‘Weekend warriors’ workout tied to longevity with low risk for CVD, cancer and all-cause mortality.

Courtesy: Pixabay

The standard recommendation by CDC[1] and American Heart Association[2] is 150 minutes of moderate or 75 minutes of vigorous physical activity per week for achieving health benefits for those aged 18 to 64 years. But, very few people can keep up with this routine and most of us just cram the workout of entire week into 1- 2 weekend sessions, 2-3 long runs or participating in our favorite sports like hiking, basketball or Zumba.

Courtesy: Pixabay

Well, although not ideal but, it reduces your risk of dying from cardiovascular, all cause and cancer by 30% according to a new study published in JAMA Internal Medicine online on January 9, 2017.[3] The study was conducted by researchers from the National Centre for Sport and Exercise Medicine–East Midlands at Loughborough University in the United Kingdom.

This study examined whether ‘weekend warriors’ also derive the same benefits as their more active, regularly hitting the gym counterparts.

Gary O’Donovan did a pooled analysis of 63 591 adult respondents (>40 years old) who answered a household based survey in England and Scotland. The survey was conducted between 1994 to 2012 and analyzed in 2016. The survey was prospectively linked to British National Health Service Central Registry which identified participants who died, including the cause of death.

For the purpose of analysis, the respondents very divided into 4 groups depending on their exercise pattern:  Those who  were inactive (reporting no moderate- or vigorous-intensity activities), insufficiently active (reporting <150 min/wk in moderate-intensity and <75 min/wk in vigorous-intensity activities), weekend warrior (reporting ≥150 min/wk in moderate-intensity or ≥75 min/wk in vigorous-intensity activities from 1 or 2 sessions), and regularly active (reporting ≥150 min/wk in moderate-intensity or ≥75 min/wk in vigorous-intensity activities from ≥3 sessions). 

The mean age of the study participants was 58.6 years with nearly equal gender ratio. About 40,000 people did not exercise at all, 14000 were insufficiently active, 2500 were weekend warriors and 7000 people were regularly active.

During the follow up period of 9 years, 8,800 people died, CVD being responsible for 2780 and cancer for 2500 deaths.

A detailed analysis of ‘weekend warriors’ group showed that, men were more likely to work vigorously on weekends, mostly engaging in some sort of sports. Walking briskly was also very popular and reported by 30% of weekend warriors. Weekend warriors spent a total of 300 minutes exercising as compared to 450 minutes spent by those who are regular.

After adjustment for all confounders, as compared to inactive participants risk of all cause death for weekend warriors was 30% less (hazard ratio [HR], 0.70), risk of CVD was 40%( HR=0.60) less and cancer death was 18% less (HR= 0.82).

Similar pattern of risk reduction was found in insufficiently active people too, indicating any exercise is better than being totally inactive.

When analysis was run between inactive group and regular exercise group, the regularly active persons have a 35% decrease in all-cause mortality (HR=0.65),  41% lower CVD death(HR=0.59), and 21% lower cancer death(HR=0.79).

During the follow up period of 9 years, 8,800 people died, CVD being responsible for 2780 and cancer for 2500 deaths.

"These findings suggest that some physical activity in an isolated session, or low activity, is certainly better than no activity for reducing mortality risk," Hannah Arem and Loretta DiPietro, of George Washington University, wrote in a commentary accompanying the new study in the journal.

The study has its own limitations that it is dependent on self-reporting and assessed the activity level only once at the start of the study. The study also did not assess the risk of injury in the weekend warriors.

But, the encouraging new conclusion emerging from the study is for those who exercise less frequently is even 1-2 vigorous activity session per week have health benefits and can lower the mortality.

The recommendations by CDC for regular physical activity can be found here.

The recommendations by American Heart Association ( AHA)  for regular physical activity can be found here.

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[1] https://www.cdc.gov/physicalactivity/basics/adults/

[2] http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/American-Heart-Association-Recommendations-for-Physical-Activity-in-Adults_UCM_307976_Article.jsp#.WIPgqBsrK00

[3] http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2596007

Sitting for more than 10 hours with sedentary life style accelerates aging in older women.

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Researchers at University of San Diego school of medicine have found a link between prolonged sitting and shortening of telomeres length which  is associated with accelerated aging. They found that cells in these sedentary women are biologically older by 8 years than women who lead an active life style.[1]

Although Telomere attrition occur as a part of natural aging, new evidence in geriatric research suggests that beside genetics and several individual factors environmental, social and lifestyle factors affects the rate of shortening. Reduced Telomere length is found in  higher age, atherosclerosis, hypertension, adipositas, diabetes, smoking, physical inactivity, heart failure, maltreatment in childhood, exposure to traffic pollution, chronic infection, single life and dementia.[2]

This study was published online January 18, 2017 in American Journal of Epidemiology.[3] The researchers found that elderly women with less than 40 minutes of moderate to vigorous physical activity (MVPA) daily with being sedentary for more than 10 hours have significantly shorter leukocyte telomere lengths (LTL).

