The Association of Physical Activity and Mortality Risk Reduction Among Smokers: Results From 1998–2009 National Health Interview Surveys–National Death Index Linkage

in Journal of Physical Activity and Health
Restricted access

Purchase article

USD  $24.95

Student 1 year subscription

USD  $115.00

1 year subscription

USD  $153.00

Student 2 year subscription

USD  $218.00

2 year subscription

USD  $285.00

Background: The mortality benefits of meeting the US federal guidelines for physical activity, which includes recommendations for both aerobic and muscle-strengthening activities, have never been examined among smokers. Our aim was to investigate the association between reporting to meet the guidelines and all-cause, cancer, cardiovascular disease, and respiratory disease mortality among smokers. Methods: We pooled data from the 1998–2009 National Health Interview Survey, which were linked to records in the National Death Index (n = 68,706). Hazard ratios (HR) were computed to estimate the effect of meeting the physical activity guidelines on mortality. Results: Smokers who reported meeting the guidelines for physical activity had 29% lower risk of all-cause mortality (HR: 0.71; 95% confidence interval [CI], 0.62–0.81), 46% lower risk of mortality from cardiovascular disease (HR: 0.54; 95% CI, 0.39–0.76), and 26% lower risk of mortality from cancer (HR: 0.74; 95% CI, 0.59–0.93), compared with those who reported meeting neither the aerobic nor the muscle-strengthening recommendations of the guidelines. Meeting the aerobic recommendation of the guidelines was associated with a 42% decline in that risk (HR: 0.58; 95% CI, 0.44–0.77). Conclusion: Smokers who adhere to physical activity guidelines show a significant reduction in mortality.

Siahpush, Grimm, Ramos, Michaud, and Johansson are with the Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE. Levan and Nguyen are with the Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE.

Siahpush (msiahpush@unmc.edu) is corresponding author.
  • 1.

    2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington DC: U.S. Department of Health and Human Services; 2018.

    • Search Google Scholar
    • Export Citation
  • 2.

    Schoenborn CA, Stommel M. Adherence to the 2008 adult physical activity guidelines and mortality risk. Am J Prev Med. 2011;40(5):514–521. PubMed ID: 21496750 doi:10.1016/j.amepre.2010.12.029

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    O’Donovan G, Hamer M, Stamatakis E. Relationships between exercise, smoking habit and mortality in more than 100,000 adults. Int J Cancer. 2017;140(8):1819–1827. doi:10.1002/ijc.30611

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Kim J. Association between meeting physical activity guidelines and mortality in Korean adults: an 8-year prospective study. J Exerc Nutrition Biochem. 2017;21(2):23–29. PubMed ID: 28715883 doi:10.20463/jenb.2016.0054

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Shiroma EJ, Sesso HD, Moorthy M, Buring JE, Lee I-M. Do moderate-intensity and vigorous-intensity physical activities reduce mortality rates to the same extent? J Am Heart Assoc. 2014;3(5):e000802. PubMed ID: 25326527 doi:10.1161/JAHA.114.000802

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Kujala UM, Kaprio J, Sarna S, Koskenvuo M. Relationship of leisure-time physical activity and mortality: the Finnish twin cohort. JAMA. 1998;279(6):440–444. PubMed ID: 9466636 doi:10.1001/jama.279.6.440

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Arem H, Moore SC, Patel A, et al. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Intern Med. 2015;175(6):959–967. PubMed ID: 25844730 doi:10.1001/jamainternmed.2015.0533

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Zahrt OH, Crum AJ. Perceived physical activity and mortality: evidence from three nationally representative US samples. Health Psychol. 2017;36(11):1017–1025. PubMed ID: 28726475 doi:10.1037/hea0000531

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Laukkanen JA, Rauramaa R, Mäkikallio T, Toriola AT, Kurl S. Intensity of leisure-time physical activity and cancer mortality in men. Br J Sports Med. 2011;45(2):125–129. PubMed ID: 19656766 doi:10.1136/bjsm.2008.056713

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Erlichman J, Kerbey A, James W. Physical activity and its impact on health outcomes. Paper 1: the impact of physical activity on cardiovascular disease and all-cause mortality: an historical perspective. Obes Rev. 2002;3(4):257–271. PubMed ID: 12458972 doi:10.1046/j.1467-789X.2002.00077.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Leitzmann MF, Park Y, Blair A, et al. Physical activity recommendations and decreased risk of mortality. Arch Intern Med. 2007;167(22):2453–2460. PubMed ID: 18071167 doi:10.1001/archinte.167.22.2453

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults in the United States. 2018; https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm. Accessed January 23, 2018.

