title: Inhibition of platelet aggregability by moderate-intensity physical exercise: a randomized clinical trial in overweight men. Regular Physical Activity Improves Endothelial Function in Patients With Coronary Artery Disease by Increasing Phosphorylation of Endothelial Nitric Oxide Synthase Weight loss in combination with physical activity improves endothelial dysfunction in human obesity. Relationship of Physical Activity and Body Mass Index to the Risk of Hypertension: A Prospective Study in Finland All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work. 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. Physical inactivity and short-term all-cause mortality in adults with chronic disease. Effect of 4 weeks of aerobic or resistance exercise training on arterial stiffness, blood flow and blood pressure in pre- and stage-1 hypertensives Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol Self-reported physical activity predicts long-term coronary heart disease and all-cause mortalities. Twenty-one-year follow-up of the Israeli Ischemic Heart Disease Study. The Belgian Heart Disease Prevention Project: 10-year mortality follow-up. The Losartan Intervention For Endpoint reduction (LIFE) in Hypertension study: rationale, design, and methods. The LIFE Study Group. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Occupational, commuting, and leisure-time physical activity in relation to risk for Type 2 diabetes in middle-aged Finnish men and women Physical activity and cause-specific mortality in men with Type 2 diabetes/impaired glucose tolerance: evidence from the Whitehall study. Leisure time and occupational physical activity: risk of death from ischemic heart disease. Work and leisure time physical activity and mortality in men and women from a general population sample. Physical demands at work, physical fitness, and 30-year ischaemic heart disease and all-cause mortality in the Copenhagen Male Study. Physical activity, change in blood pressure and predictors of mortality in older South Africans--a 2-year follow-up study. Characteristics of 9194 patients with left ventricular hypertrophy: the LIFE study. Losartan Intervention For Endpoint Reduction in Hypertension. Exercise and cardiovascular outcomes in hypertensive patients in relation to structure and function of left ventricular hypertrophy: the LIFE study Hypertensive men who exercise regularly have lower rate of cardiovascular mortality.
abstract: It has been postulated that platelet function plays an important role in the initiation of atherosclerosis . Currently there are no definitive data on the longer-term effects of regular physical exercise on platelet function in humans . We assessed the influence of regular moderate-intensity physical exercise ( brisk walking to slow jogging ) on platelet aggregation in a population -based sample of middle-aged , overweight , mildly hypertensive men in eastern Finl and . In this controlled study , we evaluated the net effect of exercise on platelet aggregation by study ing changes in optical density and ATP release in platelet-rich plasma . A significant inhibition of secondary platelet aggregation from 27 % to 36 % was observed in the men taking regular exercise .  These findings give new insight into the possible protective effects of exercise against the risk of ischemic heart disease Background —In stable coronary artery disease ( CAD ) , exercise training has well-documented positive effects on arterial endothelial function . NO derived from endothelial NO synthase ( eNOS ) is regarded as a protective factor against atherosclerosis . The aim of the present study was to investigate the effects of exercise training on the endothelial function in relation to the expression of eNOS and Akt-dependent eNOS phosphorylation in the left internal mammary artery ( LIMA ) of patients with stable CAD . Methods and Results —In 17 training patients ( T ) and 18 control patients ( C ) , endothelium-dependent vasodilation and average peak flow velocity ( APV ) in response to  acetylcholine  were measured invasively at study beginning and after 4 weeks in the LIMA . In LIMA tissue sample d during bypass surgery , eNOS expression and content of pospho-eNOS-Ser1177 , Akt , and phospho-Akt were determined by Western blot and quantitative reverse transcriptase – polymerase chain reaction . After exercise training , LIMA APV in response to acetylcholine was increased by 56±8 % ( from + 48±8 % at beginning to + 104±11 % after 4 weeks , P < 0.001 ) . Patients in T had a 2-fold higher eNOS protein expression ( T 1.0±0.7 versus C 0.5±0.3 arbitrary units , P < 0.05 ) and 4-fold higher eNOS Ser1177-phosphorylation levels in LIMA-endothelium ( 1.2±0.9 versus 0.3±0.2 arbitrary units , P < 0.01 ) . A linear correlation was confirmed between Akt phosphorylation and phospho-eNOS levels ( R = 0.80 , P < 0.05 ) and between phospho-eNOS and & Dgr ; APV ( R = 0.59 , P < 0.05 ) . Conclusions —Exercise training in stable CAD leads to an improved agonist-mediated endothelium-dependent vasodilatory capacity . The change in acetylcholine-induced vasodilatation was closely related to a