Plasma fibrinogen levels in healthy postmenopausal women: physical activity and hormone replacement status

BACKGROUND: Fibrinogen is a major component of the coagulation system and a powerful independent risk factor for cardiovascular disease in postmenopausal women. Regular physical activity has been recommended as an effective clinical approach to lowering plasma fibrinogen levels; currently, however, there are little or no data to support a relationship between habitual exercise status and plasma fibrinogen levels in healthy postmenopausal women who either use or do not use hormone replacement therapy (HRT). METHODS: Plasma fibrinogen levels were measured in 20 physically active (56 +/- 1 yr) and 31 sedentary (58 +/- 1 yr) healthy postmenopausal women. Nine (45%) physically active and 15 (48%) sedentary women had been using HRT for > 1 year; the others were nonusers of HRT. RESULTS: Plasma fibrinogen levels were approximately 15% lower (p = .001) in the physically active women (2.48 +/- .08 g/L) than the sedentary controls (2.92 +/- .06 g/L) and approximately 7% lower (p = .04) in the users (2.65 +/- .08 g/L) versus nonusers (2.84 +/- .08 g/L) of HRT. Moreover, the lower (0.4 g/L) plasma fibrinogen levels associated with regular physical activity were evident in both the users (2.39 +/- .11 vs 2.80 +/- .08 g/L, p = .001) and nonusers (2.56 +/- .11 vs 3.03 +/- .08 g/L, p = .006) of HRT. Stepwise multiple regression analysis revealed that percent body fat was the primary determinant of plasma fibrinogen levels, accounting for 30% of the variability. CONCLUSIONS: Regular physical activity is associated with lower plasma fibrinogen levels in postmenopausal women; the lower plasma fibrinogen levels associated with regular physical activity are evident in both users and nonusers of HRT; and plasma fibrinogen levels are positively related to percent body fat in postmenopausal women differing in physical activity and HRT status. Lower plasma fibrinogen levels in physically active postmenopausal women may contribute to their lower risk of cardiovascular disease.     

A randomized trial of physical activity interventions: design and baseline data from project active

Recently, we developed a highly pathogenic variant of simian-human immunodeficiency virus, SHIV-4 (containing the tat, rev, vpu, and env of the HXB2 strain of HIV-1 in a genetic background of SIVmac239), through a series of four bone marrow-bone marrow passages-first in rhesus monkeys and then in pig-tailed macaques [Joag et al. (1996) J. Virol. 70, 3189-3197]. Inoculation of pig-tailed macaques with this pathogenic virus (SHIVKU-1) causes subtotal elimination of CD4(+) T cells and fatal opportunistic infections, usually within 6 months. Genetic characterization of SHIVKU-1 showed that it has a functional vpu gene (the first codon is ATG vs ACG for the vpu of SHIV-4) and several amino acid substitutions in Env and nef [Stephens et al. (1997) Virology 231, 313-321]. Two pig-tailed macaques, PPc and PQc, were the first to develop a severe loss of CD4(+) T cells and the acquired immune deficiency syndrome and were euthanized at 26 and 105 weeks, respectively. In this report, we analyzed the changes that occurred in the vpu, nef, and env (gp120) genes of the virus used to inoculate macaques PPc and PQc and established the chronology of changes that occurred in these viral genes as these two animals lost their CD4(+) T cells and progressed to develop acquired immune deficiency syndrome. Compared with SHIV-4, the virus used to inoculate macaques PPc and PQc had 0, 3, and 0 consensus amino acid changes in the Vpu, gp120, and Nef, respectively. An analysis of the viral sequences amplified from peripheral blood mononuclear cells samples taken at various times after inoculation of PPc revealed that the vpu had not reverted to an open reading frame (closed vpu, ACG) at 4 weeks after inoculation, but by 16 weeks vpu had reverted to an open reading frame (open vpu, ATG). Macaque PQc, which had a longer course of disease, had a closed vpu at 4 and 16 weeks, but by 28 weeks, both closed and open vpu were detected. From 39 to 105 weeks, only an open vpu was detected. In both macaques, the reversion to an open vpu correlated well with the second phase (major) of CD4(+) T cell loss. An analysis of the nef and env sequences isolated from the same times after inoculation revealed an association between the reversion of vpu to an open reading frame and the accumulation of increased numbers of consensus changes in these two viral proteins. These data suggest that the concomitant reversion of vpu to an open reading frame along with increased substitutions in Nef and gp120 were important genetic changes in the viral genome that were responsible for the increased and highly efficient rate of replication of the virus in CD4(+) T cells and macrophages, which in turn led to elimination of the CD4(+) T cells and profound loss of immunocompetence in the infected animals.     

