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. 2025 Jan 6;32(1):20-29.
doi: 10.1093/eurjpc/zwae248.

Association of accelerometer-derived physical activity with all-cause and cause-specific mortality among individuals with cardiovascular diseases: a prospective cohort study

Zhi Cao  1   2 , Jiahao Min  1 , Yabing Hou  3 , Keyi Si  4 , Mingwei Wang  5   6 , Chenjie Xu  1
Affiliations

Association of accelerometer-derived physical activity with all-cause and cause-specific mortality among individuals with cardiovascular diseases: a prospective cohort study

Zhi Cao et al. Eur J Prev Cardiol. .

Abstract

Aims: To investigate the association of accelerometer-measured intensity-specific physical activity (PA) with all-cause and cause-specific mortality among individuals with cardiovascular disease (CVD).

Methods and results: In this prospective cohort study, 8024 individuals with pre-existing CVD (mean age: 66.6 years, female: 34.1%) from the UK Biobank had their PA measured using wrist-worn accelerometers over a 7-day period in 2013-2015. All-cause, cancer, and CVD mortality was ascertained from death registries. Cox regression modelling and restricted cubic splines were used to assess the associations. Population-attributable fractions (PAFs) were used to estimate the proportion of preventable deaths if more PA was undertaken. During a median follow-up of 6.8 years, 691 deaths (273 from cancer and 219 from CVD) were recorded. An inverse non-linear association was found between PA duration and all-cause mortality risk, irrespective of PA intensity. The hazard ratio (HR) of all-cause mortality plateaued at 1800 min/week for light-intensity PA (LPA), 320 min/week for moderate-intensity PA (MPA), and 15 min/week for vigorous-intensity PA (VPA). The highest quartile of PA was associated with lower risks for all-cause mortality, with HRs of 0.63 (95% confidence interval [CI]: 0.51-0.79), 0.42 (0.33-0.54), and 0.47 (0.37-0.60) for LPA, MPA, and VPA, respectively. Similar associations were observed for cancer and CVD mortality. Additionally, the highest PAFs were noted for VPA, followed by MPA.

Conclusion: We found an inverse non-linear association between all intensities of PA (LPA, MPA, VPA, and MVPA) and mortality risk in CVD patients using accelerometer-derived data, but with a larger magnitude of the associations than that in previous studies based on self-reported PA.

Keywords: Accelerometer; Cardiovascular disease; Mortality; Physical activity.

Plain language summary

This study investigated the associations of accelerometer-derived intensity-specific physical activity (PA) with the risks of all-cause and cause-specific mortality among individuals with cardiovascular disease (CVD). L-shaped dose–response relationships between PA duration and all-cause mortality were observed across all levels of PA intensities. The risk reduction for mortality exhibited a sharp decline from 0 to 1800 min/week of light-intensity PA, followed by reaching a plateau. Notably, the inflection points for moderate-intensity PA and vigorous-intensity PA were found at 320 and 15 min per week, respectively.The population-attributable fraction analysis indicated that a significant number of deaths could potentially be prevented if individuals with CVD engaged in more vigorous-intensity PA.

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Conflict of interest statement

Conflict of interest: The authors declare no competing interests.

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