DOES WALKING DECREASE THE RISK OF CARDIOVASCULAR-DISEASE HOSPITALIZATIONS AND DEATH IN OLDER ADULTS

OBJECTIVES: The purpose of this study was to determine whether walking is associated with a reduced risk of cardiovascular disease hospitali zation and death in community dwelling older men and women. DESIGN: A prospective study, with follow-up time of 4 to 5 years (average 4.2 ye ars). SETTING: A western Washington health maintenance organization. P ARTICIPANTS: Men and women aged 65 years and older from a random sampl e of HMO enrollees invited by mail to participate in a health promotio n intervention trial (36% accepted the invitation and completed questi onnaires). This report is based on 1645 older adults without severe di sability and without history of heart disease. Vital status ascertainm ent was complete (100%), and only 2.6% did not complete the follow-up. MEASUREMENTS: Reported frequency and duration of walking for exercise , work, errands, pleasure, and hiking in the 2 weeks before baseline w ere used to classify hours of walking per week. The two main outcomes were: (1) cardiovascular disease hospitalizations with a discharge dia gnosis of coronary (ICD-9-CM 410-414) or other cardiovascular diseases (ICD-9-CM 390-409, 415-448) documented by computerized hospitalizatio n records and (2) death. Numerous potential confounding factors were c onsidered, including age, sex, treated high blood pressure, current es trogen use and chronic disease score (ascertained by computerized medi cal and pharmacy records), and ethnicity, education, in come, physical function, self-rated health status, smoking, alcohol intake, and body mass index (ascertained by self-report on the mailed questionnaire). RESULTS: Walking more than 4 hours/week was associated significantly w ith a reduced risk of cardiovascular disease hospitalization in both s exes combined compared with walking less than 1 hour/week (age and sex -adjusted relative risk = 0.69; 95% confidence interval, 0.52-0.90). T his association was not altered by adjustment for baseline cardiovascu lar risk factors and indicators of general health status. The associat ion was present in all age groups, among those with and without physic al limitations, and also among those who did and did not also particip ate in more vigorous physical activities. Walking more than 4 hours/we ek was also associated with a reduced risk of death (age and sex-adjus ted relative risk = 0.73; 95% confidence interval, 0.48-1.10), however , this association was substantially diminished by adjustment for card iovascular risk factors and measures of general health status. CONCLUS IONS: Walking more than 4 hours/week may reduce the risk of hospitaliz ation for cardiovascular disease events. The association of walking mo re than 4 hours/week with reduced risk of death may be mediated by eff ects of walking on other risk factors. These findings provide much str onger evidence than previously available for advising older men and wo men to embark on or maintain a sustained program of walking to prevent cardiovascular disease events.