title: Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship.
abstract: OBJECTIVE
  The 2008 Physical Activity Guidelines for Americans recommended a minimum of 75 vigorous-intensity or 150 moderate-intensity minutes per week (7.5 metabolic-equivalent hours per week) of aerobic activity for substantial health benefit and suggested additional benefits by doing more than double this amount. However, the upper limit of longevity benefit or possible harm with more physical activity is unclear.
  
  
  OBJECTIVE
  To quantify the dose-response association between leisure time physical activity and mortality and define the upper limit of benefit or harm associated with increased levels of physical activity.
  
  
  METHODS
  We pooled data from 6 studies in the National Cancer Institute Cohort Consortium (baseline 1992-2003). Population-based prospective cohorts in the United States and Europe with self-reported physical activity were analyzed in 2014. A total of 661,137 men and women (median age, 62 years; range, 21-98 years) and 116,686 deaths were included. We used Cox proportional hazards regression with cohort stratification to generate multivariable-adjusted hazard ratios (HRs) and 95% CIs. Median follow-up time was 14.2 years.
  
  
  METHODS
  Leisure time moderate- to vigorous-intensity physical activity.
  
  
  METHODS
  The upper limit of mortality benefit from high levels of leisure time physical activity.
  
  
  RESULTS
  Compared with individuals reporting no leisure time physical activity, we observed a 20% lower mortality risk among those performing less than the recommended minimum of 7.5 metabolic-equivalent hours per week (HR, 0.80 [95% CI, 0.78-0.82]), a 31% lower risk at 1 to 2 times the recommended minimum (HR, 0.69 [95% CI, 0.67-0.70]), and a 37% lower risk at 2 to 3 times the minimum (HR, 0.63 [95% CI, 0.62-0.65]). An upper threshold for mortality benefit occurred at 3 to 5 times the physical activity recommendation (HR, 0.61 [95% CI, 0.59-0.62]); however, compared with the recommended minimum, the additional benefit was modest (31% vs 39%). There was no evidence of harm at 10 or more times the recommended minimum (HR, 0.69 [95% CI, 0.59-0.78]). A similar dose-response relationship was observed for mortality due to cardiovascular disease and to cancer.
  
  
  CONCLUSIONS
  Meeting the 2008 Physical Activity Guidelines for Americans minimum by either moderate- or vigorous-intensity activities was associated with nearly the maximum longevity benefit. We observed a benefit threshold at approximately 3 to 5 times the recommended leisure time physical activity minimum and no excess risk at 10 or more times the minimum. In regard to mortality, health care professionals should encourage inactive adults to perform leisure time physical activity and do not need to discourage adults who already participate in high-activity levels.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
authors.forename: Hannah
authors.initials: H
authors.lastname: Arem
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Moore
authors.affiliation: American Cancer Society, Atlanta, Georgia.
authors.forename: Alpa
authors.initials: A
authors.lastname: Patel
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
authors.forename: Patricia
authors.initials: P
authors.lastname: Hartge
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
authors.forename: Amy
authors.initials: A
authors.lastname: Berrington de Gonzalez
authors.affiliation: Johns Hopkins School of Public Health, Baltimore, Maryland.
authors.forename: Kala
authors.initials: K
authors.lastname: Visvanathan
authors.affiliation: American Cancer Society, Atlanta, Georgia.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Campbell
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
authors.forename: Michal
authors.initials: M
authors.lastname: Freedman
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden5Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø6Cancer Registry of Norway, Oslo7Department of Genetic Epidemiolog.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden8Department of Epidemiology, Harvard School of Public Health, Harvard University, Boston, Massachusetts.
authors.forename: Hans Olov
authors.initials: HO
authors.lastname: Adami
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
authors.forename: Martha S
authors.initials: MS
authors.lastname: Linet
authors.affiliation: Department of Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts.
authors.forename: I-Min
authors.initials: IM
authors.lastname: Lee
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Matthews
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011998:Recreation; D014481:United States; D055815:Young Adult
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