Temporal changes in personal activity intelligence and the risk of incident dementia and dementia related mortality: A prospective cohort study (HUNT)

Background: The Personal Activity Intelligence (PAI) translates heart rate during daily activity into a weekly score. Obtaining a weekly PAI score ≥100 is associated with reduced risk of premature morbidity and mortality from cardiovascular diseases. Here, we determined whether changes in PAI score are associated with changes in risk of incident dementia and dementia-related mortality. Methods: We conducted a prospective cohort study of 29,826 healthy individuals. Using data from the Trøndelag Health-Study (HUNT), PAI was estimated 10 years apart (HUNT1 1984-86 and HUNT2 1995-97). Adjusted hazard-ratios (aHR) and 95%-confidence intervals (CI) for incidence of and death from dementia were related to changes in PAI using Cox regression analyses. Findings: During a median follow-up time of 24.5 years (interquartile range [IQR]: 24.1-25.0) for dementia incidence and 23.6 years (IQR: 20.8-24.2) for dementia-related mortality, there were 1998 incident cases and 1033 dementia-related deaths. Individuals who increased their PAI score over time or maintained a high PAI score at both assessments had reduced risk of dementia incidence and dementia-related mortality. Compared with persistently inactive individuals (0 weekly PAI) at both time points, the aHRs for those with a PAI score ≥100 at both occasions were 0.75 (95% CI: 0.58-0.97) for incident dementia, and 0.62 (95% CI: 0.43-0.91) for dementia-related mortality. Using PAI score <100 at both assessments as the reference cohort, those who increased from <100 at HUNT1 to ≥100 at HUNT2 had aHR of 0.83 (95% CI: 0.72-0.96) for incident dementia, and gained 2.8 (95% CI: 1.3-4.2, P<0.0001) dementia-free years. For dementia-related mortality, the corresponding aHR was 0.74 (95% CI: 0.59-0.92) and years of life gained were 2.4 (95% CI: 1.0-3.8, P=0.001). Interpretation: Maintaining a high weekly PAI score and increases in PAI scores over time were associated with a reduced risk of incident dementia and dementia-related mortality. Our findings extend the scientific evidence regarding the protective role of PA for dementia prevention, and suggest that PAI may be a valuable tool in guiding research-based PA recommendations. Funding: The Norwegian Research Council, the Liaison Committee between the Central Norway Regional Health Authority and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.The Norwegian Research Council, the Liaison Committee between the Central Norway Regional Health Authority and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.publishedVersio

Personal Activity Intelligence and Ischemic Heart Disease in a Healthy Population: China Kadoorie Biobank Study

Background: Personal Activity Intelligence (PAI) is a physical activity metric that translates heart rate during physical activity into a simple score, where a weekly score of 100 or greater is associated with a lower risk of cardiovascular disease and mortality. Here, we prospectively investigated the association between PAI and ischemic heart disease (IHD) mortality in a large healthy population from China. Methods: Using data from the China Kadoorie Biobank, we studied 443,792 healthy adults (60% women). The weekly PAI score of each participant was estimated based on the questionnaire data and divided into four groups (PAI scores of 0, &le;50, 51&ndash;99, or &ge;100). Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for fatal IHD and nonfatal myocardial infraction (MI) related to PAI were estimated using Cox proportional hazard regression analyses. Results: There were 3050 IHD deaths and 1808 MI events during a median follow-up of 8.2 years (interquartile range, 7.3&ndash;9.1; 3.6 million person-years). After adjustments for multiple confounders, a weekly PAI score &ge; 100 was associated with a lower risk of IHD (aHR: 0.91 (95% CI: 0.83&ndash;1.00)), compared with the inactive group (0 PAI). The corresponding aHR for MI was 0.94 (95% CI: 0.83&ndash;1.05). In participants aged 60 years or older at baseline, the aHR associated with a weekly PAI score &ge; 100 was 0.84 (95% CI, 0.75&ndash;0.93) for IHD and 0.84 (95% CI, 0.73&ndash;0.98) for MI. Conclusion: Among healthy Chinese adults, a weekly PAI score of 100 or greater was associated with a lower risk of IHD mortality across all age groups; moreover, a high PAI score significantly lowered the risk of MI but only in those 60 years and older at baseline. The present findings extend the scientific evidence that PAI may have prognostic significance in diverse settings for IHD outcomes and suggest that the PAI metric may be useful in delineating the magnitude of weekly physical activity needed to reduce the risk of IHD mortality

Personal activity intelligence (PAI), sedentary behavior and cardiovascular risk factor clustering - the HUNT study

