Key points
A question
What is the optimal combination of moderate aerobic physical activity (MPA), vigorous aerobic physical activity (VPA), and muscle-strengthening activity (MSA) to reduce the risk of all-cause mortality, cardiovascular disease, and cancer?
Findings
In this cohort study of 500,705 participants, the combined balanced amounts of MPA, VPA, and MSA were associated with a lower risk of mortality. These risk reductions may be greater for higher-vigorous and moderate-intensity aerobic physical activity than current recommendations for all-cause mortality and cancer mortality, respectively.
Meaning
Combined balanced levels of MPA, VPA, and MSA may be associated with optimal mortality risk reduction.
Importance
Studies examining the associations of various combinations of intensity-specific aerobic and muscle-strengthening activity (MSA) with all-cause mortality and all-cause mortality are scarce; the few estimates available are different.
Objective
To investigate the prospective associations of various combinations of moderate aerobic physical activity (MPA), vigorous aerobic physical activity (VPA) and MSA with all-cause mortality, cardiovascular disease (CVD) and cancer.
Design, setting and participants
This nationwide prospective cohort study used data from the US National Health Interview Survey. A total of 500,705 eligible US adults were enrolled in the study and followed for a median of 10.0 years (5.6 million person-years) from 1997 to 2018. Data were analyzed from September 1 to September 30 2022
Exposures
Self-reported cumulative episodes (75 weekly minutes) of MPA and VPA with recommended MSA guidelines (yes or no) to yield 48 mutually exclusive exposure categories.
Main outcomes and measures
All-cause, CVD and cancer mortality. Participants were linked to the National Death Index through December 31, 2019.
Results
A total of 500,705 participants (avg [SD] age, 46.4 [17.3] years; 210 803 [58%] female; 277,504 [77%] White) were included in the study. Compared with the reference group (doing no MPA or VPA and less than the recommended MSA), the category associated with the lowest hazard ratio (HR) for all-cause mortality was more than 0 to 75 minutes of MPA combined with more than 150 minutes of VPA and 2 or more MSA sessions per week (HR, 0.50; 95% CI, 0.42-0.59). The optimal combinations for reducing CVD risk and cancer mortality were more than 150 to 225 minutes of MPA, more than 0 to 75 minutes of VPA, and 2 or more MSA sessions per week (HR, 0.30; 95% CI, 0.15 -0.57) and more than 300 minutes of MPA, more than 0 to 75 minutes of VPA, and 2 or more MSA sessions per week (HR, 0.44; 95% CI, 0.23-0.82), respectively. Adjusted mortality rates represent an approximately 50% lower mortality rate for all-cause and cancer mortality and an approximately 3-fold lower mortality rate for CVD mortality.
Conclusions and relevance
This cohort study demonstrated that combined balanced levels of MPA, VPA, and MSA may be associated with optimal mortality risk reduction. Higher-than-recommended levels of MPA and VPA may further reduce cancer risk and overall mortality.