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It is unclear how engaging in physical activity after long periods of inactivity provides expected health benefits.To determine whether physically inactive primary care patients reduce their mortality risk by increasing physical activity, even in low doses.Prospective cohort of 3357 physically inactive patients attending 11 Spanish public primary healthcare centres.Change in physical activity was repeatedly measured during patients' participation in the 'Experimental Program for Physical Activity Promotion' clinical trial between 2003 and 2006, using the '7-day Physical Activity Recall'. Mortality to 31 December 2018 (312 deaths) was recorded from national statistics, and survival time from the end of the clinical trial analysed using proportional hazard models.After 46 191 person-years of follow-up, compared with individuals who remained physically inactive, the mortality rates of those who achieved the minimum recommendations of 150-300 min/week of moderate- or 75-150 min/week of vigorous-intensity exercise was reduced by 45% (adjusted hazard ratio [aHR] 0.55; 95% confidence interval [95% CI] = 0.41 to 0.74); those who did not meet these recommendations but increased physical activity in low doses, that is, 50 min/week of moderate physical activity, showed a 31% reduced mortality (aHR 0.69, 95% CI = 0.51 to 0.93); and, those who surpassed the recommendation saw a 49% reduction in mortality (aHR 0.51, 95% CI = 0.32 to 0.81). The inverse association between increased physical activity and mortality follows a continuous curvilinear dose-response relationship.Physically inactive primary care patients reduced their risk of mortality by increasing physical activity, even in doses below recommended levels. Greater reduction was achieved through meeting physical activity recommendations or adopting levels of physical activity higher than those recommended.

Background Cognitive decline is a common non-motor feature characterizing Spinocerebellar Ataxia type 2 (SCA2) during the prodromal stage, nevertheless a reduced number of surrogate biomarkers of these alterations have been described. Objective To provide insights into cognitive dysfunction in SCA2 patients using P300 event-related potentials (ERP) and to evaluate these measures as biomarkers of the disease. Methods A cross-sectional study was performed with 30 SCA2 patients, 20 preclinical carriers and 33 healthy controls, who underwent visual, auditory P300 ERPs, and neurological examinations and ataxia scoring. Results SCA2 patients showed significant increase in P300 latencies and decrease of P300 amplitudes for visual and auditory stimuli, whereas preclinical carriers exhibit a less severe, but significant prolongation of P300 latencies. Multiple regression analyses disclosed a significant effect of SARA score on visual P300 abnormalities in patients as well as of the time to ataxia onset on visual P300 latencies in preclinical carriers. Conclusions This paper demonstrated the role of P300 ERP for the study of attentional, discriminative and working memory abnormalities in SCA2 patients and for the search of surrogate biomarkers from prodromal to the symptomatic stages. Moreover, our findings provide psychophysiological evidences supporting the cerebellar involvement in cognitive processes and allows us to identify promising outcome measures for future trials focusing on cognitive dysfunction.

