Association of Leisure Time Physical Activity Types and Risks of All-Cause, Cardiovascular, and Cancer Mortality Among Older Adults

Abstract

Importance: Higher amounts of physical activity are associated with increased longevity. However, whether different leisure time physical activity types are differentially associated with mortality risk is not established.

Objectives: To examine whether participation in equivalent amounts of physical activity (7.5 to <15 metabolic equivalent of task [MET] hours per week) through different activity types is associated with mortality risk and to investigate the shape of the dose-response association.

Design, setting, and participants: Participants in this cohort were respondents from the National Institutes of Health-AARP Diet and Health Study who completed the follow-up questionnaire between 2004 and 2005. This questionnaire collected data on weekly durations of different types of physical activities. Mortality was ascertained through December 31, 2019.

Exposures: MET hours per week spent participating in the following activities: running, cycling, swimming, other aerobic exercise, racquet sports, golf, and walking for exercise.

Main outcomes and measures: All-cause, cardiovascular, and cancer mortality. Separate multivariable-adjusted Cox proportional hazards regression models were fitted to estimate hazard ratios (HRs) and 95% CIs of mortality for each of the 7 types of leisure time physical activities, as well as the sum of these activities.

Results: A total of 272 550 participants (157 415 men [58%]; mean [SD] age at baseline, 70.5 [5.4] years [range, 59-82 years]) provided information on types of leisure time activity, and 118 153 (43%) died during a mean (SD) follow-up of 12.4 (3.9) years. In comparison with those who did not participate in each activity, 7.5 to less than 15 MET hours per week of racquet sports (HR, 0.84; 95% CI, 0.75-0.93) and running (HR, 0.85; 95% CI, 0.78-0.92) were associated with the greatest relative risk reductions for all-cause mortality, followed by walking for exercise (HR, 0.91; 95% CI, 0.89-0.93), other aerobic activity (HR, 0.93; 95% CI, 0.90-0.95), golf (HR, 0.93; 95% CI, 0.90-0.97), swimming (HR, 0.95; 95% CI, 0.92-0.98), and cycling (HR, 0.97; 95% CI, 0.95-0.99). Each activity showed a curvilinear dose-response association with mortality risk; low MET hours per week of physical activity for any given activity type were associated with a large reduction in mortality risk, with diminishing returns for each increment in activity thereafter. Associations were similar for cardiovascular and cancer mortality.

Conclusions and relevance: This cohort study of older individuals found differences between different types of leisure time activities and mortality risk, but there were significant associations between participating in 7.5 to less than 15 MET hours per week of any activity and mortality risk.

Figure 1.. Associations of Mean Total Sum Metabolic Equivalent of Task (MET) Hours per Week of the 7 Activities With All-Cause, Cardiovascular, and Cancer Mortality

Categories are based on the Physical Activity Guidelines for Americans. Hazard ratios (HRs) were adjusted for age; sex; racial and ethnic group; educational level; smoking status; body mass index; alcohol consumption; marriage status; trouble with physical activity; history of stroke; history of myocardial infarction, angina, or coronary artery disease; history of diabetes; ever received a diagnosis of cancer; total MET hours per week from nonleisure time activities; sedentary time; and weight training frequency. The data points indicate the HRs, and vertical lines indicate 95% CIs. The line joinings the data points are to illustrate the shape of the dose-response association. The position of the categories along the x-axis was based on the reported median MET hours per week.

Figure 2.. Associations of Mean Metabolic Equivalent of Task (MET) Hours per Week of Running, Cycling, Swimming, and Other Aerobic Activities With All-Cause, Cardiovascular, and Cancer Mortality

Hazard ratios (HRs) were adjusted for age; sex; racial and ethnic group; educational level; smoking status; body mass index; alcohol consumption; marriage status; trouble with physical activity; history of stroke; history of myocardial infarction, angina, or coronary artery disease; history of diabetes; ever received a diagnosis of cancer; total MET hours per week from nonleisure time activities; sedentary time; weight training frequency; and total MET hours per week from other leisure time activities (excluding the activity of interest). The data points indicate the HRs, and vertical lines indicate 95% CIs. The lines joining the data points are to illustrate the shape of the dose-response association.

Figure 3.. Associations of Mean Metabolic Equivalent of Task (MET) Hours per Week of Racquet Sports, Golf, and Walking With All-Cause, Cardiovascular, and Cancer Mortality

Hazard ratios (HRs) were adjusted for age; sex; racial and ethnic group; educational level; smoking status; body mass index; alcohol consumption; marriage status; trouble with physical activity; history of stroke; history of myocardial infarction, angina, or coronary artery disease; history of diabetes; ever received a diagnosis of cancer; total MET hours per week from nonleisure time activities; sedentary time; weight training frequency; and total MET hours per week from other leisure time activities (excluding the activity of interest). The data points indicate the HRs, and vertical lines indicate 95% CIs. The lines joining the data points are to illustrate the shape of the dose-response association.