Az. Lacroix et al., DOES WALKING DECREASE THE RISK OF CARDIOVASCULAR-DISEASE HOSPITALIZATIONS AND DEATH IN OLDER ADULTS, Journal of the American Geriatrics Society, 44(2), 1996, pp. 113-120
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.