It is known that women on an average lose 21 base pairs/year. In the study population LTL was an average 170 base pair shorter in the women with least physical activity as compared to her counterpart with adequate physical activity. This lead to the conclusion that most sedentary women were biologically 8 years older than women of same chronological age with good amount of physical activity.

Nearly 15,000 women participated in this cross-sectional study, mean age 79 years (64-95 years). Activity time was measured by all women wearing accelerometer and also self-reporting by the participants.

After adjusting for confounding factors, it was seen that African- American women were considerably more active than white women. Women with sedentary life style were white, older, obese and have high B.P., chronic diseases and have experienced fall much more in last few months. Shorter LTL is also associated with CVD, diabetes and many types of malignancies.

“Our study found that cells age faster with a sedentary lifestyle. Chronological age doesn’t always match biological age,” said Aladdin Shadyab, PhD, lead author of the study with the Department of Family Medicine and Public Health at UC San Diego School of Medicine.

“We found that women who sat longer did not have shorter telomere length if they exercised for at least 30 minutes a day, the national recommended guideline,” said Shadyab. “Discussions about the benefits of exercise should start when we are young, and physical activity should continue to be part of our daily lives as we get older, even at 80 years old.” 

Full text of the article

UC San Diego News Letter 

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[1] http://ucsdnews.ucsd.edu/pressrelease/too_much_sitting_too_little_exercise_may_accelerate_biological_aging

[2] https://www.ncbi.nlm.nih.gov/pubmed/21915807

[3] https://academic.oup.com/aje/article/2915786/Associations-of-Accelerometer-Measured-and-Self#56238637

ACOG supports the USPSTF’s broader list of risk factors for supplementing low dose aspirin in preeclampsia risk reduction.

low dose aspirin 

The current ACOG recommendation for supplementing low dose aspirin for reducing the risk of developing preeclampsia is based on report by Task Force on Hypertension in Pregnancy in 2013.

The task force recommended 60-80 mg of aspirin started late first trimester for all women who are at risk by their obstetric history:

• history of preeclampsia in more than one prior pregnancy.
• history of early onset preeclampsia with preterm delivery at <34 weeks' gestation.

The U.S.Preventive Services Task Force (USPSTF) conducted a systematic review and meta-analysis of several good quality RCTs and published the results as clinical guidelines. It expanded its list of high risk pregnancies at risk for developing preeclampsia in 2014.[1]  The list was divided into 3 categories: high, medium and low risk for developing preeclampsia.

1) Women are considered at high risk if one or more of the following factors are present:

• History of preeclampsia, especially when accompanied by an adverse outcome
• Multifetal gestation
• Chronic hypertension
• Type 1 or 2 diabetes
• Renal disease
• Autoimmune disease such as systemic lupus erythematous, antiphospholipid syndrome.

2) Women are considered at moderate risk if they have several of these moderate-risk factors:

• Nulliparity
• Obesity (body mass index >30 kg/m²)
• Family history of preeclampsia (mother or sister)
• Sociodemographic characteristics (African American race, low socioeconomic status)
• Age ≥35 years
• Personal history factors (e.g., low birthweight or small for gestational age, previous adverse pregnancy outcome, >10-year pregnancy interval)

3) Women are considered at low risk if they have:

• A history of uneventful term delivery.

ACOG issued a practice advisory in July 2016[2] supporting  the recommendation by USPSTF to consider the use of low-dose aspirin (81 mg/day), initiated between 12 and 28 weeks of gestation, for the prevention of preeclampsia, and recommends using the high-risk factors as recommended by the USPSTF and listed above.

Supplementing the low dose aspirin reduced the reduced the risk for preeclampsia by 24% in clinical trials and reduced the risk for preterm birth by 14% and IUGR by 20%.

In a meta-analysis of RCTs and observational studies, USPSTF did found any evidence of increased risk of placental abruption, postpartum hemorrhage, or fetal intracranial bleeding even in moderate to low risk patients.

It is estimated that ten million women develop preeclampsia each year around the world, with 76,000 deaths due preeclampsia and related hypertensive disorders.  It is also responsible for 50,000 stillbirths and early neonatal deaths in developing nations.

A woman in developing country is seven times more likely to develop preeclampsia than a woman in a developed country, contributing to 10-25% of all Maternal mortality.

In the United States, it affects 5-8% of all pregnancies.

Establishing casualty, early detection and prevention of preeclampsia along with identifying the women at risk has been the mainstay of preeclampsia research in the last decade.

Link to USPSTF complete final recommendation  can be found here. 

Link to ACOG practice advisory can be found here. 

  

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[1] https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication

[2] http://www.acog.org/About-ACOG/News-Room/Practice-Advisories/Practice-Advisory-Low-Dose-Aspirin-and-Prevention-of-Preeclampsia-Updated-Recommendations