Leisure-time running reduces all-cause and cardiovascular mortality risk

Abstract

Background: Although running is a popular leisure-time physical activity, little is known about the long-term effects of running on mortality. The dose-response relations between running, as well as the change in running behaviors over time, and mortality remain uncertain.

Objectives: We examined the associations of running with all-cause and cardiovascular mortality risks in 55,137 adults, 18 to 100 years of age (mean age 44 years).

Methods: Running was assessed on a medical history questionnaire by leisure-time activity.

Results: During a mean follow-up of 15 years, 3,413 all-cause and 1,217 cardiovascular deaths occurred. Approximately 24% of adults participated in running in this population. Compared with nonrunners, runners had 30% and 45% lower adjusted risks of all-cause and cardiovascular mortality, respectively, with a 3-year life expectancy benefit. In dose-response analyses, the mortality benefits in runners were similar across quintiles of running time, distance, frequency, amount, and speed, compared with nonrunners. Weekly running even <51 min, <6 miles, 1 to 2 times, <506 metabolic equivalent-minutes, or <6 miles/h was sufficient to reduce risk of mortality, compared with not running. In the analyses of change in running behaviors and mortality, persistent runners had the most significant benefits, with 29% and 50% lower risks of all-cause and cardiovascular mortality, respectively, compared with never-runners.

Conclusions: Running, even 5 to 10 min/day and at slow speeds <6 miles/h, is associated with markedly reduced risks of death from all causes and cardiovascular disease. This study may motivate healthy but sedentary individuals to begin and continue running for substantial and attainable mortality benefits.

Keywords: all-cause mortality; cardiovascular mortality; dose response; epidemiology; physical exercise; running pattern.

Figure 1. Hazard Ratios of All-Cause and Cardiovascular Mortality by Subgroup

The reference group for all analyses includes non-runners. All hazard ratios were adjusted for baseline age (years), sex (not in sex-stratified analyses), examination year, smoking status (never, former, or current [not in smoking-stratified analyses]), alcohol consumption (heavy drinker or not [not in alcohol drinking-stratified analyses]), other physical activities except running (0, 1-499, or ≥500 MET-minutes per week), and parental cardiovascular disease (yes or no). Unhealthy was defined as the presence of one or more of the following health conditions: abnormal ECG, hypertension, diabetes, or hypercholesterolemia. Heavy alcohol drinking was defined as >14 and >7 drinks per week for men and women, respectively. BMI=body mass index, CI=confidence interval, ECG=electrocardiogram.

Figure 2. Hazard Ratios of All-Cause and Cardiovascular Mortality by Running Distance, Frequency, Total Amount, and Speed

Participants were classified into six groups: non-runners and five quintiles of each running distance, frequency, total amount, and speed. All hazard ratios were adjusted for baseline age (years), sex, examination year, smoking status (never, former, or current), alcohol consumption (heavy drinker or not), other physical activities except running (0, 1-499, or ≥500 MET-minutes per week), and parental cardiovascular disease (yes or no). The bars indicate 95% confidence intervals and hazard ratios are shown next to the bars. CVD=cardiovascular disease, MET=metabolic equivalent.

Figure 3. Hazard Ratios of All-Cause and Cardiovascular Mortality by Change in Running Behaviors

Model 1 was adjusted for baseline age (years), sex, examination year, and interval between the baseline and last examinations (years). Model 2 was adjusted for Model 1 plus baseline smoking status (never, former, or current), alcohol consumption (heavy drinker or not), other physical activities except running (0, 1-499, or ≥500 MET-minutes per week), and parental CVD (yes or no). The number of participants (deaths) in remained non-runners, became non-runners, became runners, and remained runners were 13,522 (1,013), 2,847 (141), 1,578 (131), and 2,700 (113) for all-cause mortality, and 12,885 (376), 2,753 (47), 1,485 (38), and 2,616 (29) for cardiovascular mortality, respectively. The bars indicate 95% confidence intervals and hazard ratios are shown next to the bars. CVD=cardiovascular disease.

Figure 4. Baseline Cardiorespiratory Fitness by Weekly Running Time

Cardiorespiratory fitness was estimated from the final treadmill speed and grade during the maximal exercise test in a subsample of 50,995 participants. All p-values for linear trend across weekly running time were <0.001 after adjusting for age and sex (not in sex-stratified analyses). MET=metabolic equivalent.

Figure. Central Illustration: Leisure-Time Running Reduces All-Cause and Cardiovascular Mortality Risk

Legend: Hazard ratios of all-cause and cardiovascular mortality by running characteristics (weekly running time, distance, frequency, total amount, and speed). Participants were classified into six groups: non-runners (reference group) and five quintiles of each running characteristic. All hazard ratios were adjusted for baseline age (years), sex, examination year, smoking status (never, former, or current), alcohol consumption (heavy drinker or not), other physical activities except running (0, 1-499, or ≥500 MET-minutes/week), and parental history of cardiovascular disease (yes or no). All p values for hazard ratios across running characteristics were <0.05 for all-cause and cardiovascular mortality except for running frequency of ≥6 times/week (p=0.11) and speed of <6.0 mph (p=0.10) for cardiovascular mortality. MET=metabolic equivalent.