Br J Sports Med doi:10.1136/bjsports-2016-096194
  • Original article

Does physical activity moderate the association between alcohol drinking and all-cause, cancer and cardiovascular diseases mortality? A pooled analysis of eight British population cohorts

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  1. E Stamatakis2,4,5
  1. 1Département de Médecine Sociale et Préventive, Université de Montréal, Institut de Recherche en Santé Publique, Montréal, Québec, Canada
  2. 2University of Sydney, Charles Perkins Centre, School of Public Health, Johns Hopkins Drive, Camperdown, New South Wales, Australia
  3. 3Faculty of Medicine, Department of Public Health and General Practice, HUNT Research Centre, NTNU, Norwegian University of Science and Technology, Levanger, Norway
  4. 4Faculty of Health Sciences, University of Sydney, Discipline of Exercise and Sport Sciences, Cumberland Campus, Lidcombe, New South Wales, Australia
  5. 5Department of Epidemiology and Public Health, University College London, London, UK
  1. Correspondence to Dr E Stamatakis, Charles Perkins Centre, University of Sydney, Johns Hopkins Drive, Sydney, NSW 2006, Australia; emmanuel.stamatakis{at}
  • Accepted 19 June 2016
  • Published Online First 31 August 2016


Objective To examine whether physical activity (PA) moderates the association between alcohol intake and all-cause mortality, cancer mortality and cardiovascular diseases (CVDs) mortality.

Design Prospective study using 8 British population-based surveys, each linked to cause-specific mortality: Health Survey for England (1994, 1998, 1999, 2003, 2004 and 2006) and Scottish Health Survey (1998 and 2003).

Participants 36 370 men and women aged 40 years and over were included with a corresponding 5735 deaths and a mean of 353 049 person-years of follow-up.

Exposures 6 sex-specific categories of alcohol intake (UK units/week) were defined: (1) never drunk; (2) ex-drinkers; (3) occasional drinkers; (4) within guidelines (<14 (women); <21 (men)); (5) hazardous (14–35 (women); 21–49 (men)) and (6) harmful (>35 (women) >49 (men)). PA was categorised as inactive (≤7 MET-hour/week), active at the lower (>7.5 MET-hour/week) and upper (>15 MET-hour/week) of recommended levels.

Main outcomes and measures Cox proportional-hazard models were used to examine associations between alcohol consumption and all-cause, cancer and CVD mortality risk after adjusting for several confounders. Stratified analyses were performed to evaluate mortality risks within each PA stratum.

Results We found a direct association between alcohol consumption and cancer mortality risk starting from drinking within guidelines (HR (95% CI) hazardous drinking: 1.40 (1.11 to 1.78)). Stratified analyses showed that the association between alcohol intake and mortality risk was attenuated (all-cause) or nearly nullified (cancer) among individuals who met the PA recommendations.

Conclusions Meeting the current PA public health recommendations offsets some of the cancer and all-cause mortality risk associated with alcohol drinking.

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