Woodcock, James, Franco, Oscar H., Orsini, Nicola and Roberts, Ian, Ph.D. (2011) Non-vigorous physical activity and all-cause mortality : systematic review and meta-analysis of cohort studies. International Journal of Epidemiology, Volume 40 (Number 1). pp. 121-138. ISSN 0300-5771

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Abstract

Background Although previous studies have found physical activity to be associated with lower mortality, the dose response relationship remains unclear. In this systematic review and meta-analysis we quantify the dose-response relationship of non-vigorous physical activity and all-cause mortality. Methods We aimed to include all cohort studies in adult populations with a sample size of more than 10 000 participants that estimated the effect of different levels of light or moderate physical activity on all-cause mortality. We searched Medline, Embase, Cochrane (DARE), Web of Science and Global Health (June 2009). We used dose-response meta-regression models to estimate the relation between non-vigorous physical activity and mortality. Results We identified 22 studies that met our inclusion criteria, containing 977 925 (334 738 men and 643 187 women) people. There was considerable variation between the studies in their categorization of physical activity and adjustment for potential confounders. We found that 2.5 h/week (equivalent to 30 min daily of moderate intensity activity on 5 days a week) compared with no activity was associated with a reduction in mortality risk of 19% [95% confidence interval (CI) 15-24], while 7h/week of moderate activity compared with no activity reduced the mortality risk by 24% (95% CI 19-29). We found a smaller effect in studies that looked at walking alone. Conclusion Being physically active reduces the risk of all-cause mortality. The largest benefit was found from moving from no activity to low levels of activity, but even at high levels of activity benefits accrue from additional activity.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General)
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Exercise, Systematic reviews (Medical research), Meta-analysis, Cohort analysis, Mortality
Journal or Publication Title:	International Journal of Epidemiology
Publisher:	Oxford University Press
ISSN:	0300-5771
Date:	February 2011
Volume:	Volume 40
Number:	Number 1
Page Range:	pp. 121-138
Identification Number:	10.1093/ije/dyq104
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
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The effects of physical activity and body mass index on cardiovascular, cancer and allcause mortality among 47,212 middle-aged Finnish men and women. Int J Obesity 2005;29:894–902. 43 Fujita K, Takahashi H, Miura C et al. Walking and mortality in Japan: the Miyagi Cohort Study. J Epidemiol 2004;14(Suppl 1):S26–32. 44 Barengo NC, Hu G, Lakka TA, Pekkarinen H, Nissinen A, Tuomilehto J. Low physical activity as a predictor for total and cardiovascular disease mortality in middleaged men and women in Finland. Eur Heart J 2004;25: 2204–11. 45 Batty GD, Shipley MJ, Marmot M, Smith GD. Physical activity and cause-specific mortality in men: Further evidence from the Whitehall study. Eur J Epidemiol 2001;17: 863–69. 46 Rockhill B, Willett WC, Manson JE et al. Physical activity and mortality: a prospective study among women. Am J Public Health 2001;91:578–83. 47 Lee IM, Paffenbarger RS Jr. Associations of light, moderate, and vigorous intensity physical activity with longevity. The Harvard Alumni Health Study. Am J Epidemiol 2000;151:293–99. 48 Kujala UM, Kaprio J, Sarna S, Koskenvuo M. Relationship of leisure-time physical activity and mortality: The Finnish Twin Cohort. JAMA 1998;279:440–44. 49 Leon AS, Myers MJ, Connett J. Leisure time physical activity and the 16-year risks of mortality from coronary heart disease and all-causes in the Multiple Risk Factor Intervention Trial (MRFIT). Int J Sports Med Suppl 1997;18: S208–15. 50 Kushi LH, Fee RM, Folsom AR, Mink PJ, Anderson KE, Sellers TA. Physical activity and mortality in postmenopausal women.[see comment]. JAMA 1997;277:1287–92. 51 Kampert JB, Blair SN, Barlow CE, Kohl HW 3rd. Physical activity, physical fitness, and all-cause and cancer mortality: a prospective study of men and women. Ann Epidemiol 1996;6:452–57. 52 Khaw K-T, Jakes R, Bingham S et al. Work and leisure time physical activity assessed using a simple, pragmatic, validated questionnaire and incident cardiovascular disease and all-cause mortality in men and women: The European Prospective Investigation into Cancer in from coronary heart disease, stroke, respiratory diseases, and cancer. The Copenhagen City Heart Study. Eur J Cardiovasc Prevent Rehabil 2006;13:173–79. 21 Fried LP, Kronmal RA, Newman AB et al. Risk factors for 5-year mortality in older adults: The cardiovascular health study. JAMA 1998;279:585–92. 22 Mensink GB, Deketh M, Mul MD, Schuit AJ, Hoffmeister H. Physical activity and its association with cardiovascular risk factors and mortality. Epidemiology 1996;7:391–97. 23 Arraiz GA, Wigle DT, Mao Y. Risk assessment of physical activity and physical fitness in the Canada health survey mortality follow-up study. J Clin Epidemiol 1992;45: 419–28. 24 King DE, Mainous AG, Geesey ME. Turning back the clock: adopting a healthy lifestyle in middle age. Am J Med 2007;120:598–603. 