IJE Advance Access originally published online on March 24, 2004
International Journal of Epidemiology 2004 33(4):759-767; doi:10.1093/ije/dyh042
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IJE vol.33 no.4 © International Epidemiological Association 2004; all rights reserved.
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Physical activity and risk of coronary heart disease in India
1 Department of Nutrition, Harvard School of Public Health
2 Division of Nutrition, St John's Medical College and Hospital
3 Department of Biostatistics, Harvard School of Public Health
4 Department of Epidemiology, Harvard School of Pubilc Health
5 Department of Cardiology, All India Institute of Medical Sciences
Correspondence: Dr Tanuja Rastogi, NEB, Division of Cancer Epidemiology & Genetics, National Cancer Institute, NIH, DHHS, 6120 Executive Blvd, EPS 320, Rockville MD 20852 USA. E-mail: trastogi{at}post.harvard.edu
Background Physical exercise has been inversely associated with coronary heart disease (CHD) risk in Western populations; however, the association has not been examined in India where physical inactivity levels in urban areas are now comparable with the West.
Methods We conducted a hospital-based case-control study and collected data from 350 cases of acute myocardial infarction and 700 controls matched on age, gender, and hospital in New Delhi and Bangalore. We used conditional logistic regression to control for the matching and other risk factors.
Results Of the controls, 48% participated in some form of leisure-time exercise compared with 38% of cases. In age- and sex-adjusted analyses, people in the highest level of leisure-time exercise (>145 metabolic equivalents [MET]-minutes per day, equivalent to 36 minutes of brisk walking per day) had a relative risk of 0.45 (95% CI: 0.31, 0.66) compared with non-exercisers. Multivariate adjustment for other risk factors did not substantially alter the association. We observed a positive association between non-work sedentary activity and CHD risk; people with >3.6 hours per day of sedentary activity (for example, television viewing) had an elevated risk of 1.88 (95% CI: 1.09, 3.20) compared with <70 minutes per day in multivariate analysis.
Conclusion Leisure-time exercise, including as much as 35–40 minutes per day of brisk walking, was protective for CHD risk and sedentary lifestyles were positively associated with risk of CHD. Given limited resources for care of CHD in India and the important role of physical exercise in disease risk in urban India, improvements in physical activity should be promoted.
Keywords Physical activity, leisure-time exercise, sedentary lifestyles, coronary heart disease, India, developing countries
Accepted 7 October 2003
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