Nutrition, physical activity, and bone health in women

Calcium and vitamin D can significantly impact bone mineral and fracture risk in women. Unfortunately, calcium intakes in women are low and many elderly have poor vitamin D status. Supplementation with calcium (approximately 1000 mg) can reduce bone loss in premenopausal and late postmenopausal women, especially at sites that have a high cortical bone composition. Vitamin D supplementation slows bone loss and reduces fracture rates in late postmenopausal women. While an excess of nutrients such as sodium and protein potentially affect bone mineral through increased calcium excretion, phytoestrogens in soy foods may attenuate bone loss through estrogenlike activity. Weight-bearing physical activity may reduce the risk of osteoporosis in women by augmenting bone mineral during the early adult years and reducing the loss of bone following menopause. High-load activities, such as resistance training, appear to provide the best stimulus for enhancing bone mineral; however, repetitive activities, such as walking, may have a positive impact on bone mineral when performed at higher intensities. Irrespective of changes in bone mineral, physical activities that improve muscular strength, endurance, and balance may reduce fracture risk by reducing the risk of falling. The combined effect of physical activity and calcium supplementation on bone mineral needs further investigation.     

Antiatherogenic effects of adjuvant antiestrogens: a randomized trial comparing the effects of tamoxifen and toremifene on plasma lipid levels in postmenopausal women with node-positive breast cancer

PURPOSE: To evaluate whether a novel antiestrogen, toremifene, has similar antiatherogenic effects as tamoxifen. PATIENTS AND METHODS: Forty-nine postmenopausal patients with node-positive breast cancer were randomized in a trial that compared the effects of tamoxifen and toremifene on serum lipoproteins. Tamoxifen was given at 20 mg and toremifene at 60 mg orally per day for 3 years. Serum concentrations of apolipoprotein (apo) A-I, A-II, and B, and lipoprotein(a) [Lp(a)], cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol were measured before and after 12 months of antiestrogen therapy. RESULTS: Both antiestrogens significantly reduced serum total and LDL cholesterol and apo B levels. However, the response of HDL cholesterol to treatments was clearly different between the groups. Toremifene increased the HDL level by 14%, whereas tamoxifen decreased it by 5% (P = .001). As a consequence, both cholesterol-to-HDL and LDL-to-HDL ratios decreased more in the toremifene than tamoxifen group (P = .008 and P = .03, respectively). Toremifene also increased the apo A-I level (P = .00007) and apo A-I-to-A-II ratio (P = .018). Both tamoxifen and toremifene decreased the Lp(a) concentration significantly (change, 34% v 41%). CONCLUSION: These results provide positive evidence that toremifene has antiatherogenic properties with potency to improve all lipoproteins that are associated with increased coronary heart disease (CHD) risk.     

Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial

The simulated extended pedigree data of the Genetic Analysis Workshop 10 were used to examine the relationship between several quantitative traits (Q1-Q5), an environmental factor, age and sex and to identify genes contributing to the quantitative traits. A forward selection procedure was used to identify regression models for each trait. Residuals from these regression models were used as quantitative traits in linkage analysis. Two-point sib-pair analysis was performed on Replicate 1 of the data set using SIBPAL. Sixteen regions on 8 chromosomes yielded two-point p-values < 0.005 in Replicate 1. Two strategies for utilizing a second data set were evaluated. In a two-stage approach, only those regions with p-value < 0.005 in Replicate 1 were followed up in the second data set. Nine of these regions had p-values < 0.05 in Replicate 2; four were associated with major genes included in the generating model and the remaining five regions were false positives. An alternative strategy was to perform a repeat genome wide screen in the second data set. This strategy resulted in the identification of 20 regions with p-values < 0.05 in both replicates; five of which included major genes included in the generating model. Although the false positive rate increased when a complete genome screen was performed on both data sets, the two-stage screen, with a more stringent initial criterion for identifying suggestive linkages, had a higher rate of false negatives. For some studies, conducting two complete genome screens in a split-sample design may be worthwhile.     