Prolonged sedentary behavior (SB) positively associates with clustering of risk factors for cardiovascular disease (CVD). The recently developed metric for physical activity (PA) tracking called Personal Activity Intelligence (PAI) takes into account age, sex, resting and maximum heart rate, and a score of ≥100 weekly PAI has been shown to reduce the risk of premature CVD death in healthy as well as individuals with known CVD risk factors, regardless of whether or not the current PA recommendations were met. The aim of the present study was to examine if PAI modifies the associations between SB and CVD risk factor (CV-RF) clustering in a large apparently healthy general population cohort (n = 29,950, aged ≥20 years). Logistic regression revealed that in those with ≥100 weekly PAI, the likelihood of CV-RF clustering prevalence associated with prolonged SB was attenuated across age groups. Monitoring weekly PAI-level could be useful to ensure that people perform enough PA to combat SB's deleterious association with CV-RF

Temporal changes in cardiorespiratory fitness and risk of dementia incidence and mortality: a population-based prospective cohort study

Cardiorespiratory fitness is associated with risk of dementia, but whether temporal changes in cardiorespiratory fitness influence the risk of dementia incidence and mortality is still unknown. We aimed to study whether change in estimated cardiorespiratory fitness over time is associated with change in risk of incident dementia, dementia-related mortality, time of onset dementia, and longevity after diagnosis in healthy men and women at baseline. Methods We linked data from the prospective Nord-Trøndelag Health Study (HUNT) done in Nord-Trøndelag, Norway with dementia data from the Health and Memory Study and cause of death registries (n=30 375). Included participants were apparently healthy individuals for whom data were available on estimated cardiorespiratory fitness and important confounding factors. Datasets were matched to each participant through their 11-digit personal identification number. Cardiorespiratory fitness was estimated on two occasions 10 years apart, during HUNT1 (1984–86) and HUNT2 (1995–97). HUNT2 was used as the baseline for follow-up. Participants were classified into two sex-specific estimated cardiorespiratory fitness groups according to their age (10-year categories): unfit (least fit 20% of participants) and fit (most fit 80% of participants). To assess the association between change in estimated cardiorespiratory fitness and dementia, we used four categories of change: unfit at both HUNT1 and HUNT2, unfit at HUNT1 and fit at HUNT2, fit at HUNT1 and unfit at HUNT2, fit at both HUNT1 and HUNT2. Using Cox proportional hazard analyses, we estimated adjusted hazard ratios (AHR) for dementia incidence and mortality related to temporal changes in estimated cardiorespiratory fitness. Findings During a median follow-up of 19·6 years for mortality, and 7·6 years for incidence, there were 814 dementia-related deaths, and 320 incident dementia cases. Compared with participants who were unfit at both assessments, participants who sustained high estimated cardiorespiratory fitness had a reduced risk of incident dementia (AHR 0·60, 95% CI 0·36–0·99) and a reduced risk of dementia mortality (0·56, 0·43–0·75). Participants who had an increased estimated cardiorespiratory fitness over time had a reduced risk of incident dementia (AHR 0·52, 95% CI 0·30–0·90) and dementia mortality (0·72, 0·52–0·99) when compared with those who remained unfit at both assessments. Each metabolic equivalent of task increase in estimated cardiorespiratory fitness was associated with a risk reduction of incident dementia (adjusted HR 0·84, 95% CI 0·75–0·93) and dementia mortality (0·90, 0·84–0·97). Participants who increased their estimated cardiorespiratory fitness over time gained 2·2 (95% CI 1·0–3·5) dementia-free years, and 2·7 (0·4–5·8) years of life when compared with those who remained unfit at both assessments. Interpretation Change in estimated cardiorespiratory fitness is an independent risk factor for incidence dementia and dementia mortality. Maintaining or improving cardiorespiratory fitness over time may be a target to reduce risk of dementia incidence and mortality, delay onset, and increase longevity after diagnosis. Our data highlight the importance of assessing cardiorespiratory fitness in health risk assessment for people at risk of dementia

Temporal changes in cardiorespiratory fitness and risk of dementia incidence and mortality: a population-based prospective cohort study

