Aerobic, Muscle-Strengthening, and Flexibility Physical Activity in Relation to All-Cause and Cancer Mortality: A Population-Based Prospective Cohort Study in Korea

Abstract

ObjectivesWe examined the independent associations of aerobic, muscle-strengthening, and flexibility physical activity with all-cause and cancer mortality. We also compared the mortality risk between participants meeting national guidelines for both aerobic and muscle-strengthening activities and those who do not meet any of the guidelines.MethodsThis analysis included 35,794 participants (aged 19–80 years) in the Korea National Health and Nutrition Examination Survey (KNHANES) 2007–2013 who agreed to mortality follow-up through December 31, 2019 (mean follow-up: 8.1 years). Levels of aerobic, muscle-strengthening, and flexibility physical activity were self-reported at baseline. Participants engaging in ≥10 MET-hr/wk of moderate- and vigorous-intensity aerobic activity and ≥2 d/wk of muscle-strengthening activity were considered as meeting the guidelines. Cox proportional hazards model was used to estimate hazard ratios (HR) and 95% confidence intervals (CI), adjusting for potential confounders.ResultsAerobic activity was inversely associated with both all-cause (≥20 vs. 0 MET-hr/wk: HR [95% CI]: 0.79 [0.70–0.89]) and cancer mortality (0.83 [0.68–1.00]), adjusting for other activity types. Muscle-strengthening (≥5 vs. 0 d/wk: 0.86 [0.71–1.04]) and flexibility activities (≥5 vs. 0 d/wk: 0.84 [0.73–0.96]) were inversely associated with all-cause mortality but were not associated with cancer mortality. Compared to participants who did not meet any guidelines (54%), those meeting both aerobic and muscle-strengthening guidelines (12%) had the lowest all-cause mortality (0.75 [0.62, 0.92]) but the interaction between two activity types was not statistically significant.ConclusionsOur data suggest that engaging in higher levels of aerobic, muscle-strengthening, and flexibility physical activity are all independently associated with lower all-cause mortality.Funding SourcesThis work was supported by Korea University and National Research Foundation of Korea.