International Journal of Epidemiology 2000;29:655-660
© International Epidemiological Association 2000
Quantifying the association between habitual energy expenditure and blood pressure
a Department of Community Medicine, University of Cambridge, Cambridge CB2 2SR, UK.
b Department of Mathematics, Hong Kong University of Science and Technology, Hong Kong.
c Clinical Epidemiology Unit, University of Manchester Medical School,M13 9PT, UK.
d Medical Research Council Biostatistics Unit, Cambridge CB2 2SR, UK.
Reprint requests to: Dr NJ Wareham, Department of Community Medicine, Institute of Public Health, University of Cambridge, Robinson Way, Cambridge CB2 2SR, UK. E-mail: njw1004{at}medschl.cam.ac.uk
Background Previous studies have demonstrated an association between physical inactivity and hypertension, but the methods used to assess activity have been subjective and imprecise. Recently methods have become available allowing measurement of energy expenditure in free-living populations. Our aim was to employ these methods to assess the independent association between energy expenditure, cardio-respiratory fitness and blood pressure.
Methods In a cross-sectional study of 775 people (45–70 years) participating in a continuing population-based cohort study, energy expenditure was assessed by 4 days of heart rate monitoring with individual calibration of the relationship between heart rate and energy expenditure, a method validated against doubly-labelled water and whole body calorimetry. Cardio-respiratory fitness was assessed in a sub-maximal test. To adjust for measurement error in the assessment of usual energy expenditure and fitness, 190 subjects repeated both tests on three further occasions at 4-monthly intervals.
Results A highly significant linear trend in blood pressure was found across quintiles of the physical activity level, the ratio of total energy expenditure to basal metabolic rate. The differences in the mean systolic/diastolic blood pressure between the top and bottom quintile was 6.3/4.4 mmHg in men and 10.7/5.9 mmHg in women. These effects were independent of obesity and cardio-respiratory fitness. Correction for measurement error suggests that the true underlying relationship between usual energy expenditure and blood pressure is stronger still.
Conclusions These findings are compatible with a strong association between usual energy expenditure and blood pressure and support public health strategies aimed at increasing overall energy expenditure.
Keywords Energy expenditure, physical activity, exercise, fitness, blood pressure, hypertension, population study
Accepted 5 January 2000
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