European Primary Care Cardiovascular Society

Physical activity important to lower CVD risk in overweight or obese individuals

Koolhaas CM, Eur J Prev Cardiol 2017

Impact of physical activity on the association of overweight and obesity with cardiovascular disease: The Rotterdam Study

Koolhaas CM, Dhana K, Schoufour JD, et al.
Eur J Prev Cardiol 2017; published online ahead of print


Overweight and obesity are associated with an increased CVD risk, whereas higher levels of physical activity (PA) are associated with a decreased CVD risk [1-6]. However, it is not clear to what extent PA can counterbalance the CVD risk associated with overweight and obesity.
In this study, the role of PA in the association between BMI and CVD was evaluated, in middle-aged and elderly participants, based on data from the large population-based Rotterdam
Study, with 5344 participants who were followed for 15 years. Intensity of activity was quantified using metabolic equivalent of task (MET) scores to all activities. Normal weight with high levels of PA was used as the reference category in all analyses including BMI, PA as well as CVD.

Main results

  • Based on the quantity of PA, 2 groups were created: the high PA group exercised 111.3 MET∙hours∙week-1 (IQR 93.7–139.6) and the low PA group exercised 54.6 MET∙hours∙week-1 (IQR 39.0–67.5).
  • The participants with low PA levels were more often male, older and current smokers compared with those with a high PA level.
  • Compared with normal weight participants, overweight (HR 1.13, 95% CI 0.97–1.57) or obese (HR 1.20, 95% CI 0.99–1.46) participants were not at significantly increased CVD risk. P for trend across BMI categories was 0.05.
  • Compared with the higher PA level (irrespective of obesity), participants with a low PA level were at higher CVD risk (HR 1.22, 95% CI 1.06–1.41).
  • Compared with normal weight participants with high PA levels, CVD risk was not significantly different in  overweight (HR 1.03, 95% CI 0.82–1.29) or obese (HR 1.12, 95% CI 0.83–1.52) participants with a high PA level.
  • Compared with normal weight participants with low PA levels, CVD risk was increased in overweight (HR 1.33, 95% CI 1.07-1.66) or obese (HR 1.35, 95% CI 1.04-1.75) participants with high PA levels.


In this long-term follow-up study, only overweight and obese participants with low PA, and not those with high PA, were at increased risk for CVD, when compared to participants with normal weight. These findings suggests that regular PA reduces CVD risk in these individuals and that further benefits can be gained from maintaining a healthy weight.
Find this article online at Eur J Prev Cardiol


1. Lavie CJ, Milani RV and Ventura HO. Obesity and cardiovascular disease: Risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 2009; 53: 1925–1932.
2. Calle EE, Thun MJ, Petrelli JM, et al. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999; 341: 1097–1105.
3. Klein S, Allison DB, Heymsfield SB, et al. Waist circumference and cardiometabolic risk: A consensus statement from Shaping America’s Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Am J Clin Nutr 2007; 85: 1197–1202.
4. Williams PT. Dose-response relationship of physical activity to premature and total all-cause and cardiovascular disease mortality in walkers. PLoS One 2013; 8:e78777.
5. Manson JE, Greenland P, LaCroix AZ, et al. Walking compared with vigorous exercise for the prevention of cardiovascular events in women. N Engl J Med 2002;347: 716–725.
6. Armstrong ME, Green J, Reeves GK, et al. Frequent physical activity may not reduce vascular disease risk as much as moderate activity: Large prospective study of women in the United Kingdom. Circulation 2015; 131:721–729.