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January 14, 2004

Level of Exercise and Risk of Cardiovascular Disease—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(2):183. doi:10.1001/jama.291.2.183-b

In Reply: We agree with Drs Tosiello and Reddy about the importance of assessing physical activity as part of a comprehensive approach to cardiovascular risk stratification. Previous studies have clearly demonstrated a lower incidence of cardiovascular disease in individuals who were more physically active.1,2 In our study, regular exercise was defined as self-reported regular participation in strenuous exercise or hard physical labor, a very insensitive and imprecise measure. In univariable Cox logistic regression analysis, regular exercise was associated with a nonsignificantly lower risk of cardiovascular death (unadjusted hazard ratio, 0.75; 95% confidence interval, 0.44-1.28). However, after adjusting for other cardiovascular risk factors, there was no association with either cardiovascular or all-cause death, and hence it was not included in the final model. Thus, the simple question used to assess regular exercise in these asymptomatic women was not very useful. We do not know if a more complete activity questionnaire would have the predictive value of the objective and standardized direct measure of fitness obtained from treadmill testing in this population.

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