Cardiorespiratory fitness is associated with risk of dementia, but whether temporal changes in cardiorespiratory fitness influence the risk of dementia incidence and mortality is still unknown. We aimed to study whether change in estimated cardiorespiratory fitness over time is associated with change in risk of incident dementia, dementia-related mortality, time of onset dementia, and longevity after diagnosis in healthy men and women at baseline. Methods We linked data from the prospective Nord-Trøndelag Health Study (HUNT) done in Nord-Trøndelag, Norway with dementia data from the Health and Memory Study and cause of death registries (n=30 375). Included participants were apparently healthy individuals for whom data were available on estimated cardiorespiratory fitness and important confounding factors. Datasets were matched to each participant through their 11-digit personal identification number. Cardiorespiratory fitness was estimated on two occasions 10 years apart, during HUNT1 (1984–86) and HUNT2 (1995–97). HUNT2 was used as the baseline for follow-up. Participants were classified into two sex-specific estimated cardiorespiratory fitness groups according to their age (10-year categories): unfit (least fit 20% of participants) and fit (most fit 80% of participants). To assess the association between change in estimated cardiorespiratory fitness and dementia, we used four categories of change: unfit at both HUNT1 and HUNT2, unfit at HUNT1 and fit at HUNT2, fit at HUNT1 and unfit at HUNT2, fit at both HUNT1 and HUNT2. Using Cox proportional hazard analyses, we estimated adjusted hazard ratios (AHR) for dementia incidence and mortality related to temporal changes in estimated cardiorespiratory fitness. Findings During a median follow-up of 19·6 years for mortality, and 7·6 years for incidence, there were 814 dementia-related deaths, and 320 incident dementia cases. Compared with participants who were unfit at both assessments, participants who sustained high estimated cardiorespiratory fitness had a reduced risk of incident dementia (AHR 0·60, 95% CI 0·36–0·99) and a reduced risk of dementia mortality (0·56, 0·43–0·75). Participants who had an increased estimated cardiorespiratory fitness over time had a reduced risk of incident dementia (AHR 0·52, 95% CI 0·30–0·90) and dementia mortality (0·72, 0·52–0·99) when compared with those who remained unfit at both assessments. Each metabolic equivalent of task increase in estimated cardiorespiratory fitness was associated with a risk reduction of incident dementia (adjusted HR 0·84, 95% CI 0·75–0·93) and dementia mortality (0·90, 0·84–0·97). Participants who increased their estimated cardiorespiratory fitness over time gained 2·2 (95% CI 1·0–3·5) dementia-free years, and 2·7 (0·4–5·8) years of life when compared with those who remained unfit at both assessments. Interpretation Change in estimated cardiorespiratory fitness is an independent risk factor for incidence dementia and dementia mortality. Maintaining or improving cardiorespiratory fitness over time may be a target to reduce risk of dementia incidence and mortality, delay onset, and increase longevity after diagnosis. Our data highlight the importance of assessing cardiorespiratory fitness in health risk assessment for people at risk of dementia

Temporal changes in cardiorespiratory fitness and risk of dementia incidence and mortality: a population-based prospective cohort study

Background: Cardiorespiratory fitness is associated with risk of dementia, but whether temporal changes in cardiorespiratory fitness influence the risk of dementia incidence and mortality is still unknown. We aimed to study whether change in estimated cardiorespiratory fitness over time is associated with change in risk of incident dementia, dementia-related mortality, time of onset dementia, and longevity after diagnosis in healthy men and women at baseline. Methods: We linked data from the prospective Nord-Trøndelag Health Study (HUNT) done in Nord-Trøndelag, Norway with dementia data from the Health and Memory Study and cause of death registries (n=30 375). Included participants were apparently healthy individuals for whom data were available on estimated cardiorespiratory fitness and important confounding factors. Datasets were matched to each participant through their 11-digit personal identification number. Cardiorespiratory fitness was estimated on two occasions 10 years apart, during HUNT1 (1984–86) and HUNT2 (1995–97). HUNT2 was used as the baseline for follow-up. Participants were classified into two sex-specific estimated cardiorespiratory fitness groups according to their age (10-year categories): unfit (least fit 20% of participants) and fit (most fit 80% of participants). To assess the association between change in estimated cardiorespiratory fitness and dementia, we used four categories of change: unfit at both HUNT1 and HUNT2, unfit at HUNT1 and fit at HUNT2, fit at HUNT1 and unfit at HUNT2, fit at both HUNT1 and HUNT2. Using Cox proportional hazard analyses, we estimated adjusted hazard ratios (AHR) for dementia incidence and mortality related to temporal changes in estimated cardiorespiratory fitness. Findings: During a median follow-up of 19·6 years for mortality, and 7·6 years for incidence, there were 814 dementia-related deaths, and 320 incident dementia cases. Compared with participants who were unfit at both assessments, participants who sustained high estimated cardiorespiratory fitness had a reduced risk of incident dementia (AHR 0·60, 95% CI 0·36–0·99) and a reduced risk of dementia mortality (0·56, 0·43–0·75). Participants who had an increased estimated cardiorespiratory fitness over time had a reduced risk of incident dementia (AHR 0·52, 95% CI 0·30–0·90) and dementia mortality (0·72, 0·52–0·99) when compared with those who remained unfit at both assessments. Each metabolic equivalent of task increase in estimated cardiorespiratory fitness was associated with a risk reduction of incident dementia (adjusted HR 0·84, 95% CI 0·75–0·93) and dementia mortality (0·90, 0·84–0·97). Participants who increased their estimated cardiorespiratory fitness over time gained 2·2 (95% CI 1·0–3·5) dementia-free years, and 2·7 (0·4–5·8) years of life when compared with those who remained unfit at both assessments. Interpretation: Change in estimated cardiorespiratory fitness is an independent risk factor for incidence dementia and dementia mortality. Maintaining or improving cardiorespiratory fitness over time may be a target to reduce risk of dementia incidence and mortality, delay onset, and increase longevity after diagnosis. Our data highlight the importance of assessing cardiorespiratory fitness in health risk assessment for people at risk of dementia. Funding: The KG Jebsen Foundation, the Norwegian Research Council, the Liaison Committee between the Central Norway Regional Health Authority, and the Norwegian University of Science and Technology

