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. 2024 Feb 27;83(8):783-793.
doi: 10.1016/j.jacc.2023.12.019.

Sex Differences in Association of Physical Activity With All-Cause and Cardiovascular Mortality

Hongwei Ji  1 , Martha Gulati  2 , Tzu Yu Huang  2 , Alan C Kwan  2 , David Ouyang  2 , Joseph E Ebinger  2 , Kaitlin Casaletto  3 , Kerrie L Moreau  4 , Hicham Skali  5 , Susan Cheng  6
Affiliations

Sex Differences in Association of Physical Activity With All-Cause and Cardiovascular Mortality

Hongwei Ji et al. J Am Coll Cardiol. .

Abstract

Background: Although physical activity is widely recommended for reducing cardiovascular and all-cause mortality risks, female individuals consistently lag behind male individuals in exercise engagement.

Objectives: The goal of this study was to evaluate whether physical activity derived health benefits may differ by sex.

Methods: In a prospective study of 412,413 U.S. adults (55% female, age 44 ± 17 years) who provided survey data on leisure-time physical activity, we examined sex-specific multivariable-adjusted associations of physical activity measures (frequency, duration, intensity, type) with all-cause and cardiovascular mortality from 1997 through 2019.

Results: During 4,911,178 person-years of follow-up, there were 39,935 all-cause deaths including 11,670 cardiovascular deaths. Regular leisure-time physical activity compared with inactivity was associated with 24% (HR: 0.76; 95% CI: 0.73-0.80) and 15% (HR: 0.85; 95% CI: 0.82-0.89) lower risk of all-cause mortality in women and men, respectively (Wald F = 12.0, sex interaction P < 0.001). Men reached their maximal survival benefit of HR 0.81 from 300 min/wk of moderate-to-vigorous physical activity, whereas women achieved similar benefit at 140 min/wk and then continued to reach a maximum survival benefit of HR 0.76 also at ∼300 min/wk. Sex-specific findings were similar for cardiovascular death (Wald F = 20.1, sex interaction P < 0.001) and consistent across all measures of aerobic activity as well as muscle strengthening activity (Wald F = 6.7, sex interaction P = 0.009).

Conclusions: Women compared with men derived greater gains in all-cause and cardiovascular mortality risk reduction from equivalent doses of leisure-time physical activity. These findings could enhance efforts to close the "gender gap" by motivating especially women to engage in any regular leisure-time physical activity.

Keywords: mortality; physical activity; sex differences.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported in part by National Institutes of Health grants K23HL153888, K23AG058752, R21HL156132, R01HL142983, R01HL151828, R01HL131532, R01HL143227, R01AG072475, U54AG062319, and U54AG065141, and the Erika J. Glazer Family Foundation, National Key R&D Program of China (2022YFC2502800), National Natural Science Foundation of China (82103908), Shandong Provincial Natural Science Foundation (ZR2021QH014), Shuimu Scholar Program of Tsinghua University, and National Postdoctoral Innovative Talent Support Program (BX20230189). The funding sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The National Center for Health Statistics Disclosure Review Board approves the NHIS. Data analyses for this study were additionally approved by the Cedars-Sinai Medical Center Institutional Review Board. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1.
Figure 1.. Sex-Specific Association of Moderate-to-Vigorous Aerobic Physical Activity with All-Cause Mortality.
The multivariable-adjusted association of moderate-to-vigorous intensity aerobic physical activity (MVPA) duration with all-cause mortality is shown by sex overall (Panel A) and with focused comparison on the maximal survival benefit achieved for females compared to males (Panel B).
Figure 2.
Figure 2.. Sex-Specific Association of Muscle Strengthening Physical Activity with All-Cause Mortality.
The multivariable-adjusted association of muscle strengthening frequency with all-cause mortality is shown by sex overall (Panel A) and with focused comparison on the maximal survival benefit achieved for females compared to males (Panel B).
Central Illustration.
Central Illustration.. Sex Differences in Physical Activity Associated Mortality Risk Reduction.
We studied 412,413 U.S. adults and found that females compared to males derived greater gains in all-cause and cardiovascular mortality risk reduction from equivalent doses of leisure-time physical activity.
See this image and copyright information in PMC

Comment in

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