2006) Gender-Specific Prediction of Cardiac Disease. Cardiology in Review 14:6, 281-285
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Michael S Kramer, Sheila W McDonald, Michael S Kramer. 2006. Aerobic exercise for women during pregnancy. .
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Tzuo-Yun Lan, Hsing-Yi Chang, Tong-Yuan Tai. (2006) Relationship between components of leisure physical activity and mortality in Taiwanese older adults. Preventive Medicine 43:1, 36-41
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Carolyn Albright, Dixie L. Thompson. (2006) The Effectiveness of Walking in Preventing Cardiovascular Disease in Women: A Review of the Current Literature. Journal of Women's Health 15:3, 271-280
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Giuseppe Lippi, Federico Schena, Gian Luca Salvagno, Martina Montagnana, Filippo Ballestrieri, Gian Cesare Guidi. (2006) Comparison of the lipid profile and lipoprotein(a) between sedentary and highly trained subjects. Clinical Chemistry and Laboratory Medicine 44:3, 322-326
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Emily M. Krumm, Olivera L. Dessieux, Pamela Andrews, Dixie L. Thompson. (2006) The Relationship between Daily Steps and Body Composition in Postmenopausal Women. Journal of Women's Health 15:2, 202-210
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John M. Jakicic, Amy D. Otto. (2006) Treatment and Prevention of Obesity: What is the Role of Exercise?. Nutrition Reviews 64, S57-S61
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Robert Kushner, Julie Roth. 2006. Nutritional Strategies for Patients with Obesity and the Metabolic Syndrome. , 55-80.
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Barbara J. Speck, Stephen W. Looney. (2006) Self-Reported Physical Activity Validated by Pedometer: A Pilot Study. Public Health Nursing 23:1, 88-94
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Steven N. Blair. (2005) The Evolution of Physical Activity Recommendations: What Should I Tell My Patients?. Obesity Management 1:6, 231-233
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Cheryl L. Albright, Leslie Pruitt, Cynthia Castro, Alma Gonzalez, Sandi Woo, Abby C. King. (2005) Modifying physical activity in a multiethnic sample of low-income women: One-year results from the IMPACT (Increasing Motivation for Physical ACTivity) project. Annals of Behavioral Medicine 30:3, 191-200
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Bess Marcus, Beth Lewis, Joseph Hogan, Teresa King, Anna Albrecht, Beth Bock, Alfred Parisi, Raymond Niaura, David Abrams. (2005) The efficacy of moderate‐intensity exercise as an aid for smoking cessation in women: A randomized controlled trial. Nicotine & Tobacco Research 7:6, 871-880
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CAROLINE R. RICHARDSON, SABRINA A. AVRIPAS, DAVID L. NEAL, SHEILA M. MARCUS. (2005) Increasing Lifestyle Physical Activity in Patients with Depression or Other Serious Mental Illness. Journal of Psychiatric Practice 11:6, 379-388
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Amanda J. Dawson, Jan Sundquist, Sven-Erik Johansson. (2005) The Influence of Ethnicity and Length of Time since Immigration on Physical Activity. Ethnicity & Health 10:4, 293-309
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Hiroyuki Noda, Hiroyasu Iso, Hideaki Toyoshima, Chigusa Date, Akio Yamamoto, Shogo Kikuchi, Akio Koizumi, Takaaki Kondo, Yoshiyuki Watanabe, Yasuhiko Wada, Yutaka Inaba, Akiko Tamakoshi. (2005) Walking and Sports Participation and Mortality From Coronary Heart Disease and Stroke. Journal of the American College of Cardiology 46:9, 1761-1767
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FRIEDERIKE ROSENBERGER, TIM MEYER, WILFRIED KINDERMANN. (2005) Running 8000 m Fast or Slow: Are There Differences in Energy Cost and Fat Metabolism?. Medicine & Science in Sports & Exercise 37:10, 1789-1793
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G. Schuler. (2005) Körperliche Aktivität. Zeitschrift für Kardiologie 94:S3, iii11-iii14
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MARTIN BUCHHEIT, CHANTAL SIMON, ANNE CHARLOUX, ST??PHANE DOUTRELEAU, FRAN??OIS PIQUARD, GABRIELLE BRANDENBERGER. (2005) Heart Rate Variability and Intensity of Habitual Physical Activity in Middle-Aged Persons. Medicine & Science in Sports & Exercise 37:9, 1530-1534
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V. Mohan, K. Gokulakrishnan, R. Deepa, C. S. Shanthirani, M. Datta. (2005) Association of physical inactivity with components of metabolic syndrome and coronary artery disease-the Chennai Urban Population Study (CUPS no. 15). Diabetic Medicine 22:9, 1206-1211
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K Esposito, D Giugliano. (2005) Obesity, the metabolic syndrome, and sexual dysfunction. International Journal of Impotence Research 17:5, 391-398
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James W.E. Rush, Steven G. Denniss, Drew A. Graham. (2005) Vascular Nitric Oxide and Oxidative Stress: Determinants of Endothelial Adaptations to Cardiovascular Disease and to Physical Activity. Canadian Journal of Applied Physiology 30:4, 442-474
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Roberto Elosua. (2005) Actividad física. Un eficiente y olvidado elemento de la prevención cardiovascular, desde la infancia hasta la vejez. Revista Española de Cardiología 58:8, 887-890
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Anne Kouvonen, Mika Kivimäki, Marko Elovainio, Marianna Virtanen, Anne Linna, Jussi Vahtera. (2005) Job strain and leisure-time physical activity in female and male public sector employees. Preventive Medicine 41:2, 532-539
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Mary Zasadil, Pamela S. Douglas. (2005) The Master Female Athlete. Medicine & Science in Sports & Exercise 37:8, 1444-1446
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I Berlin, Cl Sachon, A Grimaldi. (2005) Identification of factors associated with impaired hypoglycaemia awareness in patients with type 1 and type 2 diabetes mellitus. Diabetes & Metabolism 31:3, 246-251
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Graham A. Colditz, Susan E. Hankinson. (2005) The Nurses' Health Study: lifestyle and health among women. Nature Reviews Cancer 5:5, 388-396
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