Re: Exercise, body mass index and heart disease survival

[Guest guest]

Hi folks:

Two comments on this study:

1) It is BLAIR. AGAIN!!!

2) Have they really demonstrated that exercise reduces the risk of

death from CVD in diabetics in proportion to how much they exercise?

(Which is what they would like us to believe they have

demonstrated). Or have they, rather, demonstrated that the more

occluded the subjects' arteries are (and therefore the closer they

are to infarction and death) the less capable they are of exercise

and so, in consequence, they perform less well on the tests done by

the investigators to determine their fitness level?

IMO the latter is obviously true. Whether the former is true or not

I really have no idea, and from what I have seen of it I do not think

this study helps elucidate the issue. But Dr. Henry has an

opinion, lol.

Rodney.

--- In , Al Pater <old542000@y...>

wrote:

>

> Hi All,

>

> Does lower body mass index mean that exercise is of less benefit?

>

> See the below pdf-available comments and article addressed in the

comments. It

> seemed to be from Table 3 that the patients of diabetes with lower

body mass indices

> more significantly had an association of exercise with survival

from heart disease.

>

> In This Issue of Archives of Internal Medicine

> Arch Intern Med. 2005 Oct 10;165(18):2052.

> Cardiorespiratory Fitness and BMI as Predictors of CVD Mortality

Among Men With

> Diabetes

>

> Questions remain as to whether higher levels of cardiorespiratory

fitness are

> associated with lower risk of cardiovascular disease (CVD)

mortality in overweight

> and obese individuals with diabetes. In this prospective

epidemiological study of

> 2316 men with diabetes, Church et al sought to quantify the

independent and joint

> relations of cardiorespiratory fitness and body mass index with CVD

mortality. They

> found that low cardiorespiratory fitness was associated with

increased risk of CVD

> mortality within normal weight, overweight, and class 1 obese

weight categories.

> These results further reinforce that health care providers should

give increased

> attention to counseling for increasing activity and improving

fitness in patients

> with diabetes for the intrinsic benefits associated with increased

fitness and for

> the critical role regular physical activity plays in long-term

weight loss and

> maintenance.

>

> Church TS, Lamonte MJ, Barlow CE, Blair SN.

> Cardiorespiratory fitness and body mass index as predictors of

cardiovascular

> disease mortality among men with diabetes.

> Arch Intern Med. 2005 Oct 10;165(18):2114-20.

> PMID: 16217001

>

> ABSTRACT

>

> Background Questions remain as to whether higher levels of

cardiorespiratory

> fitness, a measure of regular physical activity, are associated

with lower risk of

> cardiovascular disease (CVD) mortality in overweight and obese

individuals with

> diabetes. Our objective was to quantify the independent and joint

relations of

> cardiorespiratory fitness (hereafter, fitness) and body mass index

(BMI; calculated

> as weight in kilograms divided by the square of height in meters)

with CVD mortality

> in men with diabetes.

>

> Methods This study was conducted using prospective observational

data from the

> Aerobics Center Longitudinal Study. Study participants comprised

2316 men with no

> history of stroke or myocardial infarction and who were diagnosed

as having diabetes

> (mean [sD] age, 50 [10] years); had a medical examination,

including a maximal

> exercise test during 1970 to 1997 with mortality surveillance to

December 31, 1998;

> and had a BMI of 18.5 or greater and less than 35.0. The main

outcome measure was

> CVD mortality across levels of fitness with stratification by BMI.

>

> Results We identified 179 CVD deaths during a mean (SD) follow-up

of 15.9 (7.9)

> years and 36 710 man-years of exposure. In a model containing age,

examination year,

> fasting glucose level, systolic blood pressure, parental history of

premature CVD,

> total cholesterol level, cigarette smoking, abnormal resting, and

exercise

> electrocardiograms, a significantly higher adjusted risk of

mortality was observed

> in men with a low fitness level who were normal weight (hazard

ratio, 2.7 [95%

> confidence interval, 1.3-5.7]), overweight (hazard ratio, 2.7 [95%

confidence

> interval, 1.4-5.1]), and class 1 obese (hazard ratio, 2.8 [95%

confidence interval,

> 1.4-5.1]) compared with normal weight men with a high fitness

level.

