Long-Term Leisure-Time Physical Activity Intensity and All-Cause and Cause-Specific Mortality: A Prospective Cohort of US Adults.
Level 3 - non-randomized controlled study
Prospective cohort study with repeated exposure measurements over 30 years.
PubMed 35876019 · doi:10.1161/CIRCULATIONAHA.121.058162
What was done
Analyzed 116,221 adults from two large prospective US cohorts (Nurses' Health Study and Health Professionals Follow-up Study, 1988–2018) followed for 30 years. Leisure-time moderate physical activity (MPA) and vigorous physical activity (VPA) were self-reported through validated questionnaires administered up to 15 times. Cox proportional hazards regression models, mutually adjusted for MPA and VPA, evaluated the relationship between long-term activity intensity and all-cause, cardiovascular disease (CVD), and non-CVD mortality.
What was found
Across 30 years of follow-up, 47,596 deaths occurred. Meeting the VPA guideline (75–149 min/wk vs no VPA) was associated with lower all-cause mortality (HR 0.81; 95% CI, 0.76–0.87), CVD mortality (HR 0.69; 95% CI, 0.60–0.78), and non-CVD mortality (HR 0.85; 95% CI, 0.79–0.92). Meeting the MPA guideline (150–299 min/wk) was associated with a 19% to 25% lower risk across mortality categories. Performing 2 to 4 times the recommended minimum (150–299 min/wk of VPA or 300–599 min/wk of MPA) was associated with an additional 2% to 4% and 3% to 13% lower mortality, respectively. Activity beyond ≥300 min/wk of VPA or ≥600 min/wk of MPA showed no clear further benefit but showed no excess mortality harm. For individuals reporting ≥300 min/wk of MPA, additional VPA provided no extra mortality reduction.
Why it matters
These findings suggest that exceeding minimum physical activity guidelines by 2- to 4-fold provides modest incremental survival benefit, while providing reassurance that very high volumes of physical activity do not increase mortality risk.
Limits
Physical activity was self-reported rather than objectively measured by wearable devices. The study population was restricted to US health professionals, which may limit generalizability to racially, ethnically, or socioeconomically diverse groups. As an observational study, residual confounding from diet, baseline health status, or other lifestyle factors cannot be ruled out.
Cited by
- contradicts Exceeding approximately 150 minutes of moderate-intensity exercise and 70 minutes of high-intensity exercise per week increases the risk of atherosclerosis, mortality, and arterial stiffness.