Six-month physical activity and fitness changes in Project Active, a randomized trial

PURPOSE: Project Active is a randomized clinical trial (N = 235) comparing a lifestyle physical activity program with a structured exercise program in changing physical activity (total energy expenditure [kcal.kg-1.d-1]) and cardiorespiratory fitness (VO2peak in mL.kg-1.min-1). METHODS: Sedentary but healthy adults (N = 235) aged 35-60 years received 6 months of intensive intervention. RESULTS: Analysis of covariance (ANCOVA), adjusting for baseline measure, age, gender, body mass index (BMI), cohort, and ethnicity, showed that at 6 months both lifestyle and structured groups significantly increased energy expenditure over baseline (P < 0.001). The mean increases +/- SE, 1.53 +/- 0.19 kcal.kg-1.d-1 for the lifestyle group and 1.34 +/- 0.20 kcal.kg-1 d-1 for the structured group, were not significantly different between groups (P = 0.49). For cardiorespiratory fitness, both groups had significant increases from baseline (P < 0.001). Mean increases +/- SE were 1.58 +/- 0.33 mL.kg-1.min-1 and 3.64 +/- 0.33 mL.kg-1.min-1 for the lifestyle and structured groups, respectively. This was significantly greater in the structured group (P < 0.001). We also studied changes in intensity of physical activity. Both groups significantly increased moderate intensity activity from baseline, but the increase was significantly greater in the lifestyle group than the structured group (P = 0.02). In contrast, the structured group increased its hard activity more than the lifestyle group, but the difference was not significantly different (P = 0.02). In contrast, the structured group increased its hard increased (P < 0.01) for both groups by 0.25 kcal.kg-1.d-1. CONCLUSION: Both intervention approaches are effective for increasing physical activity and fitness over a 6-month period in initially sedentary men and women.     

Multicenter randomized clinical trial of home uterine activity monitoring: pregnancy outcomes for all women randomized

OBJECTIVE: Our purpose was to evaluate the impact of home uterine activity monitoring on pregnancy outcomes among women at high risk for preterm labor and delivery. STUDY DESIGN: Women at high risk for preterm labor at three centers were randomly assigned to receive high-risk prenatal care alone (not monitored) or to receive the same care with twice-daily home uterine activity monitoring without increased nursing support (monitored). There were 339 women with singleton gestations randomized with caregivers blinded to group assignment. The two groups were medically and demographically similar at entry into the study. RESULTS: Women in the monitored group had prolonged pregnancy survival (p = 0.02) and were less likely to experience a preterm delivery (relative risk 0.59; p = 0.04). Infants born to monitored women with singleton gestations were less likely to be of low birth weight (< 2500 gm; relative risk 0.47, p = 0.003), and were less likely to be admitted to a neonatal intensive care unit (relative risk 0.5, p = 0.01). CONCLUSION: These data show, among women with singleton gestations at high risk for preterm delivery, that the use of home uterine activity monitoring alone, without additional intensive nursing care, results in improved pregnancy outcomes, including prolonged gestation, decreased risk for preterm delivery, larger-birth-weight infants, and a decreased need for neonatal intensive care.     

A four-year randomized controlled trial of hormone replacement and bisphosphonate, alone or in combination, in women with postmenopausal osteoporosis

The aim of this study was to investigate the extent of natural intrinsic fluorescence in carious human dentine and any correspondence of such autofluorescence (AF) to the mineral distribution within the lesion. Two investigative techniques were used, both employing the same sample set and fields in diamond-polished block surfaces of polymethylmethacrylate-embedded carious teeth. AF at emission wavelengths >515 nm, excited by 488-nm laser light, was assessed using a confocal laser scanning optical microscope (CLSM), the recordings made under standard operating conditions. The relative mineral content was assessed using digital backscattered scanning electron microscopy (20 kV BSE-SEM). The AF intensity correlated with the level of demineralisation as seen by BSE, but the depth of the lesion as seen by CLSM was significantly greater implying that the AF is not directly related to the mineral component.     

