Long-Term Leisure-Time Physical Activity Intensity and All-Cause and Cause-Specific Mortality: A Prospective Cohort of US Adults

Abstract

Background: The 2018 physical activity guidelines for Americans recommend a minimum of 150 to 300 min/wk of moderate physical activity (MPA), 75 to 150 min/wk of vigorous physical activity (VPA), or an equivalent combination of both. However, it remains unclear whether higher levels of long-term VPA and MPA are, independently and jointly, associated with lower mortality.

Methods: A total of 116 221 adults from 2 large prospective US cohorts (Nurses' Health Study and Health Professionals Follow-up Study, 1988-2018) were analyzed. Detailed self-reported leisure-time physical activity was assessed with a validated questionnaire, repeated up to 15 times during the follow-up. Cox regression was used to estimate the hazard ratio and 95% CI of the association between long-term leisure-time physical activity intensity and all-cause and cause-specific mortality.

Results: During 30 years of follow-up, we identified 47 596 deaths. 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% CI, 0.76-0.87) for all-cause mortality, 0.69 (95% CI, 0.60-0.78) for cardiovascular disease (CVD) mortality, and 0.85 (95% CI, 0.79-0.92) for non-CVD mortality. Meeting the long-term leisure-time MPA guideline (150-299 min/wk) was similarly associated with lower mortality: 19% to 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 to 4 times above the recommended minimum of long-term leisure-time VPA (150-299 min/wk) or MPA (300-599 min/wk) showed 2% to 4% and 3% to 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 nearly maximum association with lower mortality was achieved by performing ≈150 to 300 min/wk of long-term leisure-time VPA, 300 to 600 min/wk of long-term leisure-time MPA, or an equivalent combination of both.

Keywords: cardiovascular diseases; exercise; guidelines as topic; mortality.

Figure 1.. Dose-response relationship of long-term leisure-time MPA and VPA with all-cause mortality (pooled results of HPFS and NHS, 1988–2018)

Restricted cubic spline model with 3 knots specified at 10th, 50th and 90th percentiles was performed using age (month) as time scale with stratification by calendar time (year) and cohort, and additionally adjusting for race (white or non-white), family history of cardiovascular disease (yes or no), family history of cancer (yes or no), postmenopausal hormone use (premenopausal, postmenopausal current user, or postmenopausal never/past user), alcohol intake (0, 0.1–4.9, 5–9.9, 10–14.9, or 15.0+ g/day), total energy intake (quintiles), smoking status (never, past, or current: 1–14, 15–24, ≥25 cigs/day), sleep duration (≤6, 7–8, or ≥8 hours/day), Alternate Healthy Eating Index (quintiles), body mass index (<21, 21–22.9, 23–24.9, 25–26.9, 27–29.9, 30–34.9, 35–39.9, or ≥40 kg/m2). VPA and MPA were mutually adjusted.

Figure 2.. Joint association of long-term leisure-time VPA and MPA with all-cause and cause-specific mortality (pooled results of HPFS and NHS, 1988–2018)

Multivariable-adjusted model used Cox regression model using age (month) as time scale with stratification by calendar time (year) and cohort, and additionally adjusted for race (white or non-white), family history of cardiovascular disease (yes or no), family history of cancer (yes or no), postmenopausal hormone use (women only) (premenopausal, postmenopausal current user, or postmenopausal never/past user), alcohol intake (0, 0.1–4.9, 5–9.9, 10–14.9, or 15.0+ g/day), total energy intake (quintiles), smoking status (never, past, or current: 1–14, 15–24, ≥25 cigs/day), sleep duration (≤6, 7–8, or >8 hours/day), Alternate Healthy Eating Index (quintiles), body mass index (<21, 21–22.9, 23–24.9, 25–26.9, 27–29.9, 30–34.9, 35–39.9, or ≥40 kg/m²). NA, not available due to insufficient power (less than 10 deaths).