| Summary: | Introduction
Emerging evidence suggests that vigorous physical activity may be associated with
greater cardioprotective and metabolic benefits than moderate physical activity, but this
topic requires further study. Furthermore, no longitudinal study has investigated the
combined effect of the Mediterranean diet and the intensity of physical activity on
mortality and cardiovascular disease..
Objective
This study aims to evaluate the long-term relationship betweenthe intensity of physical
activity and the risk of developing metabolic syndrome and cardiovascular disease in a
prospective cohort study. We also intend to assess the individual and combined effects of
adherence to the Mediterranean diet and intensity of physical activity on all-cause
mortality and cardiovascular disease.
Methods and design
The Seguimiento Universidad de Navarra (SUN) Project comprises Spanish university
graduates. When evaluating the incidence of metabolic syndrome or cardiovascular
disease, we excluded participants with any component of metabolic syndrome or
cardiovascular disease prior to study entry. We estimated the mean intensity of leisuretime physical activity using a validated questionnaire. An 8-item score was also
constructed to assess an active lifestyle. Adherence to the Mediterranean diet was
obtained from a validated 136-item food frequency questionnaire and we used two
validated dietary scores. The association between intensity of leisure-time physical
activity and metabolic syndrome or cardiovascular disease (myocardial infarction, stroke,
and death from cardiovascular causes) was evaluated with logistic regression models or
Cox proportional hazards models respectively, adjusting for total energy expenditure and
other confounding factors. In addition, multivariable Cox regression models were used to
study the individual and combined effect of adherence to the Mediterranean diet, intensity
of physical activity, and an active lifestyle on all-cause mortality and cardiovascular
disease.
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Results
Among 10,145 participants without any criteria for metabolic syndrome, 412 new cases
of metabolic syndrome were observed. Vigorous physical activity was associated with a
37% relatively lower risk (Adjusted OR=0.63, 95% CI=0.44, 0.89) compared with light
activity, independent of the total energy expenditure and with a linear trend. During
172,299 person-years of follow-up, we recorded 127 cases of cardiovascular disease.
Vigorous physical activity was associated with a 69% relatively lower risk (Adjusted
HR=0.31, 95% CI=0.12, 0.79) compared with inactivity, independent of the total energy
expenditure and with a linear trend. During a median follow-up of 10.3 years, we recorded
305 deaths. Participants with an active lifestyle and greater adherence to the
Mediterranean diet had lower mortality (adjusted HR=0.39, 95% CI=0.21, 0.72), and
when intensity was added to this combination, its power protective was even greater
(adjusted HR=0.33, 95% CI=0.15, 0.71). Likewise, when analyzing joint exposure to the
Mediterranean diet and an active lifestyle or intensity of physical activity, the greatest
benefit was related to greater adherence to the Mediterranean diet and a more active
lifestyle or vigorous physical activity, respectively. In any case, although there is a
synergy, a multiplicative interaction between the Mediterranean diet and the intensity of
physical activity was not found.
Conclusions
In the SUN cohort, given the same level of energy expenditure, respondents who engage
in vigorous leisure-time physical activity have a lower risk of developing metabolic
syndrome and cardiovascular disease. In the SUN cohort, the combined effect of
Mediterranean diet adherence and physical activity intensity had synergistic effects on
mortality and cardiovascular disease risk reduction.
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