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Physical activity and cornonary heart disease

BMJ 2004; 329 doi: (Published 01 July 2004) Cite this as: BMJ 2004;329:0407267
  1. G David Batty1,
  2. I-Min Lee, associate professor of medicine senior research fellow in epidemiology2
  1. 1Department of Social Medicine, Institute of Public Health, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark
  2. 2Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 900 Commonwealth Avenue East, Boston, MA 02215, USA

Fifty years of research confirms inverse relationship, say G David Batty and I-Min Lee

Fifty years ago the first empirical investigation of what was subsequently termed “the exercise hypothesis”-physical activity reduces the occurrence of coronary heart disease-was undertaken by Morris et al.1 Using data from two cohorts of British workers, they reported lower rates of coronary heart disease in bus conductors than in less occupationally active bus drivers, and in postmen relative to deskbound telephonists and other office based employees. Although this research was pioneering, it was not without its shortcomings. Early statistical methods were limited in their capacity to explore the issue of confounding-for example, it was possible that higher levels of overweight, high blood pressure, stress, or pre-existing ischaemia in the less active groups, rather than their sedentary behaviour, placed them at increased risk of coronary heart disease. Further, the study focused exclusively on work activity. Morris et al, and subsequently Paffenbarger et al, went on to address these issues, showing physical activity in leisure time to be cardioprotective, an effect that held after controlling for a range of covariates.23

The work of these researchers prompted a series of other investigations, including the study of the association between cardiorespiratory fitness-a physiological outcome of physical activity and therefore an objective proxy for it-and cardiovascular disease, which showed that higher levels, which were none the less eminently attainable by non-athletes, conferred protection against coronary heart disease.4 These studies, and those of physical activity, represent a range of methodological rigour and have, with few exceptions, shown an inverse association between activity and coronary heart disease, which is testimony to the robustness of the relation. Until recently this research has focused on men. In the past two decades, however, the same degree of consistency has been observed in …

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