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Physical activity less than the recommended amount may prevent the onset of major biological risk factors for cardiovascular disease: a cohort study of 198 919 adults
  1. David Martinez-Gomez1,2,
  2. Irene Esteban-Cornejo3,
  3. Esther Lopez-Garcia2,4,
  4. Esther García-Esquinas4,
  5. Kabir P Sadarangani5,6,
  6. Oscar L Veiga1,
  7. Fernando Rodriguez-Artalejo2,4
  1. 1 Department of Physical Education, Sport and Human Movement, Facultad de Formación de Profesorado y Educación, Universidad Autónoma de Madrid, Madrid, Spain
  2. 2 IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
  3. 3 PROFITH "PROmotingFITness and Health through physical activity" research group, Department of Physical Education and Sport, Universidad de Granada, Granada, Andalucía, Spain
  4. 4 Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/ IdiPaz, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
  5. 5 School of Physiotherapy, Faculty of Health Sciences, Universidad San Sebastián, Santiago, Chile
  6. 6 Escuela de Kinesiología, Facultad de Salud y Odontología, Universidad Diego Portales, Santiago, Chile
  1. Correspondence to Dr David Martinez-Gomez, Department of Physical Education, Sport and Human Movement, Facultad de Formación de Profesorado y Educación, Universidad Autónoma de Madrid, Madrid 28029, Spain; d.martinez{at}


Objectives We examined the dose–response relationship between physical activity (PA) and incidence of cardiovascular disease (CVD) risk factors in adults in Taiwan.

Methods This study included 1 98 919 participants, aged 18–97 years, free of CVD, cancer and diabetes at baseline (1997–2013), who were followed until 2016. At baseline, participants were classified into five PA levels: inactive’ (0 metabolic equivalent of task (MET)-h/week), ‘lower insufficiently active’ (0.1–3.75 MET-h/week), ‘upper insufficiently active’ (3.75–7.49 MET-h/week), ‘active’ (7.5–14.99 MET-h/week) and ‘highly active’ (≥15 MET-h/week]. CVD risk factors were assessed at baseline and at follow-up by physical examination and laboratory tests. Analyses were performed with Cox regression and adjusted for the main confounders.

Results During a mean follow-up of 6.0±4.5 years (range 0.5–19 years), 20 447 individuals developed obesity, 19 619 hypertension, 21 592 hypercholesterolaemia, 14 164 atherogenic dyslipidaemia, 24 275 metabolic syndrome and 8548 type 2 diabetes. Compared with inactive participants, those in the upper insufficiently active (but not active) category had a lower risk of obesity (HR 0.92; 95% CI 0.88 to 0.95), atherogenic dyslipidaemia (0.96; 0.90 to 0.99), metabolic syndrome (0.95; 0.92 to 0.99) and type 2 diabetes (0.91; 0.86 to 0.97). Only highly active individuals showed a lower incidence of CVD risk factors than their upper insufficiently active counterparts.

Conclusion Compared with being inactive, doing half the recommended amount of PA is associated with a lower incidence of several common biological CVD risk factors. Given these benefits, half the recommended amount of PA is an evidence based target for inactive adults.

  • physical activity
  • cardiovascular
  • epidemiology
  • prevention

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  • Contributors DM-G and FR-A had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: DM-G, IE-C, KPS, OLV and FR-A. Analysis and interpretation of the data: all authors. Drafting of the manuscript: DM-G and FR-A. Critical revision of the manuscript for important intellectual content: IE-C, EL-G, EG-E, KPS and OLV. Statistical analysis: DM-G, EL-G and FR-A. Administrative, technical or material support: IE-C, EG-E and KPS. Study supervision: FR-A. All authors have read and approved the final manuscript.

  • Funding This work was supported by grant 02/2014 from the Plan Nacional sobre Drogas (Ministry of Health of Spain), FIS grants 12/1166 and 16/609 (State Secretary of R+D+I and FEDER/FSE), MINECO R+D+I grant (DEP2013-47786-R), the ATHLOS project (European project H2020- Project ID: 635316) and the SALAMANDER project (PCIN 2016-145). DM-G is supported by a ‘Ramon y Cajal’ contract (RYC-2016-20546). All data used in this research were authorised by, and received from MJ Health Research Foundation by MJ Health Research Centre (authorization codes: MJHRF2017006A and MJHRF2017007A). Any interpretation or conclusions described in this work do not represent the views of MJ Health Research Foundation and the sponsors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the institutional review boards of the MJ Health Management Institution and the National Health Research Institutes, Taiwan.

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