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Dose–response association of aerobic and muscle-strengthening physical activity with mortality: a national cohort study of 416 420 US adults
  1. Carver J Coleman1,
  2. Daniel J McDonough2,
  3. Zachary C Pope3,4,
  4. C Arden Pope1
  1. 1 Department of Economics, Brigham Young University, Provo, Utah, USA
  2. 2 University of Minnesota Twin Cities, School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota, USA
  3. 3 Well Living Lab, Rochester, Minnesota, USA
  4. 4 Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr C Arden Pope, Department of Economics, Brigham Young University, Provo, UT 84602, USA; cap3{at}


Objectives To investigate the dose–response association of aerobic physical activity (PA) and muscle-strengthening exercise (MSE) with all-cause mortality.

Methods National Health Interview Survey data (1997–2014) were linked to the National Death Index through 2015, which produced a cohort of 416 420 US adults. Cox proportional-hazard models were used to estimate HRs and 95% CIs for the associations of moderate aerobic PA (MPA), vigorous aerobic PA (VPA) and MSE with mortality risk. Models controlled for age, sex, race-ethnicity, income, education, marital status, survey year, smoking status, body mass index and chronic conditions.

Results Relative to those who engaged in no aerobic PA, substantial mortality risk reduction was associated with 1 hour/week of aerobic PA (HR: 0.85, 95% CI: 0.83 to 0.86) and levelled off at 3 hours/week of aerobic PA (0.73, 0.71 to 0.75). Similar results were observed for men and women and for individuals younger and older than 60 years. MSE conferred additional mortality risk reduction at 1 time/week (0.89, 0.81 to 0.97) and appeared no longer beneficial at 7 times/week (0.99, 0.94 to 1.04).

Conclusion The minimum effective dose of aerobic PA for significant mortality risk reduction was 1 hour/week of MPA or VPA, with additional mortality risk reduction observed up to 3 hours/week. For older adults, only small decreases in mortality risk were observed beyond this duration. Completing MSE in combination with aerobic PA conferred additional mortality risk reduction, with a minimum effective dose of 1–2 times/week.

  • Exercise
  • Physical activity
  • Death
  • Cohort Studies
  • Weight lifting

Data availability statement

Data are available in a public, open access repository. De-identified National Health Interview Survey data are publicly available on the NCHS website (For example, data for 2014 is found at the following URL:

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Data availability statement

Data are available in a public, open access repository. De-identified National Health Interview Survey data are publicly available on the NCHS website (For example, data for 2014 is found at the following URL:

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  • Contributors All authors conceived of the study design and approach. CJC and CAP constructed the cohort from the NHIS data and conducted the primary statistical analyses. All authors contributed to initial drafting of the manuscript, interpretation of the results, manuscript presentation, critical revisions of the manuscript and final approval to submit the manuscript for publication. CJC is the guarantor and accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding This report was supported in part by the Center for Air Climate and Energy Solutions (CACES), which was supported under Assistance Agreement No. R835873 awarded by the US Environmental Protection Agency. CAP was funded by the Mary Lou Fulton Professorship, Brigham Young University.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.