Association of accelerometer-measured physical activity and sedentary behavior with incident cardiovascular disease, myocardial infarction, and ischemic stroke: The women's health study
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Background Few studies have investigated associations of acclerometer-based assessments of physical activity (PA) and sedentary behavior (SB) with incidence of cardiovascular disease (CVD) and its components. This prospective cohort study assessed the associations of accelerometer-measured PA and SB with total CVD, myocardial infarction, and ischemic stroke (IS). Methods and Results The authors included 16 031 women aged 62 years and older, free of CVD, with adherent accelerometer wear (≥10 hours/day for ≥4 days) from the Women's Health Study (mean age, 71.4 years [SD, 5.6 years]). Hip-worn ActiGraph GT3X+ accelerometers measured total volume of PA (total average daily vector magnitude), minutes per day of high-light PA and moderate to vigorous PA (MVPA), and SB. Women reported diagnoses of CVD, which were adjudicated using medical records and death certificates. Hazard ratios (HRs) were estimated for each exposure, and 95% CIs using Cox proportional hazards models were adjusted for accelerometer wear time, age, self-reported general health, postmenopausal hormone therapy, smoking status, and alcohol use. The hypothetical effect of replacing 10 minutes/day of SB or high-light PA with MVPA on CVD incidence was assessed using adjusted isotemporal substitution Cox models. Over a mean of 7.1 years (SD, 1.6 years) of follow-up, 482 total CVD cases, 107 myocardial infarction cases, and 181 IS cases were diagnosed. Compared with the lowest quartiles of total average daily vector magnitude and MVPA (≤60 minutes), women who were in the highest quartiles (>120 minutes of MVPA) had a 43% (95% CI, 24%-58%) and 38% (95% CI, 18%-54%) lower hazard of total CVD, respectively. Estimates were similar for total average daily vector magnitude and MVPA with IS, but PA was not associated with myocardial infarction overall. High-light PA was not associated with any CVD outcomes. Women who spent <7.4 hours sedentary per day had a 33% (95% CI, 11%-49%) lower hazard of total CVD compared with those who spent ≥9.5 hours sedentary. Replacing 10 minutes of SB with MVPA was associated with a 4% lower incidence of total CVD (HR, 0.96 [95% CI, 0.93-0.99]). Conclusions Accelerometer-assessed total PA and MVPA were inversely associated with total CVD and IS incidence, and SB was directly associated with total CVD; high-light PA was not related to CVD.
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The existing evidence regarding associations between light-intensity physical activity and risks for developing cardiovascular events in the general population is conflicting.
“The existing evidence regarding associations between LPA and risks for developing cardiovascular events in the general population is conflicting.13, 14, 15, 16”
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“Additionally, regular physical activity and minimization of sedentary behavior reduce the incidence of IS, MI, and cardiovascular disease (CVD) related deaths [14–16].”
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“15 Recently, a growing number of studies has explored the potential of PA and sleep monitoring with accelerometers to predict CeVD 16–19 ; however, subsequent findings are limited by small sample sizes and the exclusion of underdiagnosed and less prevalent CeVDs, like retinal artery occlusion.”
Leveraging the accelerometer data for precise blood pressure assessment and management
Veetil, J. C., Gunasekaran, I., Riaz, Z., & Keramat, A. (2023) · Sensing and Bio-Sensing Research · doi:10.1016/j.sbsr.2023.100612 · Cited by 6 · see citing works
Lin, Y., Li, X., Hu, M., Zhao, J., & Zhu, C. (2024) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003601 · Cited by 6 · see citing works
“However, recent investigations focusing on IS as a single endpoint re-ported no association between sedentary time and IS when using accelerometry data (7).”
InfluentialNiu, Y., Chen, X., & Feng, L. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1511888 · Cited by 4 · see citing works
“In this context, sedentary lifestyles are becoming increasingly prevalent in modern society, posing a signi fi cant threat to cardiovascular health (1, 2).”
Yu, L.-H., & Zhang, G.-L. (2024) · Journal of Cardiovascular Translational Research · doi:10.1007/s12265-024-10530-w · Cited by 4 · see citing works
Prevalência do infarto agudo do miocárdio em mulheres e fatores de risco associados
Caires, O. M. R., Silva, A. C. B., Almeida, A. I., Soares, C. A. D. R. U., Xavier, G. R., Goulart, J. R. C. S., Machado, K. G., de Oliveira, K. P., Santos, L. R. M. D., Zanolla, L. H. F. P., et al. (2024) · Brazilian Journal of Implantology and Health Sciences · doi:10.36557/2674-8169.2024v6n8p1361-1372 · Cited by 2 · see citing works
Dong, X.-F., Zhang, Q., Wei, J.-N., Zhou, Q.-Y., Yang, F., Liu, Y.-J., Li, Y.-S., & Sun, C.-Q. (2024) · Nature and Science of Sleep · doi:10.2147/nss.s482276 · Cited by 2 · see citing works
“22 These congruent findings underscore the potential of non-pharmacological interventions, focused on elevating daily PA levels and reducing SB, to significantly lower the risk of stroke.”