>

> Conclusion In this cohort of men with diabetes, low fitness level

was associated

> with increased risk of CVD mortality within normal weight,

overweight, and class 1

> obese weight categories.

>

> ... Table 1. Baseline Characteristics of 2316 Men With Diabetes

Grouped by Survival

> Status (Aerobics Center Longitudinal Study, 1970-1997)*

> ==============

> ----Participants----

> Characteristic----Survivors (n = 2137) CVD mortality (n = 179)----P

> ==============

> Man-years of observation 34,487 2222

> Age, y 49.6 (9.9) 56.0 (9.8) <.001

> Body mass index 26.9 (3.4) 27.0 (3.2) .70

> Maximal METs obtained, METs 10.4 (2.1) 8.9 (2.0) <.001

> Cholesterol level, mg/dL 225.1 (43.7) 233.4 (48.2) .02

> Fasting glucose level, mg/dL 134.4 (48.9) 146.3 (60.1) .002

> Systolic BP, mm Hg 126.5 (15.6) 133.4 (16.8) <.001

> Diastolic BP, mm Hg 83.5 (9.9) 85.6 (11.1) .01

> Cigarette smoking, % – – – .01

> Never 35.8 28.0

> Past 44.0 48.6

> Current 20.2 23.4

> Hypertension, % 30.4 49.1 <.001

> Parental history of premature CVD, % 14.1 21.0 .003

> Abnormal resting ECG, % 8.0 22.9 <.001

> Abnormal exercise ECG, % 11.8 36.9 <.001

> =============

> Abbreviations: BMI, body mass index; BP, blood pressure; CVD,

cardiovascular

> disease; ECG, electrocardiogram; MET, metabolic equivalent.

> SI conversion factors: To convert cholesterol to millimoles per

liter, multiply by

> 0.0259; to convert glucose to millimoles per liter, multiply by

0.0555.

> *Unless otherwise indicated, values are presented as mean (SD).

>

> ... Table 2. Age- and Examination Year–Adjusted Hazard Ratios (HRs)

of CVD Death (n

> = 179) According to Exercise Capacity, BMI, and Other Clinical,

Health Status, and

> Lifestyle Variables for 2316 Men With Diabetes, Aerobics Center

Longitudinal Study,

> 1970-1997

> ==============

> Variable HR (95% CI) P

> ==============

> Maximal METs obtained (per 1-MET increment) 1.20 (1.10-1.32) <.001

> BMI (per 1-unit increment) 1.00 (0.95-1.05) .90

> Fasting glucose (per 10-mg/dL increment) 1.04 (1.02-1.06) <.001

> Systolic BP (per 10-mm Hg increment) 1.10 (1.01-1.19) .04

> Parental history of premature CVD 1.72 (1.20-2.50) .004

> Total cholesterol level (per 10-mg/dL increment) 1.02 (0.98-

1.05) .33

> Cigarette smoking

> Past 1.05 (0.73-1.49) .80

> Current 1.26 (0.82-1.95) .29

> Abnormal resting ECG 1.32 (0.90-1.92) .16

> Abnormal exercise ECG 2.2 (1.55-3.09) <.001

> ===============

> Abbreviations: BMI, body mass index; BP, blood pressure; CI,

confidence interval;

> CVD, cardiovascular disease; ECG, electrocardiogram; HR, hazard

ratio from

> proportional hazard models; METs, metabolic equivalents (1 MET =

3.5 mL of oxygen

> uptake/kg -1 per minute -1 ).