shear stress – induced/Akt-dependent phosphorylation of eNOS on Ser1177 OBJECTIVE To test whether weight loss may improve endothelial dysfunction in human obesity , we recruited 28 healthy obese subjects , aged 30 - 46 years , with BMI 30 - 43 kg/m(2 ) . RESEARCH DESIGN AND METHODS Endothelium-dependent and -independent vasodilation were investigated by intra-arterial infusion of increasing doses of acetylcholine ( ACh ; 7.5 , 15 , and 30 microg x ml(-1 ) x min(-1 ) ) and sodium nitroprusside ( 0.8 , 1.6 , and 3.2 microg x ml(-1 ) x min(-1 ) ) . Insulin resistance was estimated by homeostasis model assessment ( HOMA ) . Weight loss was obtained by caloric restriction and physical activity . RESULTS We observed a significant reduction in BMI ( from 33.1 + /- 4.2 to 27.5 + /- 4.5 kg/m(2 ) , -16.9 % , P < 0.0001 ) and in waist circumference ( from 108.2 + /- 12.1 to 96.8 + /- 12.9 cm , -10.5 % , P < 0.0001 ) . Weight loss was also associated with a significant increase in ACh-stimulated forearm blood flow ( FBF ) , from 7.4 + /- 2.8 to 12.9 + /- 3.4 ml . 100 ml(-1 ) of tissue x min(-1 ) kg/m(2 ) ( P < 0.0001 ) . Multivariate regression analysis demonstrated that the only independent predictor of FBF was HOMA , accounting for 44.5 % of the variation , whereas the addition of BMI explained another 2.3 % of the variation . CONCLUSIONS Our data demonstrate that energy-restricted diet associated with physical activity induce a significant and clinical ly relevant improvement in ACh-stimulated vasodilation in obese healthy subjects Abstract — Prospect i ve studies on physical activity in relation to the risk for hypertension are scant , particularly in women . This study aim ed at finding out whether regular physical activity can reduce the risk of hypertension in both men and women , and in subjects with and without overweight . We prospect ively followed 8302 Finnish men and 9139 women aged 25 to 64 years without a history of antihypertensive drug use , coronary heart disease , stroke , and heart failure at baseline . Both single and joint associations of physical activity and body mass index with the risk of hypertension were examined using Cox proportional hazard models . During a mean followup of 11 years , there were 1600 incident cases of drug-treated hypertension . Multivariate-adjusted hazards ratios of hypertension associated with light , moderate , and high physical activity were 1.00 , 0.63 , and 0.59 in men ( Ptrend<0.001 ) , and 1.00 , 0.82 , and 0.71 in women ( Ptrend=0.005 ) , respectively . This association persisted both in subjects who were overweight and in those who were not . Multivariate-adjusted hazards ratios of hypertension based at different levels of body mass index ( < 25 , 25 to 29.9 , and ≥30 ) were 1.00 , 1.18 , and 1.66 for men ( Ptrend<0.001 ) , and 1.00 , 1.24 , and 1.32 for women ( Ptrend=0.007 ) , respectively . Further adjustment for baseline systolic blood pressure did not affect the protective effect associated with physical activity , but it weakened markedly the association between body mass index and hypertension . The present study indicates that regular physical activity and weight control  can reduce the risk of hypertension . The protective effect of physical activity was observed in both sexes regardless of the level of obesity BACKGROUND Physical activity is associated with low mortality in men , but little is known about the association in women , different age groups , and everyday activity . OBJECTIVE To evaluate the relationship between levels of physical activity during work , leisure time , cycling to work , and sports participation and all-cause mortality . DESIGN Prospect i ve study to assess different types of physical activity associated with risk of mortality during follow-up after the subsequent examination . Mean follow-up from examination was 14.5 years . SETTING Copenhagen University Hospital , Copenhagen , Denmark . PARTICIPANTS Participants were 13,375 women and 17,265 men , 20 to 93 years of age , who were r and omly selected .  Physical activity was assessed by self-report , and health status , including  blood pressure , total cholesterol level , triglyceride levels , body mass index , smoking , and educational level  , was evaluated . MAIN OUTCOME MEASURE All-cause mortality . RESULTS A total of 2,881 women and 5,668 men died . Compared with the sedentary , age- and sex-adjusted mortality rates in leisure time physical activity groups 2 to 4 were 0.68 ( 95 % confidence interval , 0.64 - 0.71 ) , 0.61 ( 95 % confidence interval , 0.57 - 0.66 ) , and 0.53 ( 95 % confidence interval , 0.41 - 0.68 ) , respectively , with no difference between sexes and age groups . Within the moderately and highly active persons , sports participants experienced only half the mortality of non participants . Bicycling to work decreased risk of mortality in approximately 40 % after multivariate adjustment , including leisure time physical activity . CONCLUSIONS Leisure time physical activity was inversely associated with  all-cause mortality in both men and women in all age groups . Benefit was found from moderate leisure time