BackgroundXu, C., Zhang, Q., Xu, S., Xiao, Y., Zhao, L., Li, T.-J., Guo, W.-J., Zhong, Y., & Chen, H.-T. (2025) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2025-002547 · Cited by 1 · see citing works
“Further investigation is needed to validate these findings.”
Metabolic Status and Atrioventricular Block Risk: The Role of Physical Activity
Chung, H.-G., Yang, P., Jang, E., Joung, D., Kim, D., Yu, H. T., Kim, T., Uhm, J., Sung, J., Pak, H., et al. (2025) · Reviews in Cardiovascular Medicine · doi:10.31083/rcm37291 · Cited by 1 · see citing works
“Many previous studies have used a 7-day accelerometer workup to measure more precise and accurate physical activity, even though short-term monitoring of physical activity could introduce measurement errors due to seasonal or temporary behavioral changes [21,22].”
Hoepel, S. J. W., Ikram, M. K., Ikram, M. A., Voortman, T., & Luik, A. I. (2025) · Journal of Sleep Research · doi:10.1111/jsr.70166 · Cited by 1 · see citing works
DeMarco, E. C., Lindish, J., Bradford, E. H., & Longhurst, J. K. (2025) · Journal of Physical Activity and Health · doi:10.1123/jpah.2024-0583 · Cited by 1 · see citing works
Sun, X., Zhou, Z., Guo, J., Tian, Z., & Gu, N. (2026) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2026.1708003 · Cited by 1 · see citing works
“Furthermore, the effect of activity intensity on cardiovascular clinical outcomes demonstrated a clear threshold effect, with SB replacement with MVPA significantly reducing CVD risk, whereas HLPA replacement did not show a significant risk reduction (39, 43).”
InfluentialExercise training for the prevention and treatment of cardiometabolic disease
Kong, S., Foulkes, S., & Peters, A. E. (2026) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000001288 · Cited by 2 · see citing works
APTIDÃO FÍSICA, SAÚDE MENTAL E NUTRIÇÃO NO ADOLESCENTE
da Silva, L. P., Lima, G. D. S. O., Noleto, D. C. D. S., & do Nascimento, M. A. (2023) · doi:10.22533/at.ed.3512328097
EXERCÍCIO FÍSICO E ANSIEDADE NO ADOLESCENTE
Rabelo, A. S., de Oliveira, K. H. D. S., Abreu, L. M. S., Correia, M. B., & RIBEIRO, F. B. (2023) · doi:10.22533/at.ed.3512328092
Exercício físico e saúde do adolescente
Dias, C. J. M., Filho, C. A. A. D., Mostarda, C. T., & Costa, H. A. (2023) · doi:10.22533/at.ed.351232809
DEFINIÇÕES E CLASSIFICAÇÃO DA ADOLESCÊNCIA
Pereira, M. E. V., Oliveira, N. G., Ribeiro, P. R. F., da Silva, T. M. C., & Dias, C. J. M. (2023) · doi:10.22533/at.ed.3512328091
ASPECTOS ETIOPATOGÊNICOS DO CÂNCER DE TESTÍCULO EM ADOLESCENTES E SEU IMPACTO NA SAÚDE MENTAL
Filho, C. A. A. D., Ferreira, F. D., Ferreira, F. R. D., Carneiro, J. G. P., Neto, J. C. G. P., & Cardoso, M. E. S. (2023) · doi:10.22533/at.ed.3512328096
EXERCÍCIO FÍSICO E ADOLESCÊNCIA
Soares, N. D. J. S., Pires, F. D. O., & Cavalcante, L. F. P. (2023) · doi:10.22533/at.ed.3512328093
COMPORTAMENTO PARENTAL ASSOCIADO A FATORES DE RISCO CARDIOVASCULAR EM ADOLESCENTES
Costa, H. A., Rabelo, A. S., Costa, V. D. A. M., da Silva, F. E. L., & Pinto, B. F. P. (2023) · doi:10.22533/at.ed.3512328098
ASPECTOS E FATORES ASSOCIADOS À OBESIDADE NA ADOLESCÊNCIA
Durans, L. H. F., Miranda, T. D. C., Silva, H. N. D. S. E., Santos, E. R. V., Leitão, S., & Mostarda, C. T. (2023) · doi:10.22533/at.ed.3512328099
DIABETES MELLITUS TIPO 2 EM ADOLESCENTES E OS RISCOS DO DESENVOLVIMENTO DE INSUFICIÊNCIA CARDÍACA
Filho, C. A. A. D., de Carvalho, R. G. V., Carneiro, J. G. P., Neto, J. C. G. P., Rocha, L. T. S., & Rodrigues, P. A. V. (2023) · doi:10.22533/at.ed.3512328095
HIPERTENSÃO ARTERIAL NO ADOLESCENTE
Soares, N. D. J. S., Pires, F. D. O., & Cavalcante, L. F. P. (2023) · doi:10.22533/at.ed.3512328094
TREINAMENTO DE FORÇA, CRESCIMENTO E DESENVOLVIMENTO EM CRIANÇAS E ADOLESCENTES
Marques, R. F., & Ribeiro, R. M. (2023) · doi:10.22533/at.ed.35123280910
Łoboda, D., Stepanik, M., Durmała, J., Gardas, R., & Golba, K. S. (2023) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2410299
“Low physical activity and cardiorespiratory fitness (CRF) are strong and independent predictors of CV diseases, coronary artery events, and all-cause or CV mortality in the general population [1–4].”
