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Work due 01 Jan 2099
Further work required: The Commission Decision of 3 February 1997 establishes the formats, which Member States are to use in the annual reporting on the Directive on Packaging and Packaging Waste. However, the decision does not define methods to estimate the quantities of packaging put on the market or to calculate the recovery and recycling rates in more detail to ensure data comparability.
Not started
For references, please go to www.eea.europa.eu/soer or scan the QR code.
This briefing is part of the EEA's report The European Environment - State and Outlook 2015. The EEA is an official agency of the EU, tasked with providing information on Europe's environment.
PDF generated on 21 Oct 2016, 05:06 PM

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Please use this identifier to cite or link to this item:
|Towards a computational case-based model for creative planning
|Macedo, Luís
Pereira, Francisco C.
Grilo, Carlos Fernando Almeida
Cardoso, Fernando Amílcar Bandeira
|Creative planning
Computational case-based model
Musical composition
|Issue Date:
|MACEDO, Luís e outros - Towards a computational case-based model for creative planning. In: European Workshop on Cognitive Modelling. Berlin: [s.n.], 1996. p. 170-178.
|This paper describes a computational case-based model for the creative planning process. Our approach is inspired in Wallas' model for the creative process in that we consider that creativity involves a sequence of four stages: preparation, incubation, illumination and verification. Preparation includes problem acquisition and assimilation of background knowledge, which is represented by cases, i.e., documented past experiences. With the aim of achieving a flexible knowledge representation, as a means to potentiate specific creative abilities like Fluency, Synthesis and Analysis, we structure each case as a network of hierarchically and temporally related case pieces. These case pieces can be considered individually, providing better recombinations of them. These recombinations, rather than made by chance, are guided by those hierarchical and temporal case piece relations (or explanations). We explain the role of opportunistic knowledge acquisition at the incubation stage. We sustain that illumination may comprise recursive calls of the sequence of the first three stages. This computational model is implemented in the system INSPIRER (ImagiNation1 taking as Source Past and Imperfectly RElated Reasonings). An application in musical composition domain is presented. We also show how a musical composition task may be cognitively modelled and treated as a planning task. We also present a short example illustrating how INSPIRER generates music.
|Appears in Collections:
|Comunicações em conferências e congressos internacionais
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Kanye West: Ben Carson Won't Talk to Me!
He may have all the stage presence of a can of Spam and the same bigoted views on Muslims as your drunk uncle, but it seems Ben Carson has been making some undeniably smart decisions during his presidential campaign.
For example, he refuses to have anything to do with Kanye West. We know this because Kanye West said so.


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America Really, Really Wants the Cowboys to Lose to the Redskins on Sunday
The Dallas Cowboys, despite a season defined largely by extended periods of mediocrity, improbably, inexplicably find themselves on the cusp of their first playoff berth in three years. It all comes down to Sunday. If they beat the Redskins, they're in. If they lose, they're out.
One would expect that America would be thrilling to the prospect of its favorite football team finally returning to postseason respectability. Not so. America -- at least the one that votes in ESPN SportsNation polls -- seems to be over the 'Boys.
Roughly three-fourths of respondents in a SportsNation poll indicated they'll be rooting for the Redskins to beat the Cowboys on Sunday night. As you can see from the map above, the preference holds in every single state except Texas, where Dallas is favored by a relatively slim 55-45 margin. Just to put that in perspective, that's two points worse than Mitt Romney.
The poll was enough to lead BuzzFeed to pen an obit of the "America's Team" nickname, not that anyone has deployed that phrase in a serious fashion this millennium. BuzzFeed bolsters its case by linking, inexplicably, to a Reddit thread about the Chiefs. (To quote from BuzzFeed's comments section: "Regardless of content, is this what passes for an "article" any more? Journalism is dead." Response: "It's Buzzfeed. If you're looking for hard hitting news I suggest you look elsewhere.")
The survey should come with a number of caveats. As of this morning, 180,000 people have responded, an infinitesimally small portion of the football-loving population. Keep in mind, too, that the voters all voluntarily responded to a SportsNation poll, which tells you something. Finally, the Redskins have Robert Griffin III, who is absolutely impossible to dislike, sort of like a teddy bear who happens to be freakishly good at picking apart your team's defense. So take the whole thing with a grain of salt.