How to Be 80 Year Old and Have a VO2max of a 35 Year Old

Background. To discuss the cardiovascular and pulmonary physiology and common risk factors of an 80-year-old man with a world record maximal oxygen uptake of 50 mL·kg−1·min−1. Methods. Case report. Results. His maximal oxygen uptake of 3.31 L·min−1, maximal heart rate of 175 beats·min−1, and maximal oxygen pulse of 19 mL·beats−1 are high. He is lean (66.6 kg) and muscular (49% skeletal muscle mass). His echo parameters of mitral flow (left ventricular filling, E = 82 cm·s−1 and E/A = 1.2) were normal for 40- to 60-year-old men. Systolic and diastolic function increased adequately during exercise, with no increase in left ventricular filling pressure. He has excellent pulmonary function (FVC = 4.31 L, FEV1 = 3.41, FEV1/FVC = 0.79, and DLCO = 12.0 Si1) and normal FMD and blood volumes (5.8 L). He has a high level of daily activity (10,900 steps·day−1 and 2:51 hours·day−1 of physical activity) and a lifelong history of physical activity. Conclusion. The man is in excellent cardiopulmonary fitness and is highly physically active. His cardiac and pulmonary functions are above expectations for his age, and his V is comparable to that of an inactive 25-year-old and of a normal, active 35-year-old Norwegian man

Temporal changes in personal activity intelligence and mortality : data from the aerobics center longitudinal study

Background Personal activity intelligence (PAI) is a metric developed to simplify a physically active lifestyle for the participants. Regardless of following today's advice for physical activity, a PAI score ≥100 per week at baseline, an increase in PAI score, and a sustained high PAI score over time were found to delay premature cardiovascular disease (CVD) and all-cause mortality in a large population of Norwegians. However, the association between long-term temporal change in PAI and mortality in other populations have not been investigated. Objective To test whether temporal change in PAI is associated with CVD and all-cause mortality in a large population from the United States. Methods We studied 17,613 relatively healthy participants who received at least two medical examinations in the Aerobics Center Longitudinal Study between 1974 and 2002. The participant's weekly PAI scores were estimated twice, and adjusted hazard ratios (AHR) and 95% confidence intervals (CI) for CVD and all-cause mortality related to changes in PAI between baseline and last examination were assessed using Cox proportional hazard regression analyses. Results During a median follow-up time of 9.3 years [interquartile range, 2.6–16.6; 181,765 person-years], there were 1144 deaths, including 400 CVD deaths. We observed an inverse linear association between change in PAI and risk of CVD mortality (P=0.007 for linear trend, and P=0.35 for quadratic trend). Compared to participants with zero PAI at both examinations, multivariable-adjusted analyses demonstrated that participants who maintained high PAI scores (≥100 PAI at both examinations) had a 51% reduced risk of CVD mortality [AHR, 0.49: 95% CI, 0.26–0.95)], and 42% reduced risk of all-cause mortality [AHR, 0.58: 95% CI, 0.41–0.83)]. For participants who increased their PAI scores over time (PAI score of zero at first examination and ≥100 at last examination), the AHRs were 0.75 (95% CI, 0.55–1.02) for CVD mortality, and 0.82 (95% CI, 0.69–0.99) for all-cause mortality. Participants who maintained high PAI score had 4.8 (95% CI, 3.3–6.4) years of life gained. For those who increased their PAI score over time, the corresponding years gained were 1.8 years (95% CI, 0.1–3.5). Conclusion Among relatively healthy participants, an increase in PAI and maintaining a high PAI score over time was associated with reduced risk of CVD and all-cause mortality. Condensed abstract Our objective was to investigate the association between temporal changes in PAI and mortality in a large population from the United States. In this prospective cohort study of 17,613 relatively healthy participants at baseline, maintaining a high PAI score and an increase in PAI score over an average period of 6.3 years was associated with a significant reduction in CVD and all-cause mortality. Based on our results, clinicians can easily recommend that patients obtain at least 100 PAI for most favourable protection against CVD- and all-cause mortality, but can also mention that significant benefits also occur at maintaining low-to-moderate PAI levels.peerReviewe