BackgroundDong, X., Zhang, Q., Wei, J., Zhou, Q., Yangfan, J., Liu, Y., Li, Y., & Sun, C. (2024) · SSRN Electronic Journal · doi:10.2139/ssrn.4796043
Liao, Y., Deng, Y., Yu, C., Chen, X., Zhang, P., Wang, S., Zhou, M., Ling, W., Chen, X., & Xue, H. (2025) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2025.101272
Chen, G., Ren, J., Shen, Y., Zheng, K., Cai, Y., & Ni, X. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.108719
Cheon, D. Y., Han, K. D., Lee, Y. J., Lee, J. H., Park, M. S., Kim, D. Y., Choi, J. H., Lee, S. J., Yu, K.-H., Han, S., et al. (2024) · Figshare · doi:10.6084/m9.figshare.25762950
Wang, H., Du, H., Chen, L., Xie, K., Cao, Y., Shen, Z., Lv, J., Yu, C., Sun, D. J. Y., Pei, P., et al. (2026) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2025.1612278
Huang, X. L., Gao, D., Zhang, W., Ji, M., Pan, Y., Zhang, Y., Dai, Y., Wu, A., Zheng, F., & Xie, W. (2026) · Biology of Sex Differences · doi:10.1186/s13293-026-00867-z
Pan, J., Wang, Z., He, Y., Liu, S., Zhang, K., Peng, J., Xu, C., Zhang, J., & Huang, P. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1792601
“Although foundational evidence highlighting these cardiovascular risks, such as the Women’s Health Study (25), was limited to female cohorts, our mixed-gender analysis extends this literature by confirming that these sedentary-driven mechanisms are broadly applicable across both sexes in stroke…”
Johnson, M. A. (2026) · Current Epidemiology Reports · doi:10.1007/s40471-026-00390-0
Dong, H., Han, C., Chen, Y., Zhang, Z., Xu, X., Wang, Y., Zhao, Z., Gao, X., & Sun, L. (2026) · Nutrition Journal · doi:10.1186/s12937-026-01358-y
“Higher duration and intensity of physical activity are consistently associated with lower risk of incident CVD [6–12], and even intermittent bouts of activity have demonstrated benefits [13–15].”
Dong, H., Wang, Y., Chen, Y., Han, C., Gao, W., Zhang, Z., Xu, X., 田芳, Ma, F., Zhao, Z., et al. (2026) · JACC Advances · doi:10.1016/j.jacadv.2026.103338
- Authors
- Peter‐Marske, K. M., Evenson, K. R., Moore, C. C., Cuthbertson, C. C., Howard, A. G., Shiroma, E. J., Buring, J. E., & Lee, I.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- East Carolina University (US)
- National Institute on Aging (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Peter‐Marske, Kennedy M.
- ORCID
- Venue
- Journal of the American Heart Association
- Published
- 2023-04-04
- Volume
- 12
- Issue
- 7
- Pages
- e028180-e028180
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC10122899
- OpenAlex
- W4361190687
- Cited by
- 50
- References
- 56
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 16 · 2023: 14
- FWCI
- 8.88
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UNC Libraries
- Funders
- National Institutes of Health (5r01hl043851-10, HL-043851, CA182913)
- National Institute on Aging
- National Heart, Lung, and Blood Institute (R01HL080467, HL043851, R01‐HL043851, HL099355, HL007055, RC1HL099355, and HL099355, HL080467, CA182913, CA047988, T32HL007055)
- National Cancer Institute (HL-080467, HL-099355, CA182913, R01CA227122, HL-043851, CA 047988, UM1CA182913, R01CA154647, R01CA047988, U01CA182913)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Context-Aware Activity Recognition Systems
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- physical activity, sedentary behavior, cardiovascular disease, myocardial infarction, ischemic stroke, moderate-to-vigorous physical activity, accelerometer-measured activity, older women, isotemporal substitution, cardiovascular risk reduction, Women's Health Study, hormone replacement therapy, smoking, alcohol consumption, postmenopausal women
- MeSH terms
- Ischemic Stroke, Aged, Cardiovascular Diseases, Female, Humans, Myocardial Infarction, Prospective Studies, Exercise, Women's Health, Sedentary Behavior, Accelerometry
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