Amount of physical activity necessary for a normal level of high-sensitivity C-reactive protein in ELSA-Brasil

a cross-sectional study

Authors

Keywords:

Motor activity, Risk factors, ROC curve, Cardiovascular diseases, Inflammation

Abstract

BACKGROUND: Studies have shown that physical activity levels can be inversely associated with high-sensitivity C-reactive protein (hs-CRP) levels. However, the amount of physical activity required to maintain normal hs-CRP levels is still a matter for speculation. OBJECTIVE: To identify the amount of physical activity necessary to discriminate the hs-CRP levels in adults. DESIGN AND SETTING: Cross-sectional study at six teaching and research institutions. METHODS: The study sample comprised 10,231 adults aged 35 to 74 years who were participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Receiver operating characteristic (ROC) curves were constructed to compare the amount of physical activity in two domains (leisure time and commuting) with hs-CRP levels. The sensitivity and specificity were calculated to identify the best cutoff for physical activity level that would be needed to maintain normal levels of hs-CRP (< 3 mg/l). RESULTS: The area under the ROC curve was only statistically significant for discriminating normal levels of hs-CRP according to the amount of physical activity when the two study domains were added together. The accumulated physical activity level of 200 minutes/week was the best cutoff for discriminating normal levels of hs-CRP in adults of both sex. CONCLUSIONS: Physical activity in the leisure-time and commuting domains together, of duration 200 minutes/week, was associated with normal hs-CRP values.

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Author Biographies

Ciro Oliveira Queiroz, Universidade Federal da Bahia

MSc. Assistant Professor, Department of Physical Education, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador (BA), Brazil. Postgraduate Student, Postgraduate Program in Biotechnology in Health and Investigative Medicine, Centro de Pesquisa Gonçalo Muniz (CPqGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador (BA), Brazil.

Francisco Pitanga, Universidade Federal da Bahia

PhD. Associate Professor, Department of Physical Education, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.

Paulo Andrade Lotufo, Universidade de São Paulo

MD, PhD. Full Professor, Clinical and Epidemiological Research Center, Universidade de São Paulo (USP), São Paulo (SP), Brazil.

Maria Del Carmen Bisi Molina, Universidade Federal do Espírito Santo

PhD. Associate Professor, Public Health Program, Universidade Federal do Espirito Santo (UFES), Vitória (ES), Brazil.

Estela Maria Leão de Aquino, Universidade Federal da Bahia

MD, PhD. Full Professor, Institute of Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.

Maria Conceição Chagas Almeida, Fundação Oswaldo Cruz

PhD. Public Health Researcher, Centro de Pesquisas Gonçalo Moniz (CPqGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador (BA), Brazil.

References

Duncan BB, Chor D, Aquino EM, et al. Doenças Crônicas Não Transmissíveis no Brasil: prioridade para enfrentamento e investigação [Chronic non-communicable diseases in Brazil: priorities for disease management and research]. Rev Saúde Publica. 2012;46 Suppl 1:126-34. PMID: 23532314; doi: 10.1590/S0034-89102012000700017.

GBD 2013 Mortality and Causes of Death Collaborators. Global, regional and national levels of age-specific mortality and 240 causes of death, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117-71. PMID: 25530442; doi: 10.1016/S0140-6736(14)61682-2.

Wilson PW, D’Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837-47. PMID: 9603539; doi: 10.1161/01.CIR.97.18.1837.

Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med. 1997;336(14):973-9. PMID: 9077376; doi: 10.1056/NEJM199704033361401.

Ridker PM, Danielson E, Fonseca FA, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359(21):2195-207. PMID: 18997196; doi: 10.1056/NEJMoa0807646.

Verma S, Szmitko PE, Yeh ET. C-reactive protein: structure affects function. Circulation. 2004;109(16):1914-7. PMID: 15117860; doi: 10.1161/01.CIR.0000127085.32999.64.

Calabrò P, Golia E, Yeh ET. CRP and the risk of atherosclerotic events. Semin Immunopathol. 2009;31(1):79-94. PMID: 19415283; doi: 10.1007/s00281-009-0149-4.

Karakas M, Koenig W. CRP in cardiovascular disease. Herz. 2009;34(8):607-13. PMID: 20024640; doi: 10.1007/s00059-009-3305-7.

Emerging Risk Factors Collaboration, Kaptoge S, Angelantonio E, Pennells L, et al. C-reactive protein, fibrinogen, and cardiovascular disease prediction. N Engl J Med. 2012;367(14):1310-20. PMID: 23034020; doi: 10.1056/NEJMoa1107477.

