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Cited by 289Physical Activity and HealthCardiovascular and exercise physiologyCardiovascular Effects of Exercise

Long-Term leisure-time physical activity intensity and all-cause and cause-specific mortality: a prospective cohort of US adults

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Lee, Dong Hoon, Rezende, Leandro F.M., Joh, Hee-Kyung, Keum, NaNa, Ferrari, Gerson, Rey-Lopez, Juan Pablo, Rimm, Eric B., Tabung, Fred K. +1 more·2022·Circulation
DOI 10.1161/circulationaha.121.058162PMC PMC9378548
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Abstract

BACKGROUND: The 2018 physical activity guidelines for Americans recommend a minimum of 150 to 300 min/wk of moderate physical activity (MPA), 75 to 150 min/wk of vigorous physical activity (VPA), or an equivalent combination of both. However, it remains unclear whether higher levels of long-term VPA and MPA are, independently and jointly, associated with lower mortality. METHODS: A total of 116 221 adults from 2 large prospective US cohorts (Nurses' Health Study and Health Professionals Follow-up Study, 1988-2018) were analyzed. Detailed self-reported leisure-time physical activity was assessed with a validated questionnaire, repeated up to 15 times during the follow-up. Cox regression was used to estimate the hazard ratio and 95% CI of the association between long-term leisure-time physical activity intensity and all-cause and cause-specific mortality. RESULTS: During 30 years of follow-up, we identified 47 596 deaths. In analyses mutually adjusted for MPA and VPA, hazard ratios comparing individuals meeting the long-term leisure-time VPA guideline (75-149 min/wk) versus no VPA were 0.81 (95% CI, 0.76-0.87) for all-cause mortality, 0.69 (95% CI, 0.60-0.78) for cardiovascular disease (CVD) mortality, and 0.85 (95% CI, 0.79-0.92) for non-CVD mortality. Meeting the long-term leisure-time MPA guideline (150-299 min/wk) was similarly associated with lower mortality: 19% to 25% lower risk of all-cause, CVD, and non-CVD mortality. Compared with those meeting the long-term leisure-time physical activity guidelines, participants who reported 2 to 4 times above the recommended minimum of long-term leisure-time VPA (150-299 min/wk) or MPA (300-599 min/wk) showed 2% to 4% and 3% to 13% lower mortality, respectively. Higher levels of either long-term leisure-time VPA (≥300 min/wk) or MPA (≥600 min/wk) did not clearly show further lower all-cause, CVD, and non-CVD mortality or harm. In joint analyses, for individuals who reported <300 min/wk of long-term leisure-time MPA, additional leisure-time VPA was associated with lower mortality; however, among those who reported ≥300 min/wk of long-term leisure-time MPA, additional leisure-time VPA did not appear to be associated with lower mortality beyond MPA. CONCLUSIONS: The nearly maximum association with lower mortality was achieved by performing ≈150 to 300 min/wk of long-term leisure-time VPA, 300 to 600 min/wk of long-term leisure-time MPA, or an equivalent combination of both.

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  • These findings may in part explain why moderate and vigorous physical activity beyond a specific amount of time does not offer additional reduction in mortality risk, thereby exhibiting a nadir in the dose-response relationship.

    “These findings may in part explain why moderate and vigorous physical activity beyond a specific amount of time does not offer additional reduction in mortality risk, thereby exhibiting a nadir in the dose–response relationship.32,33”

    From Lifelong endurance exercise and its relation with coronary atherosclerosis (2023) · cites this paper as [33]

  • No positive or negative association with cardiovascular disease and all-cause mortality was observed beyond the WHO-recommended physical activity level.

    “However, no positive-or negative-association was observed beyond this level.”

    From Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation (2023) · cites this paper as [3]

  • In a 30-year follow-up of 116,221 adults, self-reported leisure-time moderate and vigorous physical activity were independently and inversely associated with cardiovascular disease and all-cause mortality risk.

    “In a large (n = 116 221) 30-year follow-up, both self-reported leisuretime MPA and VPA were independently and inversely associated with CVD and all-cause mortality risk”

    From Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation (2023) · cites this paper as [3]

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Authors
Lee, D. H., Rezende, L. F. M., Joh, H.-K., Keum, N., Ferrari, G., Rey-Lopez, J. P., Rimm, E. B., Tabung, F. K., & Giovannucci, E. L.
Affiliations
  • Harvard University (US)
  • Universidade Federal de São Paulo (BR)
  • Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Santiago, Chile (G.F.).
  • Faculty of Health Sciences, International University of Valencia (VIU), Spain (J.P.R.-L.).
  • Brigham and Women's Hospital (US)
Corresponding author
Lee, Dong Hoon
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2022-08-16
Volume
146
Issue
7
Pages
523-534
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.121.058162
PMC
PMC9378548
OpenAlex
W4287219229
Cited by
288
References
32
Citations by year
2026: 60 · 2025: 102 · 2024: 74 · 2023: 45 · 2022: 7
FWCI
35.41
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Seoul National University Open Repository (Seoul National University) (submittedVersion)
Funders
  • National Institutes of Health (CA-167552, CA 87969)
  • National Cancer Institute (P01CA087969, UM1CA186107, UM1CA167552, P30CA016058, U01CA167552)
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, physical activity intensity, high-intensity exercise, moderate physical activity, all-cause mortality, cardiovascular mortality, non-CVD mortality, physical activity guidelines, long-term physical activity, Nurses' Health Study, Health Professionals Follow-up Study, dose-response relationship, physical activity frequency, physical activity timing
MeSH terms
Adult, Cardiovascular Diseases, Cause of Death, Follow-Up Studies, Humans, Leisure Activities, Prospective Studies, Exercise

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