>

> ... Table 3. Rates and Hazard Ratios of Cardiovascular Disease

Death by Body Mass

> Index and Cardiorespiratory Fitness Level

> ===============

> Cardiorespiratory fitness No. Man-years deaths Rate* HR† (95% CI)

Ptrend HR‡ (95%

> CI) Ptrend

> ===============

> BMI, 18.5-24.9 – – – <.001 – – – <.001

> Low 116 2111.7 17 79.0 4.2 (2.0-8.6) 2.7 (1.3-5.7)

> Moderate 279 5319.4 27 51.3 2.7 (1.4-5.3) 2.3 (1.2-4.6)

> High 354 6143.4 13 18.9 1.0 (Reference) 1.0 (Reference)

> BMI, 25.0-29.9 – – – <.001 – – – .07

> Low 339 5730.5 44 80.7 4.3 (2.3-7.9) 2.7 (1.4-5.1)

> Moderate 519 8068.3 31 34.9 1.9 (0.9-3.6) 1.6 (0.9-3.2)

> High 247 3408.8 12 32.5 1.7 (0.8-3.8) 1.5 (0.7-3.4)

> BMI, 30.0-34.9 – – – <.001 – – – .02

> Low 256 3622.4 27 84.2 4.5 (2.3-8.7) <.001 2.8 (1.4-5.6)

> Moderate/high 206 2305.7 8 32.2 1.7 (0.7-4.1) 1.5 (0.6-3.6)

> ===============

> Abbreviations: BMI, body mass index (calculated as weight in

kilograms divided by

> the square of height in meters); CI, confidence interval; HR,

hazard ratio from

> proportional hazard models.

> *Per 10,000 man-years with adjustment for age and examination year.

> †Adjusted for age and examination year.

> ‡Adjusted for age, examination year, fasting glucose level,

systolic blood pressure,

> parental history of premature CVD, total cholesterol level,

cigarette smoking,

> abnormal resting, and exercise electrocardiograms.

>

> ... Table 4. Rates and Hazard Ratios of Cardiovascular Disease

Death by

> Cardiorespiratory Fitness Level Quantified in 1-MET Increments

Obtained During a

> Maximal Treadmill Test

> =============

> METs No. Man-Yyars No. of deaths Rate* HR (95% CI)† HR (95% CI)‡

> =============

> <7.0 126 1602 31 142.8 2.8 (1.6-4.7) 1.6 (0.9-2.8)

> 7.0-7.9 205 3117 35 110.8 2.1 (1.3-3.5) 1.7 (1.0-2.8)

> 8.0-8.9 293 4159 35 91.7 1.8 (1.1-2.9) 1.6 (0.9-2.6)

> 9.0-9.9 415 6450 27 51.8 1.0 (Reference) 1.0 (Reference)

> 10.0-10.9 486 8078 26 41.8 0.8 (0.5-1.4) 0.9 (0.5-1.5)

> 11.0-11.9 299 5014 14 40.6 0.8 (0.4-1.5) 0.9 (0.5-1.8)

> 12.0-12.9 242 4168 5 17.1 0.3 (0.1-0.9) 0.3 (0.1-0.9)

> =/>13.0 250 4118 6 23.1 0.4 (0.2-1.1) 0.6 (0.3-1.4)

> ==============

> Abbreviations: CI, confidence interval; HR, hazard ratio from

proportional

> hazard models; METs, metabolic equivalents (1 MET = 3.5 mL of

oxygen uptake/kg -1

> per minute -1 ).

> *Per 10,000 man-years with adjustment for age and examination year.

> †Adjusted for age and examination year (P value for trend, <.001).

> ‡Adjusted for age, examination year, fasting glucose level,

systolic blood pressure,

> parental history of premature cardiovascular disease, total

cholesterol level,

> cigarette smoking, abnormal resting, and exercise

electrocardiograms (P value for

> trend, <.001).

>

> Al Pater, PhD; email: old542000@y...

>

>

>

>

> __________________________________

> - PC Magazine Editors' Choice 2005

> http://mail.

