{"id":7986,"date":"2018-08-22T18:44:31","date_gmt":"2018-08-22T17:44:31","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=7986"},"modified":"2018-08-22T18:51:04","modified_gmt":"2018-08-22T17:51:04","slug":"the-association-of-light-intensity-physical-activity-lipa-with-adult-cardiometabolic-health-and-mortality-by-chastin-and-colleagues-letter-to-the-editor","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2018\/08\/22\/the-association-of-light-intensity-physical-activity-lipa-with-adult-cardiometabolic-health-and-mortality-by-chastin-and-colleagues-letter-to-the-editor\/","title":{"rendered":"The association of light intensity physical activity (LIPA) with adult cardiometabolic health and mortality by Chastin and colleagues (Letter to the Editor)"},"content":{"rendered":"
<\/h6>\n

Letter in response to BJSM Open Access Review:\u00a0Chastin SFM, Craemer M de, Cocker K de, et al. How does light-intensity physical activity associate with adult cardiometabolic health and mortality? Systematic review with meta-analysis of experimental and observational studies. Br J Sports Med\u00a0<\/em>2018.\u00a0<\/a><\/strong><\/p>\n

Dear Editor,<\/p>\n

We read the recent systematic review with meta-analysis on the association of light intensity physical activity (LIPA) with adult cardiometabolic health and mortality by Chastin and colleagues with great interest [1]. We appreciate the authors\u2019 contribution to this emerging field however, we have some comments and concerns regarding their paper.<\/p>\n

The major challenge in providing a systematic review in this field, as the authors acknowledge, is the identification of relevant studies. The information provided by the authors on the search strategy and inclusion criteria raises the question whether they indeed succeeded in \u201cfully captur[ing] the literature comprehensively\u201d.<\/p>\n

First of all, the issue of how LIPA is defined is crucial for all subsequent steps of the analysis. We disagree with the authors\u2019 statement that there is a \u201clack of a standardised definition and operationalisation of LIPA\u201d. Even if not absolutely standardized, there is a commonly accepted definition of LIPA in terms of metabolic cost (\u22651.5 <3 MET), and there are references for the operationalisations in terms of cardiorespiratory load as well as perceived exertion, such as the ACSM classification (57-63% HRmax, 37-45% VO2max, 30-39% HRR\/VO2R, 9-11 RPE) [2]. We wonder why the authors do not make any reference to this or any other classification.<\/p>\n

Further, the authors provide very little information on the validity of self-report PA instruments and how self-reports \u201ctranslate\u201d into MET-intensities. Also, among intervention studies there is a large and an unexplained heterogeneity of how intensity is defined. \u00a0Intensity is given e.g. as \u201e50% oxygen consumption\u201c (maximal or peak oxygen uptake?), \u201clactate threshold\u201d, \u201c7 to 8 km walks per day\u201d, \u201cyoga class\u201d. Clearly, the volume (7 to 8 km per day) or the type of activity (yoga) do not define intensity. Based on the ACSM classification, 50% VO2max falls into the moderate intensity range. If for any reason (which is not stated) the authors decide to include exercise studies at 50% VO2max, we wonder why some of the well-known dose-response studies, e.g. STRIDE study (exercise intensity of 40-55% VO2peak in one of the intervention groups) [3], or the DREW study (exercise intensity of 50% VO2peak in one of the intervention groups) [4] are not included.<\/p>\n

Also, the cardiometabolic effects of yoga have been examined in a number of recent reviews [5], [6], [7], [8], so again we are not sure why these studies are not mentioned, if one yoga study is included.<\/p>\n

In our recent systematic review we summarized the then available evidence on LIPA and health based on the NHANES dataset [9]. We wonder why some of the studies we identified were not included in the current review [10], [11], [12].<\/p>\n

Another important issue to consider is the choice of the study population. The authors state that their focus is on primary prevention, and exclude therefore \u201ccardiac rehabilitation programmes and secondary cardiovascular disease prevention trials and longitudinal studies\u201d and \u201cstudies which investigated only populations with diagnosed cardiovascular diseases or patients with cancer\u201d. It seems incongruent that at the same time studies in participants who \u201chave some form of metabolic impairment (eg, obesity or type 2 diabetes)\u201d, conditions which evidently increase the risk of cardiovascular disease and mortality, were included. Whereas in the case of \u201cacute mechanistic studies\u201d separate analyses were conducted for healthy and non-healthy samples, no such distinction was made in case of the training studies and prospective studies. A simple and strict dichotomy (healthy vs. non-healthy) would have been more rigorous.<\/p>\n

The main outcomes of the review are \u201ccardiometabolic health markers\u201d and mortality. It is surprising to find one single training study with the outcome fitness to be included, since effects of low-intensity training on cardiorespiratory fitness have been subject of quite a number of studies [13-16].<\/p>\n

A discussion of study findings in the light of the systematic reviews on LIPA and cardiometabolic health cited [16] and not cited [9] would have been interesting. And finally, we miss a discussion on the adjustment or lack thereof for major confounding variables, first and foremost of moderate-vigorous PA activity.<\/p>\n

