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Beneficial associations of low and large doses of leisure time physical activity with all-cause, cardiovascular disease and cancer mortality: a national cohort study of 88,140 US adults
  1. Min Zhao1,
  2. Sreenivas P Veeranki2,3,
  3. Shengxu Li4,
  4. Lyn M Steffen5,
  5. Bo Xi6
  1. 1 Department of Nutrition and Food Hygiene, Shandong University, Jinan, China
  2. 2 Premier Applied Sciences, Premier Inc, Charlotte, USA
  3. 3 University of Texas Medical Branch, Galveston, Texas, USA
  4. 4 Children’s Hospitals and Clinics, Minneapolis, USA
  5. 5 Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, USA
  6. 6 Department of Epidemiology, Shandong University, Jinan, China
  1. Correspondence to Dr Bo Xi, Department of Epidemiology, School of Public Health, Shandong University, Jinan 250100, China; xibo2007{at}


Background Evidence on the role of very low or very high volumes of leisure time physical activity (PA) on the risk of all-cause and cause-specific mortality is limited. We aimed to examine the associations of different levels of leisure time PA with the risk of all-cause, cardiovascular disease (CVD) and cancer-specific mortality.

Methods Data were from 12 waves of the National Health Interview Surveys (1997–2008) linked to the National Death Index records through 31 December 2011. A total of 88 140 eligible participants aged 40–85 years were included.

Results Compared with inactive individuals, those performing 10–59 min/week of PA had 18% lower risk of all-cause mortality (hazard ratio (HR): 0.82, 95% confidence interval (CI): 0.72–0.95). Those who reported 1–2 times (150–299 min/week) the recommended level of leisure time PA had 31% (HR: 0.69, 95%CI: 0.63–0.75) reduced risk of all-cause mortality. Importantly, the continued benefits were observed among those performing leisure time PA 10 or more times (≥1500 min/week) the recommended minimum level (HR: 0.54, 95% CI: 0.45–0.64). For 10–59, 150–299 and ≥1500 min/week of PA, the corresponding HRs (95% CIs) for CVD-specific mortality were 0.88 (0.67–1.17), 0.63 (0.52–0.78) and 0.67 (0.45–0.99), respectively: for cancer-specific mortality were 0.86 (0.66–1.11), 0.76 (0.64–0.89) and 0.53 (0.39–0.73), respectively. In addition, there was a larger reduction in all-cause and cause-specific mortality for vigorous vs. moderate intensity PA.

Conclusions We found that beneficial association between leisure time PA and mortality starts from a low dose. Doing more vigorous exercise could lead to additional health benefits.

  • physical activity
  • cardiology
  • death
  • cohort study
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  • Contributors BX and MZ designed the study, performed data analyses and had full access to all the data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis. MZ drafted the manuscript. SPV, LMS and SL made critical revision of the manuscript for important intellectual content. All authors approved the final submitted version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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