>

[Guest guest]

Hi folks:

Two comments on this study:

1) It is BLAIR. AGAIN!!!

2) Have they really demonstrated that exercise reduces the risk of

death from CVD in diabetics in proportion to how much they exercise?

(Which is what they would like us to believe they have

demonstrated). Or have they, rather, demonstrated that the more

occluded the subjects' arteries are (and therefore the closer they

are to infarction and death) the less capable they are of exercise

and so, in consequence, they perform less well on the tests done by

the investigators to determine their fitness level?

IMO the latter is obviously true. Whether the former is true or not

I really have no idea, and from what I have seen of it I do not think

this study helps elucidate the issue. But Dr. Henry has an

opinion, lol.

Rodney.

--- In , Al Pater <old542000@y...>

wrote:

>

> Hi All,

>

> Does lower body mass index mean that exercise is of less benefit?

>

> See the below pdf-available comments and article addressed in the

comments. It

> seemed to be from Table 3 that the patients of diabetes with lower

body mass indices

> more significantly had an association of exercise with survival

from heart disease.

>

> In This Issue of Archives of Internal Medicine

> Arch Intern Med. 2005 Oct 10;165(18):2052.

> Cardiorespiratory Fitness and BMI as Predictors of CVD Mortality

Among Men With

> Diabetes

>

> Questions remain as to whether higher levels of cardiorespiratory

fitness are

> associated with lower risk of cardiovascular disease (CVD)

mortality in overweight

> and obese individuals with diabetes. In this prospective

epidemiological study of

> 2316 men with diabetes, Church et al sought to quantify the

independent and joint

> relations of cardiorespiratory fitness and body mass index with CVD

mortality. They

> found that low cardiorespiratory fitness was associated with

increased risk of CVD

> mortality within normal weight, overweight, and class 1 obese

weight categories.

> These results further reinforce that health care providers should

give increased

> attention to counseling for increasing activity and improving

fitness in patients

> with diabetes for the intrinsic benefits associated with increased

fitness and for

> the critical role regular physical activity plays in long-term

weight loss and

> maintenance.

>

> Church TS, Lamonte MJ, Barlow CE, Blair SN.

> Cardiorespiratory fitness and body mass index as predictors of

cardiovascular

> disease mortality among men with diabetes.

> Arch Intern Med. 2005 Oct 10;165(18):2114-20.

> PMID: 16217001

>

> ABSTRACT

>

> Background Questions remain as to whether higher levels of

cardiorespiratory

> fitness, a measure of regular physical activity, are associated

with lower risk of

> cardiovascular disease (CVD) mortality in overweight and obese

individuals with

> diabetes. Our objective was to quantify the independent and joint

relations of

> cardiorespiratory fitness (hereafter, fitness) and body mass index

(BMI; calculated

> as weight in kilograms divided by the square of height in meters)

with CVD mortality

> in men with diabetes.

>

> Methods This study was conducted using prospective observational

data from the

> Aerobics Center Longitudinal Study. Study participants comprised

2316 men with no

> history of stroke or myocardial infarction and who were diagnosed

as having diabetes

> (mean [sD] age, 50 [10] years); had a medical examination,

including a maximal

> exercise test during 1970 to 1997 with mortality surveillance to

December 31, 1998;

> and had a BMI of 18.5 or greater and less than 35.0. The main

outcome measure was

> CVD mortality across levels of fitness with stratification by BMI.

>

> Results We identified 179 CVD deaths during a mean (SD) follow-up

of 15.9 (7.9)

> years and 36 710 man-years of exposure. In a model containing age,

examination year,

> fasting glucose level, systolic blood pressure, parental history of

premature CVD,

> total cholesterol level, cigarette smoking, abnormal resting, and

exercise

> electrocardiograms, a significantly higher adjusted risk of

mortality was observed

> in men with a low fitness level who were normal weight (hazard

ratio, 2.7 [95%

> confidence interval, 1.3-5.7]), overweight (hazard ratio, 2.7 [95%

confidence

> interval, 1.4-5.1]), and class 1 obese (hazard ratio, 2.8 [95%

confidence interval,

> 1.4-5.1]) compared with normal weight men with a high fitness

level.