A randomized trial of deflazacort versus 6-methylprednisolone in renal transplantation--immunosuppressive activity and side effects

Blue-flowering genotypes of Campanula were classified into four phenotypes on the basis of the anthocyanin composition of their flowers. The flowers contained one, two, three or four of the following anthocyanins: bisdeacylplatyconin (7-O-(beta-D-glucopyranosyl)-3-O-(6-O-alpha-L-rhamnopyranosyl-beta-D- glucopyranosyl)delphinidin), violdelphin (7-O-(6-O-(4-O-(6-O-(4-hydroxybenzoyl)-beta-D-glucopyranosyl)-oxybenz oyl)-beta- D-glucopyranosyl)-3-O-(6-O-alpha-L-rhamnopyranosyl-beta-D-glucopyranosyl ) delphinidin), an unknown anthocyanin and campanin (7-O-(6-O-(4-O-(6-O-(4-O-(6-O-p-hydroxybenzoyl-beta-D-glucopyranosyl) oxybenzoyl)-beta-D-glucopyranosyl)oxybenzoyl)-beta-D-glucopy ranosyl)-3-O-(6-O- (alpha-L-rhamnopyranosyl)-beta-D-glucopyranosyl)delphinidin). The structure of the unknown anthocyanin has been determined as 7-O-(6-O-(4-O-(6-O-(4-O-(beta-D-glucopyranosyl)oxybenzoyl)-beta-D- glucopyranosyl)oxybenzoyl)-beta-D-glucopyranosyl)-3-O-(6-O-(alpha- L- rhamnopyranosyl)-beta-D-glucopyranosyl)-delphinidin, i.e. monodeacylcampanin. The genetic evidence is consistent with a biosynthetic pathway in which bisdeacylplatyconin, violdelphin and monodeacylcampanin are intermediates in the biosynthesis of campanin.     

A typology of teacher-rated child behavior: Revisiting subgroups over 10 years later.

The purpose of this article was to examine a typology of child behavior using the Behavioral Assessment System for Children, Teacher Rating Scale (BASC TRS-C, 2nd edition; Reynolds & Kamphaus, 2004). The typology was compared with the solution identified from the 1992 BASC TRS-C norm dataset. Using cluster analysis, a seven-cluster solution was identified and replicated using internal and external validation procedures. Five of the seven clusters were similar to the original solution; however, two new maladaptive behavior clusters emerged. Results also showed that the percentages of students exhibiting problematic behavior increased over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Worksite intervention effects on sleep quality: A randomized controlled trial.

Employees with sleep disturbance are at increased risk of disease. Exercise is believed to be effective for improving sleep quality, but few studies have been conducted. This study investigated the effects of a 24-week worksite exercise/behavioral intervention on self-rated sleep quality, via the Pittsburgh Sleep Quality Index (PSQI), in 73 employees. Greater post-test improvements in the PSQI (-2.0 ± 2.6 vs. -1.3 ± 2.7 points, p = .006, and -16 ± 61 vs. -1 ± 76%, p = .02) were found in treatment versus controls, and in women versus men (by -2.7 points [-5.0 to -0.3 points, p = .03], and by -72% [-142 to -2%, p = .04]). Similar results were found in the shift worker subgroup. Changes in sleep scores were not significantly related to baseline characteristics, changes in psychological health or quality-of-life scores, or level of exercise compliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomized trial

