Elsevier

Preventive Medicine

Volume 85, April 2016, Pages 106-112
Preventive Medicine

Work, household, and leisure-time physical activity and risk of mortality in the EPIC-Spain cohort

https://doi.org/10.1016/j.ypmed.2016.02.009Get rights and content

Highlights

  • Different domains of physical activity exert specific effects on death risk.

  • Household physical activity showed the largest preventive effect.

  • To keep a physically active lifestyle, also consider household activities.

Abstract

Objective

Large-scale longitudinal data on the association of domain-specific physical activity (PA) and mortality is limited. Our objective was to evaluate the association of work, household (HPA), and leisure time PA (LTPA) with overall and cause-specific mortality in the EPIC-Spain study.

Methods

38,379 participants (62.4% women), 30–65 years old, and free of chronic disease at baseline were followed-up from recruitment (1992 - 1996) to December 31st, 2008 to ascertain vital status and cause of death. PA was evaluated at baseline and at a 3-year follow-up with a validated questionnaire (EPIC-PAQ) and combined variables were used to classify the participants by sub-domains of PA. Associations with overall, cancer, and cardiovascular mortality risks were assessed using competing risk Cox regression models adjusted by potential confounders.

Results

After 13.6 years of mean follow-up, 1371 deaths were available for analyses. HPA was strongly associated to reduced overall (hazard ratio (HR) for Q4 vs. Q1 = 0.47 (0.34, 0.64)) and cause-specific mortalities in women and to lower cancer mortality in men (P for trend = 0.004), irrespective of age, education, and lifestyle and morbidity variables. LTPA was associated with lower mortality in women (HR for Q4 vs. Q1 = 0.71 (0.52, 0.98)), but not men. No relationships were found between sedentariness at work and overall mortality.

Conclusions

HPA was associated to lower mortality risk in men and women from the EPIC-Spain cohort, whereas LTPA also contributed to reduce risk of death in women. Considering the large proportion of total daily PA that HPA represents in some population groups, these results are of public health importance.

Introduction

Physical activity (PA) is considered one of the lifestyle cornerstones of health promotion, contributing to healthy living and increased longevity. There is extensive epidemiological evidence supporting the benefits of physical activity for prevention of ischemic heart disease (Thompson et al., 2003), stroke (Wendel-Vos et al., 2004), diabetes (Colberg et al., 2010, The Interact Consortium, 2012), and cancer (WCRF-AICR, 2007). In addition, chronic patients in better physical fitness exhibit reduced mortality than their inactive counterparts (Kokkinos et al., 2009). Nowadays, a recommendation for performing at least 150 min a week of moderate-intensity physical activity (or equivalently 75 min of high-intensity physical activity) has been adopted worldwide as a public health goal for targeting chronic disease risk at all ages (U.S. Department of Health and Human Services (USDHHS), 2008, World Health Organization (WHO), 2010).

Large-scale prospective studies allow the evaluation of PA guidelines and a proper characterization of PA effects, by type and intensity, for preventing mortality (Autenrieth et al., 2011, Samitz et al., 2011, Wen et al., 2011). The systematic review and meta-analysis of prospective studies on domain-specific PA and mortality conducted by Samitz et al. (2011) supports a preventive role for different types of PA on all-cause mortality risk. However, for domains such as transportation, work, or daily living activities, the results from this meta-analysis were based on a limited number of studies, since few large prospective cohorts have assessed the effect of domain-specific physical activities on the risk of death (Autenrieth et al., 2011, Sabia et al., 2012, Samitz et al., 2011). Most studies to date have focused on the evaluation of leisure-time physical activity as the main exposure (Nocon et al., 2008, Samitz et al., 2011), which has been the major goal of PA promotion policies. Nevertheless, household and occupational activities could also contribute to meet PA recommendations and have a non-negligible health impact (Autenrieth et al., 2011, Khaw et al., 2006). Accruing evidence suggests that PA at home adds to the benefits of total daily physical activity and significantly contributes to reduce mortality risk (Autenrieth et al., 2011, Besson et al., 2008, Chen et al., 2012, Martínez-Gómez et al., 2014, Ottenbacher et al., 2012, Stamatakis et al., 2009), especially in women in whom low-intensity household activities could account for a large proportion of total daily living activities (Martínez-Gómez et al., 2014), whereas the benefits of occupational PA are less clear (Clays et al., 2014, Holtermann et al., 2012, Khaw et al., 2006, Richard et al., 2015).

The present study was conducted to assess the specific association between physical activity domains (at work, at home, and during leisure time) and risk of cardiovascular, cancer, and total mortality, in men and women of diverse age and lifestyle characteristics from the Spanish EPIC (European Prospective Investigation into Cancer and Nutrition) study.

Section snippets

Study population

The EPIC (European Prospective Investigation into Cancer and Nutrition) study is a multi-center prospective investigation on half a million volunteers from ten European countries (Riboli and Kaaks, 1997, Riboli et al., 2002). The Spanish branch (EPIC-Spain) included 41,438 participants (62.3% women), 29 to 69 years old at baseline, recruited between 1992 and 1996 from 5 regions (Asturias, Gipuzkoa, Navarra, Granada, and Murcia). The participants were blood donors (≈ 60%), civil servants, and the

Results

Table 1 presents the baseline characteristics of the participants by quarters of household and recreational physical activity combined, for men and women. In general, men with the highest PA were older, more educated, and thinner, and less likely to smoke, and to drink alcohol. They showed better adherence to the Mediterranean diet and presented a lower prevalence of diabetes and hypertension. Like men, higher levels of PA in women were inversely associated to smoking and alcohol consumption

Discussion

Physical activity levels were inversely associated with overall and cause-specific mortalities in women. The strongest association was found for household activities, which showed an inverse gradient with mortality from cancer and cardiovascular disease, and with overall mortality risk. Women engaging in higher levels of recreational activities were also at lower risk of premature death as compared to those not meeting the recommended levels. On the contrary, no significant association was

Conclusions

Our study contributes prospective data that endorse the relevance of household physical activity in the prevention of mortality, and supports previous evidence on the health effect of adhering to recommendations for recreational physical activity in women. Lack of association of occupational activity and of recreational PA in men deserves further study.

Conflict of interest statement

The authors declare that there are no conflicts of interest.

Acknowledgments

The EPIC- Spain study received financial support from the International Agency for Research on Cancer (AEP/93/06), the European Commission (SO-97-200302-05F02, SP23-CT-2005-006438), the Health Research Fund (FIS) of the Spanish Ministry of Health, the Red Temática de Investigación Cooperativa de Centros de Cáncer (RTICCC C03/10, RD06/0020), the CIBER de Epidemiología y Salud Pública (CIBERESP), the participating Regional Governments of Andalusia, Asturias, Basque Country, Murcia (no. 6236), and

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