El Grupo de Prevencion Cardiovascular del Programa de Actividades Preventivas y de Promocion de la Salud (PAPPS) de la Sociedad Espanola de Medicina de Familia y Comunitaria (semFYC) presenta la octava actualizacion de las recomendaciones preventivas cardiovasculares1-8 que desde el ano 1997 viene publicando. El objetivo de este trabajo es ofrecer recomendaciones de cribado, control y tratamiento de las actividades preventivas cardiovasculares, centrandonos en actualizar los factores de riesgo cardiovascular (RCV) mas importantes como la hipertension arterial (HTA), la dislipemia y la diabetes, habida cuenta de que el tabaquismo se aborda en otro apartado del documento. Tambien se presenta, como en ediciones anteriores, una guia clinica resumida de actuacion sobre la HTA y la dislipemia. El contenido de cada actividad preventiva trata de resolver de forma resumida distintas cuestiones esenciales para la prevencion, diagnostico y tratamiento de los factores de riesgo. En la tabla 1 se muestran los aspectos abordados en cada uno de los apartados y los tipos de estudios de referencia en los que se ha basado la recomendacion. Se ha hecho especial hincapie en emitir recomendaciones practicas para aplicar al paciente a partir de la evidencia. La clasifi cacion de la evidencia se ha realizado utilizando una descripcion literal de la gradacion, para facilitar la lectura del documento buscando como resultado principal la reduccion de la morbilidad y mortalidad cardiovasculares (tabla 2). De esta forma hay recomendaciones con mayores evidencias sustentadas en ensayos clinicos y metaanalisis de reduccion de la morbilidad y mortalidad cardiovascular o total que ocurren en diferentes grupos de poblacion, o bien estudios de cohortes bien disenados en el apartado de la prueba diagnostica. Tambien estaria el grupo de las recomen daciones con menos evidencias o utiles en determinadas circunstancias, como pueden ser las que estan fundamentadas en ensayos clinicos limitados a poblaciones muy especifi cas o a pocos casos o estudios; en este apartado se ha incluido la periodicidad de las pruebas de cribado que se basan en la opinion de grupos de expertos. En otro grado se encontrarian las cuestiones que no tienen sufi ciente evidencia para demostrar la reduccion de la enfermedad cardiovascular (ECV) y no es posible decidirse por una recomendacion. Por ultimo estarian las intervenciones que generarian mas dano que benefi cio.

ObjetivoInvestigar si la carrera a pie influye sobre el hábito tabáquico.DiseñoEstudio de casos y controles, con emparejamiento 1:1. Observación longitudinal retrospectiva.EmplazamientoAtención primaria. Ciudad de Toledo.ParticipantesCasos: 48 corredores voluntarios sanos de 47 ± 7,8 años de edad. Controles: 48 sujetos sanos, emparejados por sexo y año de nacimiento, elegidos al azar entre la población adscrita al medico investigador.Mediciones principalesHábito tabáquico y gramos semanales de alcohol mediante cuestionario, peso, talla, presión arterial y frecuencia cardíaca de reposo. Se obtuvieron las odds ratio (OR) de las proporciones de sujetos que fumaban o habían fumado alguna vez, de los que seguían fumando y de las probabilidades de abandono del tabaco de cada grupo.ResultadosLa OR de la proporción de sujetos que fumaban o habían fumado entre los grupos de corredores (54,2%) y controles (70,9%) era de 0,486 (intervalo de confianza [IC] del 95%, 0,205-1,149; χ2=2,8; p=0,093). La OR para continuación del hábito entre los grupos de corredores (8,4%) y controles (41,7%) era de 0,127 (IC del 95%, 0,035-0,456; χ2=14,0; p=0,0002). En el grupo de corredores había abandonado el tabaco el 45,8% y en el de controles, el 31,2% (OR=7,85; IC del 95%, 1,89-32,52; χ2=11,8; p=0,0007). El 50% de los corredores que fumaban lo había dejado desde que comenzó a correr y el 76,9% de éstos lo había dejado justo en el momento de comenzar a correr.ConclusionesHay una asociación negativa entre carrera a pie y tabaco. Si un fumador decide comenzar a correr regularmente, tiene muchas probabilidades de dejar de fumar y mantenerse así.ObjectiveTo investigate whether running influences smoking habits.DesignStudy of cases and controls, with 1:1 pairing. Retrospective longitudinal observational study.SettingPrimary care City of Toledo, Spain.ParticipantsCases: 48 healthy volunteer runners of 47±7.8 years of age. Controls: 48 healthy subjects, paired by gender and year of birth, chosen at random from the medical list assigned to the medical researcher.Principal measurementsSmoking habits and alcohol consumption in grams per week using a questionnaire, weight, height, blood pressure, and heart rate at rest. The odds ratio (OR) was obtained on the proportion of subjects who smoked or smoked at some time, those who continued smoking and the probabilities of giving up tobacco in each group.ResultsThe OR of the proportion of subjects who smoked or had smoked between the groups of runners (54.2%) and controls (70.9%) was 0.486 (95% confidence interval [CI], 0.205-1.149; χ2=2.8; P=.093). The OR for continuing the habit between groups of runners (8.4%) and controls (41.7%) was 0.127 (95% CI, 0.035-0.456; χ2=14.0; P=.0002). In the group of runners, 45.8% had stopped smoking, as well as 31.2% of the controls (OR=7.85; 95% CI, 1.89-32.52; χ2=11.8; P=.0007); 50% of the runners who smoked had given it up since starting to run and 76.9% of these had given it up just at the time of starting to run.ConclusionsThere is a negative association between running and tobacco. If a smoker decides to run regularly he/she has high probabilities of giving up smoking and continue to do so.

