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Long-Term Leisure-Time Physical Activity Intensity and Mortality
Quick Takes
- Maximal benefit for the reduction in mortality was observed at approximately 150–300 min/wk of long-term leisure-time vigorous physical activity, 300–600 min/wk of long-term leisure-time moderate physical activity, or an equivalent combination of both.
- No additional mortality was noted for adults reporting more than four times the recommended minimum levels of long-term leisure-time moderate or vigorous physical activity.
- These data support the current recommendations for physical activity.
Study Questions:
What are levels of long-term vigorous or moderate physical activity associated with all-cause and cause-specific mortality?
Methods:
Data from two large prospective US cohorts were used for the present analysis. The Nurses' Health Study includes 121,701 female nurses, with enrollment starting in 1976. The Health Professionals Follow-up Study included 51,529 male health professionals (aged 40-76 years) with enrollment beginning in 1986. For both cohorts, the present analysis included participants with data available on leisure-time physical activity in 1986. Participants with a diagnosis of cardiovascular disease (CVD) or cancer at baseline were excluded. Leisure-time physical activity was assessed by self-report using a validated questionnaire, first assessed in 1986 and then every 2 years for up to 15 times during the follow-up. The intensity of physical activity was defined based on metabolic equivalent task (MET), with moderate physical activity (MPA) defined as <6 METs. Vigorous physical activity (VPA) was defined as ≥6 METs. Mortality was the primary outcome of interest, which was assessed through the National Death Index, next of kin, or postal system.
Results:
Data from 116,221 adults were included. Over 30 years of follow-up, 47,596 deaths were identified. Participants' mean age and body mass index over the follow-up were 66 and 26 kg/m2. The majority of participants were White, and the percentage of women was 63%. Among participants with any physical activity, participants with higher long-term leisure-time VPA were younger, whereas participants with higher long-term leisure-time, MPA were older. In addition, participants with higher long-term leisure-time VPA or MPA were leaner and had higher alcohol intake and diet quality scores and a lower prevalence of current smoking.
In analyses mutually adjusted for MPA and VPA, hazard ratios comparing individuals meeting the long-term leisure-time VPA guideline (75–149 min/wk) versus no VPA were 0.81 (95% confidence interval [CI], 0.76–0.87) for all-cause mortality, 0.69 (95% CI, 0.60–0.78) for CVD mortality, and 0.85 (95% CI, 0.79–0.92) for non-CVD mortality. The long-term leisure time MPA guideline (150–299 min/wk) was similarly associated with lower mortality: 19-25% lower risk of all-cause, CVD, and non-CVD mortality. Compared with those meeting the long-term leisure-time physical activity guidelines, participants who reported 2-4 times above the recommended minimum of long-term leisure-time VPA (150–299 min/wk) or MPA (300–599 min/wk) showed 2–4% and 3–13% lower mortality, respectively. Higher levels of either long-term leisure-time VPA (≥300 min/wk) or MPA (≥600 min/wk) did not clearly show further lower all-cause, CVD, and non-CVD mortality or harm. In joint analyses, for individuals who reported <300 min/wk of long-term leisure-time MPA, additional leisure-time VPA was associated with lower mortality; however, among those who reported ≥300 min/wk of long-term leisure-time MPA, additional leisure-time VPA did not appear to be associated with lower mortality beyond MPA.
Conclusions:
The investigators concluded that the nearly maximum association with lower mortality was achieved by performing approximately 150–300 min/wk of long-term leisure-time VPA, 300–600 min/wk of long-term leisure-time MPA, or an equivalent combination of both.
Perspective:
Data from two large cohorts with extensive follow-up support the current recommendations for MPA or VPA. This study added to prior studies with long-term follow-up and inclusion of repeated MPA/VPA measurements. In addition, the investigators noted that levels of physical activity beyond the current recommendation did not confer additional mortality reduction. In contrast, no increase in mortality was noted at higher levels of physical activity.
Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Diet, Exercise, Smoking
Keywords: Alcohol Drinking, Body Mass Index, Cardiovascular Diseases, Diet, Exercise, Leisure Activities, Metabolic Equivalent, Primary Prevention, Smoking
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