Trends in the Association Between Meeting the Physical Activity Guidelines and Risk of Total and Cause-specific Mortality in the US Over 2 Decades
Authors: Martinez-Gomez David , Rodriguez-Artalejo Fernando , Ding Ding , Ekelund Ulf , Cabanas-Sanchez Veronica 
Published: September 2023

Background

It is unclear whether the association between meeting the physical activity (PA) guidelines and mortality varied in the last two decades among the US adult population.

Methods

We included seventeen annual representative samples of US adults in the National Health Interview Survey (1998-2014; n=482,756 individual participant data) and all-cause and cause-specific mortality ascertained through December 2019. Participants were grouped according to the 2018 US PA Guidelines: 150 or more min/week in aerobic PA and muscle-strengthening activities 2 or more times/week. To provide further context, we also examined the trends in mortality risk associated with other modifiable health factors.

Results

Meeting the PA guidelines was associated with lower 5-year all-cause mortality risk (HR=0.59, 95%CI, 0.55, 0.63) based on the pooled analyses, but there was a nonsignificant trend association (P for trend=0.305) between meeting PA guidelines and 5-year mortality across the seventeen annual surveys. Meeting the recommended PA guidelines was associated with 5-year cardiovascular (HR=0.59, 95%CI, 0.50, 0.69) and cancer mortality (HR=0.76, 95%CI, 0.64, 0.90) without indication of trend in the associations (P for trend=0.975 and 0.366, respectively). In pooled analyses, attain a high educational level, body mass index less than 30 kg/m2, being noncurrent smoker, nonheavy drinker, and living without history of hypertension and diabetes with 5-year mortality were 0.70 (95%CI, 0.67, 0.73), 1.19 (95%CI, 1.15, 1.23), 0.56 (95%CI, 0.54, 0.59), 0.85 (95%CI,0.79, 0.92), 0.91 (95%CI, 0.88-0.94) and 0.65 (95%CI, 0.88, 0.94), respectively, but only diabetes showed a significant trend analysis (P for trend<0.001) that attenuated the association.

Conclusions

Meeting PA guidelines lower mortality risk and this association has not changed in the US adult population over the last two decades. Encouraging adults to meet the PA guidelines may provide substantial health benefits, despite social, demographic and lifestyle changes, as well as the advances in medical technology and pharmacological treatments.

Clinical Perspective

What is new?

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It is unclear whether the social, demographic, and lifestyle changes, well as the advances in medical technology and pharmacological treatments in the last two decades have influenced the relationship between the recommended physical activity guidelines and the risk of mortality.

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In this observational study that included 482 756 individual-participant data from 17 annual nationwide surveys, the association between meeting physical activity guidelines and all-cause and cause-specific mortality risk has not changed, that is, remained stable, in the US adult population.

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We provided context for our findings examining the trends in mortality risk associated with other modifiable health factors and only living without diabetes mellitus showed that the association was attenuated over the study time.

What Are the Clinical Implications?

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These findings reinforce the public health message of the 2018 Physical Activity Guidelines by encouraging Americans to be physically active to provide substantial health benefits for the adult population.