***<\/p>\n

Eszter F\u00fcz\u00e9ki, Ph.D.<\/p>\n

Tobias Engeroff Ph.D., M.D.<\/p>\n

Winfried Banzer, Prof. Ph.D., M.D.<\/p>\n

Department of Sports Medicine, Goethe University Frankfurt<\/p>\n

fuezeki@sport.uni-frankfurt.de<\/a><\/p>\n

References<\/strong><\/em><\/p>\n

1\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Chastin SFM, Craemer M de, Cocker K de, et al. How does light-intensity physical activity associate with adult cardiometabolic health and mortality? Systematic review with meta-analysis of experimental and observational studies. Br J Sports Med<\/em>2018. Published Online First: 25 April 2018. doi: 10.1136\/bjsports-2017-097563<\/p>\n

2\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Med Sci Sports Exerc<\/em>2011;43(7):1334\u201359.<\/p>\n

3\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Slentz CA, Houmard JA, Kraus WE. Modest exercise prevents the progressive disease associated with physical inactivity. Exerc Sport Sci Rev<\/em>2007;35(1):18\u201323.<\/p>\n

4\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Church TS, Earnest CP, Skinner JS, et al. Effects of different doses of physical activity on cardiorespiratory fitness among sedentary, overweight or obese postmenopausal women with elevated blood pressure: A randomized controlled trial. JAMA<\/em>2007;297(19):2081\u201391.<\/p>\n

5\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Chu P, Gotink RA, Yeh GY, et al. The effectiveness of yoga in modifying risk factors for cardiovascular disease and metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials. Eur J Prev Cardiol<\/em>2016;23(3):291\u2013307.<\/p>\n

6\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Abel AN, Lloyd LK, Williams JS. The effects of regular yoga practice on pulmonary function in healthy individuals: A literature review. J Altern Complement Med<\/em>2013;19(3):185\u201390.<\/p>\n

7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Cramer H, Lauche R, Haller H, et al. Effects of yoga on cardiovascular disease risk factors: A systematic review and meta-analysis. Int J Cardiol<\/em>2014;173(2):170\u201383.<\/p>\n

8\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tyagi A, Cohen M. Yoga and hypertension: A systematic review. Altern Ther Health Med<\/em>2014;20(2):32\u201359.<\/p>\n

9\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 F\u00fcz\u00e9ki E, Engeroff T, Banzer W. Health Benefits of Light-Intensity Physical Activity: A Systematic Review of Accelerometer Data of the National Health and Nutrition Examination Survey (NHANES). Sports Med<\/em>2017;47(9):1769\u201393.<\/p>\n

10\u00a0\u00a0\u00a0\u00a0 Camhi SM, Sisson SB, Johnson WD, et al. Accelerometer-determined moderate intensity lifestyle activity and cardiometabolic health. Prev Med<\/em>2011;52(5):358\u201360.<\/p>\n

11\u00a0\u00a0\u00a0\u00a0 Loprinzi PD. Effects of light-intensity physical activity on red blood cell distribution width: Implications for a novel mechanism through which light-intensity physical activity may influence cardiovascular disease. Int J Cardiol<\/em>2016;203:724\u201325.<\/p>\n

12\u00a0\u00a0\u00a0\u00a0 Gay JL, Buchner DM, Schmidt MD. Dose\u2013response association of physical activity with HbA1c: Intensity and bout length. Prev Med<\/em>2016;86:58\u201363.<\/p>\n

13\u00a0\u00a0\u00a0\u00a0 Asikainen T-M, Miilunpalo S, Oja P, et al. Randomised, controlled walking trials in postmenopausal women: The minimum dose to improve aerobic fitness? Br J Sports Med<\/em>2002;36(3):189\u201394.<\/p>\n

14\u00a0\u00a0\u00a0\u00a0 Stevenson JS, Topp R. Effects of moderate and low intensity long-term exercise by older adults. Res Nurs Health<\/em>1990;13(4):209\u201318.<\/p>\n

15\u00a0\u00a0\u00a0\u00a0 Swain DP, Franklin BA. VO(2) reserve and the minimal intensity for improving cardiorespiratory fitness. Med Sci Sports Exerc<\/em>2002;34(1):152\u201357.<\/p>\n

16\u00a0\u00a0\u00a0\u00a0 Batacan RB, Duncan MJ, Dalbo VJ, et al. Effects of Light Intensity Activity on CVD Risk Factors: A Systematic Review of Intervention Studies. Biomed Res Int<\/em>2015;2015:596367.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Letter in response to BJSM Open Access Review:\u00a0Chastin SFM, Craemer M de, Cocker K de, et al. How does light-intensity physical activity associate with adult cardiometabolic health and mortality? Systematic review with meta-analysis of experimental and observational studies. Br J Sports Med\u00a02018.\u00a0 Dear Editor, We read the recent systematic review with meta-analysis on the association […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[16068,8265,1807,16058],"class_list":["post-7986","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-featured","tag-letter-to-the-editor","tag-physical-activity","tag-physical-activity-and-population-health-series"],"yoast_head":"\nThe association of light intensity physical activity (LIPA) with adult cardiometabolic health and mortality by Chastin and colleagues (Letter to the Editor) - BJSM blog - social media's leading SEM voice<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bjsm\/2018\/08\/22\/the-association-of-light-intensity-physical-activity-lipa-with-adult-cardiometabolic-health-and-mortality-by-chastin-and-colleagues-letter-to-the-editor\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The association of light intensity physical activity (LIPA) with adult cardiometabolic health and mortality by Chastin and colleagues (Letter to the Editor) - BJSM blog - social media's leading SEM voice\" \/>\n<meta property=\"og:description\" content=\"Letter in response to BJSM Open Access Review:\u00a0Chastin SFM, Craemer M de, Cocker K de, et al. 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