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Cited by 172Physical Activity and HealthCardiovascular and exercise physiologyContext-Aware Activity Recognition Systems

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

Open access
Ahmadi, Matthew N, Hamer, Mark, Gill, Jason M R, Murphy, Marie, Sanders, James P, Doherty, Aiden, Stamatakis, Emmanuel·2023·The Lancet Public Health
DOI 10.1016/s2468-2667(23)00183-4
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Abstract

BACKGROUND: Guidelines emphasise the health benefits of bouts of physical activity of any duration. However, the associations of intermittent lifestyle physical activity accumulated through non-exercise with mortality and major adverse cardiovascular events (MACE) remain unclear. We aimed to examine the associations of bouts of moderate-to-vigorous intermittent lifestyle physical activity (MV-ILPA) and the proportion of vigorous activity contributing within these bouts with mortality and MACE. METHODS: In this prospective cohort study, we used data from the UK Biobank on adults who do not exercise (ie, those who did not report leisure-time exercise) who had wrist-worn accelerometry data available. Participants were followed up until Nov 30, 2022, with the outcome of interest of all-cause mortality obtained through linkage with NHS Digital of England and Wales, and the NHS Central Register and National Records of Scotland, and MACE obtained from inpatient hospitalisation data provided by the Hospital Episode Statistics for England, the Patient Episode Database for Wales, and the Scottish Morbidity Record for Scotland. MV-ILPA bouts were derived using a two-level Random Forest classifier and grouped as short (<1 min), medium (1 to <3 min; 3 to <5 min), and long (5 to <10 min). We further examined the dose-response relationship of the proportion of vigorous physical activity contributing to the MV-ILPA bout. FINDINGS: Between June 1, 2013, and Dec 23, 2015, 103 684 Biobank participants wore an accelerometer on their wrist. 25 241 adults (mean age 61·8 years [SD 7·6]), of whom 14 178 (56·2%) were women, were included in our analysis of all-cause mortality. During a mean follow-up duration of 7·9 years (SD 0·9), 824 MACE and 1111 deaths occurred. Compared with bouts of less than 1 min, mortality risk was lower for bouts of 1 min to less than 3 min (hazard ratio [HR] 0·66 [0·53-0·81]), 3 min to less than 5 min (HR 0·56 [0·46-0·69]), and 5 to less than 10 min (HR 0·48 [0·39-0·59]). Similarly, compared with bouts of less than 1 min, risk of MACE was lower for bouts of 1 min to less than 3 min (HR 0·71 [0·54-0·93]), 3 min to less than 5 min (0·62 [0·48-0·81]), and 5 min to less than 10 min (0·59 [0·46-0·76]). Short bouts (<1 min) were associated with lower MACE risk only when bouts were comprised of at least 15% vigorous activity. INTERPRETATION: Intermittent non-exercise physical activity was associated with lower mortality and MACE. Our results support the promotion of short intermittent bouts of non-exercise physical activity of moderate-to-vigorous intensity to improve longevity and cardiovascular health among adults who do not habitually exercise in their leisure time. FUNDING: Australian National Health, Medical Research Council, and Wellcome Trust.

AI snapshot

Written from the paper’s full text.

TL;DR

In UK Biobank adults who reported no leisure-time exercise, device-measured moderate-to-vigorous intermittent lifestyle physical activity (MV-ILPA) accumulated in bouts of 1 to <10 min was associated with lower all-cause mortality and major adverse cardiovascular events (MACE) compared with bouts <1 min. Associations were independent of total physical activity and were stronger with a higher proportion of vigorous-intensity activity.

Key findings

  • Among 25,241 non-exercisers (mean age 61.8 years; 56.2% women; 1,111 deaths over mean 7.9 years), MV-ILPA bouts of 1 to <3 min, 3 to <5 min, and 5 to <10 min were associated with lower MACE risk than <1 min bouts: HR 0.71 (95% CI 0.54–0.93), 0.62 (0.48–0.81), and 0.59 (0.46–0.76), respectively.
  • For all-cause mortality, 5-year risk was 4.28% (95% CI 3.23–5.32) for the <1 min reference group versus 2.83% (2.20–3.45) for 1 to <3 min, 2.43% (1.93–2.93) for 3 to <5 min, and 2.09% (1.67–2.50) for 5 to <10 min; the paper reports 29–44% lower mortality/MACE risk for 5 to <10 min bouts versus <1 min.
  • In dose-response models, 10 min/day of MVPA with only <1 min MV-ILPA bouts had HR 0.92 (0.88–0.96) for all-cause mortality, versus 0.69 (0.56–0.86) for 1 to <3 min bouts and 0.64 (0.51–0.80) for 5 to <10 min bouts.
  • Vigorous-intensity proportion mattered: <1 min bouts were associated with lower all-cause mortality when at least 12% of MV-ILPA duration was vigorous (HR 0.78 [0.60–0.99]); for MACE, <1 min bouts were associated with lower risk only when at least 15% was vigorous, and 3 to <5 min bouts with 15% vigorous had HR 0.56 (0.43–0.74).

