Research Article| Volume 60, ISSUE 6, P757-765, June 2021

Physical Activity and Hypertension From Young Adulthood to Middle Age


      The optimum physical activity dose to achieve during young adulthood to prevent hypertension using the 2017 American College of Cardiology/American Heart Association guidelines remains undefined. This study aims to determine the association between level and change in physical activity through the adult life course and the onset of hypertension using these 2017 definitions.


      In 2020, prospective community-based cohort data of 5,115 Coronary Artery Risk Development in Young Adults study participants were analyzed. The cohort included Black and White men and women aged 18–30 years at baseline (1985–1986) at 4 urban sites, collected through 30 years of follow-up (2015–2016). Individualized physical activity trajectories were developed for each participant using linear mixed models.


      Black women reported the lowest physical activity levels from young adulthood through middle age. Lower physical activity score (per 100 units) at age 18 years was associated with 4% (95% CI=1%, 7%, p=0.002) higher odds of hypertension incidence. Each additional 1-unit reduction per year in physical activity score was associated with 2% (95% CI=1%, 3%, p=0.001) higher annual odds of hypertension incidence. Meeting approximately the current minimum physical activity guideline levels at age 18 years and through follow-up was not protective of hypertension incidence; however, meeting approximately twice the current minimum physical activity guideline level at age 18 years and through follow-up was protective of hypertension incidence.


      Moderate physical activity levels may need to exceed current minimum guidelines to prevent hypertension onset using 2017 American College of Cardiology/American Heart Association definitions.
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        • Virani SS
        • Alonso A
        • Benjamin EJ
        • et al.
        Heart disease and stroke statistics-2020 update: a report from the American Heart Association.
        Circulation. 2020; 141: e139-e596
        • Whelton PK
        • Carey RM
        • Aronow WS
        • et al.
        2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines [published correction appears in Hypertension. 2018;71(6):e140–e144].
        Hypertension. 2018; 71: e13-e115
        • Parker ED
        • Schmitz KH
        • Jacobs Jr, DR
        • Dengel DR
        • Schreiner PJ.
        Physical activity in young adults and incident hypertension over 15 years of follow-up: the CARDIA study.
        Am J Public Health. 2007; 97: 703-709
        • Sternfeld B
        • Gabriel KP
        • Jiang SF
        • et al.
        Risk estimates for diabetes and hypertension with different physical activity methods.
        Med Sci Sports Exerc. 2019; 51: 2498-2505
        • Diaz KM
        • Shimbo D.
        Physical activity and the prevention of hypertension.
        Curr Hypertens Rep. 2013; 15: 659-668
        • Kwon S
        • Janz KF
        • Letuchy EM
        • Burns TL
        • Levy SM.
        Developmental trajectories of physical activity, sports, and television viewing during childhood to young adulthood: Iowa bone development study.
        JAMA Pediatr. 2015; 169: 666-672
        • Li K
        • Haynie D
        • Lipsky L
        • Iannotti RJ
        • Pratt C
        • Simons-Morton B.
        Changes in moderate-to-vigorous physical activity among older adolescents.
        Pediatrics. 2016; 138e20161372
      1. HHS, Office of Disease Prevention and Health Promotion. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: HHS, Office of Disease Prevention and Health Promotion., Published 2018. Accessed March 1, 2021.