physical activity , with further benefit from sports activity and bicycling as transportation OBJECTIVES Physical activity ( PA ) is a preventive strategy for cardiovascular disease and for managing cardiovascular risk factors . There is little information on the effectiveness of PA for the prevention of cardiovascular outcomes once cardiovascular disease is present . Thus , we studied the relationship between PA at baseline and cardiovascular events in a high-risk population . DESIGN A prespecified analyses of observational data in a prospect i ve , r and omized hypertension study . SETTING Losartan Intervention For Endpoint reduction in hypertension ( LIFE ) study . SUBJECTS Hypertension and left ventricular hypertrophy ( LVH ) ( n = 9,193 ) . INTERVENTIONS Losartan versus atenolol . MAIN OUTCOME MEASURES Reported level of PA : never exercise , exercise < or=30 min twice per week , or exercise > 30 min twice per week at baseline and after a mean of 4.8 years of treatment with losartan- versus atenolol-based therapy . Risk reductions were calculated by level of PA for the primary composite end-point and its components cardiovascular death , stroke and myocardial infa rct ion , and also all-cause mortality and new-onset diabetes . RESULTS A modest level of PA ( > 30 min twice per week ) was associated with significant reductions in risk for the primary composite end-point [ adjusted hazard ratio ( aHR ) 0.70 , P < 0.001 ) and its components , all-cause mortality ( aHR 0.65 , P < 0.001 ) , and new-onset diabetes ( aHR 0.66 , P < 0.001 ) . CONCLUSION A modest level of self-reported PA ( > 30 min twice per week ) in patients with hypertension and LVH in the LIFE study was associated with significant reductions in risk for the primary composite end-point and its components of cardiovascular death , stroke , and myocardial infa rct ion , all-cause mortality , and new-onset diabetes OBJECTIVE To ascertain the relationship of physical inactivity and short-term all-cause mortality in a prospect i ve cohort of r and omly selected managed care organization members aged 40 years and older who have multiple chronic diseases . METHODS Clinical data bases were used to identify all health plan members aged 40 years and older with 2 or more chronic health conditions ( hypertension , coronary heart disease , diabetes mellitus , or dyslipemia ) in 1994 . A r and om sample of 2336 members was surveyed by mail and telephone interview regarding their health-related behaviors .  Survey data were linked to mortality data from the 1995 to 1997 Minnesota Death Index . Cox proportional hazards regression was used to ascertain the association between physical inactivity and subsequent all-cause mortality , adjusting for potential confounders . RESULTS Members who reported less than 30 minutes a week of physical activity at baseline had a subsequent mortality risk ratio of 2.82 ( P<.001 ) vs those with 30 or more minutes of physical activity a week . Increased mortality risk persisted ( mortality risk ratio , 2.15 ; P<.001 ) after adjustments for age , sex , current smoking , functional impairment , and comorbidity score . CONCLUSIONS In adults with chronic diseases , the physically inactive had higher observed mortality within a 42-month period . If physical inactivity reflects an independent mortality risk , efforts to maintain physical activity in such patients may yield significant clinical benefits within a short period . By contrast , if inactivity is primarily a proxy for other factors that elevate mortality risks , a simple physician inquiry regarding inactivity may help to identify patients at risk of death The benefits of aerobic exercise ( AE ) training on  blood pressure ( BP ) and arterial stiffness are well established , but the effects of resistance training are less well delineated . The purpose of this study was to determine the impact of resistance vs aerobic training on haemodynamics and arterial stiffness . Thirty pre- or stage-1 essential hypertensives ( 20 men and 10 women ) , not on any medications , were recruited ( age : 48.2±1.3 years ) and r and omly assigned to 4 weeks of either resistance ( RE ) or AE training . Before and after training , BP , arterial stiffness ( pulse wave velocity ( PWV ) ) and vasodilatory capacity ( VC ) were measured . Resting systolic BP ( SBP ) decreased following both training modes ( SBP : RE , pre 136±2.9 vs post 132±3.4 ; AE , pre 141±3.8 vs post 136±3.4 mm Hg , P=0.005 ; diastolic BP : RE , pre 78±1.3 vs post 74±1.6 ; AE , pre 80±1.6 vs post 77±1.7 mm Hg , P=0.001 ) . Central PWV increased ( P=0.0001 ) following RE ( 11±0.9–12.7±0.9 m s−1 ) but decreased after AE ( 12.1±0.8–11.1±0.8 m s−1 ) . Peripheral PWV also increased ( P=0.013 ) following RE ( RE , pre 11.5±0.8 vs post 12.5±0.7 m s−1 ) and decreased after AE ( AE , pre 12.6±0.8 vs post 11.6±0.7 m s−1 ) . The VC area under the curve ( VCAUC ) increased more with RE than that with AE ( RE , pre 76±8.0 vs post 131.1±11.6 ; AE , pre 82.7±8.0 vs post 110.1±11.6 ml per min per s per 100 ml , P=0.001 ) . Further , peak VC ( VCpeak ) increased more following resistance training compared to