Methods

  • Prospective, population-based cohort study using UK Biobank participants who wore an Axivity AX3 accelerometer on the dominant wrist for 7 days; analyses included non-exercisers with at least 3 valid wear days (≥16 h/day, including ≥1 weekend day), excluding missing covariate data and events within the first 24 months.
  • MV-ILPA was classified by a validated two-level Random Forest activity scheme and grouped by longest bout: <1 min, 1 to <3 min, 3 to <5 min, and 5 to <10 min; outcomes were all-cause mortality and MACE, with follow-up to Nov 30, 2022.
  • Cox proportional hazards regression estimated all-cause mortality HRs; Fine-Gray subdistribution models estimated MACE with non-cardiovascular deaths as a competing risk; restricted cubic splines assessed joint dose-response with MVPA volume and vigorous-intensity proportion, plus E-values, negative control outcomes, and sensitivity analyses.

Limitations

  • The paper states that observational design means unmeasured or residual confounding cannot be ruled out, and reverse causation from prodromal disease remains possible despite exclusions; accelerometer misclassification of MVPA may still occur, and MVPA precision for lifting heavy external loads might be underestimated.
  • The paper notes a median lag of 5.5 years between UK Biobank baseline covariate measurement and the accelerometry study, and a low UK Biobank response rate, though it cites prior work suggesting poor representativeness does not materially influence physical activity–mortality associations.
  • Evident from the text: the analytic sample was restricted to adults who did not exercise, was predominantly White (96.2%), and had a mean age of 61.8 years, so findings may not generalize to exercising adults or more diverse/younger populations.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/s2468-2667(23)00183-4

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 34 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Accumulating physical activity in MV-ILPA bouts of less than 1 min was associated with lower all-cause mortality risk.

    “Accumulating physical activity in MV-ILPA bouts of less than 1 min was associated with lower all-cause mortality risk.”
    Quote in the paperSubstantial claim
  • Findingown data

    These associations were independent of total physical activity.

    “These associations were independent of total physical activity.”
    Quote in the paperSubstantial claim
  • Findingown data

    A higher proportion of vigorous intensity (>12 to 15%) enhanced the associations across all MV-ILPA bout lengths in a dose-response manner.

    “A higher proportion of vigorous intensity (>12 to 15%) enhanced the associations across all MV-ILPA bout lengths in a dose-response manner.”
    Quote in the paperSubstantial claim
  • Findingown data

    Bouts of less than 1 min were only associated with a lower risk of major adverse cardiovascular events when bouts included some activity of vigorous intensity.

    “However, bouts of less than 1 min were only associated with a lower risk of major adverse cardiovascular events when bouts included some activity of vigorous intensity.”
    Quote in the paperSubstantial claim
  • Findingown data

    Incidental nonexercise MVPA is associated with 30% lower mortality risk from approximately 10 MVPA min per day and 1 to less than 5 min MV-ILPA bouts accrued during daily living.

    “We found consistent evidence of beneficial associations for incidental nonexercise MVPA with 30% lower mortality risk from approximately 10 MVPA min per day and 1 to less than 5 min MV-ILPA bouts accrued during daily living.”
    Quote in the paperSubstantial claim
  • May combine two claims. 34
  • Classified as probably not a substantial claim. 49

  • May combine two claims.

    Findingown data

    Associations for MV-ILPA bouts of 5 min to less than 10 min were similar to those for 1-5 min bouts, with risk of all-cause mortality and major cardiovascular events 29-44% lower than bouts of less than 1 min.

    “and that these associations were similar for MV-ILPA bouts of 5 min to less than 10 mins, for which risk of all-cause mortality and major cardiovascular events was 29-44% lower than bouts of less than 1 min.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    MV-ILPA bouts of between 1 min and 5 min were associated with reductions in all-cause mortality and major adverse cardiovascular events.

    “Our study found that moderate-to-vigorous intermittent lifestyle physical activity (MV-ILPA) bouts of between 1 min and 5 min were associated with reductions in all-cause mortality and major adverse cardiovascular events”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Analysis of stroke risk showed an inverse association pattern with wide 95% CIs and no association with higher proportions of vigorous physical activity.

    “Analysis of stroke risk showed an inverse association pattern with wide 95% CIs and no association with higher proportions of vigorous physical activity (appendix p 21).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The median MV-ILPA volume was 26.8 min per day (IQR 15.6-44.0).

