Association of Leisure-Time Physical Activity Across the Adult Life Course With All-Cause and Cause-Specific Mortality | Adolescent Medicine | JAMA Network Open | JAMA Network
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    2 Comments for this article
    Personal SURVIVAL Plan
    Paul Nelson, M.D., M.S. | Family Health Care, P.C. retired
    The underlying character for each person's HEALTH originates within their Family as a dependent person. Of the many attributes of a person's Family, the traditions underlying its responsibility to form the dimension's of a Personal SURVIVAL Plan for each Family member may be most important. I offer a possible view for the dimensions of such a PLAN at:
    Assessment of the intensity of physical acitivity (PA) and the ARP Risk Factor Questionnaire
    Domenico Di Raimondo, MD, PhD | Promise Department, University of Palero
    Data collected by Saint-Maurice and colleagues are of great interest and give a very strong message about improving awareness of becoming physically active also later in life, although further analysis is needed in non-US populations to confirm (or not) these interesting findings.
    A concern raises regarding the assessment of the intensity of physical activity (PA) in this study. According to the ARP Risk Factor Questionnaire (eFigure 1), the intensity of PA is only investigated providing some examples of "moderate and vigorous activities".
    1) Every of the activities listed could have a different level of perceived intensity, variable from
    a subject to another representing a possible bias of under/overestimation of the intensity of PA.
    2) "heavy gardening, cheerleading or heavy housework" are listed as examples of moderate and vigorous activities in the same way as "swimming, weight lifting or climbing mountains"; probably some differences in objective/perceived intensity might be observed between these types of PA.
    3) according to available data health benefit associated with moderate intensity PA are quite different than vigorous intensity PA (Wen CP, Wai JP, Tsai MK, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet. 2011 Oct 1;378(9798):1244-53). Standardise the data without distinguish between moderate intensity and vigorous intensity PA could not allow authors to identify an adequate amount of PA to guarantee health benefit, nevertheless this is not the aim of the present study.
    Original Investigation
    March 8, 2019

    Association of Leisure-Time Physical Activity Across the Adult Life Course With All-Cause and Cause-Specific Mortality

    Author Affiliations
    • 1Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
    • 2Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
    • 3Health Economics and Evidence Synthesis Group, Institute of Health and Society, Newcastle University, United Kingdom
    • 4Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California
    • 5Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic, Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
    JAMA Netw Open. 2019;2(3):e190355. doi:10.1001/jamanetworkopen.2019.0355
    Key Points español 中文 (chinese)

    Question  Does an association exist between patterns in leisure-time physical activity occurring during adolescence (15-18 years of age) or early (19-29 years of age), middle (35-39 years of age), and later (40-61 years of age) adulthood and all-cause or cause-specific mortality?

    Findings  This cohort study of 315 059 participants found that maintaining physical activity from adolescence into later adulthood was associated with 29% to 36% lower risk for all-cause mortality and that being inactive but increasing physical activity during midlife was associated with 32% to 35% lower risk for mortality.

    Meaning  Although long-term participation in physical activity may be important to lower mortality risk, the present study provides evidence that becoming physically active later in adulthood (40-61 years of age) may provide comparable health benefits.


    Importance  Although the benefits of leisure-time physical activity (LTPA) in middle age are established, the health effects of long-term participation and changes in LTPA between adolescence and middle age have not been documented.

    Objective  To determine whether an association exists between LTPA life course patterns and mortality.

    Design, Setting, and Participants  This prospective cohort study used data from the National Institutes of Health–AARP (formerly American Association of Retired Persons) Diet and Health Study established in 1995 to 1996. Data analysis was conducted from March 2017 through February 2018. Data were analyzed for 315 059 adult AARP members living in 6 states, namely, California, Florida, Louisiana, New Jersey, North Carolina, or Pennsylvania, or 2 metropolitan areas, Atlanta, Georgia, or Detroit, Michigan.

    Exposures  Self-reported LTPA (hours per week) at the baseline interview for ages grouped as 15 to 18, 19 to 29, 35 to 39, and 40 to 61 years.

    Main Outcomes and Measures  All-cause, cardiovascular disease (CVD)–related, and cancer-related mortality records available through December 31, 2011.

    Results  Of 315 059 participants, 183 451 (58.2%) were men, and the participants were 50 to 71 years of age at enrollment. Ten LTPA trajectories (categorized as maintaining, increasing, and decreasing LTPA across time) were identified, and 71 377 deaths due to all causes, 22 219 deaths due to CVD, and 16 388 deaths due to cancer occurred. Compared with participants who were consistently inactive throughout adulthood, participants who maintained the highest amount of LTPA in each age period were at lower risks for all-cause, CVD-related, and cancer-related mortality. For example, compared with participants who were consistently inactive, maintaining higher amounts of LTPA was associated with lower all-cause (hazard ratio [HR], 0.64; 95% CI, 0.60-0.68), CVD-related (HR, 0.58; 95% CI, 0.53-0.64), and cancer-related (HR, 0.86; 95% CI, 0.77-0.97) mortality. Adults who were less active throughout most of the adult life course but increased LTPA in later adulthood (40-61 years of age) also had lower risk for all-cause (HR, 0.65; 95% CI, 0.62-0.68), CVD-related (HR, 0.57; 95% CI, 0.53-0.61), and cancer-related (HR, 0.84; 95% CI, 0.77-0.92) mortality.

    Conclusions and Relevance  Maintaining higher LTPA levels and increasing LTPA in later adulthood were associated with comparable low risk of mortality, suggesting that midlife is not too late to start physical activity. Inactive adults may be encouraged to be more active, whereas young adults who are already active may strive to maintain their activity level as they get older.