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Original Investigation
November 23, 2020

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

Author Affiliations
  • 1Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
  • 2Department of Sociology and Institute for Empirical Social Science Research, School of Humanities and Social Sciences, Xi’an Jiaotong University, Xi’an, China
  • 3Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile CH, Santiago, Chile
  • 4i+HEALTH Research Group, Department of Health Sciences, Universidad Europea Miguel de Cervantes, Valladolid, Spain
  • 5Departamento de Medicina Preventiva, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brazil
JAMA Intern Med. 2021;181(2):203-211. doi:10.1001/jamainternmed.2020.6331
Key Points

Question  Is vigorous physical activity associated with additional mortality risk reduction compared with moderate physical activity?

Findings  In this cohort study of 403 681 participants, a higher proportion of vigorous physical activity to total moderate to vigorous physical activity was associated with statistically significantly lower all-cause mortality. For the same amount of total moderate to vigorous physical activity, participants with a greater proportion of vigorous physical activity to moderate physical activity had lower all-cause mortality.

Meaning  Although most of the health benefit associated with meeting recommended weekly physical exercise goals may be achieved through moderate physical activity, the results suggest that an increased proportion of vigorous physical activity is associated with additional health benefits.

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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    1 Comment for this article
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    RE: Association of physical activity intensity with mortality
    Tomoyuki Kawada, MD | Nippon Medical School
    Wang et al. reported the advantage of increasing the proportion of vigorous physical activity (VPA) to total physical activity for lowering mortality (1). By adjusting sociodemographic characteristics, lifestyle risk factors, and chronic conditions at baseline, moderate physical activity (MPA) of 150-299 minutes per week had the same lowering effect on all-cause and cardiovascular disease mortality with VPA of 75-149 minutes per week. In addition, VPA of 75-149 minutes per week showed a stronger inverse association with cancer mortality compared with MPA of 150-299 minutes per week. Furthermore, a higher proportion of VPA to total physical activity was associated with lower all-cause mortality. The authors emphasized a potential benefit of increasing the proportion of VPA to suppress mortality risk, and I have a comment about their study.

    Wang et al. cited a paper by Gebel et al. regarding the effect of moderate to vigorous PA on all-cause mortality (2), and Wang et al. revised information by separating PA into MPA and VPA. There is a recommendation of 150 minutes or more per week of MPA or equivalent physical load including VPA (3). The level of physical load might differ in subjects with different health conditions, and 30 minutes of MPA per day during week day might be reasonable by considering safety and health effects. Although risk reduction in mortality was observed by statistical analysis, the transition from MPA to VPA should be cautious. As many subjects have a difficulty of continuing MPA, VPA might be more difficult for keeping it as one of the healthy habits.

    References
    1. Wang Y, Nie J, Ferrari G, et al. Association of Physical Activity Intensity With Mortality: A National Cohort Study of 403 681 US Adults. JAMA Intern Med 2021;181(2):203-211.
    2. Gebel K, Ding D, Chey T, et al. Effect of Moderate to Vigorous Physical Activity on All-Cause Mortality in Middle-aged and Older Australians. JAMA Intern Med 2015;175(6):970-7.
    3. Piercy KL, Troiano RP, Ballard RM, et al. The Physical Activity Guidelines for Americans. JAMA 2018;320(19):2020-2028.
    CONFLICT OF INTEREST: None Reported
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