    “The median MV-ILPA volume was 26•8 min per day (IQR 15•6-44•0).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The multivariable adjusted HR for 10 min of MVPA per day and 1 to less than 3 min MV-ILPA bouts was 0.72 (0.55-0.95), and the HR for 3 to less than 5 min MV-ILPA bouts was 0.70 (0.52-0.92).

    “For example, the multivariable adjusted HR for 10 min of MVPA per day and 1 to less than 3 min MV-ILPA bouts was 0•72 (0•55-0•95), and the HR for 3 to less than 5 min MV-ILPA bouts was 0•70 (0•52-0•92).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The 5-year risk of mortality for the reference group (MV-ILPA bout <1 min) was 4.28% (95% CI 3.23-5.32) compared with 2.83% (2.20-3.45) for bouts of 1 min to less than 3 min.

    “The 5-year risk of mortality for the reference group (MV-ILPA bout <1 min) was 4•28% (95% CI 3•23-5•32) compared with 2•83% (2•20-3•45) for bouts of 1 min to less than 3 min”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Exclusion of participants with prevalent cancer and cardiovascular disease for the total mortality analysis attenuated the effect sizes for each MV-ILPA bout group (HR 0.71 [0.52-0.95] for 1 to <3 min; 0.54 [0.42-0.70] for 5 to <10 min), but showed a similar pattern to the main analysis.

    “Exclusion of participants with prevalent cancer and cardiovascular disease for the total mortality analysis attenuated the effect sizes for each MV-ILPA bout group (HR 0•71 [0•52-0•95] for 1 to <3 min; 0•54 [0•42 -0•70] for 5 to <10 min), but showed a similar pattern to the main analysis (appendix p 19).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For MACE, the 5-year risk was 3.50% (2.59-4.39) for the reference group and 2.27% (1.72-2.81) for bouts of 1 min to less than 3 min.

    “For MACE, corresponding results were 3•50% (2•59-4•39) for the reference group, 2•27% (1•72-2•81) for bouts of 1 min to less than 3 min”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    MV-ILPA bouts with durations between 1 min and 5 min had similar associations with mortality and MACE when compared with bouts of 5 to less than 10 min, with a 29-44% reduction in risk of mortality and MACE when compared with bouts of less than 1 min.

    “We found that MV-ILPA bouts with durations between 1 min and 5 min had similar associations with mortality and MACE when compared with bouts of 5 to less than 10 min, with a 29-44% reduction in risk of mortality and MACE when compared with bouts of less than 1 min.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    With the negative control outcome, the HR point estimate pattern was inconsistent with wide 95% CIs and no significant associations were observed.

    “Specifically, with the negative control outcome, the HR point estimate pattern was inconsistent with wide 95% CIs and no significant associations were observed (appendix p 18).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The MACE analyses sample, which excluded participants with prevalent cardiovascular disease, included 22 446 participants with 824 events.

    “The MACE analyses sample, which excluded participants with prevalent cardiovascular disease, included 22 446 parti cipants with 824 events (figure 1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    During a mean follow-up time of 7.9 years (0.9), corresponding to 200 599 person-years, 1111 deaths occurred.

    “During a mean follow-up time of 7•9 years (0•9), corresponding to 200 599 personyears, 1111 deaths occurred.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    When vigorous intensity contributed 15% of 1 to less than 3 min bouts (approximately 9 to <27 s of vigorous activity per bout) MACE risk was 0.67 (0.51-0.89) and 0.56 (0.43-0.74) for bouts of 3 to less than 5 min (approximately 27 to <45 s per bout).

    “When vigorous intensity contributed 15% of 1 to less than 3 min bouts (approximately 9 to <27 s of vigorous activity per bout) MACE risk was 0•67 (0•51-0•89) and 0•56 (0•43-0•74) for bouts of 3 to less than 5 min (approximately 27 to <45 s per bout).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For all-cause mortality, bouts of between 1 min and less than 10 min and for MACE, bouts of 5 to less than 10 min had a similar association as that for bouts of 10 min or longer.

    “For all-cause mortality, bouts of between 1 min and less than 10 min and for MACE, bouts of 5 to less than 10 min had a similar association as that for bouts of 10 min or longer (appendix pp 30-31).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Associations of 1 to less than 5 min bouts of moderate-to-vigorous incidental lifestyle physical activity with mortality and major cardiac events were comparable in magnitude to those of 5 to less than 10 min bouts, and more favourable than bouts of less than 1 min.

    “Associations of 1 to less than 5 min bouts of moderate-to-vigorous incidental lifestyle physical activity with mortality and major cardiac events were comparable in magnitude to those of 5 to less than 10 min bouts, and more favourable than bouts of less than 1 min.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Such guidance is based on absence of evidence to support a minimum bout duration (previously set to 10 min), rather than direct evidence for the health benefits of shorter intermittent bouts.

