Research Highlights:
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An analysis of more than 100,000 participants over a 30-year follow-up period found that adults who do two to four times the currently recommended amount of moderate or vigorous physical activity per week have a significantly reduced risk of mortality, according to new research. published in Circulation , the flagship peer-reviewed journal of the American Heart Association.
The reduction was 21 to 23 percent for people who did two to four times the recommended amount of vigorous physical activity, and 26 to 31 percent for people who did two to four times the recommended amount of moderate physical activity each week.
Summary
Background :
The 2018 Physical Activity Guidelines for Americans recommend a minimum of 150 to 300 min/week of moderate physical activity (MPA), 75 to 150 min/week of vigorous physical activity (VPA), or an equivalent combination of both. However, it is unclear whether higher long-term VPA and MPA levels are independently and jointly associated with lower mortality.
Methods:
A total of 116,221 adults were analyzed from 2 large US prospective cohorts (Nurses’ Health Study and Health Professionals Follow-up Study, 1988–2018). Self-reported leisure-time physical activity was assessed in detail with a validated questionnaire, repeated up to 15 times during 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 analyzes mutually adjusted for AMP and VPA, hazard ratios comparing individuals who met the long-term leisure-time VPA guideline (75–149 min/week) 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 0.69 (95% CI, 0.60–0.78) for cardiovascular disease (CVD) mortality. 85 (95% CI, 0.79–0.92) for non-CVD mortality.
Meeting the long-term leisure-time AMP guideline (150-299 min/week) was similarly associated with lower mortality: 19% to 25% lower risk of all-cause, CVD, and non-CVD mortality. CVD.
Compared with those who met long-term leisure-time physical activity guidelines, participants who reported 2 to 4 times the minimum recommended long-term leisure-time VPA (150–299 min/wk) or AMP (300–599 min/ wk) showed 2% to 4% and 3% to 13% less mortality, respectively.
Higher long-term leisure time VPA (≥300 min/week) or AMP (≥600 min/week) levels did not clearly show lower all-cause, CVD, and non-CVD mortality or harm.
In pooled analyses, for individuals reporting <300 min/week of long-term leisure-time VPA, additional leisure-time VPA was associated with lower mortality; however, among those who reported ≥300 min/week of long-term leisure-time AMP, additional leisure-time VPA did not appear to be associated with lower mortality beyond AMP.
Conclusions:
The near-maximal association with lower mortality was achieved by performing ≈150 to 300 min/week of long-term leisure-time VPA, 300 to 600 min/week of long-term leisure-time AMP, or an equivalent combination of both .
Comments
It is well documented that regular physical activity is associated with a lower risk of cardiovascular disease and premature death. In 2018, the U.S. Department of Health and Human Services’ Physical Activity Guidelines for Americans recommended that adults get at least 150 to 300 minutes a week of moderate physical activity or 75 to 150 minutes a week of physical activity vigorous or an equivalent combination of both intensities.
Current recommendations from the American Heart Association , which are based on the Physical Activity Guidelines, are at least 150 minutes per week of moderate-intensity aerobic exercise or 75 minutes per week of vigorous aerobic exercise, or a combination of both.
“The potential impact of physical activity on health is great, but it is still unclear whether engaging in high levels of prolonged, vigorous, or moderate-intensity physical activity above recommended levels provides additional benefits or harmful effects on cardiovascular health.” said Dong Hoon Lee, Sc.D., MS, research associate in the nutrition department at Harvard TH Chan School of Public Health in Boston. "Our study leveraged repeated measures of self-reported physical activity over decades to examine the association between long-term physical activity during middle and late adulthood and mortality."
The researchers analyzed mortality data and medical records from more than 100,000 adults collected from two large prospective studies: the all-female Nurses’ Health Study and the all-male Health Professionals Follow-up Study 1988-2018 . The participants whose data were examined were 63% female and more than 96% were white adults. They had an average age of 66 years and an average body mass index (BMI) of 26 kg/m2 during the 30-year follow-up period.