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Marijuana Blog
Missouri Lawmaker Proposes Taxing Illegal Drugs
While the Missouri legislature can barely loosen their collective sphincter to allow the passing of an ultra-restrictive medical marijuana program, one snidely lawmaker is working to ensure the state gets its fair share of the illegal drug trade.
Earlier this month, State Representative Shawn Rhoads submitted a proposal (House Bill 1138) that aims to generate tax revenue from marijuana and other illegal drugs by implementing a hypocritical policy that forces drug dealers to shell out a percentage of their dope proceeds to supplement the state's coffers.
The goal of this seemingly ridiculous measure is to follow in the footsteps of some 20 states across nation that require members of the black market drug trade to purchase state-issued tax stamps and apply them to their products. This method of financial madness, in turn, holds the proprietors of back alley dope slinging operations responsible for reporting their taxable income to the state.
Interestingly, although many characters of the underground working as amateur pharmaceutical representatives consider this controversial form of taxation a laughable matter, the law can actually come with some serious consequences for the ones who find themselves busted without tax stamps on illegal contraband.
In 2008, The New York Times reported that tax officials in Tennessee penalized a young dealer to the tune of $11,506 after he was caught selling marijuana-infused Rice Krispie Treats at a concert – a small fine in comparison to another dealer busted in the Volunteer State, who was charged $1.1 million for smuggling just over 42 grams of weed without tax stamps.
Read More:http://www.hightimes.com/read/missouri-lawmaker-proposes-taxing-illegal-drugs
It's the weekend, time to relax.
Baby Boomers Increasingly Behind Legalizing Marijuana
The support for legalizing marijuana has grown rapidly over the last decade but the oldest Americans aren't ready to sign off on it yet. Four states and Washington, D.C. have passed measures legalizing marijuana, and today 53 percent of Americans favor legalization and 44 are opposed. In 2006, those numbers stood at 32 percent in favor of legalization and 60 percent opposed, according to a survey from Pew Research Center.
The numbers have grown because of support among Baby Boomers, the group that came after them, Generation Xers, and the most recent generation, Millennials (those 18 to 34).
Some 68 percent of Millennials, 52 percent of Gen Xers and 50 percent of Baby Boomers, those 51 to 69, support legalization.
What's holding the numbers back are those 70 to 87 who are known as the Silent Generation with only 29 percent favoring legalizing marijuana.
"We know this generation expresses more conservative views on a range of issues-- marijuana, marriage equality and others-- and they came of age when opinion was predominantly against legalization of marijuana," says Alec Tyson, a senior researcher at Pew. "There has been a modest shift in their views. They have become slightly more likely to favor marijuana legalization but they came in age at a time when opinion was lopsided against legalization and landscape was much different in terms of state laws that allow medicinal or recreational use as you see today."
Only 8 percent of the Silent Generation supported marijuana legalization in 1997, showing that group has gained some acceptance of the issue. From a previous survey by Pew, that generation was more likely to say it's morally wrong, Tyson says.
"We do know that generation has much more negative views of the harms of the drug itself," Tyson says. "They're more likely to see it as dangerous and harmful." (Remember, that's the generation that grew up with the film Reefer Madness).
Read More:http://www.huffingtonpost.com/buck-wargo/baby-boomers-marijuana_b_7079040.html
Blue Widow (Indica)
Missouri House Passes Bill To Legalize Hemp Cultivation
Hemp is a very versatile plant. Some estimates say that hemp can be used to make over 25,000 products. Importing hemp and hemp products is legal in the United States, but hemp cultivation is not allowed at the federal level. Even in states that have legalized hemp cultivation, farmers are having a hard time getting an actual crop started due to federal prohibition (such as in Oregon). Missouri used to be one of the top hemp producing states in America. Missouri's House of Representatives passed a hemp cultivation bill this week. Per The Joint Blog:
Missouri's House of Representatives has given initial approval to House Bill 830, a proposal to legalize the production and cultivation of industrial hemp. A companion bill,Senate Bill 255, has already been approved unanimously by the Senate Committee on Agriculture, Food Production and Outdoor Resources.