    “Such guidance is based on absence of evidence to support a minimum bout duration (previously set to 10 min), rather than direct evidence for the health benefits of shorter intermittent bouts.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Participants were categorised on the basis of their longest MV-ILPA bout; this ensured there was no cross-bout overlap that would have occurred if mean bout duration was used.

    “Participants were categorised on the basis of their longest MV-ILPA bout; this ensured there was no cross-bout overlap that would have occurred if mean bout duration was used.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The two-level physical activity classification scheme minimised the possibility of false-positive MV-ILPA from stationary activities with high wrist movement, such as ironing and cleaning dishes because activities have to be classified first by level 1 as ambulatory activities and level 2 as moderate or vigorous.

    “The two-level physical activity classification scheme minimised the possibility of false-positive MV-ILPA from stationary activities with high wrist movement, such as ironing and cleaning dishes because activities have to be classified first by level 1 as ambulatory activities and level 2 as moderate or vigorous.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationown data

    Our findings highlight the potential public health value of brief intermittent physical activity bouts of moderate-to-vigorous intensity performed outside the domain of structured exercise, and provide information for intervention goal setting and monitoring.

    “Our findings both highlight the potential public health value of brief intermittent physical activity bouts of moderate-to-vigorous intensity performed outside the domain of structured exercise, and provide information for intervention goal setting and monitoring.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Public health guidelines emphasise the health value of short bouts of intermittent physical activity, including nonexercise activities, to lower mortality and cardiovascular disease risk.

    “Public health guidelines 7 emphasise the health value of short bouts of intermittent physical activity, including nonexercise activities, to lower mortality and cardiovascular disease risk.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Bull, 2020, World Health Organization 2020 guidelines on physical activity and sedentary behaviour, Br J Sports Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    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”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [8] Wang, 2021, Association of physical activity intensity with mortality: a national cohort study of 403 681 US adults, JAMA Intern Med source

      Not checked in the free run.

    • cites [9] Swain, 2006, Comparison of cardioprotective benefits of vigorous versus moderate intensity aerobic exercise, Am J Cardiol source

      Not checked in the free run.

    • cites [10] Sultana, 2019, The effect of low-volume high-intensity interval training on body composition and cardiorespiratory fitness: a systematic review and meta-analysis, Sports Med source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisereasoning

    Although national and WHO guidelines emphasise the importance of brief activity bouts, there is a paucity of evidence to directly support the potential benefits of short intermittent moderate-to-vigorous bouts of daily living activities.

    “Although national and WHO guidelines emphasise the importance of brief activity bouts, there is a paucity of evidence to directly support the potential benefits of short intermittent moderate-to-vigorous bouts of daily living activities.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisereasoning

    For most adults, incorporating moderate-to-vigorous intermittent lifestyle physical activity (MV-ILPA) into their day might be more feasible than sustained bouts of planned and structured exercise.

    “For most adults, incorporating moderate-to-vigorous intermittent lifestyle physical activity (MV-ILPA) into their day, defined as brief bouts (<10 min) done as part of activities of daily living, might be more feasible than sustained bouts of planned and structured exercise.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    Few studies have assessed short bouts of activity embedded into activities of daily living.

    “Few studies have assessed short bouts of activity embedded into activities of daily living.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Data obtained from wearable devices show that as few as four short bouts of vigorous physical activity totalling approximately 2-3 min per day are associated with a substantially lower risk of all-cause cardiovascular disease and cancer mortality.

    “Data obtained from wearable devices show that as few as four short bouts of vigorous physical activity totalling approximately 2-3 min per day are associated with a substantially lower risk of all-cause cardiovascular disease and cancer mortality.5,6”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [5] Stamatakis, 2022, Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality, Nat Med source

      Not checked in the free run.

    • cites [6] Ahmadi, 2022, Vigorous physical activity, incident heart disease, and cancer: how little is enough?, Eur Heart J source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisenone given

    Most studies focused on the health and cardiovascular impact of exercise-based physical activity done during leisure time, accrued primarily from longer bouts lasting for at least 10-15 min, and most used self-reported physical activity.

    “Most studies focused on the health and cardiovascular impact of exercise-based physical activity done during leisure time, accrued primarily from longer bouts lasting for at least 10-15 min, and most used self-reported physical activity.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Physical activity intensity was classified with a validated accelerometer-based two-level Random Forest machine learning activity scheme that first classifies activity type and then intensity.

    “Physical activity intensity was classified with a validated accelerometer-based two-level Random Forest machine learning activity scheme that first classifies activity type and then intensity.5,6,17”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [5] Stamatakis, 2022, Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality, Nat Med source

      Not checked in the free run.