CONTEXT: Even though the strong association between physical inactivity and ill health is well documented, 60% of the population is inadequately active or completely inactive. Traditional methods of prescribing exercise have not proven effective for increasing and maintaining a program of regular physical activity. OBJECTIVE: To compare the 24-month intervention effects of a lifestyle physical activity program with traditional structured exercise on improving physical activity, cardiorespiratory fitness, and cardiovascular disease risk factors. DESIGN: Randomized clinical trial conducted from August 1, 1993, through July 31, 1997. PARTICIPANTS: Sedentary men (n = 116) and women (n = 119) with self-reported physical activity of less than 36 and 34 kcal/kg per day, respectively. INTERVENTIONS: Six months of intensive and 18 months of maintenance intervention on either a lifestyle physical activity or a traditional structured exercise program. MAIN OUTCOME MEASURES: Primary outcomes were physical activity assessed by the 7-Day Physical Activity Recall and peak oxygen consumption (VO2peak) by a maximal exercise treadmill test. Secondary outcomes were plasma lipid and lipoprotein cholesterol concentrations, blood pressure, and body composition. All measures were obtained at baseline and at 6 and 24 months. RESULTS: Both the lifestyle and structured activity groups had significant and comparable improvements in physical activity and cardiorespiratory fitness from baseline to 24 months. Adjusted mean changes (95% confidence intervals [CIs]) were 0.84 (95% CI, 0.42-1.25 kcal/kg per day; P<.001) and 0.69 (95% CI, 0.25-1.12 kcal/kg day; P = .002) for activity, and 0.77 (95% CI, 0.18-1.36 mL/kg per minute; P = .01) and 1.34 (95% CI, 0.72-1.96 mL/kg per minute; P<.001) for VO2peak for the lifestyle and structured activity groups, respectively. There were significant and comparable reductions in systolic blood pressure (-3.63 [95% CI, -5.54 to -1.72 mm Hg; P<.001] and -3.26 [95% CI, -5.26 to -1.25 mm Hg; P = .002]) and diastolic blood pressure (-5.38 [95% CI, -6.90 to -3.86 mm Hg; P<.001] and -5.14 [95% CI, -6.73 to -3.54 mm Hg; P<.001) for the lifestyle and structured activity groups, respectively. Neither group significantly changed their weight (-0.05 [95% CI, -1.05 to 0.96 kg; P = .93] and 0.69 [95% CI, -0.37 to 1.74 kg; P = .20]), but each group significantly reduced their percentage of body fat (-2.39% [95% CI, -2.92% to -1.85%; P<.001] and -1.85% [95% CI, -2.41 % to -1.28%; P<.001]) in the lifestyle and structured activity groups, respectively. CONCLUSIONS: In previously sedentary healthy adults, a lifestyle physical activity intervention is as effective as a structured exercise program in improving physical activity, cardiorespiratory fitness, and blood pressure.     

Isotretinoin for acne vulgaris--10 years later: a safe and successful treatment

The purpose of this study was to assess the long-term benefit of isotretinoin in otherwise therapy-resistant acne. We also assessed risk factors which might influence the long-term outcome. We studied 88 patients (mean age 20.8 years), most of whom had suffered from acne for many years (mean 7.4 years). They received isotretinoin in an initial dose of 0.5 or 1.0 mg/kg/day. The dose was subsequently adjusted according to response and side-effects. Most patients only required 4 months' therapy to produce at least 85% clinical improvement. The patients were seen up to 10 years post-therapy (mean 9 years). Sixty-one patients were still virtually clear of disease. Of the others, 16% required further treatment with conventional antibiotics and 23% required a second course of isotretinoin. Of those who relapsed, 96% did so within 3 years of stopping therapy. The patients' age, sex, and duration of acne did not influence outcome. However, in patients with predominantly truncal acne, especially when severe, there was an increased incidence of relapse. Sebum excretion is known to correlate with acne severity, but the long-term degree of sebum suppression was found not to be related to relapse. The dose schedule, in particular cumulative dose, was an important factor in determining relapse rate. Those patients who received 0.5 mg/kg daily, or a cumulative dose of < 120 mg/kg, had a significantly higher relapse rate than patients receiving a larger dose. We did not elicit any long-term systemic or biochemical side-effects. We conclude that isotretinoin is a safe and effective therapy.(ABSTRACT TRUNCATED AT 250 WORDS)     

A randomized controlled trial of the effects of group psychological therapy on survival in women with metastatic breast cancer

In order to test the effect of a psychological intervention on survival from cancer, 66 women with metastatic breast cancer, all receiving standard medical care, were randomly assigned into two groups; one group (n = 30) attended the psychological intervention, consisting of 35 weekly, 2 h sessions of supportive plus cognitive behavioral therapy; the control group (n = 36) received only a home study cognitive behavioral package. No significant difference was found in survival post-randomization between the groups as assessed by a log rank test 5 years after the commencement of the study. As expected, several prognostic factors were significant predictors of survival: metastatic site, hormonal receptor status, and chemotherapy prior to randomization. While many personal and demographic variables did not influence survival, there was a significant effect of self-reported exercise (possibly due to better health). A small subgroup of intervention subjects who attended outside support groups also survived significantly longer than those who did not. The strengths and limitations of the present study are discussed, and the results contrasted with those of a well known study by Spiegel et al. (Spiegel, D., Bloom, J.R., Kraemer, H.C. and Gottheil, E. (1989) Lancet ii, 888-891). We propose that a different experimental design (correlative) may be needed to show any effect of self-help behaviors and psychological attributes in a small minority of patients.     

