Sex Differences in Association of Physical Activity With All-Cause and Cardiovascular Mortality

J Am Coll Cardiol. 2024 Feb 27;83(8):783-793. doi: 10.1016/j.jacc.2023.12.019.


Background: Although physical activity is widely recommended for reducing cardiovascular and all-cause mortality risks, female individuals consistently lag behind male individuals in exercise engagement.

Objectives: The goal of this study was to evaluate whether physical activity derived health benefits may differ by sex.

Methods: In a prospective study of 412,413 U.S. adults (55% female, age 44 ± 17 years) who provided survey data on leisure-time physical activity, we examined sex-specific multivariable-adjusted associations of physical activity measures (frequency, duration, intensity, type) with all-cause and cardiovascular mortality from 1997 through 2019.

Results: During 4,911,178 person-years of follow-up, there were 39,935 all-cause deaths including 11,670 cardiovascular deaths. Regular leisure-time physical activity compared with inactivity was associated with 24% (HR: 0.76; 95% CI: 0.73-0.80) and 15% (HR: 0.85; 95% CI: 0.82-0.89) lower risk of all-cause mortality in women and men, respectively (Wald F = 12.0, sex interaction P < 0.001). Men reached their maximal survival benefit of HR 0.81 from 300 min/wk of moderate-to-vigorous physical activity, whereas women achieved similar benefit at 140 min/wk and then continued to reach a maximum survival benefit of HR 0.76 also at ∼300 min/wk. Sex-specific findings were similar for cardiovascular death (Wald F = 20.1, sex interaction P < 0.001) and consistent across all measures of aerobic activity as well as muscle strengthening activity (Wald F = 6.7, sex interaction P = 0.009).

Conclusions: Women compared with men derived greater gains in all-cause and cardiovascular mortality risk reduction from equivalent doses of leisure-time physical activity. These findings could enhance efforts to close the "gender gap" by motivating especially women to engage in any regular leisure-time physical activity.

Keywords: mortality; physical activity; sex differences.

MeSH terms

  • Adult
  • Cardiovascular Diseases* / prevention & control
  • Exercise / physiology
  • Female
  • Humans
  • Leisure Activities*
  • Male
  • Middle Aged
  • Mortality
  • Prospective Studies
  • Sex Characteristics