If passed into law, House Bill 830 would remove hemp from the state's list of controlled substance, reclassifying it as a legal agricultural product in the state. The bill would establish a system of licensing and regulations for those wanting to grow the crop, which would be defined as having no more than 0.3% THC. The proposal explicitly states that a change in federal law – or approval from the federal government – will not be required for the state to begin implementation of the law.
Missouri's farmers deserve to grow a crop that is completely harmless. Virtually all of the arguments against hemp cultivation are not based upon science, but instead are based upon politics and fear mongering. The focus now moves to the Missouri Senate, where I'm hopeful it will pass considering SB 255 already received a unanimous approval from a key Senate Committee. A thriving hemp industry would help out Missouri quite a bit.
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Psy 103 introduction to psychology - homeworktips.org
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A selection of articles related to nutmeg world production.
Original articles from our library related to the Nutmeg World Production. See Table of Contents for further available material (downloadable resources) on Nutmeg World Production.
- Manifesting World Enlightenment: Part 3
- One of the very best ways to raise personal or group consciousness, is to MANIFEST spiritual Intentions into the environment at large. The projection of love into one's surroundings for instance, results in love being reflected back to the sender, like...
Mind >> World Mind
- Manifesting World Enlightenment: Part 2
- When thoughts are replaced by silence in the mind, perception arises. It is a part of the modern condition wherein the mind of humanity is constantly overwhelmed, by a million considerations and thoughts. In acquiring silence, the mind is enabled to get out...
Mind >> World Mind
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- Part 1 | Part 2 Part 1 The wise live in accord with natural laws. It is they who understand that the laws of nature are much higher than the laws of man, because breaking them implies penalties far greater than a fine or prison sentence. When a person...
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- There can be no doubt that the world situation today is grave. It is becoming increasingly apparent that the institutions, governments, and traditional methods of society, have little effectiveness in solving a collective crisis of global proportions. In this...
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Mind >> World Mind
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Zen Pro CBD Review :- I am a wall street trader and hence stress and anxiety are two main aspects of my life. Most of the times, I spend my day worrying over things, and then there are personal issues. Because of all that, my life started becoming very upset and I started having continuous fights with my partner. Even after seeing so many doctors, I could not find relief. Then a fellow trader recommended me Zen Pro CBD. These are amazing pills that changed my life forever.
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When the new BCS rankings are released later today, LSU will still be ranked No. 1 in the country.
If we truly had the best team at No. 1, that team would be the Alabama Crimson Tide. More proof that the BCS is a joke, but I'll leave that for another article.
Luckily for us, this game will serve as a playoff game. It will certainly eliminate the loser from championship contention, barring several upsets in the coming weeks.
At this point, it doesn't matter because LSU has to play Alabama on the road Nov. 5. I don't see any way Alabama drops this game at home with so much on the line. They are much too talented and experienced to allow that to happen.
When Alabama wins this game, they will be on top of the BCS rankings without question, a spot they have earned.
There are several reasons I feel this way, I will give you a few of the main reasons in the following slideshow.


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BATON ROUGE, La. — Louisiana conducted its first statewide survey of public college campuses on issues of violence and sexual assault, but so few students participated that the findings released Thursday don't provide much insight into campus safety.
A recent state law mandated the campus climate survey. Colleges administered it last spring. Participation is voluntary for students.
The findings were presented to the Louisiana Board of Regents, which oversees the law's efforts to improve the way public colleges handle sexual assaults. The results also will be forwarded to state lawmakers.
The board was warned against generalizing the findings. Only 5 percent of college students across the state's campuses took the survey — a response rate that the Regents staff said isn't a representative sample of students.
"While these findings are important for us to discuss, they just can't be generalized to the populations," said Claire Norris, a Regents senior policy analyst.
Nearly three-quarters of those who responded to the survey were female, and 71 percent identified themselves as white. The report says that overall, survey participants said they perceive their campuses to be "moderately safe," though male respondents were more likely than female students to deem them safe.
