ABC | Volume 110, Nº1, January 2018

Original Article Leisure-Time Physical Activity, but not Commuting Physical Activity, is Associated with Cardiovascular Risk among ELSA-Brasil Participants Francisco José Gondim Pitanga, 1 Sheila M.A. Matos, 1 Maria da Conceição Almeida, 2 Sandhi Maria Barreto, 3 Estela M. L. Aquino 1 Universidade Federal da Bahia (UFBA); 1 Centro de Pesquisas Gonçalo Moniz da Fundação Oswaldo Cruz (FIOCRUZ), 2 Salvador, BA; Universidade Federal de Minas Gerais (UFMG), 3 Belo Horizonte, MG, Brazil Mailing Address: Francisco José Gondim Pitanga • Rua Artur Gomes de Carvalho, 537, apto. 303. CEP 4000-000, Pituba, Salvador, BA – Brazil E-mail: pitanga@lognet.com.br Manuscript received November 24, 2016, revised manuscript June 01, 2017, accepted July 04, 2017 DOI: 10.5935/abc.20170178 Abstract Background: Despite reports in the literature that both leisure-time physical activity (LTPA) and commuting physical activity (CPA) can promote health benefits, the literature lacks studies comparing the associations of these domains of physical activity with cardiovascular risk scores. Objective: To investigate the association between LTPA and CPA with different cardiovascular risk scores in the cohort of the Longitudinal Study of Adult Health ELSA-Brasil. Methods: Cross-sectional studywithdata from13,721participantsof bothgenders, aged35-74years, freeof cardiovascular disease, from ELSA Brazil. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ). Five cardiovascular risk scores were used: Framingham score — coronary heart disease (cholesterol); Framingham score — coronary heart disease (LDL-C); Framingham score — cardiovascular disease (cholesterol); Framingham score — cardiovascular disease (body mass index, BMI); and pooled cohort equations for atherosclerotic cardiovascular disease (ASCVD). Associations adjusted for confounding variables between physical activity and different cardiovascular risk scores were analyzed by logistic regression. Confidence interval of 95% (95%CI) was considered. Results: LTPA is inversely associated with almost all cardiovascular risk scores analyzed, while CPA shows no statistically significant association with any of them. Dose-response effect in association between LTPA and cardiovascular risk scores was also found, especially in men. Conclusions: LTPA was shown to be associated with the cardiovascular risk scores analyzed, but CPA not. The amount of physical activity (duration and intensity) was more significantly associated, especially in men, with cardiovascular risk scores in ELSA-Brasil. (Arq Bras Cardiol. 2018; 110(1):36-43) Keywords: Exercise; ExerciseMovement Techniques; Risk Factors; Cardiovascular Diseases / prevention& control; Epidemiology. Introduction Physical activity (PA) is inversely associated with all‑cause mortality, especially with cardiovascular mortality. 1,2 Several studies have shown that PA, especially when considered in leisure-time domain, has a protective effect against chronic diseases and cardiovascular risk factors, including diabetes, dyslipidemia, hypertension and inflammatory markers. 3-7 Cardiovascular risk scores are algorithms that have been proposed to stratify coronary and/or cardiovascular risks in order to estimate the probability of developing such diseases in ten years from the calculation in a given population. The first to be developed was presented by Wilson et al. 8 , focusing on coronary artery disease risk and based on the Framingham score. Afterwards, D'Agostino et al. 9 developed an assessment tool that would allow the identification of patients at high risk for all and any initial atherosclerotic event in ten years from the test application (coronary artery disease, cerebrovascular diseases, peripheral vascular disease, and heart failure) by means of measures readily available in clinical practice. More recently, the American College of Cardiology (ACC) and the American Heart Association (AHA) 10 suggested new pooled equations to assess the risk of atherosclerotic cardiovascular diseases (within ten years), defined as the first occurrence of nonfatal myocardial infarction, death from coronary artery disease, and fatal/nonfatal stroke. Despite reports in the literature that both leisure-time physical activity (LTPA) 11,12 and commuting physical activity (CPA) 13 can benefit health, there is a lack of studies analyzing and comparing the association of both PA domains with cardiovascular risk scores. 14 The main explanations for associations found between PA and cardiovascular risk scores are related to the favorable changes caused that PA causes in blood pressure, lipid profile, and glycemic levels. 15-17 Establishing a quantitative relation between LTPA and/or CPA with cardiovascular risk scores can help public health authorities in best spreading messages that encourage the society to practice physical activities. 36