Leisure Time Physical Activity and Mortality: A Detailed Pooled Analysis of the Dose-Response Relationship

By H. Arem, S. Moore, Alpa V. Patel, P. Hartge, A. D. de González, K. Visvanathan, P. Campbell, Michal Freedman, E. Weiderpass, H. Adami and 3 more. JAMA Internal Medicine, 2015

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Importance The 2008 Physical Activity Guidelines for Americans recommended a minimum of 75 vigorous-intensity or 150 moderate-intensity minutes per week (7.5 metabolic equivalent hours per week (MET h/wk)) of aerobic activity for “substantial” health benefit, and suggested “additional” benefits by doing more than double this amount. However, the upper limit of longevity benefit or possible harm with more physical activity is unclear. Objective To quantify the dose-response association between leisure-time physical activity and mortality, and to define the upper limit of benefit or harm associated with more physical activity. Design We pooled data from six studies in the NCI Cohort Consortium (baseline 1992–2003). We used Cox proportional hazards regression with cohort stratification to generate multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI). Median follow-up time was 14.2 years. Setting Population-based prospective cohorts in the U.S. and Europe with self-reported physical activity. Participants 661,137 men and women (116,686 deaths); median age 62 (range 21–98) years. Exposure Leisure-time moderate- to vigorous-intensity physical activity Main Outcome Mortality Results Compared to those reporting no leisure-time physical activity, we observed a 20% lower mortality risk among those performing less than the recommended 7.5 MET h/wk minimum (HR=0.80, 95% CI 0.78–0.82), a 31% lower risk at 1–2 times the recommended minimum (0.69, 0.67–0.70), and a 37% lower risk at 2–3 times the minimum (0.63, 0.62–0.65). An upper threshold for mortality benefit occurred at 3–5 times the physical activity recommendation (0.61, 0.59–0.62), but compared to the recommended minimum, the additional benefit was modest (31% vs. 39%). There was no evidence of harm at 10+ times the recommended minimum (0.68, 0.59–0.78). A similar dose-response was observed for mortality due to cardiovascular disease and to cancer. Conclusions and Relevance Meeting the Guideline minimum by either moderate- or vigorous-intensity activities was associated with nearly the maximum longevity benefit. We observed a benefit threshold around 3–5 times the recommended leisure-time physical activity minimum, and no excess risk at 10+ times the minimum. In regard to mortality, clinicians should encourage inactive adults to perform leisure-time physical activity and do not need to discourage adults who already participate in high activity levels.

Subfields: Oncology, Physiology, Public Health, Environmental and Occupational Health

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