Only 47 percent of the 10,186 students who participated in the survey said they knew where to get help on campus in the event of a sexual assault, and even fewer students said they know how to report an assault. Of the respondents, 724 said they "experienced sexual contact without consent" since becoming a student at their school, but only 41 said they reported the crime to police while some others said they told campus faculty or staff.
Regents board member Robert Levy questioned why so few students responded to the survey. "What's the disconnect?" he asked.
Efforts will be made, Norris said, to try to boost participation next year by shrinking the number of questions and seeking incentives for students to take the survey. She said the survey was long, with more than 100 questions, and that might have deterred students.
Levy said the board needs to "keep pushing institutions" to coordinate with local law enforcement and to provide information about sexual assault reporting at student events.
A 2015 state law by Sen. J.P. Morrell, D-New Orleans, called for the survey as part of a package of bills aimed at improving the way public colleges and police handle sexual assaults. As part of the effort, the Board of Regents has enacted uniform guidelines for handling assault allegations and bolstering prevention efforts.
Follow Melinda Deslatte on Twitter at http://twitter.com/melindadeslatte


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Physical Activity and Coronary Heart Disease in Men
The Harvard Alumni Health Study
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Background—The quantity and intensity of physical activity required for the primary prevention of coronary heart disease (CHD) remain unclear. Therefore, we examined the association of the quantity and intensity of physical activity with CHD risk and the impact of other coronary risk factors.
Methods and Results—We followed 12 516 middle-aged and older men (mean age 57.7 years, range 39 to 88 years) from 1977 through 1993. Physical activity was assessed at baseline in kilojoules per week (4.2 kJ=1 kcal) from blocks walked, flights climbed, and participation in sports or recreational activities. During follow-up, 2135 cases of incident CHD, including myocardial infarction, angina pectoris, revascularization, and coronary death, occurred. Compared with men expending <2100 kJ/wk, men expending 2100 to 4199, 4200 to 8399, 8400 to 12 599, and ≥12 600 kJ/wk had multivariate relative risks of 0.90, 0.81, 0.80, and 0.81, respectively (P for trend=0.003). When we considered the independent effects of specific physical activity components, only total sports or recreational activities (P for trend=0.042) and vigorous activities (P for trend=0.02) were inversely associated with the risk of CHD. These associations did not differ within subgroups of men defined by coronary risk factors. Finally, among men with multiple coronary risk factors, those expending ≥4200 kJ/wk had reduced CHD risk compared with men expending <4200 kJ/wk.
Conclusions—Total physical activity and vigorous activities showed the strongest reductions in CHD risk. Moderate and light activities, which may be less precisely measured, showed nonsignificant inverse associations. The association between physical activity and a reduced risk of CHD also extends to men with multiple coronary risk factors.
Coronary heart disease (CHD) is the leading cause of death in the United States, accounting for >700 000 deaths in 1996.1 Several studies have confirmed the overall benefit of physical activity in reducing the risk of CHD.2 Still, more than 60% of American adults are not regularly active.3 The necessary quantity and intensity of physical activity for the primary prevention of CHD remain unclear. Few studies have simultaneously considered physical activity of different intensities with the risk of CHD. Some reports suggest that only participation in vigorous activities is associated with reductions in CHD risk,4 5 6 7 8 whereas others extend benefits to moderate activities.9 10 11 12 Two recent trials indicate that incorporating moderate-intensity activities into the lifestyle may have benefits on coronary risk factors comparable to those derived from structured exercise programs.13 14
Therefore, we sought to update earlier findings on physical activity and risk of CHD in the Harvard Alumni Study15 by examining the quantity, type, and intensity of physical activity in 1977. We also assessed whether, given the multifactorial etiology of CHD, physical activity impacts the risk of CHD in the presence of other coronary risk factors.
The Harvard Alumni Study is an ongoing cohort study of men matriculating as undergraduates at Harvard University between 1916 and 1950 that was initiated in 1962. For the present study, we were interested in 17 835 men who returned the 1977 questionnaire. We excluded 2863 men reporting physician-diagnosed cardiovascular disease or cancer and 607 men with missing data on physical activity or other coronary risk factors. We successfully followed 12 516 (87.1%) of the remaining 14 365 men; those successfully followed were the men who returned questionnaires in 1988 or 1993 or died by the end of 1993.