>

> Conclusion In this cohort of men with diabetes, low fitness level

was associated

> with increased risk of CVD mortality within normal weight,

overweight, and class 1

> obese weight categories.

>

> ... Table 1. Baseline Characteristics of 2316 Men With Diabetes

Grouped by Survival

> Status (Aerobics Center Longitudinal Study, 1970-1997)*

> ==============

> ----Participants----

> Characteristic----Survivors (n = 2137) CVD mortality (n = 179)----P

> ==============

> Man-years of observation 34,487 2222

> Age, y 49.6 (9.9) 56.0 (9.8) <.001

> Body mass index 26.9 (3.4) 27.0 (3.2) .70

> Maximal METs obtained, METs 10.4 (2.1) 8.9 (2.0) <.001

> Cholesterol level, mg/dL 225.1 (43.7) 233.4 (48.2) .02

> Fasting glucose level, mg/dL 134.4 (48.9) 146.3 (60.1) .002

> Systolic BP, mm Hg 126.5 (15.6) 133.4 (16.8) <.001

> Diastolic BP, mm Hg 83.5 (9.9) 85.6 (11.1) .01

> Cigarette smoking, % – – – .01

> Never 35.8 28.0

> Past 44.0 48.6

> Current 20.2 23.4

> Hypertension, % 30.4 49.1 <.001

> Parental history of premature CVD, % 14.1 21.0 .003

> Abnormal resting ECG, % 8.0 22.9 <.001

> Abnormal exercise ECG, % 11.8 36.9 <.001

> =============

> Abbreviations: BMI, body mass index; BP, blood pressure; CVD,

cardiovascular

> disease; ECG, electrocardiogram; MET, metabolic equivalent.

> SI conversion factors: To convert cholesterol to millimoles per

liter, multiply by

> 0.0259; to convert glucose to millimoles per liter, multiply by

0.0555.

> *Unless otherwise indicated, values are presented as mean (SD).

>

> ... Table 2. Age- and Examination Year–Adjusted Hazard Ratios (HRs)

of CVD Death (n

> = 179) According to Exercise Capacity, BMI, and Other Clinical,

Health Status, and

> Lifestyle Variables for 2316 Men With Diabetes, Aerobics Center

Longitudinal Study,

> 1970-1997

> ==============

> Variable HR (95% CI) P

> ==============

> Maximal METs obtained (per 1-MET increment) 1.20 (1.10-1.32) <.001

> BMI (per 1-unit increment) 1.00 (0.95-1.05) .90

> Fasting glucose (per 10-mg/dL increment) 1.04 (1.02-1.06) <.001

> Systolic BP (per 10-mm Hg increment) 1.10 (1.01-1.19) .04

> Parental history of premature CVD 1.72 (1.20-2.50) .004

> Total cholesterol level (per 10-mg/dL increment) 1.02 (0.98-

1.05) .33

> Cigarette smoking

> Past 1.05 (0.73-1.49) .80

> Current 1.26 (0.82-1.95) .29

> Abnormal resting ECG 1.32 (0.90-1.92) .16

> Abnormal exercise ECG 2.2 (1.55-3.09) <.001

> ===============

> Abbreviations: BMI, body mass index; BP, blood pressure; CI,

confidence interval;

> CVD, cardiovascular disease; ECG, electrocardiogram; HR, hazard

ratio from

> proportional hazard models; METs, metabolic equivalents (1 MET =

3.5 mL of oxygen

> uptake/kg -1 per minute -1 ).