aerobic training ( RE , pre 17±1.9 vs post 25.8±2.1 ; AE , pre 19.2±8.4 vs post 22.9±8.4 ml per min per s per 100 ml , P=0.005 ) . Although both RE and AE  training decreased BP , the change in pressure may be due to different mechanisms BACKGROUND Blood pressure reduction achieved with beta-blockers and diuretics is the best recorded intervention to date for prevention of cardiovascular morbidity and death in patients with hypertension . Left ventricular hypertrophy ( LVH ) is a strong independent indicator of risk of cardiovascular morbidity and death . We aim ed to establish whether selective blocking of angiotensin II improves LVH beyond reducing blood pressure and , consequently , reduces cardiovascular morbidity and death . METHODS We did a double-masked , r and omised , parallel-group trial in 9193 participants aged 55 - 80 years with essential hypertension ( sitting blood pressure 160 - 200/95 - 115 mm Hg ) and LVH ascertained by electrocardiography ( ECG ) . We assigned participants once daily losartan-based or atenolol-based antihypertensive treatment for at least 4 years and until 1040 patients had a primary cardiovascular event ( death , myocardial infa rct ion , or stroke ) . We used Cox regression analysis to compare regimens . FINDINGS Blood pressure fell by 30.2/16.6 ( SD 18.5/10.1 ) and 29.1/16.8 mm Hg ( 19.2/10.1 ) in the losartan and atenolol groups , respectively . The primary composite endpoint occurred in 508 losartan ( 23.8 per 1000 patient-years ) and 588 atenolol patients ( 27.9 per 1000 patient-years ; relative risk 0.87 , 95 % CI 0.77 - 0.98 , p=0.021 ) . 204 losartan and 234 atenolol patients died from cardiovascular disease ( 0.89 , 0.73 - 1.07 , p=0.206 ) ; 232 and 309 , respectively , had fatal or non-fatal stroke ( 0.75 , 0.63 - 0.89 , p=0.001 ) ; and myocardial infa rct ion ( non-fatal and fatal ) occurred in 198 and 188 , respectively ( 1.07 , 0.88 - 1.31 , p=0.491 ) . New-onset diabetes was less frequent with losartan . Interpretation Losartan prevents more cardiovascular morbidity and death than atenolol for a similar reduction in blood pressure and is better tolerated . Losartan seems to confer benefits beyond reduction in blood pressure OBJECTIVE To determine whether self-reported physical activity predicts a decreased rate of coronary heart disease ( CHD ) and all-cause mortalities in middle-aged men when rates are adjusted for known confounders . DESIGN Cohort Analytic Study of Israeli government employees in 1963 . SUBJECTS Eight thous and four hundred sixty-three Israeli male government employees , aged 40 years or older , representing six areas of birth , excluding those with known cardiovascular disease in either 1963 or 1965 , from an original cohort of 10,059 . MAIN OUTCOME MEASURE Comparison of rates of death due to CHD and all causes , determined from death certificates in 21 years of follow-up , for subjects with different baseline levels of self-reported leisure-time and work-related physical activities measured in 1965 . RESULTS Self-reported leisure-time but not work-related physical activity was inversely related to both CHD ( adjusted relative risk , 0.79 ; 95 % confidence interval , 0.66 to 0.95 ) and all-cause mortalities ( adjusted relative risk , 0.91 ; 95 % confidence interval , 0.83 to 0.99 ) . Most of the apparent benefit accrued was from light physical activity on less than a daily basis . These inverse relationships persisted after adjustment for age , systolic blood pressure , cigarette smoking , total and high-density lipoprotein cholesterol levels , body mass index , psychosocial factors , and other potential confounders . CONCLUSION Baseline levels of self-reported leisure-time physical activity predicted a decreased rate of CHD and all-cause mortalities in employed middle-aged Israeli men followed up prospect ively for 21 years The Belgian Heart Disease Prevention Project was a controlled , r and omized multifactorial intervention trial in middle-aged men which lasted 6 years . Significant net differences between intervention and control groups were observed in change in risk profile , in total mortality and in CHD incidence . The net difference in risk profile change was greatest at two years , intermediate at four years and minimal at six years . Total and cause-specific mortality rates were systematic ally followed from the 6th to the 10th year . Follow-up at 10 years was 99.3 % complete . The differences between intervention and control groups in total , coronary and cardiovascular mortality reduced from the 6th to the 10th year . The results suggest that changes in risk profile are rapidly followed by changes in cardiovascular mortality , but this applies in both directions . Thus risk reduction should be maintained in order to achieve a long-lasting preventive effect The treatment of hypertension mainly with diuretics and beta blockers reduces cardiovascular mortality and morbidity , largely due to a decreased incidence of stroke , whereas the beneficial effects of antihypertensive therapy on the occurrence of coronary events have been less than expected from epidemiological studies . Furthermore , treated hypertensive patients still have a higher cardiovascular complication rate , compared with matched normotensives . This is particularly evident in patients with left ventricular hypertrophy ( LVH ) , a major independent risk indicator for cardiovascular disease . In addition to elevating blood pressure , angiotensin II ( A-II ) exerts an important influence on cardiac structure and function , stimulating cell proliferation and growth . Thus , to further reduce morbidity and mortality when treating hypertensive patients , it may be important to effectively block the effects of A-II . This can be achieved directly at the A-II receptor level by losartan , the first of a new class of antihypertensive agents . It therefore seems pertinent to investigate whether selective A-II receptor blockade with losartan not only lowers blood pressure but also reduces LVH more effectively than current therapy , and thus improves prognosis . The Losartan Intervention For Endpoint reduction ( LIFE ) in Hypertension study is a double-blind , prospect i ve , parallel group study design ed to compare the effects of losartan with those of the beta-blocker atenolol on the reduction of cardiovascular morbidity and mortality in approximately 8,300 hypertensive patients ( initial sitting diastolic blood pressure 95 to 115 mm Hg or systolic blood pressure 160 to 200 mm Hg ) with electrocardiographically documented LVH . The study , which will continue for at least 4 years and until 1,040 patients experience one primary endpoint , has been design ed with a statistical power that will detect a difference of at least 15 % between groups in the incidence of combined cardiovascular morbidity and mortality . It is also the first prospect i ve study with adequate power to link reversal of LVH to reduction in major cardiovascular events . The rationale of the study , which will involve more than 800 clinical centers in Sc and inavia , the United Kingdom , and the United States , is discussed , and the major features of its design and general organization are described . On April 30 , 1997 , when inclusion was stopped , 9,218 patients had been r and omized OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Aim /hypothesisLeisure-time physical activity can reduce the risk of Type 2 diabetes , but the potential effect of different types of physical activity is still uncertain . This study is to examine the relationship of occupational , commuting and leisure-time physical activity with the incidence of Type 2 diabetes . Methods We prospect ively followed 6898 Finnish men and 7392 women of 35 to 64 years of age without a history of stroke , coronary heart disease , or diabetes at baseline . Hazards ratios of incidence of Type 2 diabetes were estimated by levels of occupational , commuting , and leisure-time physical activity . Results During a mean follow-up of 12 years , there were 373 incident cases of Type 2 diabetes . In both men and women combined , the hazards ratios of diabetes associated with light , moderate and active work were 1.00 , 0.70 and 0.74 ( p=0.020 for trend ) after adjustment for confounding factors ( age , study year , sex , systolic blood pressure , smoking , education , the two other types of physical activity and BMI ) . The multivariate-adjusted hazards ratios of diabetes with none , 1 to 29 , and more than 30 min of walking or cycling to and from work were 1.00 , 0.96 , and 0.64 ( p=0.048 for trend ) . The multivariate-adjusted hazards ratios of diabetes for low , moderate , high levels of leisure-time physical activity were 1.00 , 0.67 , and 0.61 ( p=0.001 for trend ) ; after additional adjustment for BMI , the hazards ratio was no longer significant . Conclusions /interpretationModerate and high occupational , commuting or leisure-time physical activity independently and significantly reduces risk of Type 2 diabetes among the middle-aged general population AIMS Given that studies of individuals with Type 2 diabetes or impaired glucose tolerance indicate that physical activity has a normalizing effect on several indices of coronary heart disease ( CHD ) risk-including body weight , blood pressure , blood lipids , and cardiorespiratory fitness-it is plausible that activity may reduce CHD incidence in this group in the long term . The aim of the present analysis was to explore this hypothesis using data from a prospect i ve observational study . METHODS We examined the relation of two indices of physical activity-walking pace and leisure activity-to total mortality , CHD , and other cardiovascular diseases in a 25-year follow-up of 6408 male British Civil Servants who underwent an oral glucose tolerance test at study entry . RESULTS In 352 men who were identified as having Type 2 diabetes or impaired glucose tolerance ( diabetes/IGT ) at baseline , 215 had died at follow-up and , in 6056 normoglycaemics , 2550 deaths had occurred . The two indices of physical activity were inversely related to all-cause , CHD , and other cardiovascular disease mortality in both normoglycaemics and in men with diabetes/IGT . Although these associations were attenuated somewhat after statistical