Assessment of Physical Activity and Other CHD Risk Factors
We estimated an index of weekly energy expenditure in 1977 from the reported daily number of flights of stairs climbed, city blocks walked, and sports or recreational activities engaged in during the past year.16 For each sport or activity, we asked for details regarding the frequency (weeks per year) and duration (time per week when active). This assessment of physical activity is both reliable and valid.17 18 19 20 21 We estimated that climbing up and down a flight of stairs (1 flight=10 steps) daily expended 59 kJ/wk (4.2 kJ=1 kcal)22 and that walking a city block (1 block=1/12 mile=0.13 km) daily expended 235 kJ/wk.23 Each activity was assigned a multiple of resting metabolic rate (MET score).24 Because resting metabolic rate is ≈4.2 kJ/kg body wt per hour, we estimated the average weekly energy expenditure for each activity by multiplying its MET score by body weight and hours per year and then dividing by 52. We summed kilojoules per week from flights climbed, blocks walked, and all sports or recreational activities and categorized this into <2100, 2100 to 4199, 4200 to 8399, 8400 to 12 599, and ≥12 600 kJ/wk (or <500, 500 to 999, 1000 to 1999, 2000 to 2999, and ≥3000 kcal/wk, respectively).
We next examined the type and intensity of physical activity. Men were categorized into approximate fifths of flights climbed (2 flights=1 story), walking (1 block=0.13 km), and total energy expended from sports or recreational activities. We then separately calculated and categorized energy expenditure from vigorous (≥6 METs), moderate (4 to <6 METs), and light (<4 METs) activities.25
On the 1977 questionnaire, we also collected information on age (in years), cigarette smoking (nonsmoker or current smoker [≤20 or >20 cigarettes/d]), alcohol consumption (none, <100, or ≥100 g/wk), early parental death at <65 years (yes or no), weight and height (combined into body mass index [kg/m2] and categorized as <22.5, 22.5 to <23.5, 23.5 to <24.5, 24.5 to <26, and ≥26 kg/m2), physician-diagnosed hypertension (yes or no), and physician-diagnosed diabetes mellitus (yes or no).
Ascertainment of CHD Occurrence
We ascertained cases of first CHD (including myocardial infarction, angina pectoris, coronary artery bypass graft surgery, and percutaneous transluminal coronary angioplasty) through self-reports on follow-up questionnaires sent in 1988 and 1993. The year of diagnosis was taken as the earliest reported year of diagnosis for any event from the 2 questionnaires. If different events occurred in the same year, the event was selected in hierarchical fashion: myocardial infarction, angina pectoris, revascularization, and then death. Self-reported physician-diagnosed CHD has been validated in this cohort.15 In addition, deaths were compiled continuously by the Harvard Alumni Office, which maintains a listing of deceased alumni. We traced deaths through the end of 1993. For each reported death, we requested and obtained death certificates from the appropriate state. We included deaths with either underlying or contributing causes from CHD. To verify an earlier observation that mortality follow-up was >99%,15 we used the National Death Index26 to determine whether 500 men thought to be alive through 1992 died between January 1, 1988, and December 31, 1992. We positively identified 2 of these 500 men as deceased, thereby estimating our mortality follow-up rate to be 99.6%.
Data Analyses
We first examined the distribution of characteristics according to categories of physical activity by using χ2 tests to compare proportions and ANOVA to compare means. We calculated person-years of follow-up from 1977 to the year in which CHD was first reported, the year of death, or the year of return of the latest questionnaire, whichever occurred first. Relative risks (RRs) and 95% CIs for CHD were calculated by the Cox proportional hazards model; the lowest physical activity category was used as the referent. The proportional hazards assumption was satisfied for total physical activity. Models were first adjusted for age, and multivariate models were further adjusted for the coronary risk factors described above. Linear trend tests treated the 5 categories of physical activity as a single ordinal variable by using the median values for each category. Parallel analyses were performed for each type and intensity of physical activity, further adjusting for other components of physical activity to examine the independent association of each type of activity with CHD risk. We also examined whether any coronary risk factors modified the association between physical activity and CHD.