    • cites [6] Ahmadi, 2022, Vigorous physical activity, incident heart disease, and cancer: how little is enough?, Eur Heart J source

      Not checked in the free run.

    • cites [17] Pavey, 2017, Field evaluation of a random forest activity classifier for wrist-worn accelerometer data, J Sci Med Sport source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Devices were calibrated and non-wear periods were detected using standard procedures.

    “Devices were calibrated and non-wear periods were detected using standard procedures.15,16”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] Sipos, 2011, Analyses of triaxial accelerometer calibration algorithms, IEEE Sens J source

      Not checked in the free run.

    • cites [16] Ahmadi, 2020, Non-wear or sleep? Evaluation of five non-wear detection algorithms for raw accelerometer data, J Sports Sci source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    MV-ILPA might be a feasible alternative for adults who are not willing or able to exercise in leisure time due to the high participation barrier of structured activities.

    “MV-ILPA might be a feasible alternative for adults who are not willing or able to exercise in leisure time due to the high participation barrier of structured activities.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Vigorous exercise programmes (eg, high intensity interval training) have low participation rates among middle-aged and older adults and might not be appealing to physically inactive adults who are at the highest risk of cardiovascular events.

    “Although vigorous physical activity is a time-efficient way to achieve health targets, vigorous exercise programmes (eg, high intensity interval training) have low participation rates among middle-aged and older adults [11][12][13] and might not be appealing to physically inactive adults who are at the highest risk of cardiovascular events.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [11] Lachman, 2018, When adults don't exercise: behavioral strategies to increase physical activity in sedentary middle-aged and older adults, Innov Aging source

      Not checked in the free run.

    • cites [12] Oja, 2017, Associations of specific types of sports and exercise with all-cause and cardiovascular-disease mortality: a cohort study of 80 306 British adults, Br J Sports Med source

      Not checked in the free run.

    • cites [13] O'Donovan, 2017, Association of “weekend warrior” and other leisure time physical activity patterns with risks for all-cause, cardiovascular disease, and cancer mortality, JAMA Intern Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Premisecitation

    MV-ILPA requires no time commitment or preparation, no specialist equipment or facilities, and as such might be more practical and accessible than prolonged exercise done during leisure time, particularly among physically inactive and middle-aged to older adults (≥40 years) who are unfit and unaccustomed to exercise.

    “Due to the incidental nature of MV-ILPA bouts, this type of activity requires no time commitment or preparation, no specialist equipment or facilities, and as such might be more practical and accessible than prolonged exercise done during leisure time, particularly among groups at risk, such as physically inactive and middle-aged to older adults (≥40 years) who are unfit and unaccustomed to exerc”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Stamatakis, 2021, Untapping the health enhancing potential of vigorous intermittent lifestyle physical activity (VILPA): rationale, scoping review, and a 4-pillar research framework, Sports Med source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    These studies did not have granularity in their physical activity assessments to examine short bouts of activity and considered all bouts of less than 10 min or 15 min to be synonymous.

    “These studies, however, did not have granularity in their physical activity assessments to examine short bouts of activity and considered all bouts of less than 10 min or 15 min to be synonymous.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Adverse changes in cardiac structure are mitigated by physical activity, in part, through cardiomyocyte proliferation and improved sarcomeric relaxation.

    “Adverse changes in cardiac structure are mitigated by physical activity, in part, through cardiomyocyte proliferation and improved sarcomeric relaxation.31”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Wei, 2015, What do we know about the cardiac benefits of exercise?, Trends Cardiovasc Med source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    For the analysis of the percentage contribution of vigorous physical activity, we adjusted for MV-ILPA volume to minimise the possibility that any observed effects are attributed to the higher amounts of activity achieved through vigorous physical activity.

    “For the analysis of the percentage contribution of vigorous physical activity, we adjusted for MV-ILPA volume to minimise the possibility that any observed effects are attributed to the higher amounts of activity achieved through vigorous physical activity.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    To assess the robustness of our results to an alternative analytic approach, we performed a sensitivity dose-response analysis stratified by bout length for relative and absolute risk.

    “To assess the robustness of our results to an alternative analytic approach, we performed a sensitivity dose-response analysis stratified by bout length for relative and absolute risk.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    We did sensitivity analyses to minimise bias attributable to reverse causation by excluding underweight participants (BMI <18.5 kg/m2) and participants reporting a self-perceived rating of poor health.

    “We also did sensitivity analyses to minimise bias attributable to reverse causation by excluding underweight participants (BMI <18•5 kg/m²) and participants reporting a self-perceived rating of poor health.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    We used a negative control outcome of deaths or hospital admission from accidents (excluding cycling, self-harm, and falls incidence), an outcome that does not have an explicit mechanistic link to physical activity, to assess residual confounding.

