Do moderate-intensity and vigorous-intensity physical activities reduce mortality rates to the same extent?

Abstract

Background: Limited data exist directly comparing the relative benefits of moderate- and vigorous-intensity activities with all-cause and cardiovascular (CV) disease mortality rates when controlling for physical activity volume.

Methods and results: We followed 7979 men (Harvard Alumni Health Study, 1988-2008) and 38 671 women (Women's Health Study, 1992-2012), assessing their physical activity and health habits through repeated questionnaires. Over a mean follow-up of 17.3 years in men and 16.4 years in women, there were 3551 deaths (1077 from CV disease) among men and 3170 deaths (620 from CV disease) among women. Those who met or exceeded an equivalent of the federal guidelines recommendation of at least 150 minutes of moderate-intensity activity, 75 minutes of vigorous-intensity activity, or a combination of the 2 that expended similar energy experienced significantly lower all-cause and CV disease-related mortality rates (men, 28% to 36% and 31% to 34%, respectively; women: 38% to 55% and 22% to 44%, respectively). When comparing different combinations of moderate- and vigorous-intensity activity and all-cause mortality rates, we observed sex-related differences. Holding constant the volume of moderate- to vigorous-intensity physical activity, men experienced a modest additional benefit when expending a greater proportion of moderate- to vigorous-intensity physical activity in vigorous-intensity activities (Ptrend=0.04), but women did not (Ptrend<0.001). Moderate- to vigorous-intensity physical activity composition was not associated with further cardiovascular mortality rate reductions in either men or women.

Conclusions: The present data support guidelines recommending 150 minutes of moderate-intensity activity per week, 75 minutes of vigorous-intensity activity per week, or an equivalent combination for mortality benefits. Among men, but not women, additional modest reductions in all-cause mortality rates are associated with a greater proportion of moderate- to vigorous-intensity physical activity performed at a vigorous intensity.

Keywords: epidemiology; mortality; physical activity.

© 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Figures

Figure 1.

Hazard ratio of all‐cause mortality according to total physical activity volume, Harvard Alumni Health Study (1988–2008) and Women's Health Study (1992–2012). All values are hazard ratios (95% confidence intervals) unless otherwise specified. aTotal physical activity volume was calculated from walking, climbing stairs, and participating in leisure‐time activities. bAdditionally adjusted for smoking status, dietary factors, and alcohol consumption. cAdditionally adjusted for body mass index, high cholesterol, and hypertension. dAdditionally adjusted for clinical trial randomization, smoking status, dietary factors, alcohol consumption, postmenopausal status, hormone therapy, and parental history of myocardial infarction. Hazard ratios in figure were estimated using multivariable‐adjusted model 1. MET indicates metabolic equivalent.

Figure 2.

Hazard ratio of cardiovascular disease mortality according to total physical activity volume, Harvard Alumni Health Study (1988–2008) and Women's Health Study (1992–2012). All values are hazard ratios (95% confidence intervals) unless otherwise specified. aTotal physical activity volume was calculated from walking, climbing stairs, and participating in leisure‐time activities. bAdditionally adjusted for smoking status, dietary factors, and alcohol consumption. cAdditionally adjusted for body mass index, high cholesterol, and hypertension. dAdditionally adjusted for clinical trial randomization, smoking status, dietary factors, alcohol consumption, postmenopausal status, hormone therapy, and parental history of myocardial infarction. Hazard ratios in figure were estimated using multivariable‐adjusted model 1. MET indicates metabolic equivalent.

Figure 3.

Hazard ratio of all‐cause mortality according to percent of MVPA performed at vigorous intensity, Harvard Alumni Health Study (1988–2008) and Women's Health Study (1992–2012). All values are hazard ratios (95% confidence intervals) unless otherwise specified. aTotal physical activity volume was calculated from walking, climbing stairs, and participating in leisure‐time activities. bAdditionally adjusted for smoking status, dietary factors, and alcohol consumption. cAdditionally adjusted for body mass index, high cholesterol, and hypertension. dAdditionally adjusted for clinical trial randomization, smoking status, dietary factors, alcohol consumption, postmenopausal status, hormone therapy, and parental history of myocardial infarction. Hazard ratios in figure were estimated using multivariable‐adjusted model 1. MVPA indicates moderate‐ to vigorous‐intensity physical activity.

Figure 4.

Hazard ratio of cardiovascular disease mortality according to percent of MVPA performed at vigorous intensity, Harvard Alumni Health Study (1988–2008) and Women's Health Study (1992–2012). All values are hazard ratios (95% confidence intervals) unless otherwise specified. aTotal physical activity volume was calculated from walking, climbing stairs, and participating in leisure‐time activities. bAdditionally adjusted for smoking status, dietary factors, and alcohol consumption. cAdditionally adjusted for body mass index, high cholesterol, and hypertension. dAdditionally adjusted for clinical trial randomization, smoking status, dietary factors, alcohol consumption, postmenopausal status, hormone therapy, and parental history of myocardial infarction. Hazard ratios in figure were estimated using multivariable‐adjusted model 1. MVPA indicates moderate‐ to vigorous‐intensity physical activity.