Physical Activity Participation in a Multiethnic Population
Background Physical activity (PA) participation differs by ethnicity, but contributing factors and cardiovascular (CV) outcomes related to these disparities are not well understood. We determined whether health beliefs regarding the benefit of PA contribute to ethnic differences in participation and assessed how these differences impact CV mortality.
Methods The Dallas Heart Study is a longitudinal study of CV health. We assessed PA participation and health perceptions by questionnaire among 3,018 African American, Hispanic, and white men and women at baseline visit (2000–2002). Participant mortality was obtained through 2008 using the National Death Index.
Results African Americans (odds ratio 0.65, 95% CI 0.53–0.80) and Hispanics (odds ratio 0.34, 95% CI 0.26–0.45) were less likely to be physically active compared with whites even after accounting for income, educational status, age, sex, body mass index, diabetes, hypertension, and hyperlipidemia. Beliefs regarding the benefits of PA did not contribute to this disparity, as >94% of individuals felt PA was effective in preventing a heart attack across ethnicity. Physical activity participation was associated with a lower risk of all-cause mortality (hazard ratio [HR] 0.66, 95% CI 0.46–0.93) and CV disease death (HR 0.56, 95% CI 0.32–0.97) in multivariable adjusted models. Similar results were seen when restricting to African Americans (CV disease death, HR 0.57, 95% CI 0.31–1.05).
Conclusions Ethnic minorities reported less PA participation, and lack of PA was associated with higher CV mortality overall and among African Americans. Health perception regarding the benefits of PA did not contribute to this difference, indicating there are other ethnic-specific factors contributing to physical inactivity that require future study.
Cardiovascular disease (CVD) is the leading cause of death in the United States. Compared with other racial/ethnic groups, African Americans have the highest rates of CVD mortality at all ages and the highest prevalence of uncontrolled cardiovascular (CV) risk factors. One potential contributing factor to these racial/ethnic disparities is a lower rate of physical activity (PA) participation among African Americans. Prior studies, done almost exclusively in whites, support an association between decreased PA participation and adverse CV outcomes. In contrast, there are limited data on PA participation and CV outcomes among African Americans. There is also a lack of data on whether racial/ethnic differences in health perceptions regarding the benefits of PA may explain ethnic differences in PA participation.
To further elucidate these important issues related to racial/ethnic disparities in CV outcomes, we analyzed data from the Dallas Heart Study (DHS), a large multiethnic, population-based cohort with a mean 7 years of follow-up. Our study had the following objectives: (1) to demonstrate the relationship between race/ethnicity and PA participation, (2) to quantify the association between lack of PA participation and allcause and CV mortality with a focus on African Americans, and (3) to determine to what extent racial/ethnic differences in PA participation may be explained by differences in beliefs in the preventive efficacy of PA.
Abstract and Introduction
Abstract
Background Physical activity (PA) participation differs by ethnicity, but contributing factors and cardiovascular (CV) outcomes related to these disparities are not well understood. We determined whether health beliefs regarding the benefit of PA contribute to ethnic differences in participation and assessed how these differences impact CV mortality.
Methods The Dallas Heart Study is a longitudinal study of CV health. We assessed PA participation and health perceptions by questionnaire among 3,018 African American, Hispanic, and white men and women at baseline visit (2000–2002). Participant mortality was obtained through 2008 using the National Death Index.
Results African Americans (odds ratio 0.65, 95% CI 0.53–0.80) and Hispanics (odds ratio 0.34, 95% CI 0.26–0.45) were less likely to be physically active compared with whites even after accounting for income, educational status, age, sex, body mass index, diabetes, hypertension, and hyperlipidemia. Beliefs regarding the benefits of PA did not contribute to this disparity, as >94% of individuals felt PA was effective in preventing a heart attack across ethnicity. Physical activity participation was associated with a lower risk of all-cause mortality (hazard ratio [HR] 0.66, 95% CI 0.46–0.93) and CV disease death (HR 0.56, 95% CI 0.32–0.97) in multivariable adjusted models. Similar results were seen when restricting to African Americans (CV disease death, HR 0.57, 95% CI 0.31–1.05).
Conclusions Ethnic minorities reported less PA participation, and lack of PA was associated with higher CV mortality overall and among African Americans. Health perception regarding the benefits of PA did not contribute to this difference, indicating there are other ethnic-specific factors contributing to physical inactivity that require future study.
Introduction
Cardiovascular disease (CVD) is the leading cause of death in the United States. Compared with other racial/ethnic groups, African Americans have the highest rates of CVD mortality at all ages and the highest prevalence of uncontrolled cardiovascular (CV) risk factors. One potential contributing factor to these racial/ethnic disparities is a lower rate of physical activity (PA) participation among African Americans. Prior studies, done almost exclusively in whites, support an association between decreased PA participation and adverse CV outcomes. In contrast, there are limited data on PA participation and CV outcomes among African Americans. There is also a lack of data on whether racial/ethnic differences in health perceptions regarding the benefits of PA may explain ethnic differences in PA participation.
To further elucidate these important issues related to racial/ethnic disparities in CV outcomes, we analyzed data from the Dallas Heart Study (DHS), a large multiethnic, population-based cohort with a mean 7 years of follow-up. Our study had the following objectives: (1) to demonstrate the relationship between race/ethnicity and PA participation, (2) to quantify the association between lack of PA participation and allcause and CV mortality with a focus on African Americans, and (3) to determine to what extent racial/ethnic differences in PA participation may be explained by differences in beliefs in the preventive efficacy of PA.
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