Participants self-reported their leisure-time physical activity by completing a validated questionnaire for the Nurses’ Health Study or the Health Professionals Follow-up Study every two years. The publicly available questionnaires, which were updated and expanded every two years, included questions about health information, physician-diagnosed illnesses, family medical history, and personal habits such as cigarette and alcohol consumption and exercise frequency.
Exercise data were reported as the average time spent per week in various physical activities over the past year. Moderate activity was defined as walking, low-intensity exercise, weight lifting, and calisthenics. Vigorous activity included jogging, running, swimming, cycling, and other aerobic exercise.
The analysis found that adults who engaged in twice the currently recommended range of moderate or vigorous physical activity each week had the lowest long-term mortality risk.
The analysis also found:
- Participants who met vigorous physical activity guidelines had a 31% lower observed risk of CVD mortality and a 15% lower risk of non-cardiovascular mortality, for a 19% lower overall risk of death from all causes.
- Participants who met moderate physical activity guidelines saw a 22-25% lower risk of CVD mortality and a 19-20% lower risk of non-cardiovascular mortality, for an overall 20-21% lower risk of death from all Causes.
- Participants who performed two to four times the recommended amount of long-term vigorous physical activity (150-300 min/week) had a 27-33% lower observed risk of CVD mortality and a 19% lower risk of non-CVD mortality. cardiovascular, for a total of 21 -23% lower risk of death from all causes.
- Participants who performed two to four times the recommended amount of moderate physical activity (300-600 min/week) had a 28-38% lower observed risk of CVD mortality and a 25-27% lower risk of non-cardiovascular mortality, for a total of 26- 31% lower risk of mortality from all causes.
Additionally, no harmful effects on cardiovascular health were found among adults who reported engaging in more than four times the minimum recommended activity levels. Previous studies have found evidence that long-term, high-intensity endurance exercise, such as marathons, triathlons, and long-distance cycling races, may increase the risk of adverse cardiovascular events, including myocardial fibrosis, coronary artery calcification , atrial fibrillation and cardiac death.
"This finding may reduce concerns about the possible harmful effect of engaging in high levels of physical activity observed in several previous studies," Lee noted.
However, engaging in long-term high-intensity physical activity (≥300 minutes/week) or moderate-intensity physical activity (≥600 minutes/week) at levels more than four times the recommended weekly minimum did not provide any additional reduction in Death risk.
“Our study provides evidence to guide people to choose the right amount and intensity of physical activity throughout their lives to maintain their overall health,” Lee said. "Our findings support current national physical activity guidelines and further suggest that maximum benefits may be achieved by engaging in medium to high levels of moderate or vigorous activity or a combination."
He also noted that people who do less than 75 minutes of vigorous activity or less than 150 minutes of moderate activity per week may have greater benefits in reducing mortality by consistently doing about 75 to 150 minutes of vigorous activity or 150 to 300 minutes of moderate exercise per week, or an equivalent combination of both, long term.
"We have long known that moderate and vigorous levels of physical exercise can reduce a person’s risk for both atherosclerotic cardiovascular disease and mortality," said Donna K. Arnett, MSPH, Ph.D., BSN, past president of the American Heart Association (2012-2013) and dean and professor of the department of epidemiology at the University of Kentucky College of Public Health in Lexington, Kentucky. Arnett served as co-chair of the writing committee for the 2019 American Heart Association Guideline on Primary Prevention of Cardiovascular Disease; however, she did not participate in the study.
"We’ve also seen that doing more than 300 minutes of moderate-intensity aerobic physical activity or more than 150 minutes of vigorous-intensity aerobic physical exercise each week can further reduce a person’s risk of atherosclerotic cardiovascular disease, so it makes sense "That doing those extra minutes of exercise can also reduce mortality."
Co-authors are Leandro FM Rezende, Sc.D.; Hee-Kyung Joh, M.D., Ph.D.; NaNa Keum, Ph.D.; Gerson Ferrari, Doctor of Philosophy; Juan Pablo Rey-López, Ph.D.; Eric B. Rimm, Ph.D.; Fred K. Tabung, Ph.D.; and Edward L. Giovannucci, MD, Sc.D. Author disclosures are listed in the manuscript.
The study was funded by the National Institutes of Health.
