Journal
JOURNAL OF APPLIED STATISTICS
Volume 49, Issue 14, Pages 3750-3767Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/02664763.2021.1962260
Keywords
ACLS; Aerobics Center Longitudinal Study; CVD; cardiovascular disease; RE; resistance exercise
Categories
Funding
- National Institutes of Health [AG06945, HL62508, DK088195, HL133069]
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Resistance exercise plays a significant role in reducing cardiovascular disease risks, with both resistance exercise and aerobic exercise showing direct effects on lowering the risk of total cardiovascular disease events. Total cholesterol ranks highest among potential risk factors for cardiovascular disease.
Health benefits of resistance exercise (RE), particularly in lowering cardiovascular disease (CVD) risks, are less understood in comparison to aerobic exercise (AE). Motivated by big data from the Aerobics Center Longitudinal Study (ACLS), we study the direct and indirect effects of RE on CVD risks. The primary outcome in our study, total CVD events (CVD morbidity and mortality combined), is modeled as a survival outcome. To investigate the pathway from RE to CVD outcome through potential mediators, we first conduct causal mediation analysis based on marginal structural models (MSMs). To fully account the information from repeated measurements of the mediators, we also adopt a joint model of the CVD survival outcome and multiple longitudinal trajectories of the mediators. Results show statistically significant direct effects of RE and AE on lowering the risk of total CVD events under each pathway. The causal effect of RE and AE on CVD risk is also studied across different age and gender groups. Furthermore, we produce a ranking for the relative importance of the potential risk factors for CVD, with total cholesterol ranking the highest.
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