In light of the multifactorial etiology of CHD, we further sought to examine physical activity in the presence of other coronary risk factors. We dichotomized 6 coronary risk factors: cigarette smoking (current smoker or nonsmoker), history of hypertension (yes or no), history of diabetes (yes or no), body mass index (≥25 or <25 kg/m2), alcohol consumption (none or any), and early parental death (yes or no). Men were classified according to number of coronary risk factors. Men without these risk factors served as the referent. RRs then were calculated separately by baseline physical activity (<4200 or ≥4200 kJ/wk) and age (<60 or ≥60 years) to equally distribute CHD events and enhance power.
In secondary analyses, we excluded men developing CHD during the first 3 years of follow-up to minimize any bias due to illnesses that might have affected baseline physical activity. Sensitivity analyses assessed whether altering the cut points for the various types of physical activity appreciably altered the RR estimates. Finally, we updated physical activity in a subset of 6897 men returning both the 1977 and 1988 questionnaires who were free of CHD through 1988 and followed them for 5 years through the end of 1993 (424 cases).
The mean±SD age at baseline in 1977 was 57.7±9.0 years (range 39 to 88 years), and the mean±SD body mass index was 24.4±2.8 kg/m2. Table 1⇓ compares men by physical activity category according to coronary risk factors at baseline. Men with higher levels of energy expenditure tended to be younger (P<0.001), to consume more alcohol (P<0.001), and to be less likely to smoke (P<0.001) and have diabetes mellitus (P=0.01) and hypertension (P<0.001). There were no appreciable differences in baseline coronary risk factors comparing men in the study population with those excluded because of loss to follow-up (data not shown).
The mean±SD physical activity level was 8362±8215 kJ/wk. On average, the relative contribution of energy from flights climbed, blocks walked, and total sports or recreational activities was 5.7%, 36.8%, and 57.4%, respectively. Sports or recreational activities were reported by 74.1% of the men. Most of the energy was expended on moderate (4 to <6 METs) and vigorous (≥6 METs) activities, which contributed 37.4% and 56.1%, respectively, to the total energy expended from sports or recreational activities.
During 166 410 person-years of follow-up, 2135 CHD cases (1295 identified through questionnaires and 840 from death certificates) occurred. Of the 2135 cases, 512 were from angina pectoris, 576 from myocardial infarction, 207 from revascularizations, and 840 from CHD death (709 as the primary cause). We found an L-shaped association between increasing levels of physical activity and the risk of CHD in the age-adjusted model (Table 2⇓) (P for trend<0.001), with no additional reduction in risk of CHD for levels >8400 kJ/wk. The addition of coronary risk factors to the model modestly attenuated the age-adjusted RRs, but the L-shaped association remained. We found no appreciable difference in the RRs when we considered CHD identified from questionnaires versus death certificates, when we excluded men with CHD during the first 3 years of follow-up, or when we did not adjust for body mass index, hypertension, or diabetes, which are biological mediators. When a stricter definition of CHD (angina pectoris, myocardial infarction, or CHD death as the primary cause) was used, the RRs also changed little. Finally, we found no significant evidence that coronary risk factors modified the inverse association of physical activity with CHD risk.
We then considered whether specific components of physical activity were associated with the risk of CHD (Figure⇓). In multivariate models, we found significant associations of increasing levels of total activities and vigorous activities with the risk of CHD. The lack of a linear association (P=0.08) in multivariate models between kilometers walked per week and CHD may have been due to a threshold effect beyond walking 5 km/wk. If fact, men walking ≥5 km/wk had a significant (13%) reduced risk of CHD compared with those walking <5 km/wk.
