Association of leisure-time physical activity with total and cause-specific mortality: a pooled analysis of nearly a half million adults in the Asia Cohort Consortium

Ying Liu; Xiao-Ou Shu; Wanqing Wen; Eiko Saito; M Shafiur Rahman; Shoichiro Tsugane; Akiko Tamakoshi; Yong-Bing Xiang; Jian-Min Yuan; Yu-Tang Gao; Ichiro Tsuji; Seiki Kanemura; Chisato Nagata; Myung-Hee Shin; Wen-Harn Pan; Woon-Puay Koh; Norie Sawada; Hui Cai; Hong-Lan Li; Yasutake Tomata; Yumi Sugawara; Keiko Wada; Yoon-Ok Ahn; Keun-Young Yoo; Habibul Ashan; Kee Seng Chia; Paolo Boffetta; Manami Inoue; Daehee Kang; John D Potter; Wei Zheng

doi:10.1093/ije/dyy024

Association of leisure-time physical activity with total and cause-specific mortality: a pooled analysis of nearly a half million adults in the Asia Cohort Consortium

Int J Epidemiol. 2018 Jun 1;47(3):771-779. doi: 10.1093/ije/dyy024.

Authors

Ying Liu¹, Xiao-Ou Shu¹, Wanqing Wen¹, Eiko Saito², M Shafiur Rahman³, Shoichiro Tsugane⁴, Akiko Tamakoshi⁵, Yong-Bing Xiang⁶, Jian-Min Yuan^{7

8}, Yu-Tang Gao⁶, Ichiro Tsuji⁹, Seiki Kanemura⁹, Chisato Nagata¹⁰, Myung-Hee Shin¹¹, Wen-Harn Pan¹², Woon-Puay Koh^{13

14}, Norie Sawada⁴, Hui Cai¹, Hong-Lan Li⁶, Yasutake Tomata⁹, Yumi Sugawara⁹, Keiko Wada¹⁰, Yoon-Ok Ahn¹⁵, Keun-Young Yoo¹⁶, Habibul Ashan¹⁷, Kee Seng Chia¹⁴, Paolo Boffetta¹⁸, Manami Inoue⁴, Daehee Kang^{15

19

20}, John D Potter^{21

22

23}, Wei Zheng¹

Affiliations

¹ Division of Epidemiology, Vanderbilt-Ingram Cancer Center, Vanderbilt Epidemiology Center, Nashville, TN, USA.
² Division of Cancer Statistics Integration, National Cancer Center, Tokyo, Japan.
³ Department of Global Health Policy, University of Tokyo, Tokyo, Japan.
⁴ Epidemiology and Prevention Group, National Cancer Center, Tokyo, Japan.
⁵ Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
⁶ Shanghai Cancer Institute, Shanghai Jiaotong University, Shanghai, PR China.
⁷ Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
⁸ Division of Cancer Control and Population Science, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
⁹ Tohoku University Graduate School of Medicine, Miyagi Prefecture, Japan.
¹⁰ Graduate School of Medicine, Gifu University, Gifu, Japan.
¹¹ Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea.
¹² Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.
¹³ Duke-NUS Medical School Singapore.
¹⁴ Saw Swee Hock School of Public Health, Singapore, Republic of Singapore.
¹⁵ Department of Preventive Medicine.
¹⁶ Armed Forces Capital Hospital, Seoul National University College of Medicine, Seoul, South Korea.
¹⁷ Departments of Health Studies, Medicine and Human Genetics and Cancer Research Center, University of Chicago, Chicago, IL, USA.
¹⁸ Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁹ Department of Biomedical Sciences.
²⁰ Cancer Research Institute, Seoul National University, Seoul, South Korea.
²¹ Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
²² Centre for Public Health Research, Massey University, Wellington, New Zealand.
²³ Department of Epidemiology, University of Washington, Seattle, WA, USA.

Abstract

Background: Most previous studies evaluating the association between leisure-time physical activity (LTPA) and risk of death were conducted among generally healthy individuals of European ancestry. We investigated the association of LTPA with all-cause and cause-specific mortality among East Asian populations, including healthy individuals and those with existing chronic diseases, which has been less well characterized.

Methods: We performed pooled analyses among 467 729 East Asian individuals recruited in nine prospective cohorts included in the Asia Cohort Consortium. Cox proportional hazards regressions were used to derive hazard ratios (HRs) and 95% confidence intervals (CIs) associated with LTPA after adjusting for age, sex, education and marital and smoking status.

Results: During a mean follow-up period of 13.6 years, 65 858 deaths were identified. Compared with those who reported no or less than 1 h of LTPA per week, an inverse association was observed between the amount of LTPA and all-cause and cause-specific mortality (P for trend < 0.001). The strength of the inverse association was stronger for death due to cardiovascular diseases and causes other than cancer deaths. An inverse association of LTPA with total mortality was observed among individuals with a severe and often life-threatening disease: cancer, stroke or coronary heart disease [hazard ratio (HR) = 0.81, 95% CI = 0.73-0.89 for high vs low LTPA) and those with other chronic diseases such as diabetes or hypertension (HR = 0.86, 95% CI = 0.80-0.93 for high vs low LTPA). No clear modifying effects by sex, body mass index or smoking status were identified.

Conclusions: Regular participation in LTPA is associated with reduced mortality in middle-aged and elder Asians regardless pre-existing health conditions.

Keywords: Asia; Leisure-time physical activity; cancer; cardiovascular; coronary heart disease; diabetes; hypertension; mortality; stroke.

Abstract

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