Effect of exercise training for five years on all cause mortality in older adults-The Generation 100 study: randomised controlled trial

Objective To evaluate the effect of five years of supervised exercise training compared with recommendations for physical activity on mortality in older adults (70-77 years). Design Randomised controlled trial. Setting General population of older adults in Trondheim, Norway. Participants 1567 of 6966 individuals born between 1936 and 1942. Intervention Participants were randomised to two sessions weekly of high intensity interval training at about 90% of peak heart rate (HIIT, n=400), moderate intensity continuous training at about 70% of peak heart rate (MICT, n=387), or to follow the national guidelines for physical activity (n=780; control group); all for five years. Main outcome measure All cause mortality. An exploratory hypothesis was that HIIT lowers mortality more than MICT. Results Mean age of the 1567 participants (790 women) was 72.8 (SD 2.1) years. Overall, 87.5% of participants reported to have overall good health, with 80% reporting medium or high physical activity levels at baseline. All cause mortality did not differ between the control group and combined MICT and HIIT group. When MICT and HIIT were analysed separately, with the control group as reference (observed mortality of 4.7%), an absolute risk reduction of 1.7 percentage points was observed after HIIT (hazard ratio 0.63, 95% confidence interval 0.33 to 1.20) and an absolute increased risk of 1.2 percentage points after MICT (1.24, 0.73 to 2.10). When HIIT was compared with MICT as reference group an absolute risk reduction of 2.9 percentage points was observed (0.51, 0.25 to 1.02) for all cause mortality. Control participants chose to perform more of their physical activity as HIIT than the physical activity undertaken by participants in the MICT group. This meant that the controls achieved an exercise dose at an intensity between the MICT and HIIT groups. Conclusion This study suggests that combined MICT and HIIT has no effect on all cause mortality compared with recommended physical activity levels. However, we observed a lower all cause mortality trend after HIIT compared with controls and MICT. Trial registration ClinicalTrials.gov NCT01666340

Effect of exercise training for five years on all cause mortality in older adults-The Generation 100 study: Randomised controlled trial

Objective: To evaluate the effect of five years of supervised exercise training compared with recommendations for physical activity on mortality in older adults (70-77 years). Design: Randomised controlled trial. Setting: General population of older adults in Trondheim, Norway. Participants: 1567 of 6966 individuals born between 1936 and 1942. Intervention: Participants were randomised to two sessions weekly of high intensity interval training at about 90% of peak heart rate (HIIT, n=400), moderate intensity continuous training at about 70% of peak heart rate (MICT, n=387), or to follow the national guidelines for physical activity (n=780; control group); all for five years. Main outcome measure: All cause mortality. An exploratory hypothesis was that HIIT lowers mortality more than MICT. Results: Mean age of the 1567 participants (790 women) was 72.8 (SD 2.1) years. Overall, 87.5% of participants reported to have overall good health, with 80% reporting medium or high physical activity levels at baseline. All cause mortality did not differ between the control group and combined MICT and HIIT group. When MICT and HIIT were analysed separately, with the control group as reference (observed mortality of 4.7%), an absolute risk reduction of 1.7 percentage points was observed after HIIT (hazard ratio 0.63, 95% confidence interval 0.33 to 1.20) and an absolute increased risk of 1.2 percentage points after MICT (1.24, 0.73 to 2.10). When HIIT was compared with MICT as reference group an absolute risk reduction of 2.9 percentage points was observed (0.51, 0.25 to 1.02) for all cause mortality. Control participants chose to perform more of their physical activity as HIIT than the physical activity undertaken by participants in the MICT group. This meant that the controls achieved an exercise dose at an intensity between the MICT and HIIT groups. Conclusion: This study suggests that combined MICT and HIIT has no effect on all cause mortality compared with recommended physical activity levels. However, we observed a lower all cause mortality trend after HIIT compared with controls and MICT