>

> ... Table 3. Rates and Hazard Ratios of Cardiovascular Disease

Death by Body Mass

> Index and Cardiorespiratory Fitness Level

> ===============

> Cardiorespiratory fitness No. Man-years deaths Rate* HR† (95% CI)

Ptrend HR‡ (95%

> CI) Ptrend

> ===============

> BMI, 18.5-24.9 – – – <.001 – – – <.001

> Low 116 2111.7 17 79.0 4.2 (2.0-8.6) 2.7 (1.3-5.7)

> Moderate 279 5319.4 27 51.3 2.7 (1.4-5.3) 2.3 (1.2-4.6)

> High 354 6143.4 13 18.9 1.0 (Reference) 1.0 (Reference)

> BMI, 25.0-29.9 – – – <.001 – – – .07

> Low 339 5730.5 44 80.7 4.3 (2.3-7.9) 2.7 (1.4-5.1)

> Moderate 519 8068.3 31 34.9 1.9 (0.9-3.6) 1.6 (0.9-3.2)

> High 247 3408.8 12 32.5 1.7 (0.8-3.8) 1.5 (0.7-3.4)

> BMI, 30.0-34.9 – – – <.001 – – – .02

> Low 256 3622.4 27 84.2 4.5 (2.3-8.7) <.001 2.8 (1.4-5.6)

> Moderate/high 206 2305.7 8 32.2 1.7 (0.7-4.1) 1.5 (0.6-3.6)

> ===============

> Abbreviations: BMI, body mass index (calculated as weight in

kilograms divided by

> the square of height in meters); CI, confidence interval; HR,

hazard ratio from

> proportional hazard models.

> *Per 10,000 man-years with adjustment for age and examination year.

> †Adjusted for age and examination year.

> ‡Adjusted for age, examination year, fasting glucose level,

systolic blood pressure,

> parental history of premature CVD, total cholesterol level,

cigarette smoking,

> abnormal resting, and exercise electrocardiograms.

>

> ... Table 4. Rates and Hazard Ratios of Cardiovascular Disease

Death by

> Cardiorespiratory Fitness Level Quantified in 1-MET Increments

Obtained During a

> Maximal Treadmill Test

> =============

> METs No. Man-Yyars No. of deaths Rate* HR (95% CI)† HR (95% CI)‡

> =============

> <7.0 126 1602 31 142.8 2.8 (1.6-4.7) 1.6 (0.9-2.8)

> 7.0-7.9 205 3117 35 110.8 2.1 (1.3-3.5) 1.7 (1.0-2.8)

> 8.0-8.9 293 4159 35 91.7 1.8 (1.1-2.9) 1.6 (0.9-2.6)

> 9.0-9.9 415 6450 27 51.8 1.0 (Reference) 1.0 (Reference)

> 10.0-10.9 486 8078 26 41.8 0.8 (0.5-1.4) 0.9 (0.5-1.5)

> 11.0-11.9 299 5014 14 40.6 0.8 (0.4-1.5) 0.9 (0.5-1.8)

> 12.0-12.9 242 4168 5 17.1 0.3 (0.1-0.9) 0.3 (0.1-0.9)

> =/>13.0 250 4118 6 23.1 0.4 (0.2-1.1) 0.6 (0.3-1.4)

> ==============

> Abbreviations: CI, confidence interval; HR, hazard ratio from

proportional

> hazard models; METs, metabolic equivalents (1 MET = 3.5 mL of

oxygen uptake/kg -1

> per minute -1 ).

> *Per 10,000 man-years with adjustment for age and examination year.

> †Adjusted for age and examination year (P value for trend, <.001).

> ‡Adjusted for age, examination year, fasting glucose level,

systolic blood pressure,

> parental history of premature cardiovascular disease, total

cholesterol level,

> cigarette smoking, abnormal resting, and exercise

electrocardiograms (P value for

> trend, <.001).

>

> Al Pater, PhD; email: old542000@y...

>

>

>

>

> __________________________________

> - PC Magazine Editors' Choice 2005

> http://mail.

>