OBJECTIVE: To investigate whether running influences smoking habits. DESIGN: Study of cases and controls, with 1:1 pairing. Retrospective longitudinal observational study. SETTING: Primary care City of Toledo, Spain. PARTICIPANTS: Cases: 48 healthy volunteer runners of 47±7.8 years of age. Controls: 48 healthy subjects, paired by gender and year of birth, chosen at random from the medical list assigned to the medical researcher. PRINCIPAL MEASUREMENTS: Smoking habits and alcohol consumption in grams per week using a questionnaire, weight, height, blood pressure, and heart rate at rest. The odds ratio (OR) was obtained on the proportion of subjects who smoked or smoked at some time, those who continued smoking and the probabilities of giving up tobacco in each group. RESULTS: The OR of the proportion of subjects who smoked or had smoked between the groups of runners (54.2%) and controls (70.9%) was 0.486 (95% confidence interval [CI], 0.205-1.149; χ(2)=2.8; P=.093). The OR for continuing the habit between groups of runners (8.4%) and controls (41.7%) was 0.127 (95% CI, 0.035-0.456; χ(2)=14.0; P=.0002). In the group of runners, 45.8% had stopped smoking, as well as 31.2% of the controls (OR=7.85; 95% CI, 1.89-32.52; χ(2)=11.8; P=.0007); 50% of the runners who smoked had given it up since starting to run and 76.9% of these had given it up just at the time of starting to run. CONCLUSIONS: There is a negative association between running and tobacco. If a smoker decides to run regularly he/she has high probabilities of giving up smoking and continue to do so.

Background Further research is needed to improve the evidence regarding determinants of physical activity (PA) as a crucial step to plan higher effective intervention strategies. The goal of the present study is to identify socio-demographic and clinical characteristics of primary care (PHC) insufficiently active patients that are associated with longitudinal changes in the level of physical activity. Methods Longitudinal analysis of baseline socio-demographic and clinical predictors of physical activity change in insufficiently active PHC patients who participated in a PA-promoting multi-centre randomized clinical trial conducted from October 2003 through March 2006. The primary outcome measure was the self-reported physical activity assessed with the 7-day Physical Activity Recall (PAR), at baseline, 6, 12 and 24 months. Baseline covariates included sex, age, social class, anthropometric measures and other cardiovascular risk factors or associated diseases (Diabetes, HTA, tobacco use, etc.), and stage of readiness to change PA. Generalized linear mixed models were used to estimate longitudinal association of studied variables on PA change over the three follow-up measurements. Results A total of 3691 patients (85% of the 4317 recruited in the trial) with at least one follow-up measurement were included in the longitudinal analysis. At baseline, analysed patients (mean age: 50.6 years; 64.6% women) devoted 34.7 minutes and 2.36 metabolic equivalent hours per week (MET.h/week) to moderate and vigorous physical activity. Older age, male gender, higher social class, lower BMI, diagnosis of diabetes or hypertension, and measurement season were significant predictors of PA longitudinal change. The effect of baseline readiness to change on PA dose was modified by time, showing a positive gradient in favour of those with more readiness to change that increases significantly at 12 and 24 months (p-value interaction < .0001). Conclusions Identified baseline characteristics such as readiness to change and risk factors can guide physicians to prioritize time and intervention efforts for maximizing their impact on insufficiently active PHC patients.