In sensitivity analyses, cut points >8400 kJ/wk for total energy expended from sports or recreational activities did not result in greater reductions in CHD risk. Levels of energy expenditure >8400 kJ/wk for vigorous activities were associated with a 10% to 20% reduction in the risk of CHD. We found a possible U-shaped association (P for nonlinear trend=0.10) between moderate activity and the risk of CHD, with a nadir in risk among men expending 2100 to 4199 kJ/wk compared with men reporting no moderate activities. Increasing the cut point for the highest category of moderate activity did not result in an elevated risk of CHD compared with the referent category. For light activities, the lack of an association with the risk of CHD remained at even higher cut points.
Next, we examined the association between physical activity and CHD in the presence of other coronary risk factors, stratifying the results according to men aged <60 and ≥60 years (Table 3⇓). The lower case counts among men with specific single risk factors limited our ability to make definitive conclusions in these categories. Among men aged <60 years, those who were active (≥4200 kJ/wk) had lower magnitudes of increased CHD risk compared with those who were inactive. Men with single coronary risk factors expending ≥4200 kJ/wk also had lower RRs of CHD compared with those expending <4200 kJ/wk, with the exceptions of diabetics and smokers. Among men aged ≥60 years compared with younger men, the magnitudes of RRs of CHD for increasing numbers of coronary risk factors were lower. Compared with physically active men with no risk factors, older men with single coronary risk factors expending ≥4200 kJ/wk had no increased risk of CHD.
Finally, we considered the joint effect of physical activity measured in 1977 and 1988 on the risk of CHD among 6959 men (424 CHD cases) free of CHD through 1988. Models with physical activity and other coronary risk factors as time-dependent variables did not appreciably alter the main results for physical activity.
The present study provides new data from the Harvard Alumni Study on both the quantity and intensity of physical activity and CHD risk among older men, in the context of the new Surgeon General's recommendations. We found an L-shaped association between physical activity and risk of CHD, with an ≈20% reduction in CHD risk for total physical activity levels >4200 kJ/wk. A physical activity level of 4200 kJ/wk is consistent with the Surgeon General's recommendation3 and can be attained by performing activities such as brisk walking, recreational cycling and swimming, home repair, and yard work for 30 min/d on most days of the week.27 In addition, there was a nonsignificant 10% reduction in men expending 2100 to 4199 kJ/wk.
The present study also suggests that vigorous activities are associated with a reduced risk of CHD, whereas moderate or light activities have no clear association with the risk of CHD. Finally, physical activity may favorably affect CHD risk even in the presence of other coronary risk factors. Therefore, an active lifestyle may ameliorate the deleterious effect of concomitant coronary risk factors. In particular, men aged ≥60 years who expended ≥4200 kJ/wk may have smaller increases in CHD risk in the presence of coronary risk factors.
The most relevant previous publication from this cohort was published in 197815 with the use of data from the 1962/1966 questionnaire in relation to the risk of myocardial infarction. This and other reports on morbidity and mortality from this cohort of Harvard alumni have contributed, in part, to the development of the Surgeon General's recommendation. In the 1978 article, the cohort consisted of middle-aged men, and information on physical activity was coded in far less detail. Risk estimates were also calculated without adjustment for potential coronary risk factors. The present study adds valuable new information on the association between physical activity and risk of CHD with the use of detailed coding of physical activity from the 1977 questionnaire in relation to CHD risk. As a result, the present cohort consists of older men, with sufficient detail on the quantity, intensity, and type of physical activity to directly address the Surgeon General's recommendations. Furthermore, we adjusted for known coronary risk factors that confounded the association between physical activity and CHD. Because there are few studies on quantity, type, and intensity of physical activity and the risk of CHD among older men, the present study provided an excellent opportunity to explore these hypotheses.
Recent statements from the Surgeon General,3 the National Institutes of Health Consensus Development Panel on Physical Activity and Cardiovascular Health,28 and the Centers for Disease Control and Prevention and the American College of Sports Medicine27 recommend that every adult should accumulate at least 30 minutes of moderate-intensity physical activity on most, preferably all, days of the week to prevent CHD and other chronic diseases. The decision to expand the recommendation for physical activity to include moderate activities, in addition to vigorous activities, was based on the assumptions that moderate physical activity would be more easily attainable and can be accumulated in either several small daily doses or a single large daily dose. Two recent intervention trials13 14 indicate that moderate-intensity physical activity may have benefits on coronary risk factors that are similar to those provided by structured, more vigorous activities. However, these results applied to previously sedentary, overweight, and obese individuals. It remains unclear whether short-term improvements in coronary risk factors result in long-term reductions in CHD risk.