Peroperative echography in neurosurgery. Its value and applications 10 years later

Intraoperative ultrasound imaging has many advantages over other imaging methods. The authors present their experience from hundred patients over ultrasound scanning. A large iconography is exposed. Not only the intracerebral lesions such as gliomas or metastases but also abscess or cysts can be controlled or biopsied directly. Per-operative ultrasonography is interesting for spinal cord lesions and spinal traumas. Ten years from the first utilisation in neurosurgery, the method is always used, its cost is low and its practice is very easy.     

Changes in physical activity and health outcomes in a population-based cohort of mid-life Australian-born women

Cross-sectional studies and intervention programs have suggested that physical activity is a potential contributor to the health and wellbeing of mid-life and older women. This prospective longitudinal study investigates whether natural changes in physical activity are associated with changes in health outcomes in a population-based cohort of Australian-born women aged 45-55 years living in Melbourne. Of the 352 women from the Melbourne Women's Midlife Health Project who filled in a base-line physical activity questionnaire, 292 (83 per cent) were evaluated around three years later with regard to physical activity, psychological wellbeing, self-rated health, symptoms experienced, body mass index (BMI), blood pressure and serum lipids. Mean (SD) physical activity measured at base-line was 5.9 (5.7) hours/week, or 1496 (1449) kcal/week; mean (SD) change in physical activity per week was 0.05 (5.24) hours, or 44 (1347) kcal, indicating that although mean change was small there was substantial variation in change. There were significant increases in BMI (P < 0.001), wellbeing (P < 0.05), the number of reported menopause-related symptoms, and high-density lipoprotein cholesterol (HDL-C) levels (P < 0.001), and a decrease in low-density lipoprotein cholesterol (LDL-C) levels (P < 0.05). Change in level of physical activity was positively associated with change in HDL-C (P < 0.01) and change in wellbeing (P = 0.08) and negatively associated with change in coronary heart disease risk score. By increasing physical activity in mid-life, women may reduce at least one risk factor (HDL-C) associated with coronary heart disease.     

Promoting physical activity in women: the new challenges

The optokinetic nystagmus is a phylogenetically old reflexive reaction of the eyes to the movements of the visual surroundings. Two components can be distinguished: (1) the direct one is considered to represent a cortically transmitted loop through the posterior parietal areas: MT and MST; (2) the indirect component passes through brain stem nuclei. One of them is the pretectal nucleus of the optic tract in which we found neurons related to the velocity of the moving pattern. Since in neurons of the oculomotor nuclei the neuronal activity is related to eye position, integration must take place somewhere in the circuit. The brain stern-mediated indirect component is influenced by the vestibular organs, not only by semicircular canals but also by otoliths.     

Customary physical activity and survival in later life: a study in Nottingham, UK

OBJECTIVE: To assess the value of broadly based customary physical activity scores, derived from a questionnaire inventory, in predicting 10 year mortality among elderly people. DESIGN: A 10 year survival analysis of participants in the first wave of the Nottingham longitudinal study of activity and ageing who, in face to face interviews in 1985, provided detailed information on customary physical activity, health, and lifestyle. SETTING: Urban and suburban Nottingham PARTICIPANTS: A total of 1042 people aged 65 years and over randomly sampled from general practitioner records. MAIN RESULTS: On the basis of factor scores derived from the interview questionnaire, activity levels were graded as "high", "intermediate", or "low". In Cox regression models controlling for age, health status, and cigarette smoking at the time of the activity assessment, these gradings were significantly related to 10 year survival. Relative to the "high" activity groups, the risk of dying was significantly increased in both the "intermediate" (hazard ratio (HR) 1.53; 95% CI 1.12, 2.09) and "low" (HR 2.07; 95% CI 1.53, 2.79) groups for women, and in the "low" group (HR 1.59; 95% CI 1.12, 2.25) for men (p < 0.01 throughout). CONCLUSION: Since the survival model controlled for age, health status, and cigarette smoking, it is unlikely that the activity gradings used here are simple proxies for physical health. It is concluded, therefore, that within the elderly population, recall based survey assessments covering a wide range of customary or habitual physical activities, can provide indices showing both cross sectional utility and predictive validity.