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Epidemiology: Physical Activity, Exercise and Mortality

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Textbook of Sports and Exercise Cardiology

Abstract

Cardiovascular diseases (CVD) and cardiometabolic diseases like Type 2 Diabetes Mellitus (T2DM) are the main driver of morbidity and mortality worldwide. Sedentary behavior (physical inactivity) or, in other words, the lack of regular exercise causes many cardiometabolic diseases and increases the risk for all-cause and cause-specific mortality. Higher levels of physical activity (PA) and cardiorespiratory fitness (CRF) may be used as a treatment to prevent many of these cardiometabolic diseases and thereby lower all-cause and cause-specific mortality independent of patient population. Abnormally high levels of PA may have adverse consequences and do increase the risk for atrial fibrillation. In the general population only very few individuals will reach these levels. However, at least for cardiologists working with elite athletes, an increased CVD risk may be of concern. Even though the terms PA and CRF are sometimes used interchangeably, both parameters are not the same. And even though PA and CRF act through different biological mechanisms, there is a large amount of evidence that, independent of an individual's health status (e.g. blood lipid levels, blood pressure and smoking as well as dietary habits), higher levels of PA and CRF improve the overall CVD risk profile. With regards to occupational PA, there is sufficient evidence that leisure time and sports related PA are inversely associated with all-cause and cause-specific mortality, but the relationship between occupational PA on mortality, on the other hand, is currently unclear.

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Author information

Authors and Affiliations

  1. Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany

    Martin Bahls & Marcus Dörr

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  1. Martin Bahls
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  2. Marcus Dörr
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Correspondence to Marcus Dörr .

Editor information

Editors and Affiliations

  1. Private Center for Sports and Exercise Cardiology, München, Bayern, Germany

    Axel Pressler

  2. University Institute of Sports Medicine Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria

    Josef Niebauer

Review

Review

1.1 Questions

  1. 1.

    Explain the difference between sedentarism, PA and CRF with regards to all-cause and CVD mortality.

  2. 2.

    Are there adverse consequences of high levels of PA and CRF?

  3. 3.

    Can you describe the relation between PA in different domains, and why is this differentiation important?

1.2 Answers

  1. 1.

    Sedentary behavior is casually linked with adverse remodeling of the CV system and is a driver of higher all-cause and CVD mortality. PA and CRF are inversely related to all-cause and CVD mortality. A plethora of studies with different ethnicities, age groups and patients with CVD consistently demonstrated that with each MET increase all-cause mortality decreases by approximately 10%.

  2. 2.

    Very high levels of PA are associated with an increased risk of atrial fibrillation and potentially with all-cause and CVD mortality. However, the current data suggesting these associations are mainly of concern for cardiologists who work with elite endurance athletes as high levels of 50 MET-h per week or more are unlikely to be observed in the general population.

  3. 3.

    PA may take place in different domains. Specifically, people may be physically active during leisure time (LTPA), in a sports setting (SPA) or at work (WPA). A large number of studies have explored the relation between domain specific PA and mortality. The data for LTPA and SPA is very strong in demonstrating a dose-depended inverse relationship with all-cause mortality. The currently available literature does not provide a clear direction for WPA.

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Bahls, M., Dörr, M. (2020). Epidemiology: Physical Activity, Exercise and Mortality. In: Pressler, A., Niebauer, J. (eds) Textbook of Sports and Exercise Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-35374-2_35

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  • DOI: https://doi.org/10.1007/978-3-030-35374-2_35

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