    “We used a negative control outcome of deaths or hospital admission from accidents (excluding cycling, self-harm, and falls incidence), an outcome that does not have an explicit mechanistic link to physical activity, to assess residual confounding.22”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Hamer, 2019, Examining associations between physical activity and cardiovascular mortality using negative control outcomes, Int J Epidemiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    We calculated E-values to estimate the plausibility of bias from unmeasured confounding.

    “We calculated E-values to estimate the plausibility of bias from unmeasured confounding.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    When structured exercise is not a feasible, appealing, or accessible option, the findings support an important role for intermittent lifestyle (incidental) activity bouts and suggest that even bouts as short as 1 to <5 min are associated with better cardiovascular outcomes.

    “When structured exercise is not a feasible, appealing, or accessible option, our findings support an important role for intermittent lifestyle (incidental) activity bouts and suggest that even bouts as short as 1 to <5 min are associated with better cardiovascular outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The anti hypertensive effects of physical activity are related to improvements in lipid metabolism, improved endothelial tissue function, and decreased blood viscosity.

    “The anti hypertensive effects of physical activity are related to improvements in lipid metabolism, improved endothelial tissue function, and decreased blood viscosity.30”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Padilla, 2011, Vascular effects of exercise: endothelial adaptations beyond active muscle beds, Physiology source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    We did a sensitivity analysis for total mortality excluding participants with prevalent cardiovascular disease and cancer because adjustment for prevalent disease might not fully capture confounding.

    “We did a sensitivity analysis for total mortality excluding participants with prevalent cardiovascular disease and cancer because adjustment for prevalent disease might not fully capture confounding.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The protective associations of activity bouts of less than 10 or 15 min might not be consistent across the interval, and this has hindered the translation to public health messaging.

    “The protective associations of activity bouts of less than 10 or 15 min might not be consistent across the interval, and this has hindered the translation to public health messaging.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    We further included analyses using at least 10 min bouts as the reference group, and analyses with a more stringent bout grouping definition, which excluded participants with three bouts or fewer in the originally allocated MV-ILPA exposure group.

    “We further included analyses using at least 10 min bouts as the reference group, and analyses with a more stringent bout grouping definition, which excluded participants with three bouts or fewer in the originally allocated MV-ILPA exposure group.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Previous studies have found that more fragmented physical activity (activity done in shorter bouts) is associated with lower functional status and higher all-cause mortality risk.

    “Similarly, previous studies assessing physical activity fragmentation, or the transition probability between sedentary behaviour and physical activity, have found an association between more fragmented physical activity (ie, activity done in shorter bouts) with lower functional status and higher all-cause mortality risk.25,26”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [25] Wanigatunga, 2019, Association of total daily physical activity and fragmented physical activity with mortality in older adults, JAMA Netw Open source

      Not checked in the free run.

    • cites [26] Del Pozo Cruz, 2021, Associations between activity fragmentation and subjective memory complaints in middle-aged and older adults, Exp Gerontol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The model in part B was additionally adjusted for total MV-ILPA volume using the residual method.

    “The model in part B was additionally adjusted for total MV-ILPA volume using the residual method.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    This is the first study to examine the potential cardiovascular health benefits of short moderate-to-vigorous intensity bouts of intermittent, non-exercise physical activity done as part of daily living.

    “To our knowledge, this is the first study to examine the potential cardiovascular health benefits of short moderate-to-vigorous intensity bouts of intermittent, non-exercise physical activity done as part of daily living.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    In sensitivity analyses, we adjusted for clinical factors that might be mediators (baseline waist circumference, glycated haemoglobin, HDL, LDL, diastolic and systolic blood pressure, and triglycerides).

    “In sensitivity analyses, we adjusted for clinical factors that might be mediators (baseline waist circumference, glycated haemoglobin, HDL, LDL, diastolic and systolic blood pressure, and triglycerides).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The two activity domains (leisure time exercise and activities of daily living) might elicit similar cardiovascular adaptations, which in turn would have similar associations for cardiac events.

    “Our study demonstrates some cardiovascular benefits might also be attainable through intermittent MVPA bouts through activities of daily living, suggesting that the two activity domains (leisure time exercise and activities of daily living) might elicit similar cardiovascular adaptations, which in turn would have similar associations for cardiac events.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Variations in the dose-response curves between these two subtypes could be due to differing modifications in cardiovascular pathways affected by physical activity.

    “Variations in the dose-response curves between these two subtypes could be due to differing modifications in cardiovascular pathways affected by physical activity.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Hypertension is one of the most recognisable risk factors for cerebrovascular events.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Results after stratification by bout length were broadly consistent with the main analysis.

