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The impact of physical activity and an additional behavioural risk factor on cardiovascular disease, cancer and all-cause mortality: a systematic review

Research output: Contribution to journalArticle

Original languageEnglish
JournalBMC Public Health
DateAccepted/In press - 21 May 2019


Background: Regular physical activity improves overall health, and has the capacity to
28 reduce risk of chronic diseases and death. However, better understanding of the relationship
29 between multiple lifestyle risk behaviours and disease outcomes is pertinent for prioritising
30 public health messaging. The aim of this systematic review is to examine the association
31 between physical inactivity in combination with additional lifestyle risk behaviours
32 (smoking, alcohol, diet, or sedentary behaviour) for cardiovascular disease, cancer, and all33 cause mortality.
34 Methods: We searched Ovid Medline, EMBASE, and the Cochrane Register from 1 January
35 2010 to 12 December 2017, for longitudinal observational studies of adults (18+ years) in the
36 general population with a publication date of 2010 onwards and no language restriction. Main
37 exposure variables had to include a physical activity measure plus at least one other lifestyle
38 risk factor. In total, 25,639 studies were identified. Titles, abstracts and full-text articles of
39 potentially relevant papers were screened for eligibility. Data was extracted and quality
40 assessment was completed using a modified Newcastle-Ottawa Scale (NOS).
41 Results: Across the 25 eligible studies, those participants who reported being physically
42 active combined with achieving other health behaviour goals compared to those who were
43 categorised as physically inactive and did not achieve other positive lifestyle goals, were at
44 least half as likely to experience an incident cardiovascular disease (CVD) event, die from
45 CVD, or die from any cause. These findings were consistent across participant age, sex, and
46 study length of follow-up, and even after excluding lower quality studies. We also observed a
47 similar trend among the few studies which were restricted to cancer outcomes. Most studies
48 did not consider epidemiological challenges that may bias findings, such as residual
49 confounding, reverse causality by pre-existing disease, and measurement error from self50 report data
Conclusions: High levels of physical activity in combination with other positive lifestyle
52 choices is associated with better health outcomes. Applying new approaches to studying the
53 complex relationships between multiple behavioural risk factors, including physical activity,
54 should be a priority



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