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Eur J Epidemiol (2011) 26:109116 DOI 10.1007/s10654-010-9523-8
CARDIOVASCULAR DISEASE
Long-term trajectory of leisure time physical activity and survival after rst myocardial infarction: a population-based cohort study
Yariv Gerber Vicki Myers Uri Goldbourt
Yael Benyamini Mickey Scheinowitz
Yaacov Drory
Received: 19 July 2010 / Accepted: 16 November 2010 / Published online: 30 November 2010 Springer Science+Business Media B.V. 2010
Abstract The benets of leisure time physical activity (LTPA) in cardiovascular prevention are well established. While cardiac rehabilitation programmes have been demonstrated as improving myocardial infarction (MI) prognosis, the strength of the association between LTPA and post-MI survival has yet to be quantied. We evaluated long-term survival after MI of inactive, irregularly active, and regularly active patients and examined trajectories of LTPA and their relationship to mortality risk. Consecutive patients aged B65 years (n = 1,521), discharged from 8 hospitals in central Israel after rst MI in 19921993, were
followed through 2005. Extensive clinical and sociodemographic data, including self-reported LTPA habits, were obtained at baseline and at 4 subsequent interviews. Pre-MI inactive patients (54%) had lower socioeconomic status, higher prevalence of risk factors and comorbidities and more severe MI. The point prevalence rate of regular LTPA at all follow-up interviews was approximately 40% and 18% were regularly active throughout the entire follow-up. Over a median follow-up of 13.2 years, 427 deaths occurred. After multivariable adjustment, no association was observed between pre-MI LTPA and death. However, with LTPA categories modelled as time-dependent variables, providing an estimation of cumulative assessment and accounting for changes in LTPA post-MI, a strong inverse graded association was revealed (multivariable-adjusted hazard ratios, 0.56 [95% CI: 0.420.74] for regular and 0.71 [95% CI: 0.540.95] for irregular activity vs. none). Similar estimates were obtained among pre-MI sedentary patients. In summary, after MI, regularly active patients had about half the risk of dying compared with inactive patients, irrespective of pre-MI habits.
Keywords Leisure time physical activity
Myocardial infarction Secondary prevention
Longitudinal study Epidemiology Long-term
follow-up Survival
AbbreviationsACS Acute coronary syndromes CABG Coronary artery bypass graft CHD Coronary heart diseaseCI Condence intervalCVD Cardiovascular diseaseHR Hazard ratio
This study is conducted for the Israel Study Group on First Acute Myocardial Infarction. See the Appendix for a list of participating medical centres and investigators.
Y. Gerber (&) V. Myers U....