25 Meyer HE, Sogaard AJ, Tverdal A, Selmer RM. Body mass index and mortality: The influence of physical activity and smoking. Med Sci Sports Exerc 2002;34:1065–70. 26 Hillsdon M, Thorogood M, Murphy M, Jones L. Can a simple measure of vigorous physical activity predict future mortality? Results from the OXCHECK study. Public Health Nutr 2004;7:557–62. 27 Holme I, Helgeland A, Hjermann I, Leren P, Lund- Larsen PG. Physical activity at work and at leisure in relation to coronary risk factors and social class. A 4-year mortality follow-up. The Oslo Study. Acta Med Scand 1981;209:277–83. 28 Fraser GE, Shavlik DJ. Ten years of life – is it a matter of choice? Arch Intern Med 2001;161:1645–52. 29 Wisloff U, Nilsen TIL, Droyvold WB, Morkved S, Slordahl SA, Vatten LJ. A single weekly bout of exercise may reduce cardiovascular mortality: how little pain for cardiac gain? ’The HUNT study, Norway’. Eur J Cardiovasc Prevent Rehabil 2006;13:798–804. 30 Manson JE, Greenland P, LaCroix AZ et al. Walking compared with vigorous exercise for the prevention of cardiovascular events in women. New Engl J Med 2002; 347:716–25. 31 Orsini N, Mantzoros CS, Wolk A. Association of physical activity with cancer incidence, mortality, and survival: a population-based study of men. Br J Cancer 2008;98: 1864–69. 32 Park MS, Chung SY, Chang Y, Kim K. Physical activity and physical fitness as predictors of all-cause mortality in Korean men. J Korean Med Sci 2009;24:13–19. 33 Arrieta A, Russell LB. Effects of leisure and non-leisure physical activity on mortality in U.S. adults over two decades. Ann Epidemiol 2008;18:889–95. 34 Besson H, Ekelund U, Brage S et al. Relationship between subdomains of total physical activity and mortality. Med Sci Sports Exerc 2008;40:1909–15. 35 Inoue M, Iso H, Yamamoto S et al. Daily total physical activity level and premature death in men and women: results from a large-scale population-based cohort study in Japan (JPHC study). Ann Epidemiol 2008;18: 522–30. 36 Pedersen JO, Heitmann BL, Schnohr P, Gronbaek M. The combined influence of leisure-time physical activity and weekly alcohol intake on fatal ischaemic heart disease and all-cause mortality. Eur Heart J 2008;29:204–12. 37 Ford J, Spallek M, Dobson A. Self-rated health and a healthy lifestyle are the most important predictors of survival in elderly women. Age Ageing 2008; 37:194–200. 38 Matthews CE, Jurj AL, Shu X-O et al. Influence of exercise, walking, cycling, and overall nonexercise physical activity on mortality in Chinese women.[see comment]. Am J Epidemiol 2007;165:1343–50. 39 Leitzmann MF, Park Y, Blair A et al. Physical activity recommendations and decreased risk of mortality. Arch Intern Med 2007;167:2453–60. 40 Carlsson S, Andersson T, Wolk A, Ahlbom A. Low physical activity and mortality in women: baseline lifestyle and health as alternative explanations. Scand J Public Health 2006;34:480–87. 41 Schooling CM, Lam TH, Li ZB et al. Obesity, physical activity, and mortality in a prospective chinese elderly cohort. Arch Intern Med 2006;166:1498–504. 42 Hu G, Tuomilehto J, Silventoinen K, Barengo NC, Peltonen M, Jousilahti P. The effects of physical activity and body mass index on cardiovascular, cancer and allcause mortality among 47,212 middle-aged Finnish men and women. Int J Obesity 2005;29:894–902. 43 Fujita K, Takahashi H, Miura C et al. Walking and mortality in Japan: the Miyagi Cohort Study. J Epidemiol 2004;14(Suppl 1):S26–32. 44 Barengo NC, Hu G, Lakka TA, Pekkarinen H, Nissinen A, Tuomilehto J. Low physical activity as a predictor for total and cardiovascular disease mortality in middleaged men and women in Finland. Eur Heart J 2004;25: 2204–11. 45 Batty GD, Shipley MJ, Marmot M, Smith GD. Physical activity and cause-specific mortality in men: Further evidence from the Whitehall study. Eur J Epidemiol 2001;17: 863–69. 46 Rockhill B, Willett WC, Manson JE et al. Physical activity and mortality: a prospective study among women. Am J Public Health 2001;91:578–83. 47 Lee IM, Paffenbarger RS Jr. Associations of light, moderate, and vigorous intensity physical activity with longevity. The Harvard Alumni Health Study. Am J Epidemiol 2000;151:293–99. 48 Kujala UM, Kaprio J, Sarna S, Koskenvuo M. Relationship of leisure-time physical activity and mortality: The Finnish Twin Cohort. JAMA 1998;279:440–44. 49 Leon AS, Myers MJ, Connett J. Leisure time physical activity and the 16-year risks of mortality from coronary heart disease and all-causes in the Multiple Risk Factor Intervention Trial (MRFIT). Int J Sports Med Suppl 1997;18: S208–15. 50 Kushi LH, Fee RM, Folsom AR, Mink PJ, Anderson KE, Sellers TA. Physical activity and mortality in postmenopausal women.[see comment]. JAMA 1997;277:1287–92. 51 Kampert JB, Blair SN, Barlow CE, Kohl HW 3rd. Physical activity, physical fitness, and all-cause and cancer mortality: a prospective study of men and women. Ann Epidemiol 1996;6:452–57. 52 Khaw K-T, Jakes R, Bingham S et al. Work and leisure time physical activity assessed using a simple, pragmatic, validated questionnaire and incident cardiovascular disease and all-cause mortality in men and women: The European Prospective Investigation into Cancer in
URI:	http://wrap.warwick.ac.uk/id/eprint/41364

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