    • Search Google Scholar
    • Export Citation
  • 13.

    Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quitting smoking among adults—United States, 2000–2015. MMWR Morb Mortal Wkly Rep. 2017;65(52):1457–1464. PubMed ID: 28056007 doi:10.15585/mmwr.mm6552a1

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Siahpush M, Yong HH, Borland R, Reid JL, Hammond D. Smokers with financial stress are more likely to want to quit but less likely to try or succeed: findings from the International Tobacco Control (ITC) four country survey. Addiction. 2009;104(8):1382–1390. doi:10.1111/j.1360-0443.2009.02599.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Siahpush M, Shaikh RA, Smith D, et al. The association of exposure to point-of-sale tobacco marketing with quit attempt and quit success: results from a prospective study of smokers in the United States. Int J Environ Res Public Health. 2016;13(2):203. PubMed ID: 26861379 doi:10.3390/ijerph13020203

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    U.S. Department of Health & Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2014;17.

    • Search Google Scholar
    • Export Citation
  • 17.

    Sinner P, Folsom AR, Harnack L, Eberly LE, Schmitz KH. The association of physical activity with lung cancer incidence in a cohort of older women: the Iowa Women’s Health Study. Cancer Epidemiol Biomarkers Prev. 2006;15(12):2359–2363. PubMed ID: 17164357 doi:10.1158/1055-9965.EPI-06-0251

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Blewett LA, Rivera Drew JA, King ML, Williams KCW. IPUMS Health Surveys: National Health Interview Survey, Version 6.4 [dataset]. Minneapolis, MN: IPUMS; 2019. doi:https://doi.org/10.18128/D070.V6.4

    • Search Google Scholar
    • Export Citation
  • 19.

    Botman S, Moriarity CL. Design and Estimation for the National Health Interview Survey, 1995–2004. Washington DC: National Center for Health Statistics; 2000.

    • Search Google Scholar
    • Export Citation
  • 20.

    Parsons VL, Moriarity CL, Jonas K, Moore TF, Davis KE, Tompkins L. Design and Estimation for the National Health Interview Survey, 2006–2015. Washington DC: National Center for Health Statistics; 2014.

    • Search Google Scholar
    • Export Citation
  • 21.

    National Center for Health Statistics. The National Health Interview Survey (1986–2004) Linked Mortality Files, Mortality Follow-Up Through 2006: Matching Methodology. Hyattsville, MD: National Center for Health Statistics; 2009.

    • Search Google Scholar
    • Export Citation
  • 22.

    World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva, Switzerland: World Health Organization; 1993.

    • Search Google Scholar
    • Export Citation
  • 23.

    U.S. Department of Health Human Services. Physical Activity Guidelines for Americans. Washington, DC: U.S. Department of Health Human Services; 2008.

    • Search Google Scholar
    • Export Citation
  • 24.

    Liang W, Chikritzhs T. The association between alcohol exposure and self-reported health status: the effect of separating former and current drinkers. PLoS ONE. 2013;8(2):e55881. PubMed ID: 23405228 doi:10.1371/journal.pone.0055881

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    French MT, Zavala SK. The health benefits of moderate drinking revisited: alcohol use and self-reported health status. Am J Health Promot. 2007;21(6):484–491. PubMed ID: 17674634 doi:10.4278/0890-1171-21.6.484

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Bellizzi KM, Rowland JH, Jeffery DD, McNeel T. Health behaviors of cancer survivors: examining opportunities for cancer control intervention. J Clin Oncol. 2005;23(34):8884–8893. PubMed ID: 16314649 doi:10.1200/JCO.2005.02.2343

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    U.S. Census Bureau. Poverty Thresholds. 2016; https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html. Accessed May 2, 2017.

    • Search Google Scholar
    • Export Citation
  • 28.

    Korn EL, Graubard BI. Analysis of Health Surveys. New York, NY: John Wiley & Sons; 1999.

  • 29.

    StataCorp. Stata Statistical Software: Release 14.1, MP Parallel Edition. College Station, TX: StataCorp LP; 2015.

  • 30.