Pitanga FJG, Almeida MCC, Queiroz CO, Aquino EML de A, Matos SMA. Physical activity in Brazil: lessons from ELSA-Brasil. Narrative review. Sao Paulo Med J. 2017;135(4):391-5. PMID: 28767993; doi: 10.1590/1516-3180.2017.0023190317.

Lin X, Alvim SM, Simoes EJ, et al. Leisure Time Physical Activity and Cardio-Metabolic Health: Results From the Brazilian Longitudinal Study Of Adult Health (Elsa-Brasil). J Am Hear Assoc. 2016;5(6). pii: e003337. PMID: 27412901; doi: 10.1161/JAHA.116.003337.

Richardson MR, Arikawa AY, Churilla JR. Dietary Fiber, C-Reactive Protein, and Leisure-Time Physical Activity Among U.S. Adults. Metab Syndr Relat Disord. 2018;16(2):104-9. PMID: 29377764; doi: 10.1089/met.2017.0100.

Fernandes RA, Ritti-Dias RM, Balagopal PB, et al. Self-initiated physical activity is associated with high sensitivity C-reactive protein: a longitudinal study in 5,030 adults. Atherosclerosis. 2018;273:131-5. PMID: 29544861; doi: 10.1016/j.atherosclerosis.2018.02.011.

Autenrieth C, Schneider A, Döring A, et al. Association between different domains of physical activity and markers of inflammation. Med Sci Sport Exerc. 2009;41(9):1706-13. PMID: 19657301; doi: 10.1249/MSS.0b013e3181a15512.

Hamer M, Sabia S, Batty GD, et al. Physical activity and inflammatory markers over 10 years: follow-up in men and women from the Whitehall II cohort study. Circulation. 2012;126(8):928-33. PMID: 22891048; doi: 10.1161/CIRCULATIONAHA.112.103879.

Ertek S, Cicero A. Impact of physical activity on inflammation: effects on cardiovascular disease risk and other inflammatory conditions. Arch Med Sci. 2012;8(5):794-804. PMID: 23185187; doi: 10.5114/aoms.2012.31614.

Plaisance EP, Grandjean PW. Physical activity and high-sensitivity C-reactive protein. Sport Med. 2006;36(5):443-58. PMID: 16646631; doi: 10.2165/00007256-200636050-00006.

Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Heal Rep. 1985;100(2):126-31. PMID: 3920711.

Aquino EML, Barreto SM, Bensenor IM, et al. Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): objectives and design. Am J Epidemiol. 2012;175(4):315-24. PMID: 22234482; doi: 10.1093/aje/kwr294.

Schmidt MI, Duncan BB, Mill JG, et al. Cohort Profile: Longitudinal Study of Adult Health (ELSA-Brasil). Int J Epidemiol. 2015;44(1):68-75. PMID: 24585730; doi: 10.1093/ije/dyu027.

Ridker PM. Clinical Application of C-reactive protein for cardiovascular disease detection and prevention. Circulation. 2003;107(3):363-9. PMID: 12551853; doi: 10.1161/01.CIR.0000053730.47739.3C.

Bensenor IM, Griep RH, Pinto KA, et al. Rotinas de organização de exames e entrevistas no centro de investigação ELSA-Brasil [Routines of organization of clinical tests and interviews in the ELSA-Brasil investigation center]. Rev Saúde Pública. 2013;47(Suppl 2):37-47. PMID: 24346719; doi: 10.1590/S0034-8910.2013047003780.

Matsudo SM, Araújo T, Matsudo V, et al. Questionário internacional de atividade física (IPAQ): estudo de validade e reprodutibilidade no Brasil [International physical activity questionnaire (IPAQ): study of validity and reliability in Brazil]. Rev Bras Ativ Fis Saude. 2001;6(2):6-18. doi: 10.12820/rbafs.v.6n2p5-18.

Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107(3):499-511. PMID: 12551878; doi: 10.1161/01.CIR.0000052939.59093.45.

Erdreich LS, Lee ET. Use of relative operating characteristic analysis in epidemiology. A method for dealing with subjective judgement. Am J Epidemiol. 1981;114(5):649-62. PMID: 7304595.

Liu X. Classification accuracy and cut point selection. Stat Med. 2012;31(23):2676-86. PMID: 22307964; doi: 10.1002/sim.4509.