The few studies that have focused on the intensity of physical activity in relation to CHD have yielded inconsistent results. Differences in intensity classifications, adjustment for confounders, and CHD numbers and definitions across studies may account for these results. Whereas the benefits of vigorous-intensity physical activity appear clear,4 5 6 7 8 9 10 11 12 the benefits of moderate- or light-intensity activities have been observed in some9 10 11 12 but not all4 5 6 7 8 studies. We did not find equivalent benefits for vigorous and moderate physical activity in relation to CHD risk. Greater energy expended from vigorous activities was inversely associated with the risk of CHD. In contrast, we found a possible U-shaped association for moderate activities, with the lowest risk of CHD among men expending 2100 to 4199 kJ/wk. This lack of association for moderate activities may reflect the imprecise measurement of these activities compared with vigorous activities21 or the difficulty in achieving such high levels of energy expenditure from moderate activities.
Clinical studies have demonstrated that exercise lowers blood pressure29 and improves body composition,30 glucose tolerance, and insulin sensitivity.31 In the present study, when we adjusted for some of these biological effects, the RR estimates were only modestly confounded. Other pathways leading to a reduction in CHD risk may be responsible for the observed inverse association, including improvements in HDL cholesterol30 and thrombotic function, including hematocrit, fibrinogen, platelet function, and fibrinolysis.28
Some limitations should be considered in light of our results. First, the measurement of physical activity may be susceptible to misclassification, which would, if random with respect to CHD risk, bias our results toward the null. However, a previous validation study19 suggests that the average magnitude of misclassification of nonresting energy expenditure may be ≈630 kJ/wk (150 kcal/wk); thus, we do not expect misclassification to greatly affect our risk estimates. Second, we followed men over a long period, during which physical activity levels likely fluctuated. However, when we updated information on physical activity, our findings were little changed. Third, we are unclear whether our results extend to women. Recent studies have shown both an inverse association32 33 and no association8 34 with CHD risk. Finally, the lack of control for dietary factors and lipids may introduce residual confounding.
In conclusion, we found an L-shaped association between physical activity and the risk of CHD. Older men should expend at least 4200 kJ/wk in total physical activity to potentially reduce their risk of CHD by ≈20%. Those expending 2100 to 4199 kJ/wk, slightly lower than that recommended by the Surgeon General,3 had a possible nonsignificant 10% reduction in the risk of CHD. Future research must improve the assessment of moderate and light physical activity to better distinguish whether particular types and intensities of activities derive reductions in CHD risk.
This study was supported by grants CA-44854 and HL-34174 from the National Cancer Institute and the National Heart, Lung, and Blood Institute, Bethesda, Md. We are grateful to Stacey DeCaro, Sarah E. Freeman, Tina Y. Ha, Marty Higgins, James B. Kampert, Rita W. Leung, Doris C. Rosoff, and Alvin L. Wing for their help with the College Alumni Health Study.
This is report No. LXXVI in a series on chronic disease in former college students (Harvard Alumni Health Study).
- Received February 24, 2000.
- Revision received April 5, 2000.
- Accepted April 7, 2000.
- Copyright © 2000 by American Heart Association
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Peters KD, Kochanek KD, Murphy SL. Deaths: Final Data for 1996. Hyattsville, Md: National Center for Health Statistics; 1998. National Vital Statistics Reports, Vol 47, No. 9.
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- Physical Activity and Coronary Heart Disease in MenHoward D. Sesso, Ralph S. Paffenbarger and I-Min LeeCirculation. 2000;102:975-980, originally published August 29, 2000http://dx.doi.org/10.1161/01.CIR.102.9.975
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- Physical Activity and Coronary Heart Disease in MenHoward D. Sesso, Ralph S. Paffenbarger and I-Min LeeCirculation. 2000;102:975-980, originally published August 29, 2000http://dx.doi.org/10.1161/01.CIR.102.9.975
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