    “Results after stratification by bout length were broadly consistent with the main analysis (appendix pp 22-23).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The micropatterns of physical activity (short bouts of daily living activities) investigated might be complementary to traditional exercise strategies.

    “Since fewer than one in five middle-aged adults engage in regular exercise, 12,13 the so-called micropatterns of physical activity 5,27 (short bouts of daily living activities) we investigated might be complementary to traditional exercise strategies.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The benefits of exercise are often attributed to regularly repeated sessions of sustained activity.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    This study was reported in accordance with the STROBE guideline.

    “This study was reported in accordance with the STROBE guideline.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Studies have suggested total activity volume has a stronger association with lower mortality risk than the length of activity bouts.

    “Studies have suggested total activity volume has a stronger association with lower mortality risk than the length of activity bouts.23,24”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [23] Millard, 2021, Association of physical activity intensity and bout length with mortality: an observational study of 79,503 UK Biobank participants, PLoS Med source

      Not checked in the free run.

    • cites [24] Saint-Maurice, 2021, Estimated number of deaths prevented through increased physical activity among US adults, JAMA Intern Med

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    We used the residual method in which total MVPA was regressed on the bout exposure volume; the resulting residuals were independent variables in the analyses consistent with previous research assessing activity volume over a fixed time interval.

    “We therefore used the residual method in which total MVPA was regressed on the bout exposure volume.The resulting residuals were independent variables in the analyses consistent with previous research assessing activity volume over a fixed time interval.20,21”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [20] Paluch, 2022, Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts, Lancet Public Health source

      Not checked in the free run.

    • cites [21] Lee, 2019, Association of step volume and intensity with all-cause mortality in older women, JAMA Intern Med source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Of 103 684 UK Biobank participants who wore an accelerometer, 25 241 participants were included in the analysis of all-cause mortality.

    “Of 103 684 UK Biobank participants who wore an accelerometer, 25 241 participants were included in our analysis of all-cause mortality.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The model in part A for MACE was adjusted for age, sex, smoking status, alcohol consumption, sedentary behaviour, sleep duration, diet, non-MV-ILPA group volume, MVPA volume (from ≥10 min bouts), prevalent cancer, family history of cancer and cardiovascular disease, education, medication use, and frailty index.

    “The model in part A was adjusted for age, sex, smoking status, alcohol consumption, sedentary behaviour, sleep duration, diet, non-MV-ILPA group volume, MVPA volume (from ≥10 min bouts), prevalent cancer, family history of cancer and cardiovascular disease, education, medication use, and frailty index.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Despite these extensive precautionary measures, the potential for reverse causation caused by prodromal disease remains.

    “Despite these extensive precautionary measures, the potential for reverse causation caused by prodromal disease remains.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Due to the observational design, we cannot rule out the presence of unmeasured or residual confounding.

    “Due to the observational design, we cannot rule out the presence of unmeasured or residual confounding.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Strengths of our study include the sample of adults who do not exercise, which allowed us to investigate activities embedded into daily living and the use of accelerometers to objectively measure physical activity at a high resolution.

    “Strengths of our study include the sample of adults who do not exercise, which allowed us to investigate activities embedded into daily living and the use of accelerometers to objectively measure physical activity at a high resolution.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    The response rate to the UK Biobank was low; however previous work has shown that poor representativeness does not materially influence the associations between physical activity and all-cause or cardiovascular mortality.

    “The response rate to the UK Biobank was low; however previous work has shown that poor representativeness does not materially influence the associations between physical activity and all-cause or cardiovascular mortality.42”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Stamatakis, 2021, Is cohort representativeness passé? Poststratified associations of lifestyle risk factors with mortality in the UK Biobank, Epidemiology source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    MVPA precision for lifting heavy external loads might be underestimated with accelerometry.

    “MVPA precision for lifting heavy external loads might be underestimated with accelerometry.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Vigorous activity in our study was accrued in short bouts and is therefore distinct from previous studies limited to self-report that could only assess prolonged bouts of vigorous activity, lasting a minimum of 10-15 min.

    “Vigorous activity in our study was accrued in short bouts and is therefore distinct from previous studies limited to self-report that could only assess prolonged bouts of vigorous activity, lasting a minimum of 10-15 min.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    There was a median lag of 5.5 years between the UK Biobank baseline when covariate measurements were taken and the accelerometry study, although non-exerciser status and covariates were generally stable over time, with the exception of medication.

    “There was a median lag of 5•5 years between the UK Biobank baseline when covariate measurements were taken and the accelerometry study, although non-exerciser status and covariates were generally stable over time, with the exception of medication.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The effects of moderate intensity on cardiac improvements might be optimised from a few seconds of interspersed vigorous activity, which contrasts with the findings of previous questionnaire-based studies that suggested the need for sustained bouts of vigorous activity.