    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. doi:10.1080/02701367.2000.11082780

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Slootmaker SM, Schuit AJ, Chinapaw MJM, Seidell JC, Van Mechelen W. Disagreement in physical activity assessed by accelerometer and self-report in subgroups of age, gender, education and weight status. Int J Behav Nutr Phys Act. 2009;6(1):17. doi:10.1186/1479-5868-6-17

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Hagströmer M, Oja P, Sjöström M. The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutr. 2006;9(6):755–762. doi:10.1079/PHN2005898

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Kurtze N, Rangul V, Hustvedt B-E, Flanders WD. Reliability and validity of self-reported physical activity in the Nord-Trøndelag Health Study—HUNT 1. Scand J Public Health. 2008;36(1):52–61. PubMed ID: 18426785 doi:10.1177/1403494807085373

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Dyrstad SM, Hansen BH, Holme IM, Anderssen SA. Comparison of self-reported versus accelerometer-measured physical activity. Med Sci Sports Exerc. 2014;46(1):99–106. doi:10.1249/MSS.0b013e3182a0595f

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Vartiainen E, Seppala T, Lillsunde P, Puska P. Validation of self reported smoking by serum cotinine measurement in a community-based study. J Epidemiol Community Health. 2002;56:167–170. PubMed ID: 11854334 doi:10.1136/jech.56.3.167

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Wald NJ, Nanchahal K, Thompson SG, Cuckle HS. Does breathing other people’s tobacco smoke cause lung cancer? BMJ. 1986;293:1217–1222.

  • 37.

    Caraballo RS, Giovino GA, Pechacek TF, Mowery PD. Factors associated with discrepancies between self-reports on cigarette smoking and measured serum cotinine levels among persons aged 17 years or older: Third National Health and Nutrition Examination survey, 1988–1994. Am J Epidemiol. 2001;153:807–814. PubMed ID: 11296155 doi:10.1093/aje/153.8.807

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Rebagliato M. Validation of self reported smoking: the use of cotinine as a biomarker for exposure to smoking. J Epidemiol Community Health. 2002;56(3):163–164. PubMed ID: 11854332 doi:10.1136/jech.56.3.163

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 39.

    Chiolero A, Wietlisbach V, Ruffieux C, Paccaud F, Cornuz J. Clustering of risk behaviors with cigarette consumption: a population-based survey. Prev Med. 2006;42(5):348–353. PubMed ID: 16504277 doi:10.1016/j.ypmed.2006.01.011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Bouchard C, Rankinen T. Individual differences in response to regular physical activity. Med Sci Sports Exerc. 2001;33(6 Suppl):S446–S451; discussion S452–443. PubMed ID: 11427769 doi:10.1097/00005768-200106001-00013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    U.S. Department of Health Human Services. The Health Benefits of Smoking Cessation: A Report of the Surgeon General. Washington, DC: Centers for Disease Control and Prevention; 1990.

    • Search Google Scholar
    • Export Citation
  • 42.

    Siahpush M, McNeill A, Borland R, Fong GT. Socioeconomic variations in nicotine dependence, self-efficacy and intention to quit across four countries: findings from the International Tobacco Control Policy Evaluation Survey. Tobacco Control. 2006;15(suppl 3):iii71–iii75.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Hitchman SC, Fong GT, Zanna MP, Thrasher JF, Laux FL. The relation between number of smoking friends, and quit intentions, attempts, and success: findings from the International Tobacco Control (ITC) four country survey. Psychol Addict Behav. 2014;28(4):1144–1152. PubMed ID: 24841185 doi:10.1037/a0036483

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Lee CW, Kahende J. Factors associated with successful smoking cessation in the United States, 2000. Am J Public Health. 2007;97(8):1503–1509. PubMed ID: 17600268 doi:10.2105/AJPH.2005.083527

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: Clinical Practice Guideline 2008 Update. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service; 2008.

    • Search Google Scholar
    • Export Citation
  • 46.

    Carroll JK, Fiscella K, Epstein RM, Sanders MR, Williams GC. A 5A’s communication intervention to promote physical activity in underserved populations. BMC Health Serv Res. 2012;12:374. PubMed ID: 23110376 doi:10.1186/1472-6963-12-374

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Pinto BM, Goldstein MG, Ashba J, Sciamanna CN, Jette A. Randomized controlled trial of physical activity counseling for older primary care patients. Am J Prev Med. 2005;29(4):247–255. PubMed ID: 16242586 doi:10.1016/j.amepre.2005.06.016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Whitlock EP, Orleans CT, Pender N, Allan J. Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am J Prev Med. 2002;22(4):267–284. PubMed ID: 11988383 doi:10.1016/S0749-3797(02)00415-4

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Orrow G, Kinmonth AL, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ. 2012;344:e1389. PubMed ID: 22451477 doi:10.1136/bmj.e1389

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Estabrooks PA, Glasgow RE, Dzewaltowski DA. Physical activity promotion through primary care. JAMA. 2003;289(22):2913–2916. PubMed ID: 12799388 doi:10.1001/jama.289.22.2913

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 197 197 42
Full Text Views 774 774 4
PDF Downloads 125 125 1