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The Postmenopausal Estrogens/Progestins Intervention (PEPI) Study

Gail A. Greendale, MD; Laura Bodin-Dunn; Sue Ingles, PhD; Robert Haile, PhD; Elizabeth Barrett-Connor, MD; the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial Investigators

Arch Intern Med. 1996;156(4):418-424.

Abstract
Objective
To examine the associations between self-reported leisure, home, and occupational physical activity and selected cardiovascular risk factors.

Methods
A cross-sectional analysis of baseline data from the Postmenopausal Estrogen/Progestins Intervention Trial was performed in 851 women aged 45 to 64 years. Outcomes were levels of high-density lipoprotein cholesterol, insulin (2 hours after challenge), fibrinogen, and systolic blood pressure. Race-stratified models were adjusted for age, smoking, alcohol, and previous noncontraceptive estrogen use. Models were also run with body mass index as an additional covariate.

Results
In white women, leisure physical activity was positively associated with levels of high-density lipoprotein cholesterol (P=.001) and inversely associated with levels of insulin (P=.04) and fibrinogen (P=.02). Compared with high-density lipoprotein cholesterol levels in the inactive and light leisure physical activity groups, moderate (P<.001) and heavy (P=.004) leisure activities were associated with higher high-density lipoprotein cholesterol levels. High-density lipoprotein cholesterol levels in the heavy leisure physical activity group were significantly higher than those in the moderate group (P=.01). Compared with lesser levels of leisure physical activity, significantly lower mean values of fibrinogen (P=.02) and insulin (^P=.01) were associated with the highestintensity leisure physical activity. Home physical activity was positively related to high-density lipoprotein cholesterol level (^P=.01); relative to lower levels of home physical activity, the heavy home physical activity group demonstrated significantly higher mean high-density lipoprotein cholesterol levels. The effects of leisure and home physical activities were independent of each other. Systolic blood pressure did not vary by leisure, occupational, or home physical activity.

Conclusion
The unique relationships between type of physical activity and cardiac risk factors underscore the necessity of including multiple domains of activity in epidemiologic studies of physical activity in women.

(Arch Intern Med. 1996;156:418-424)

Author Affiliations
From the Division of General Internal Medicine, UCLA School of Medicine, Los Angeles, Calif (Dr Greendale); University of California at San Francisco School of Medicine (Ms Bodin-Dunn); Department of Preventive Medicine, University of Southern California, Los Angeles (Drs Ingles and Haile); and Department of Family and Preventive Medicine, University of California, San Diego, School of Medicine, La Jolla (Dr Barrett-Connor). A list of the PEPI Trial Investigators appears in a box on page 421.

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