Physical activity trajectories and mortality: population based cohort study

Abstract

Objective: To assess the prospective associations of baseline and long term trajectories of physical activity on mortality from all causes, cardiovascular disease, and cancer.

Design: Population based cohort study.

Setting: Adults from the general population in the UK.

Participants: 14 599 men and women (aged 40 to 79) from the European Prospective Investigation into Cancer and Nutrition-Norfolk cohort, assessed at baseline (1993 to 1997) up to 2004 for lifestyle and other risk factors; then followed to 2016 for mortality (median of 12.5 years of follow-up, after the last exposure assessment).

Main exposure: Physical activity energy expenditure (PAEE) derived from questionnaires, calibrated against combined movement and heart rate monitoring.

Main outcome measures: Mortality from all causes, cardiovascular disease, and cancer. Multivariable proportional hazards regression models were adjusted for age, sex, sociodemographics, and changes in medical history, overall diet quality, body mass index, blood pressure, triglycerides, and cholesterol levels.

Results: During 171 277 person years of follow-up, 3148 deaths occurred. Long term increases in PAEE were inversely associated with mortality, independent of baseline PAEE. For each 1 kJ/kg/day per year increase in PAEE (equivalent to a trajectory of being inactive at baseline and gradually, over five years, meeting the World Health Organization minimum physical activity guidelines of 150 minutes/week of moderate-intensity physical activity), hazard ratios were: 0.76 (95% confidence interval 0.71 to 0.82) for all cause mortality, 0.71 (0.62 to 0.82) for cardiovascular disease mortality, and 0.89 (0.79 to 0.99) for cancer mortality, adjusted for baseline PAEE, and established risk factors. Similar results were observed when analyses were stratified by medical history of cardiovascular disease and cancer. Joint analyses with baseline and trajectories of physical activity show that, compared with consistently inactive individuals, those with increasing physical activity trajectories over time experienced lower risks of mortality from all causes, with hazard ratios of 0.76 (0.65 to 0.88), 0.62 (0.53 to 0.72), and 0.58 (0.43 to 0.78) at low, medium, and high baseline physical activity, respectively. At the population level, meeting and maintaining at least the minimum physical activity recommendations would potentially prevent 46% of deaths associated with physical inactivity.

Conclusions: Middle aged and older adults, including those with cardiovascular disease and cancer, can gain substantial longevity benefits by becoming more physically active, irrespective of past physical activity levels and established risk factors. Considerable population health impacts can be attained with consistent engagement in physical activity during mid to late life.

Fig 1

Associations of baseline and long term trajectories of physical activity energy expenditure (PAEE) with all cause, cardiovascular disease, and cancer mortality, stratified by age group, sex, body mass index (BMI), and disease status. Hazard ratios are mutually adjusted for both baseline PAEE and ΔPAEE, and are based on the most comprehensively adjusted model for changes in covariates, including medical history, diet quality, body mass index, blood pressure, and lipids (model 4 from table 2).

Fig 2

Joint associations of baseline and trajectories of physical activity energy expenditure (PAEE) with all cause mortality. Hazard ratios (HR) are based on the most comprehensively adjusted model for age, sex, sociodemographics, and changes in medical history, diet quality, body mass index, blood pressure, and lipids (model 4 from table 2). Adjusted mortality rates are expressed per 100 000 person years. WHO=World Health Organization.

Fig 3

Physical activity energy expenditure (PAEE) of common activities performed during leisure time and at work. MET=metabolic equivalent of task. WHO=World Health Organization