Biomedical subjects
Publications and source records attributed to A L Wing.
Several studies are reviewed that examine the role of exercise in men at work and in men at leisure activity and sports play. All show that adequate exercise reduces the risk of coronary heart disease. Many recent investigations have undertaken the study of the various mechanisms by which physical activity produces these effects.
In a study population of 14,998 Harvard male alumni, 681 hypertensives were first diagnosed during a 6-10-year follow-up beginning 16-50 years after college entrance. The study comprised 105,662 man-years of observation of these men who had entered college in 1916-1950, and who were followed from 1962 or 1966 to 1972. Presence or absence of a background of collegiate sports did not influence risk of hypertension in this study population, nor did stair-climbing, walking, or light sports play by alumni. But, alumni who did not engage in vigorous sports play were at 35% greater risk of hypertension than those who did, and this relationship held at all ages, 35-74 years. Higher levels of body mass index, weight gain since college, history of parental hypertension, and lack of strenuous exercise independently predicted increased risk of hypertension in alumni. Men 20% or more over ideal weight-for-height were at 78% greater risk than lighter men. Those who had gained 25+ lbs (c. 11.5+ kg) since entering college were at 60% greater risk than those who had gained less. Alumni with a hypertensive parent were at 83% higher risk than men without such parentage. Contemporary vigorous exercise was inversely related to hypertension risk, but chiefly among alumni overweight-for-height. In the clinical sense, attributable risk estimates ranged from 30% to nearly 50% for the alumni characteristics of overweight, weight gain, parental hypertension, and lack of vigorous exercise. In the community sense, attributable risk of these same characteristics ranged 13-26%. To sum up, vigorous exercise is associated with lower hypertension incidence, and, without necessarily altering body weight-for-height, avoids or reduces fat and promotes muscle; obesity, rather than excess weight-for-height, is associated with higher hypertension incidence; hence, vigorous exercise is appropriate for use as an intervention regimen in the prevention of hypertension.
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Risk of first heart attack was found to be related inversely to energy expenditure reported by 16,936 Harvard male alumni, aged 35-74 years, of whom 572 experienced heart attacks in 117,680 person-years of followup. Stairs climbed, blocks walked, strenuous sports played, and a composite physical activity index all opposed risk. Men with index below 2000 kilocalories per week were at 64% higher risk than classmates with higher index. Adult exercise was independent of other influences on heart attack risk, and peak exertion as strenuous sports play enhanced the effect of total energy expenditure. Notably, alumni physical activity supplanted student athleticism assessed in college 16-50 years earlier. If it is postulated that varsity athlete status implies selective cardiovascular fitness, such selection alone is insufficient to explain lower heart attack risk in later adult years. Ex-varsity athletes retained lower risk only if they maintained a high physical activity index as alumni.
From the college entrance health data of 50,000 male former students, the records of 45 who eventually died of Hodgkin's disease were compared with those of 180 surviving classmates with reference to certain indicator characteristics. Risk ratios of Hodgkin's disease tended to be lower for men who had experienced various common contagious diseases in childhood. This reduced incidence of clinical contagions may signify that: 1) Inadequate early challenge of immune mechanisms left subjects more susceptible to later Hodgkin's disease, whether or not it is of infectious origin; 2) heightened immune mechanisms that led to subclinical attacks of early contagious diseases promoted an autoimmune response that evolved as Hodgkin's disease; or 3) early childhood infections eliminated some subjects who otherwise would have attended college and ultimately developed adult-onset Hodgkin's disease. Also, Hodgkin's disease risk was higher for students who had reported early death of a parent, particularly from cancer. Moreover, the risk tended to be increased among collegians who were obese, heavy cigarette smokers, and coffee drinkers. None of these indicator characteristics was associated with 89 fatal lymphomas of other types that occurred in the same study population.
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OBJECTIVE: To examine prospectively the relationship between self-reported regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen and the risk of symptomatic diverticular disease. DESIGN: Prospective cohort study using a mailed baseline questionnaire in 1986, and follow-up every 2 years through 1992. SETTING: Male health professionals residing in 50 US states. PATIENTS: A total of 35 615 male health professionals (dentists, optometrists, veterinarians, physicians, pharmacists, osteopathic physicians, podiatrists) 40 to 75 years of age at baseline and free of diagnosed diverticular disease, colon or rectal polyp, ulcerative colitis, and cancer prior to 1988. MAIN OUTCOME MEASURES: Follow-up questionnaires in 1988, 1990, and 1992 about use of NSAIDs, acetaminophen, and other variables including the diagnosis of symptomatic diverticular disease. RESULTS: During 4 years of follow-up, we documented 310 newly diagnosed cases of symptomatic diverticular disease. After adjustment for age, physical activity, and energy-adjusted dietary fiber and total fat intake, regular and consistent use of NSAIDs and acetaminophen was positively associated with the overall risk of symptomatic diverticular disease (for users vs nonusers, relative risk [RR] for NSAIDs = 2.24, 95% confidence interval [CI], 1.28-3.91; RR for acetaminophen = 1.81, 95% CI, 0.79-4.11). Most of this positive association was attributable to cases associated with bleeding, particularly for acetaminophen (for users vs nonusers, RR for NSAIDs = 4.64, 95% CI, 0.99-21.74; RR for acetaminophen = 13.63, 95% CI, 3.53-52.60). CONCLUSIONS: These results suggest that regular and consistent use of NSAIDs in general and acetaminophen is associated with symptoms of severe diverticular disease, particularly bleeding. Further research is needed to investigate the potentially deleterious effect of NSAIDs and other medications on the lower gastrointestinal tract.