Physical Activity of Any Ilk Cuts CVD, Deaths in Global Study: PURE

Recreational, occupational, domestic: the type of physical activity doesn’t seem to matter when it comes to curbing CVD and death.

Physical Activity of Any Ilk Cuts CVD, Deaths in Global Study: PURE

Once again, higher levels of physical activity have been linked to a lower risk of cardiovascular disease and death, but in a new twist, authors from one of the world’s largest epidemiological studies say that the form of activity—be it recreational, occupational, domestic, or otherwise—makes no difference.

That’s important, say investigators from the Prospective Urban Rural Epidemiology (PURE) study, because the link between higher physical output and lower adverse events was seen across a range of countries with different economies and standards of living.

“Previous studies that have found physical activity to help prevent premature death and cardiovascular disease have come from high-income countries and they mainly focus on recreational, leisure-time activities,” lead author Scott A. Lear, MD (Simon Fraser University, Burnaby, Canada), told TCTMD.

Moreover, he continued, “studies that have looked at occupational or nonrecreational activities in high-income countries haven’t really found a benefit of activities outside of recreational activities. A large part of that is because the people who go into these studies tend to have sit-down or sedentary jobs, whereas the reverse is true in low- and middle-income countries: a higher proportion of people there have jobs on their feet or moving about and they do very little recreational activity, either because they don’t have time or because they have used a lot of their energy working outside.”

These latest data from PURE were published online September 21, 2017, ahead of print in the Lancet.

The current PURE analysis looked at 130,843 individuals with no preexisting cardiovascular disease between the ages of 35 and 70 in 17 countries: three high-income countries, seven upper-middle-income countries, three lower-middle-income counties, and four low-income countries. Activity levels were assessed using the International Physical Activity Questionnaire (IPQA) and categorized as low (< 600 metabolic equivalents x minutes per week or less than 150 minutes per week of moderate-intensity physical activity), moderate (600-3000 MET × minutes or 150–750 minutes per week), and high (> 3000 MET × minutes or > 750 minutes per week).

Over a mean 6.9 years of follow-up, people in the moderate and high physical activity groups saw reductions in both overall mortality and major cardiovascular diseases events as compared with the low physical activity group. The more physical activity, the greater the benefits, up to approximately 3000 MET x minutes per week, with benefits attenuating somewhat above that level. Importantly, the benefits of increased physical activity were seen regardless of whether that activity was recreational.   

Physical Activity Levels and Associated Events


Moderate vs Low Physical Activity

High vs Moderate Physical Activity

High vs Low Physical Activity

All-Cause Mortality or Major CVD

0.85 (0.80-0.91)

0.85 (0.80-0.90)

0.73 (0.68-0.77)

All-Cause Mortality

0.80 (0.74-0.87)

0.81 (0.75-0.87)

0.65 (0.60-0.71)

Major CVD

0.86 (0.78-0.93)

0.88 (0.82-0.94)

0.75 (0.69-0.82)

“I think this study demystifies physical activity,” Lear told TCTMD. “This suggests that it doesn’t need to be complicated. It can be activity of any type: vacuuming, walking to work, going to the gym. All of these count as activity, and so does walking or carrying loads while working. And all of these physical activity types are of benefit in reducing the risk of heart disease and premature death. That’s very enlightening, because we can break the myth that a lot of people [think] that they need to go to the gym, they have to work out, and physical activity costs money and takes time. Instead, we can see here that if we have physical activity as part of our lives, that’s beneficial and it’s a low-cost preventive strategy.”

The study did not address whether certain activities were more beneficial than others, he clarified. Nor did it look at whether certain types of activity were more beneficial in countries with a certain level of income versus another. What it did show, Lear stressed, is that physical activity of any sort had benefits across different economies and countries—that’s important as lower- and middle-income countries become more economically prosperous and jobs and activities potentially become more sedentary.

“This isn’t maybe the message that interventional cardiologists want to hear, but this shows that physical activity is a low-cost intervention that can perhaps keep people from having to see a cardiologist in the first place.”

  • Lear reports no relevant conflicts of interest.

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