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Low physical activity and mortality in women: Baseline lifestyle and health as alternative explanations

Division of Epidemiology and Social Medicine, Stockholm Centre for Public Health, Stockholm, Sweden, sofia.carlsson{at}imm.ki.se, Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

Tomas Andersson

Division of Epidemiology and Social Medicine, Stockholm Centre for Public Health, Stockholm, Sweden, Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

Alicja Wolk

Department of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

Anders Ahlbom

Division of Epidemiology and Social Medicine, Stockholm Centre for Public Health, Stockholm, Sweden, Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

Aims: The aim of this study was to investigate the association between physical activity and mortality in post-menopausal women. In addition, the authors wanted to investigate to what extent this association could be attributed to confounding from other lifestyle factors, and to reverse causation due to a number of common health problems that may inhibit the ability to exercise. Methods: A total of 27,734 women aged 51—83 years from the Swedish Mammography Cohort were investigated. In 1997 they responded to a detailed questionnaire including questions on physical activity, diet, alcohol intake, smoking, and medical problems. During follow-up in 1999—2004, 1,232 deaths were identified by linkage to the National Population Register. Results: Women with low physical activity (35 MET*h/day) had a 3.22 times increased mortality (95% confidence interval (CI)=2.35—4.43) compared with the most active women (>50 MET*h/day). No increased risk was seen in women with moderate compared with high physical activity. Sedentary women tended to have a less healthy lifestyle and more health problems at baseline, e.g. almost 30% of them reported high blood pressure compared with less than 20% of active women. Baseline medical problems and lifestyle factors such as smoking, diet, and education accounted for 30% of the excess risk seen in sedentary women (24% and 6% respectively). Conclusions: This study indicates that even fairly small amounts of activity will reduce mortality in older women. However, sedentary women seemed to be a selected group with more medical problems and a less healthy lifestyle. The findings indicate that the association between physical inactivity and mortality will be overestimated if this is not taken into account.

Key Words: Bias • confounding • epidemiology • physical activity • women

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