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Meta-Analysis
. 2020 May;35(5):431-442.
doi: 10.1007/s10654-019-00579-2. Epub 2019 Nov 14.

Physical activity and risk of venous thromboembolism: systematic review and meta-analysis of prospective cohort studies

Setor K Kunutsor  1   2 , Timo H Mäkikallio  3 , Samuel Seidu  4   5 , Claudio Gil Soares de Araújo  6 , Richard S Dey  7 , Ashley W Blom  8   9 , Jari A Laukkanen  10   11   12
Affiliations
Meta-Analysis

Physical activity and risk of venous thromboembolism: systematic review and meta-analysis of prospective cohort studies

Setor K Kunutsor et al. Eur J Epidemiol. 2020 May.

Abstract

The inverse association between physical activity and arterial thrombotic disease is well established. Evidence on the association between physical activity and venous thromboembolism (VTE) is divergent. We conducted a systematic review and meta-analysis of published observational prospective cohort studies evaluating the associations of physical activity with VTE risk. MEDLINE, Embase, Web of Science, and manual search of relevant bibliographies were systematically searched until 26 February 2019. Extracted relative risks (RRs) with 95% confidence intervals (CIs) for the maximum versus minimal amount of physical activity groups were pooled using random effects meta-analysis. Twelve articles based on 14 unique prospective cohort studies comprising of 1,286,295 participants and 23,753 VTE events were eligible. The pooled fully-adjusted RR (95% CI) of VTE comparing the most physically active versus the least physically active groups was 0.87 (0.79-0.95). In pooled analysis of 10 studies (288,043 participants and 7069 VTE events) that reported risk estimates not adjusted for body mass index (BMI), the RR (95% CI) of VTE was 0.81 (0.70-0.93). The associations did not vary by geographical location, age, sex, BMI, and methodological quality of studies. There was no evidence of publication bias among contributing studies. Pooled observational prospective cohort studies support an association between regular physical activity and low incidence of VTE. The relationship does not appear to be mediated or confounded by BMI.

Keywords: Cohort study; Meta-analysis; Physical activity; Risk factor; Systematic review; Venous thromboembolism.

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Conflict of interest statement

The authors declare they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Prospective studies of physical activity and risk of venous thromboembolism included in meta-analysis. The summary estimate presented was calculated using random effects models and was based on fully adjusted estimates (including body mass index) where relevant; sizes of data markers are proportional to the inverse of the variance of the relative ratio; CI, confidence interval (bars); PA, physical activity; RR, relative risk; VTE, venous thromboembolism; study abbreviations are listed in Table 1
Fig. 3
Fig. 3
Relative risks for venous thromboembolism comparing maximal versus minimal amount of physical activity, grouped according to several study characteristics. The summary estimates presented were calculated using random effects models; CI, confidence interval (bars); PA, physical activity; RR, relative risk; VTE, venous thromboembolism; *, p value for meta-regression; **, defined as ‘+’ minimally adjusted analysis (age and/or sex); ‘++’ as adjustment for established risk factors without body mass index (age and/or sex plus cancer, socioeconomic status, smoking, or hypertension); and ‘+++’ as adjustment for established risk factors including body mass index; †, number of cases and participants are not equal across all the subgroups because not all studies reported data on these study characteristics
See this image and copyright information in PMC

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