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IMPORTANCE In China, the patterns and levels of physical activity differed from those in high-income countries. Substantial uncertainty remains about the relevance, both qualitatively and quantitatively, of domain-specific physical activity for cardiovascular disease (CVD) subtypes in Chinese adults.

OBJECTIVE To assess the shape and strength of the associations of total, occupational, and nonoccupational physical activity with CVD subtypes in Chinese men and women. 

DESIGN, SETTING, AND PARTICIPANTS This population-based prospective cohort study in 10 (5 urban, 5 rural) areas across China included 487 334 adults who were aged 30 to 79 (mean 51) years with no prior CVD history when enrolled from June 2004 to July 2008. EXPOSURES Self-reported total, occupational, and nonoccupational physical activity, quantified as metabolic equivalent of task hours per day (MET-h/d) based on the type, frequency, and duration of specific activities. 

MAIN OUTCOMES AND MEASURES Major vascular events (n = 36 184) and their components, including major coronary events (n = 5082), ischemic stroke (n = 25 647), intracerebral hemorrhage (n = 5252), and CVD death (n = 8437). Cox regression yielded adjusted hazard ratios for each disease that was associated with physical activity. 

RESULTS Of the 487 334 study participants, 287 527 (59%) were women and the mean (SD) age was 51 (10.5) years. The overall mean (SD) total physical activity was 21.5 (12.8) MET-h/d, mainly from occupational activity, especially among men (75%vs 50% in women). Total physical activity was inversely associated with the risk of major vascular events, with the adjusted hazard ratio that compared the top vs bottom quintiles of physical activity being 0.77 (95%CI, 0.74-0.80). Throughout the range of total physical activity studied, the association with CVD with each 4 MET-h/d higher usual total physical activity (approximately 1 hour of brisk walking per day) associated with a 6%(95%CI, 5%-7%) lower risk of major vascular events, and a 9%, 5%, 6%, and 12%lower risk of major coronary events, ischemic stroke, intracerebral hemorrhage, and CVD death, respectively. The strength of the associations was similar and independent of each other for occupational and nonoccupational physical activity. However, for occupational physical activity, the associations with CVD subtypes were greatly attenuated above 20 MET-h/d, especially for intracerebral hemorrhage. The associations of total physical activity with major vascular events were similar among men and women and across different levels of sedentary leisure time but were much weaker among individuals with high blood pressure.

CONCLUSIONS AND RELEVANCE Among Chinese adults, higher occupational or nonoccupational physical activity was associated with significantly lower risks of major CVD.

Original languageEnglish
Pages (from-to)1349-1358
Number of pages10
JournalJAMA Cardiology
Issue number12
Early online date8 Nov 2017
Publication statusPublished - 1 Dec 2017
Externally publishedYes

Bibliographical note

This is an open access article distributed under the terms of the CC-BY License.


unding Information:
study is jointly coordinated by the University of Oxford and Chinese Academy of Medical Sciences. The funding body for the baseline survey is the Kadoorie Charitable Foundation, Hong Kong, China, and the founding resources for the long-term continuation of the study include grants 202922/Z/ 16/Z, 104085/Z/14/Z, and 088158/Z/09/Z from the UK Wellcome Trust; grants 81390540, 81390541, and 81390544 from the Chinese National Natural Science Foundation; and grants 2016YFC0900500, 2016YFC0900501, 2016YFC0900504, and 2016YFC1303904 from the National Key Research and Development Program of China. Core funding was provided by the British Heart Foundation, UK Medical Research Council, and Cancer Research United Kingdom to the Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford.

Funding Information:
Millwood, Collins, Peto, Z. Chen); Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England (Du, Yang, Y. Chen, Millwood); Chinese Academy of Medical Sciences, Beijing, China (Guo, Bian, Li); Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (Yu, Li); NCDs Prevention and Control Department, Huixian Centers for Disease Control and Prevention, Xianxiang, China (He); NCDs Prevention and Control Department, Meilan Centers for Disease Control and Prevention, Haikou, China (Zheng); China National Center For Food Safety Risk Assessment, Beijing, China (J. Chen).

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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