        • Friedman GD
        • Cutter GR
        • Donahue RP
        • et al.
        CARDIA: study design, recruitment, and some characteristics of the examined subjects.
        J Clin Epidemiol. 1988; 41: 1105-1116
        • Laddu DR
        • Rana JS
        • Murillo R
        • et al.
        25-year physical activity trajectories and development of subclinical coronary artery disease as measured by coronary artery calcium: the Coronary artery Risk Development in Young Adults (CARDIA) study.
        Mayo Clin Proc. 2017; 92: 1660-1670
        • Pereira MA
        • FitzerGerald SJ
        • Gregg EW
        • et al.
        A collection of Physical Activity Questionnaires for health-related research.
        Med Sci Sports Exerc. 1997; 29: S1-S205
        • Sidney S
        • Jacobs Jr, DR
        • Haskell WL
        • et al.
        Comparison of two methods of assessing physical activity in the Coronary artery Risk Development in Young Adults (CARDIA) study.
        Am J Epidemiol. 1991; 133: 1231-1245
        • Jacobs Jr, DR
        • Hahn LP
        • Haskell WL
        • Pirie P
        • Sidney S.
        Validity and reliability of short physical activity history: CARDIA and the Minnesota Heart Health Program.
        J Cardiopulm Rehabil. 1989; 9: 448-459
        • HHS
        Physical activity guidelines for Americans.
        2nd edition. HHS, Washington, DC2018 (Published)
        • Gabriel KP
        • Sidney S
        • Jacobs DR
        • et al.
        Convergent validity of a brief self-reported physical activity questionnaire.
        Med Sci Sports Exerc. 2014; 46: 1570-1577
        • Yano Y
        • Reis JP
        • Levine DA
        • et al.
        Visit-to-visit blood pressure variability in young adulthood and hippocampal volume and integrity at middle age: the CARDIA study (Coronary artery risk development in Young Adults).
        Hypertension. 2017; 70: 1091-1098
        • HHS NIH
        • The University of Alabama Birmingham
        • National Heart Lung and Blood Institute
        CARDIA Y20 manual of operations ver. 1.2: blood pressure and pulse, section 3.
        HHS, NIH, The University of Alabama Birmingham, National Heart Lung and Blood Institute, Birmingham, ALNovember 2, 2006 (Published)
        • Warnick GR.
        High-density lipoproteins: the neglected stepchildren whose importance as a risk factor continues to be defined.
        Clin Chem. 2008; 54: 923-924
        • Friedewald WT
        • Levy RI
        • Fredrickson DS.
        Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.
        Clin Chem. 1972; 18: 499-502
        • Muntner P
        • Carey RM
        • Gidding S
        • et al.
        Potential U.S. population impact of the 2017 ACC/AHA high blood pressure guideline.
        Circulation. 2018; 137: 109-118
        • Vespa J.
        The changing economics and demographics of young adulthood: 1975-2016.
        U.S. Census Bureau, Suitland-Silver Hill, MDApril 2017 (Published)
        • Stroud C
        • Walker LR
        • Davis M
        • Irwin Jr., CE
        Investing in the health and well-being of young adults.
        J Adolesc Health. 2015; 56: 127-129
        • Kwan MY
        • Cairney J
        • Faulkner GE
        • Pullenayegum EE.
        Physical activity and other health-risk behaviors during the transition into early adulthood: a longitudinal cohort study.
        Am J Prev Med. 2012; 42: 14-20
        • Bellows-Riecken KH
        • Rhodes RE.
        A birth of inactivity? A review of physical activity and parenthood.
        Prev Med. 2008; 46: 99-110
        • Sanchez E.
        Life's simple 7: vital but not easy.
        J Am Heart Assoc. 2018; 7e009324
        • Lobelo F
        • Rohm Young D
        • Sallis R
        • et al.
        Routine assessment and promotion of physical activity in healthcare settings: a scientific statement from the American Heart Association.
        Circulation. 2018; 137: e495-e522
        • Gooding HC
        • Milliren C
        • Shay CM
        • Richmond TK
        • Field AE
        • Gillman MW.
        Achieving cardiovascular health in young adulthood-which adolescent factors matter?.
        J Adolesc Health. 2016; 58: 119-121
        • Covelli MMC.
        Efficacy of a school-based cardiac health promotion intervention program for African-American adolescents.
        Appl Nurs Res. 2008; 21: 173-180
        • Brown DM
        • Bray SR
        • Beatty KR
        • Kwan MY.
        Healthy Active Living: a residence community-based intervention to increase physical activity and healthy eating during the transition to first-year university.
        J Am Coll Health. 2014; 62: 234-242
        • Jirathananuwat A
        • Pongpirul K.
        Promoting physical activity in the workplace: a systematic meta-review.
        J Occup Health. 2017; 59: 385-393
        • Lemacks JL
        • James RE
        • Abbott L
        • et al.
        The church bridge project: an academic–community perspective of a church-based weight management pilot intervention among young adult African Americans.
        Prog Community Health Partnersh. 2018; 12: 23-34
        • Garbers S
        • Hunersen K
        • Nechitilo M
        • et al.
        Healthy weight and cardiovascular health promotion interventions for adolescent and young adult males of color: a systematic review.
        Am J Mens Health. 2018; 12: 1328-1351
        • Deatrick JA
        • Klusaritz H
        • Atkins R
        • et al.
        Engaging with the community to promote physical activity in urban neighborhoods.
        Am J Health Promot. 2019; 33: 718-726
        • Lau PW
        • Lau EY
        • Wong del P
        • Ransdell L.
        A systematic review of information and communication technology-based interventions for promoting physical activity behavior change in children and adolescents.
        J Med Internet Res. 2011; 13: e48
        • Rose T
        • Barker M
        • Maria Jacob C
        • et al.
        A systematic review of digital interventions for improving the diet and physical activity behaviors of adolescents.
        J Adolesc Health. 2017; 61: 669-677
        • Pettee Gabriel K
        • Sidney S
        • Jr Jacobs DR
        • et al.
        Ten-year changes in accelerometer-based physical activity and sedentary time during midlife: the CARDIA Study.
        Am J Epidemiol. 2018; 187: 2145-2150
        • Meyer KA
        • Boone-Heinonen J
        • Duffey KJ
        • et al.
        Combined measure of neighborhood food and physical activity environments and weight-related outcomes: the CARDIA study.
        Health Place. 2015; 33: 9-18
        • Whitaker KM
        • Pettee Gabriel KP
        • Buman MP
        • et al.
        Associations of accelerometer-measured sedentary time and physical activity with prospectively assessed cardiometabolic risk factors: the CARDIA study.
        J Am Heart Assoc. 2019; 8e010212
        • Ahmed NU
        • Smith GL
        • Flores AM
        • et al.
        Racial/ethnic disparity and predictors of leisure-time physical activity among U.S. men.
        Ethn Dis. 2005; 15: 40-52
        • Orr MG
        • Kaplan GA
        • Galea S.
        Neighbourhood food, physical activity, and educational environments and black/white disparities in obesity: a complex systems simulation analysis.
        J Epidemiol Community Health. 2016; 70: 862-867