Kaitlyn Mazzilli

M.P.H

National Cancer Institute

Research Analyst

PLCO (Learn more about this study)

PLCO-508

Aug 23, 2019

Daily stair climbing and risk of mortality: a pooled analysis

Regular aerobic physical activity is known to be linked to a reduced risk of mortality (1-3) but it is not known whether muscle strengthening activities are similarly associated with lower risk of mortality. The 2018 Physical Activity Guidelines states that more research is needed to understand the importance of muscle-strengthening activities, a definition that includes daily activities such as stair climbing, on mortality risk (1).
Stair climbing is widely promoted through workplace and public space initiatives (1) and is easily intervened upon to increase regular physical activity. There is strong evidence that interventions are effective in increasing adult stair use in the short term, though results vary by intervention setting and characteristics (1, 4, 5).
To our knowledge, the literature on stair climbing and mortality is limited to analyses published from the Harvard Alumni Health Study. Among these men, the number of stairs habitually climbed was inversely associated with all-cause mortality (6). More data are needed to understand the impact of stair climbing in a larger, more generalizable sample.
To address the limitations of prior analyses, we propose a consortium-based analysis of daily stair climbing and all-cause mortality. We hypothesize that stair climbing will be associated with lower risk of all-cause mortality.

Study Population: Participants in five National Cancer Institute Cohort Consortium studies who provided daily stair climbing information (n=904,761). The five studies include; The National Institutes of Health (NIH)-American Association of Retired Persons (AARP) Diet and Health Study (n=286,740), Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) (n=102,122), Women’s Health Study (WHS) (n=39,789), The European Prospective Investigation into Cancer and Nutrition (EPIC) (n=412,343), and the U.S. Radiologic Technologists Study (USRT) (n=63,767).
Statistical analysis: We will use cox proportional hazards models, with age as the underlying time metric, to estimate the associations of self-reported daily stair climbing with mortality during follow-up in a pooled analysis from five prospective cohorts in the National Cancer Institute Cohort Consortium. To assess the dose-response relationship between stair climbing and risk of mortality, we will use restricted spline models. Analyses will be adjusted for gender, education, marital status, alcohol intake, smoking status, other physical activity measures as available (e.g. walking), and prevalent co-morbidities (including cancer other than nonmelanoma skin cancer and/or heart disease manifested as a heart attack, arrhythmia, or angina). We will examine stair climbing as a continuous variable. Where stair climbing was originally measured in categories, we will use the midpoint of the category. Life expectancies and years of life gained/lost will be calculated using direct adjusted survival curves (for participants 40+ years of age), with 95% confidence intervals (CI’s) derived by bootstrap.
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Objective: To examine daily stair climbing in relation to risk of mortality during follow-up.
Aim 1: Estimate the association between daily stair climbing and mortality.
Aim 2: Estimate the association between daily stair climbing and cause-specific mortality (cancer, and cardiovascular disease).
Aim 3: Assess the relationship between daily stair climbing and life expectancy.

References
1. 2018 Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Scientific Report. 2018.
2. Arem H, Moore SC, Patel A, Hartge P, Berrington de Gonzalez A, Visvanathan K, et al. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Intern Med. 2015;175(6):959-67. doi: 10.1001/jamainternmed.2015.0533. PubMed PMID: 25844730.
3. Moore SC, Patel AV, Matthews CE, Berrington de Gonzalez A, Park Y, Katki HA, et al. Leisure time physical activity of moderate to vigorous intensity and mortality: a large pooled cohort analysis. PLoS Med. 2012;9(11):e1001335-e. doi: 10.1371/journal.pmed.1001335. PubMed PMID: 23139642.
4. Jennings CA, Yun L, Loitz CC, Lee EY, Mummery WK. A Systematic Review of Interventions to Increase Stair Use. American journal of preventive medicine. 2017;52(1):106-14. Epub 2016/10/11. doi: 10.1016/j.amepre.2016.08.014. PubMed PMID: 27720340.
5. Bellicha A, Kieusseian A, Fontvieille AM, Tataranni A, Charreire H, Oppert JM. Stair-use interventions in worksites and public settings - a systematic review of effectiveness and external validity. Preventive medicine. 2015;70:3-13. Epub 2014/12/03. doi: 10.1016/j.ypmed.2014.11.001. PubMed PMID: 25449692.
6. Rey-Lopez JP, Stamatakis E, Mackey M, Sesso HD, Lee IM. Associations of self-reported stair climbing with all-cause and cardiovascular mortality: The Harvard Alumni Health Study. Preventive Medicine Reports. 2019;15:100938. doi: https://doi.org/10.1016/j.pmedr.2019.100938.