Haskell WL, Lee I-M, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sport Exerc. 2007;39(8):1423-34. PMID: 17762377; doi: 10.1249/mss.0b013e3180616b27.

Reis RS, Hino AA, Parra DC, Hallal PC, Brownson RC. Bicycling and walking for transportation in three Brazilian cities. Am J Prev Med. 2013;44(2):e9-17. PMID: 23332344; doi: 10.1016/j.amepre.2012.10.014.

Engbers LH, Hendriksen IJ. Characteristics of a population of commuter cyclists in the Netherlands: perceived barriers and facilitators in the personal, social and physical environment. Int J Behav Nutr Phys Act. 2010;7(1):89-93. PMID: 21143948; doi: 10.1186/1479-5868-7-89.

Rech CR, Reis RS, Hino AAF, et al. Neighborhood safety and physical inactivity in adults from Curitiba, Brazil. Int J Behav Nutr Phys Act. 2012;9:72. PMID: 22691163; doi: 10.1186/1479-5868-9-72.

Pitanga CP, Pitanga FJ, Beck CC, Gabriel RE, Moreira MH. Nível de atividade física para prevenção do excesso de gordura visceral em mulheres pós-menopáusicas: quanto é necessário? [Level of physical activity in the prevention of excess visceral fat in postmenopausal women: how much is needed?]. Arq Bras Endocrinol Metabol. 2012;56(6):358-63. PMID: 22990639; doi: 10.1590/S0004-27302012000600003.

Pitanga FJ, Lessa I, Barbosa PJ, et al. Atividade física na prevenção de diabetes em etnia negra: quanto é necessário? [Physical activity in the prevention of diabetes in black ethnicity: how much is required?]. Rev Assoc Med Bras (1992). 2010;56(6):697-704. PMID: 21271139; doi: 10.1590/S0104-42302010000600021.

Blair SN, Kohl HW, Gordon NF, Paffenbarger RS. How much physical activity is good for health? Annu Rev Public Heal. 1992;13:99-126. PMID: 1599603; doi: 10.1146/annurev.pu.13.050192.000531.

Blair SN, LaMonte MJ, Nichaman MZ. The evolution of physical activity recommendations: how much is enough? Am J Clin Nutr. 2004;79(5):913S-920S. PMID: 15113739; doi: 10.1093/ajcn/79.5.913S.

Hallal PC, Andersen LB, Bull FC, et al. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012;380(9838):247-57. PMID: 22818937; doi: 10.1016/S0140-6736(12)60646-1.

Lee IM, Shiroma EJ, Lobelo F, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219-29. PMID: 22818936; doi: 10.1016/S0140-6736(12)61031-9.

Borodulin K, Laatikainen T, Salomaa V, Jousilahti P. Associations of leisure time physical activity, self-rated physical fitness, and estimated aerobic fitness with serum C-reactive protein among 3,803 adults. Atherosclerosis. 2006;185(2):381-7. PMID: 16046219; doi: 10.1016/j.atherosclerosis.2005.06.015.

Thomas NE, Williams DR. Inflammatory factors, physical activity, and physical fitness in young people. Scand J Med Sci Sport. 2008;18(5):543-56. PMID: 18627553; doi: 10.1111/j.1600-0838.2008.00824.x.

Hallal PC, Gomez LF, Parra DC, et al. Lessons learned after 10 years of IPAQ use in Brazil and Colombia. J Phys Act Heal. 2010;7(Suppl 2):259-64. PMID: 20702914.

Sallis JF, Saelens BE. Assessment of physical activity by self-report: status, limitations, and future directions. Res Q Exerc Sport. 2000;71(Suppl 2):1-14. PMID: 25680007; doi: 10.1080/02701367.2000.11082780.

Galaviz KI, Harden SM, Smith E, et al. Physical activity promotion in Latin American populations: a systematic review on issues of internal and external validity. Int J Behav Nutr Phys Act. 2014;11:77. PMID: 24938641; doi: 10.1186/1479-5868-11-77.

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Published

2020-02-06

How to Cite

1.
Queiroz CO, Pitanga F, Lotufo PA, Molina MDCB, Aquino EML de, Almeida MCC. Amount of physical activity necessary for a normal level of high-sensitivity C-reactive protein in ELSA-Brasil: a cross-sectional study. Sao Paulo Med J [Internet]. 2020 Feb. 6 [cited 2025 Mar. 9];138(1):19-26. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/579

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