Association of Physical Activity Intensity With Mortality: A National Cohort Study of 403 681 US Adults

Wang, Yafeng; Nie, Jing; Ferrari, Gerson; Rey-Lopez, Juan Pablo; Rezende, Leandro F. M.

doi:10.1001/jamainternmed.2020.6331

Cited by 229Physical Activity and HealthCardiovascular and exercise physiologySports and Physical Education Studies

Association of Physical Activity Intensity With Mortality: A National Cohort Study of 403 681 US Adults

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Wang, Yafeng, Nie, Jing, Ferrari, Gerson, Rey-Lopez, Juan Pablo, Rezende, Leandro F. M.·2021·JAMA Internal Medicine

DOI 10.1001/jamainternmed.2020.6331PMC PMC7684516

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Abstract

Importance: It is unclear whether, for the same amount of total physical activity, a higher proportion of vigorous physical activity (VPA) to total physical activity is associated with a greater reduction in mortality. Objective: To examine the association of the proportion of VPA to total physical activity (defined as moderate to vigorous physical activity [MVPA]) with all-cause mortality, cardiovascular disease mortality, and cancer mortality. Design, Setting, and Participants: This cohort study included 403 681 adults from the National Health Interview Survey 1997-2013 who provided data on self-reported physical activity and were linked to the National Death Index records through December 31, 2015. Statistical analysis was performed from May 15, 2018, to August 15, 2020. Exposures: Proportion of VPA to total physical activity among participants performing any MVPA. Main Outcomes and Measures: All-cause mortality, cardiovascular disease mortality, and cancer mortality. Cox proportional hazards regression models were performed to estimate hazard ratios (HRs) and 95% CIs, adjusted for sociodemographic characteristics, lifestyle risk factors, and total physical activity. Result: Among the 403 681 individuals (225 569 women [51.7%]; mean [SD] age, 42.8 [16.3] years) in the study, during a median 10.1 years (interquartile range, 5.4-14.6 years) of follow-up (407.3 million person-years), 36 861 deaths occurred. Mutually adjusted models considering the recommendations of moderate physical activity (MPA; 150-299 vs 0 minutes per week) and VPA (≥75-149 vs 0 minutes per week) showed similar associations for all-cause mortality (MPA: HR, 0.83; 95% CI, 0.80-0.87; and VPA: HR, 0.80; 95% CI, 0.76-0.84) and cardiovascular disease mortality (MPA: HR, 0.75; 95% CI, 0.68-0.83; and VPA: HR, 0.79; 95% CI, 0.70-0.91). For the same contrasts, VPA (HR, 0.89; 95% CI, 0.80-0.99) showed a stronger inverse association with cancer mortality compared with MPA (HR, 0.94; 95% CI, 0.86-1.02). Among participants performing any MVPA, a higher proportion of VPA to total physical activity was associated with lower all-cause mortality but not with cardiovascular disease and cancer mortality. For instance, compared with participants with 0% of VPA (no vigorous activity), participants performing greater than 50% to 75% of VPA to total physical activity had a 17% lower all-cause mortality (hazard ratio, 0.83; 95% CI, 0.78-0.88), independent of total MVPA. The inverse association between proportion of VPA to total physical activity and all-cause mortality was consistent across sociodemographic characteristics, lifestyle risk factors, and chronic conditions at baseline. Conclusions and Relevance: This study suggests that, for the same volume of MVPA, a higher proportion of VPA to total physical activity was associated with lower all-cause mortality. Clinicians and public health interventions should recommend 150 minutes or more per week of MVPA but also advise on the potential benefits associated with VPA to maximize population health.

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The health effects of each time unit of physical activity are intensity dependent.
“The health effects of each time unit of physical activity are intensity dependent10–13.”
From Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality (2022) · cites this paper as [11]
For a given volume of physical activity, higher contributions of vigorous physical activity are associated with additional mortality risk reduction.
“For a given volume of physical activity, higher contributions of VPA are associated with additional mortality risk reduction10–13.”
From Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality (2022) · cites this paper as [11]
The seemingly sizeable difference in VPA amounts associated with a comparable effect size may be explained by different measurements and domains employed in each study, the select sample of nonexercisers employed, and the strong possibility that the referent no vigorous leisure time physical activity group in the US study may do some VILPA.
“This seemingly sizeable difference in VPA amounts associated with a comparable effect size may be explained by the different measurements and domains employed in each study, the select sample of nonexercisers we employed in our study, and the strong possibility that the referent no vigorous leisure time physical activity group in this US study11 may do some VILPA.”
From Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality (2022) · cites this paper as [11]
Questionnaires can only capture continuous blocks of time containing a mixture of vigorous activity with interruptions and rest, rather than actual time in vigorous intensity that wearable devices in the study could quantify.
“Questionnaires10–12 can only capture continuous blocks of time containing a mixture of vigorous activity with interruptions and rest, rather than actual time in vigorous intensity that the wearable devices in our study could quantify.”
From Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality (2022) · cites this paper as [11]
Higher contributions of vigorous physical activity are associated with better health outcomes due to the pronounced cardioprotective adaptations promoted by higher physical exertion.
“At present, guidance is framed around moderate-to-vigorous physical activity (MVPA); higher contributions of vigorous physical activity are associated with better health outcomes 8 due to the pronounced cardioprotective adaptations promoted by higher physical exertion.9,10”
From Brief bouts of device-measured intermittent lifestyle physical activity and its association with major adverse cardiovascular events and mortality in people who do not exercise: A prospective cohort study (2023) · cites this paper as [8]

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Authors: Wang, Y., Nie, J., Ferrari, G., Rey-Lopez, J. P., & Rezende, L. F. M.
Affiliations: Wuhan University (CN)
Xi'an Jiaotong University (CN)
Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile CH, Santiago, Chile
i+HEALTH Research Group, Department of Health Sciences, Universidad Europea Miguel de Cervantes, Valladolid, Spain
Universidade Federal de São Paulo (BR)
Corresponding author: Wang, Yafeng
ORCID: Wang, Yafeng
Nie, Jing
Rezende, Leandro F. M.
Venue: JAMA Internal Medicine
Publisher: American Medical Association (AMA)
Published: 2021-02-01
Volume: 181
Issue: 2
Pages: 203
ISSN: 2168-6106 (ISSN-L)
DOI: 10.1001/jamainternmed.2020.6331
PMC: PMC7684516
OpenAlex: W3109689256
Cited by: 229
References: 35
Citations by year: 2026: 26 · 2025: 39 · 2024: 62 · 2023: 42 · 2022: 41 · 2021: 18 · 2020: 1
FWCI: 15.34
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: JAMA Internal Medicine (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Physiology › Physical Activity and Health
Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Social Sciences › Life-span and Life-course Studies › Sports and Physical Education Studies
Keywords: high-intensity exercise, moderate physical activity, physical activity intensity, all-cause mortality, cardiovascular mortality, cancer mortality, moderate-to-vigorous physical activity, physical activity guidelines, National Health Interview Survey, National Death Index, adults, mortality risk reduction, lifestyle risk factors, sociodemographic factors, self-reported physical activity, hazard ratio
MeSH terms: Adult, Female, Health Surveys, Humans, Male, Mortality, United States, Cohort Studies, Exercise

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Association of Physical Activity Intensity With Mortality: A National Cohort Study of 403 681 US Adults

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