Vigorous physical activity, incident heart disease, and cancer: how little is enough?

Abstract

Aims: Vigorous physical activity (VPA) is a time-efficient way to achieve recommended physical activity levels. There is a very limited understanding of the minimal and optimal amounts of vigorous physical activity in relation to mortality and disease incidence.

Methods and results: A prospective study in 71 893 adults [median age (IQR): 62.5 years (55.3, 67.7); 55.9% female] from the UK Biobank cohort with wrist-worn accelerometry. VPA volume (min/week) and frequency of short VPA bouts (≤2 min) were measured. The dose-response associations of VPA volume and frequency with mortality [all-cause, cardiovascular disease (CVD) and cancer], and CVD and cancer incidence were examined after excluding events occurring in the first year. During a mean post-landmark point follow-up of 5.9 years (SD ± 0.8), the adjusted 5-year absolute mortality risk was 4.17% (95% confidence interval: 3.19%, 5.13%) for no VPA, 2.12% (1.81%, 2.44%) for >0 to <10 min, 1.78% (1.53%, 2.03%) for 10 to <30 min, 1.47% (1.21%, 1.73%) for 30 to <60 min, and 1.10% (0.84%, 1.36%) for ≥60 min. The 'optimal dose' (nadir of the curve) was 53.6 (50.5, 56.7) min/week [hazard ratio (HR): 0.64 (0.54, 0.77)] relative to the 5th percentile reference (2.2 min/week). There was an inverse linear dose-response association of VPA with CVD mortality. The 'minimal' volume dose (50% of the optimal dose) was ∼15 (14.3, 16.3) min/week for all-cause [HR: 0.82 (0.75, 0.89)] and cancer [HR: 0.84 (0.74, 0.95)] mortality, and 19.2 (16.5, 21.9) min/week [HR: 0.60 (0.50, 0.72)] for CVD mortality. These associations were consistent for CVD and cancer incidence. There was an inverse linear association between VPA frequency and CVD mortality. 27 (24, 30) bouts/week was associated with the lowest all-cause mortality [HR: 0.73 (0.62, 0.87)].

Conclusion: VPA of 15-20 min/week were associated with a 16-40% lower mortality HR, with further decreases up to 50-57 min/week. These findings suggest reduced health risks may be attainable through relatively modest amounts of VPA accrued in short bouts across the week.

Keywords: Cancer; Cardiovascular disease; Mortality; Physical activity; Vigorous intensity.

Structured Graphical Abstract

Approximately 15–20 min of vigorous activity/week accrued through short bouts were associated with lower mortality and disease incidence. VPA = vigorous physical activity.

Figure 1

Adjusted absolute risk estimates for mortality and disease incidence by vigorous physical activity volume (minutes/week). Adjusted for age, sex, wear time, light intensity, moderate intensity, frequency of vigorous bouts, smoking history, alcohol consumption, sleep score, diet, discretionary screen-time, education, self-reported parental history of CVD and cancer, and self-reported medication use (cholesterol, blood pressure, and diabetes). The range was capped at the 97.5 percentile to minimize the influence of sparse data. Mortality: n = 71 893; events: all-cause = 1,927, cardiovascular disease = 602, cancer = 1150. Cardiovascular disease: n = 71,049, events = 4567. Cancer: n = 71,070, events = 2854.

Figure 2

Adjusted 5-year risk for mortality and disease incidence by vigorous physical activity volume groups. Timescale was follow-up years. Adjusted for age, sex, wear time, light intensity, moderate intensity, frequency of vigorous bouts, smoking history, alcohol consumption, sleep score, diet, discretionary screen-time, education, self-reported parental history of CVD and cancer, and self-reported medication use (cholesterol, blood pressure, and diabetes). Mortality: n = 71 893; events: all-cause = 1,927, cardiovascular disease = 602, cancer = 1150. Cardiovascular disease: n = 71,049, events = 4567. Cancer: n = 71,070, events = 2854.

Figure 3

Adjusted survival curves for mortality and disease incidence by vigorous physical activity volume groups. Timescale was age. Adjusted for sex, wear time, light intensity, moderate intensity, frequency of vigorous bouts, smoking history, alcohol consumption, sleep score, diet, discretionary screen-time, education, self-reported parental history of CVD and cancer, and self-reported medication use (cholesterol, blood pressure, and diabetes). Mortality: n = 71 893; events: all-cause = 1,927, cardiovascular disease = 602, cancer = 1150. Cardiovascular disease: n = 71,049, events = 4567. Cancer: n = 71,070, events = 2854.

Figure 4

Dose–response association between vigorous physical activity volume (minutes/week) and all-cause, cardiovascular disease, and cancer mortality. Timescale was age. Adjusted for sex, wear time, light intensity, moderate intensity, frequency of vigorous bouts, smoking history, alcohol consumption, sleep score, diet, discretionary screen-time, education, self-reported parental history of CVD and cancer, and self-reported medication use (cholesterol, blood pressure, and diabetes). The range was capped at the 97.5 percentile to minimize the influence of sparse data. Sample = 71 893; events: all-cause = 1,927, cardiovascular disease = 602, cancer = 1150; reference= 2.2 min/week. Linearity: ACM (P < 0.01); CVD (P = 0.42); cancer (P < 0.01). Nadir: ACM [53.6 min/wk; HR = 0.64 (0.54, 0.77)]; cancer [55.4 min/wk; HR = 0.68 (0.52, 0.88)].

Figure 5

Dose–response association between vigorous physical activity volume (min/week) and incidence of cardiovascular disease (n = 71 049; events = 3730) and cancer (n = 71 070; events = 1315). Timescale was age. Adjusted for sex, wear time, light intensity physical activity, moderate intensity physical activity, frequency of vigorous bouts, smoking history, alcohol consumption, sleep score, diet, screentime, education, self-reported parental history of CVD and cancer, and self-reported medication use (cholesterol, blood pressure, and diabetes). The range was capped at the 97.5 percentile to minimize the influence of sparse data. Cardiovascular disease: n = 71,049, events = 4567. Cancer: n = 71,070, events = 2854. Reference = 2.17 min/week. Linearity: CVD (P < 0.01); cancer (P < 0.01). Nadir: CVD (56.5 min/wk; HR = 0.69 [0.63, 0.76]); cancer (46.3 min/wk; HR = 0.67 [0.55, 0.82]).