adjustment for a range of covariates , the majority held , suggesting an independent effect for physical activity . The gradient of the activity-mortality association was steeper in individuals with diabetes/IGT in comparison with the normoglycaemics , with the linear trend across activity levels for CHD risk differing markedly in the analyses of both walking pace ( P-value for interaction test = 0.05 ) and leisure activity ( P-value = 0.02 ) . CONCLUSIONS The findings of the present analysis of men with Type 2 diabetes/IGT provide support for those from a small number of other studies of persons with Type 2 diabetes suggesting that this group may benefit from physical activity in terms of CHD risk reduction The relation of leisure time and occupational physical activity to the risk of death from ischemic heart disease was investigated in a cohort of 15,088 persons aged 30 - 59 years who had no history of cardiovascular disease or other condition which hindered physical activity . Two population sample s were r and omly chosen from eastern Finl and . During a six-year follow-up , persons who were sedentary in leisure time ( relative risk = 1.3 , 95 % confidence interval ( CI ) = 1.1 - 1.6 ) or at work ( relative risk = 1.3 , 95 % CI = 1.1 - 1.6 ) had an excess risk of ischemic heart disease death when adjusted for age , health status , family history , and body mass index in multivariate logistic models . Adjustment for years of education , social network participation , cigarette consumption , serum cholesterol level , and blood pressure level weakened the residual association of low leisure time physical activity  with the risk of ischemic heart disease death ( relative risk = 1.2 , 95 % CI = 1.0 - 1.5 ) , whereas the association for low occupational physical activity remained unchanged . The lack of leisure time physical activity and a sedentary occupation are associated with an increased risk of ischemic heart disease death , and the excess risk due to lack of leisure time physical activity is , in part , accounted for by other ischemic heart disease risk factors PURPOSE The purpose of this study was to examine the long-term relationships between total physical activity and mortality from  all causes and coronary heart disease ( CHD ) in the general population . METHODS A prospect i ve design was used , following participants for 29 years , beginning in 1960 . The study population consisted of a r and omly selected sample of white male ( n = 698 ) and female ( n = 763 ) residents of Buffalo , New York with a 79.0 % participation rate and follow-up rates of 96.0 % and 90.2 % in males and females , respectively . At baseline , comprehensive information was obtained regarding participants ' usual physical activity at work and during leisure time . RESULTS As of December 31 , 1989 , three hundred and two ( 43.3 % ) men and 276 ( 41.0 % ) women died , 109 ( 15.6 % ) and 81 ( 10.6 % ) from CHD , respectively . In men , a significant interaction was found between activity and body mass index ( BMI ) for both outcomes . In women , a significant activity by age interaction was observed . In non-obese men ( BMI < 27.02 ) , activity was inversely associated with all-cause [ relative risk ( RR ) = 0.59 ; 95 % confidence interval ( CI ) , 0.39 - 0.89 ] and CHD mortality ( RR = 0.39 ; 95 % CI , 0.18 - 0.83 ) , independent from the effects of age and education . No such associations were found in obese men and increased risks could not be ruled out . Among women , younger participants ( age < 60 years ) had a significantly reduced risk of CHD death with increased activity ( RR = 0.26 ; 95 % CI , 0.07 - 0.99 ) . No other significant associations were observed . CONCLUSIONS Physical activity favorably influences mortality risks in non-obese men and younger women . Gender-specific factors should be considered for potential effect modification OBJECTIVE No previous long-term prospect i ve studies have examined if workers with low cardiorespiratory fitness have an increased risk of cardiovascular mortality due to high physical work dem and s. We tested this hypothesis . METHOD We carried out a 30-year follow-up of the Copenhagen Male Study of 5249 employed men aged 40 - 59 years . We excluded from follow-up 274 men with a history of myocardial infa rct ion , prevalent symptoms of angina pectoris , or intermittent claudication . We estimated physical fitness [ maximal oxygen consumption ( VO (2)Max ) ] using the Astr and cycling test and determined physical work dem and s with two self-reported questions . RESULTS In the Copenhagen Male Study , 587 men ( 11.9 % ) died due to ischaemic heart disease ( IHD ) . Using men with low physical work dem and s as the reference group , Cox analyses -- adjusted for age , blood pressure , smoking , alcohol consumption , body mass index , diabetes , and hypertension -- showed that high physical work dem and s were associated with an increased risk of IHD mortality in the least fit [ VO (2)Max range 15 - 26 , N=892 , hazard ratio ( HR ) 2.04 , 95 % confidence interval ( 95 % CI ) 1.20 - 3.49 ] and moderately fit ( VO (2)Max range 27 - 38 , N=3037 , HR 1.75 , 95 % CI 1.24 - 2.46 ) , but not among the most fit men ( VO (2)Max range 39 - 78 , N=1014 , HR 1.08 , 95 % CI 0.52 - 2.17 ) . We found a similar , although slightly weaker , relationship with respect to all-cause mortality . CONCLUSIONS The hypothesis was supported . Men with low and medium physical fitness have an increased risk of cardiovascular and all-cause mortality if exposed to high physical work dem and s. Ours observations suggest that , among men with high physical work dem and s , being physically fit protects against adverse cardiovascular effects OBJECTIVE A 2-year follow-up study of a cohort of 200 historically disadvantaged older South Africans was conducted to : ( i ) characterise current levels of habitual physical activity ; ( ii ) relate physical activity to current risk factors for chronic disease ; and ( iii ) identify risk factors associated with 2-year mortality . The baseline sample , drawn in 1993 , was found to have a high prevalence of hypertension ( 71.7 % ) . RESEARCH DESIGN Retrospective cohort study . METHODS A baseline sample of 200 persons aged > or = 65 years , resident in the Cape Peninsula , was r and omly drawn by means of a two-stage cluster design . Baseline measurements included : anthropometry , waist/hip ratio , systolic and diastolic blood pressure , body mass index ( BMI ) , serum albumin , serum ferritin , haemoglobin and fasting plasma glucose levels , plasma lipid profiles , oral glucose tolerance test and self-reported health status . Subjects were revisited after 2 years , at which time an adapted version of the Yale Physical Activity Survey was administered and measurements of blood pressure and anthropometry were repeated . STATISTICAL ANALYSES Spearman 's rank-order correlations were used to describe relationships between various current risk factors and physical activity . Logistic regression was used to determine predictors of 2-year mortality from baseline data . RESULTS At follow-up , 142 of the subjects ( 66 men , 76 women ) were traced and measurements collected . Thirty-two subjects were reported to have died by relatives living in the same household ( 22 men , 10 women ) . Levels of reported physical activity  in the survivors were two-thirds lower than those reported in a sample of North Americans of similar age . There was an inverse association between age and physical activity ( r = -0.31 ; P < 0.0005 ) and a positive association between BMI and physical activity ( r = 0.29 ; P < 0.005 ) . There was , however , no association between physical activity and systolic or diastolic blood pressure . In men , BMI in the lower tertile ( P = 0.07 ) and serum ferritin levels were positively associated with increased mortality . Serum albumin levels were protective over the 2-year follow-up period ( OR = 0.85 ; P < 0.05 ) . In women , being diabetic ( OR = 4.88 ; P = 0.06 ) and having a waist/hip ratio in the upper tertile ( OR = 3.26 ; P = 0.06 ) were associated with mortality . CONCLUSIONS Physical activity levels in this sample of older historically disadvantaged South Africans were habitually low . Simple anthropometric assessment s incorporating weight and waist/hip ratio , together with serum albumin measurements , may be useful to screen general health risk for older adults at primary care level and provide indications for social or medical intervention . Further , strategies for earlier detection and effective management of diabetes , particularly in older women , may reduce premature mortality in this population -Losartan was the first available orally administered selective antagonist of the angiotensin II type 1 receptor developed for the treatment of hypertension . The Losartan Intervention For Endpoint ( LIFE ) Reduction in Hypertension Study is a double-blind , prospect i ve , parallel group study design ed to compare the effects of losartan with those of the beta-blocker atenolol on the reduction of cardiovascular morbidity and mortality .  Patients with essential hypertension , aged between 55 and 80 years , and ECG-documented left ventricular hypertrophy ( LVH ) were included . Altogether , 9223 patients in Sc and inavia , the United Kingdom , and the United States were r and omized from June 1995 through April 1997 , and 9194 remain after exclusion of a study center at which irregularities were discovered . This population of hypertensives ( mean systolic/diastolic blood pressure , 174.4/97.8 mm Hg ) with LVH comprises women ( 54.1 % ) and men , mostly retired from active work ( mean age , 66.9 years ) , with a high prevalence of overweight ( mean body mass index , 28.0 kg/m2 ) , diabetes mellitus ( 12.3 % ) , lipid disorders ( 18.0 % ) , and symptoms or signs of coronary heart disease ( 15.1 % ) . There were fewer current smokers  ( < 17 % ) than in the general population , and approximately 7 % were nonwhite . Almost 30 % of participants had been untreated for at least 6 months when screened for the study . Only 1557 persons who entered the placebo run-in period of 14 days were excluded , predominantly because of sitting blood pressures above or below the predetermined range of 160 - 200/95 - 115 mm Hg and ECG-LVH criteria not met . By application of simple 12-lead ECG criteria for LVH ( Cornell voltage QRS duration product formula plus Sokolow-Lyon voltage read by a core laboratory ) , hypertensive patients with LVH with an average 5-year coronary heart disease risk of 22.3 % according to the Framingham score were identified . This population is now being treated ( goal , < 140/90 mm Hg ) in adherence with the protocol for at least 4 years after final enrollment ( ie , through April 2001 ) and until at least 1040 patients suffer myocardial infa rct ion , stroke , or cardiovascular death Background Exercise lowers blood pressure and improves cardiovascular function , but little is known about whether exercise  impacts cardiovascular morbidity and mortality independent of left ventricular hypertrophy ( LVH ) and LV geometry . Design Observational analysis of prospect ively obtained echocardiographic data within the context of a r and omized trial of antihypertensive treatment . Methods A total of 937 hypertensive patients with ECG LVH were studied by echocardiography  in the Losartan Intervention For Endpoint reduction in hypertension study . Baseline exercise status was categorized as sedentary ( never exercise ) , intermediate ( ≤ 30 min twice/week ) , or physically active ( > 30 min twice/week ) . During 4.8-year follow-up , 105 patients suffered the primary composite endpoint of myocardial infa rct ion ( MI ) , stroke , or cardiovascular death . Ml occurred in 39 , stroke in 60 , and cardiovascular death in 33 patients . Results Sedentary individuals ( n = 212 ) had , compared with those physically active ( n = 511 ) , higher heart rate ( P < 0.001 ) , weight ( P < 0.001 ) , body surface area ( P = 0.02 ) , body mass index ( P < 0.001 ) , LV mass ( LVM , P = 0.04 ) , LVM indexed for height or body surface area ( P = 0.004 ) ; thicker ventricular septum ( P = 0.012 ) and posterior wall ( P = 0.016 ) ; and larger left atrium ( P = 0.006 ) . Systolic variables did not differ . In Cox regression analysis , physically active compared with sedentary patients had lower risk of primary composite endpoint [ odds ratio ( OR ) : 0.42 , 95 % confidence interval ( CI ) : 0.26 - 0.68 , P < 0.001 ] , cardiovascular death ( OR : 0.50 , 95 % CI : 0.22 - 0.1.10 , NS ) , and stroke ( OR : 0.26 , 95 % CI : 0.13 - 0.49 , P < 0.001 ) without significant difference for Ml ( OR : 0.79 , 95 % CI : 0.35 - 1.75 , NS ) independent of systolic blood pressure , LVM index , or treatment . Conclusion In hypertensive patients with LVH , physically active patients had improved prognosis for cardiovascular endpoints , mortality , and stroke that was independent of LVM . Eur J Cardiovasc Prev Rehabil 16:242 - 248 © 2009 The European Society of BACKGROUND Regular exercise has been associated in prospect i ve studies with reduced incidence of  cardiovascular disease ( CVD ) and death  . OBJECTIVE To assess in a cohort study whether there is a similar protective effect of regular exercise among hypertensive individuals . DESIGN Population -based prospect i ve cohort study . Spare time physical activity was assessed by structured interview . SETTING Malmo , Sweden . PARTICIPANTS Healthy men ( n = 642 ) born in 1914 . A baseline examination took place in 1969 - 1970 . MAIN OUTCOME MEASURES All-cause and cardiovascular mortality rates during 25 years of follow-up in relation to blood pressure and other risk factors for atherosclerosis . RESULTS One-hundred ( 16 % ) men reported vigorous spare time physical activity . In this group , 31 had hypertension ( blood pressure > 160/95 mm Hg or treatment for hypertension ) , 47 were smokers and 39 had hyperlipidaemia . Among the 173 men with hypertension , vigorous physical activity was associated with markedly reduced rates of all-cause ( 17.3 versus 40.0 deaths per 1000 person-years ) and cardiovascular mortality ( 6.3 versus 21.0 deaths per 1000 person-years ) . The risk reductions associated with exercise remained statistically significant after adjustment for smoking , systolic blood pressure and antihypertensive therapy . The relative risk was 0.43 ( confidence interval 0.22 - 0.82 ) for total mortality and 0.33 ( confidence interval 0.11 -0.94 ) for CVD mortality . CONCLUSION People who regularly perform physical activity constitute a heterogeneous group with regard to their exposure to known cardiovascular risk factors . Our results support the view that regular physical activity is associated with a reduced incidence of cardiovascular disease and death and suggest that this protective effect may be enhanced among hypertensive individuals
target: Regular physical activity is beneficial for reducing mortality in patients with high BP .
background: BACKGROUND Physical activity has been shown to be beneficial for the prevention and management of hypertension .
  In the general population , physical activity has been shown to decrease mortality .
  PURPOSE The purpose of this systematic review was to identify and synthesize the literature examining the impact of physical activity on mortality in patients with high blood pressure ( BP ) .