    “Our results suggest that the effects of moderate intensity on cardiac improvements might be optimised from a few seconds of interspersed vigorous activity, which contrasts with the findings of previous questionnaire-based studies that suggested the need for sustained bouts of vigorous activity.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The models in part A were adjusted for age, sex, smoking status, alcohol consumption, sedentary behaviour, sleep duration, diet, non-MV-ILPA group volume, MVPA volume (from ≥10 min bouts), prevalent cancer and cardiovascular disease, family history of cancer and cardiovascular disease, education, medication use, and frailty index.

    “The models in part A were adjusted for age, sex, smoking status, alcohol consumption, sedentary behaviour, sleep duration, diet, non-MV-ILPA group volume, MVPA volume (from ≥10 min bouts), prevalent cancer and cardiovascular disease, family history of cancer and cardiovascular disease, education, medication use, and frailty index.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The two-level physical activity scheme minimises false-positive intensity classification; however, misclassification of MVPA may still occur.

    “The two-level physical activity scheme minimises false-positive intensity classification; however, misclassification of MVPA may still occur.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The presence of these factors has been found to accentuate exertion-related cardiovascular events.

    “The presence of these factors has been found to accentuate exertion-related cardiovascular events.40,41”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [40] Franklin, 2020, Exercise-related acute cardiovascular events and potential deleterious adaptations following long-term exercise training: placing the risks into perspective–an update: a scientific statement from the American Heart Association, Circulation source

      Not checked in the free run.

    • cites [41] Eijsvogels, 2016, Exercise at the extremes: the amount of exercise to reduce cardiovascular events, J Am Coll Cardiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    Such mechanistic pathways might explain the associations we observed among our sample of adults who do not exercise.

    “Such mechanistic pathways might explain the associations we observed among our sample of adults who do not exercise.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Short bouts of MV-ILPA accumulated throughout the day in the domestic, occupational, and transportation domains might lower mortality and MACE risk.

    “Our findings suggest short bouts of MV-ILPA accumulated throughout the day in the domestic, occupational, and transportation domains might lower mortality and MACE risk.”
    Quote in the paperSubstantial claim
69 of 69

  • The paper relies on this without support.

    The benefits of exercise are often attributed to regularly repeated sessions of sustained activity.

    “The benefits of exercise are often attributed to regularly repeated sessions of sustained activity.”

  • The paper relies on this without support.

    Hypertension is one of the most recognisable risk factors for cerebrovascular events.

    “One of the most recognisable risk factors for cerebrovascular events is hypertension.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Percentage of participants with a college or university degree is incorrect

    Minor

    The stated count of 9114 among 25 241 participants is 36.1%, not 36.8%. The participant-characteristics table reports 36.1% for the same count.

    Reported 36.8 · recomputed 36.10792

1 of 1

The citation lists haven’t been fetched yet

References 42 · Cited by 172

Authors
Ahmadi, M. N., Hamer, M., Gill, J. M. R., Murphy, M., Sanders, J. P., Doherty, A., & Stamatakis, E.
Affiliations
  • The University of Sydney (AU)
  • University College London (GB)
  • University of Glasgow (GB)
  • University of Ulster (GB)
  • Loughborough University (GB)
  • University of Oxford (GB)
Corresponding author
Ahmadi, Matthew N
ORCID
Venue
The Lancet Public Health
Publisher
Elsevier BV
Published
2023-10
Volume
8
Issue
10
Pages
e800-e810
ISSN
2468-2667 (ISSN-L)
DOI
10.1016/s2468-2667(23)00183-4
OpenAlex
W4387150518
Semantic Scholar
892d9adad4cf84b2efd9d3c6b17b156d9b1ce86f
Cited by
172
References
42
Citations by year
2026: 48 · 2025: 56 · 2024: 65 · 2023: 3
FWCI
30.37
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Public Health (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
  • UCL Discovery (University College London) (submittedVersion, cc-by-nc-nd)
  • Ulster University Research Portal (Ulster University) (submittedVersion, cc-by-nc-nd)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by-nc-nd)
Funders
  • Wellcome Trust (223100/Z/21/Z, 25813)
  • National Health and Medical Research Council (APP1180812, APP 1194510)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Context-Aware Activity Recognition Systems
Keywords
intermittent exercise, physical activity bouts, moderate-to-vigorous physical activity, all-cause mortality, major adverse cardiovascular events, accelerometer-measured activity, dose-response relationship, UK Biobank, sedentary lifestyle, cardiovascular risk factors, alcohol consumption, body mass index, physical activity guidelines
MeSH terms
Adult, Australia, Cardiovascular Diseases, Female, Humans, Life Style, Male, Middle Aged, Prospective Studies, Exercise, Sedentary Behavior

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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