Leisure Time Physical Activity and Mortality: A Detailed Pooled Analysis of the Dose-Response Relationship
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IMPORTANCE: The 2008 Physical Activity Guidelines for Americans recommended a minimum of 75 vigorous-intensity or 150 moderate-intensity minutes per week (7.5 metabolic-equivalent hours per week) of aerobic activity for substantial health benefit and suggested additional benefits by doing more than double this amount. However, the upper limit of longevity benefit or possible harm with more physical activity is unclear. OBJECTIVE: To quantify the dose-response association between leisure time physical activity and mortality and define the upper limit of benefit or harm associated with increased levels of physical activity. DESIGN, SETTING, AND PARTICIPANTS: We pooled data from 6 studies in the National Cancer Institute Cohort Consortium (baseline 1992-2003). Population-based prospective cohorts in the United States and Europe with self-reported physical activity were analyzed in 2014. A total of 661,137 men and women (median age, 62 years; range, 21-98 years) and 116,686 deaths were included. We used Cox proportional hazards regression with cohort stratification to generate multivariable-adjusted hazard ratios (HRs) and 95% CIs. Median follow-up time was 14.2 years. EXPOSURES: Leisure time moderate- to vigorous-intensity physical activity. MAIN OUTCOMES AND MEASURES: The upper limit of mortality benefit from high levels of leisure time physical activity. RESULTS: Compared with individuals reporting no leisure time physical activity, we observed a 20% lower mortality risk among those performing less than the recommended minimum of 7.5 metabolic-equivalent hours per week (HR, 0.80 [95% CI, 0.78-0.82]), a 31% lower risk at 1 to 2 times the recommended minimum (HR, 0.69 [95% CI, 0.67-0.70]), and a 37% lower risk at 2 to 3 times the minimum (HR, 0.63 [95% CI, 0.62-0.65]). An upper threshold for mortality benefit occurred at 3 to 5 times the physical activity recommendation (HR, 0.61 [95% CI, 0.59-0.62]); however, compared with the recommended minimum, the additional benefit was modest (31% vs 39%). There was no evidence of harm at 10 or more times the recommended minimum (HR, 0.69 [95% CI, 0.59-0.78]). A similar dose-response relationship was observed for mortality due to cardiovascular disease and to cancer. CONCLUSIONS AND RELEVANCE: Meeting the 2008 Physical Activity Guidelines for Americans minimum by either moderate- or vigorous-intensity activities was associated with nearly the maximum longevity benefit. We observed a benefit threshold at approximately 3 to 5 times the recommended leisure time physical activity minimum and no excess risk at 10 or more times the minimum. In regard to mortality, health care professionals should encourage inactive adults to perform leisure time physical activity and do not need to discourage adults who already participate in high-activity levels.
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Regular engagement in exercise training is associated with a lower risk of adverse cardiovascular events.
“Regular engagement in exercise training is associated with a lower risk of adverse cardiovascular events.1”
From Resting and exercise-induced occult hypertension and coronary atherosclerosis in male masters endurance athletes (2026) · cites this paper as [1]
Those who performed some but less than the recommended minimum physical activity had a 20% lower risk, a 31% lower risk at 1-2 times the minimum, and a 37% lower risk at 2-3 times the minimum, compared to those reporting no physical activity.
“Those who performed some but less than the recommended minimum had a 20% lower risk, a 31% lower risk at 1–2 times the minimum, and a 37% lower risk at 2–3 times the minimum, compared to those reporting no PA [41]”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [41]
A large pooled-cohort analysis of physical activity by Arem et al suggested a plateau effect of increasing physical activity volume.
“In terms of mortality, a large pooled-cohort analysis of physical activity by Arem et al24 suggested a plateau effect of increasing physical activity volume.”
From Association of Cardiorespiratory Fitness with Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing (2018) · cites this paper as [24]
If exercise is repeated regularly over the lifespan, there is lower morbidity and mortality from diseases with an immunological and inflammatory aetiology.
“Moreover, some forms of exercise are anti-inflammatory, and if repeated regularly over the lifespan, there is a lower morbidity and mortality from diseases with an immunological and inflammatory aetiology.”
From Is immunosenescence influenced by our lifetime “dose” of exercise? (2016) · cites this paper as Arem et al. 2015
If moderate-intensity exercise is undertaken regularly so that age-specific guidelines concerning duration and frequency are met, the result is a better functioning immune system and a lower incidence of disease.
“Moreover, if this form of exercise is undertaken regularly, so that age-specific guidelines concerning the recommended duration and frequency of exercise are met (e.g., 30 min of moderate intensity exercise on 5 days of the week for adults), the result is a better functioning immune system and a lower incidence of disease (Arem et al. 2015; Lee et al. 2012; World-Health-Organisation 2010).”
From Is immunosenescence influenced by our lifetime “dose” of exercise? (2016) · cites this paper as Arem et al. 2015
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- Authors
- Arem, H., Moore, S. C., Patel, A., Hartge, P., Berrington de Gonzalez, A., Visvanathan, K., Campbell, P. T., Freedman, M., Weiderpass, E., Adami, H. O., Linet, M. S., Lee, I.-M., & Matthews, C. E.
- Affiliations
- National Cancer Institute (US)
- American Cancer Society (US)
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
- Johns Hopkins University (US)
- Karolinska Institutet (SE)
- Harvard University (US)
- Corresponding author
- Arem, Hannah
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2015-06-01
- Volume
- 175
- Issue
- 6
- Pages
- 959
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC4451435
- OpenAlex
- W2119207706
- Cited by
- 1,498
- References
- 52
- Citations by year
- 2026: 99 · 2025: 111 · 2024: 124 · 2023: 135 · 2022: 130 · 2021: 151 · 2020: 210 · 2019: 166 · 2018: 150 · 2017: 104 · 2016: 83 · 2015: 33
- FWCI
- 90.86
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (Z99 CA999999, 5r01hl043851-10)
- National Institute on Aging (U01 AG 18033, U01AG018033)
- National Heart, Lung, and Blood Institute (R01HL080467, R01‐HL043851, HL099355, RC1HL099355, HL080467)
- National Cancer Institute (R01CA105069, CA 047988, UM1CA182913, CA105069, R01CA047988)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- leisure-time physical activity, mortality, dose-response relationship, physical activity guidelines, moderate physical activity, high-intensity exercise, metabolic equivalent hours, Physical Activity Guidelines for Americans, excess mortality risk, prospective cohort, pooled analysis, health benefits of physical activity, cardiovascular mortality
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Mortality, Recreation, United States, Cohort Studies, Exercise, Young Adult
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