Moderate to Vigorous Physical Activity and All-Cause Mortality | Journal Scan

Study Questions:

Does the proportion of total moderate to vigorous physical activity (MVPA) that is achieved through vigorous activity influence all-cause mortality independently of the total amount of MVPA?


A prospective cohort study with activity data was linked to all-cause mortality data from February 1, 2006, through June 15, 2014, in 217,755 adults aged 45-75 years, from a population-based cohort in Australia. Associations between different contributions of vigorous activity to total MVPA and mortality were examined using Cox proportional hazards models, adjusted for total MVPA and socio-demographic and health covariates, including nutrition and cardiometabolic disease.


Overall, 55% were women, 35% were <55 years, 38% were 55-64 years, and 26% were 65-74 years. In addition, 18% had heart disease, stroke, thrombosis, or diabetes at baseline. Mean follow-up was 6.52 [1.23] years. During 1,444,927 person-years of follow-up, 7,435 deaths were registered. Compared with those who reported no MVPA (crude death rate, 8.34%), the adjusted hazard ratios for all-cause mortality were 0.66 with crude death rate, 4.81%; 0.53 with crude death rate, 3.17%; and 0.46 with crude death rate, 2.64% for reporting 10-149, 150-299, and 300 minutes/week or more of activity, respectively. Among those who reported any MVPA, the proportion of vigorous activity revealed an inverse dose-response relationship with all-cause mortality. Compared with those reporting no vigorous activity (crude death rate, 3.84%), the fully adjusted hazard ratio was 0.91 with crude death rate, 2.35% in those who reported some vigorous activity (but <30% of total activity) and 0.87 with crude death rate, 2.08% among those who reported 30% or more of activity as vigorous. These associations were consistent in men and women, across categories of body mass index and volume of MVPA, and in those with and without existing cardiovascular disease or diabetes mellitus.


Among people reporting any activity, there was an inverse dose-response relationship between proportion of vigorous activity and mortality. The findings suggest that vigorous activities should be endorsed in clinical and public health activity guidelines to maximize the population benefits of physical activity.


Over the past 15 years, the public health message has been that even mild exercise improves overall health, and persons of all ages should participate. While true, this study adds to the considerable evidence that while moderate activity reduces cardiovascular risk, higher-intensity activities provide even more cardiovascular and metabolic benefits and maintenance of physical function.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Sports and Exercise Cardiology, Exercise

Keywords: Cardiovascular Diseases, Diabetes Mellitus, Exercise, Physical Fitness, Mortality, Risk, Risk Factors, Body Mass Index, Stroke, Thrombosis, Demography, Public Health, Cohort Studies, Follow-Up Studies, Prospective Studies, Proportional Hazards Models, Metabolic Syndrome X, Primary Prevention

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