Abstract
Although the benefits of leisure-time physical activity (LTPA) in middle age are established, the health effects of long-term participation and changes in LTPA between adolescence and middle age have not been documented. To determine whether an association exists between LTPA life course patterns and mortality. This prospective cohort study used data from the National Institutes of Health-AARP (formerly American Association of Retired Persons) Diet and Health Study established in 1995 to 1996. Data analysis was conducted from March 2017 through February 2018. Data were analyzed for 315 059 adult AARP members living in 6 states, namely, California, Florida, Louisiana, New Jersey, North Carolina, or Pennsylvania, or 2 metropolitan areas, Atlanta, Georgia, or Detroit, Michigan. Self-reported LTPA (hours per week) at the baseline interview for ages grouped as 15 to 18, 19 to 29, 35 to 39, and 40 to 61 years. All-cause, cardiovascular disease (CVD)-related, and cancer-related mortality records available through December 31, 2011. Of 315 059 participants, 183 451 (58.2%) were men, and the participants were 50 to 71 years of age at enrollment. Ten LTPA trajectories (categorized as maintaining, increasing, and decreasing LTPA across time) were identified, and 71 377 deaths due to all causes, 22 219 deaths due to CVD, and 16 388 deaths due to cancer occurred. Compared with participants who were consistently inactive throughout adulthood, participants who maintained the highest amount of LTPA in each age period were at lower risks for all-cause, CVD-related, and cancer-related mortality. For example, compared with participants who were consistently inactive, maintaining higher amounts of LTPA was associated with lower all-cause (hazard ratio [HR], 0.64; 95% CI, 0.60-0.68), CVD-related (HR, 0.58; 95% CI, 0.53-0.64), and cancer-related (HR, 0.86; 95% CI, 0.77-0.97) mortality. Adults who were less active throughout most of the adult life course but increased LTPA in later adulthood (40-61 years of age) also had lower risk for all-cause (HR, 0.65; 95% CI, 0.62-0.68), CVD-related (HR, 0.57; 95% CI, 0.53-0.61), and cancer-related (HR, 0.84; 95% CI, 0.77-0.92) mortality. Maintaining higher LTPA levels and increasing LTPA in later adulthood were associated with comparable low risk of mortality, suggesting that midlife is not too late to start physical activity. Inactive adults may be encouraged to be more active, whereas young adults who are already active may strive to maintain their activity level as they get older.
Highlights
National guidelines for aerobic physical activity recommend adults should participate in at least 150 minutes per week of moderate intensity aerobic activity or 75 minutes per week of vigorous intensity activity or an equivalent combination of both.[1,2,3] Levels of physical activity equivalent to meeting this guideline have been associated with substantial health benefits, including reductions in all-cause,[4,5] cardiovascular disease (CVD)–related,[4,6] and cancer-related[4,7,8] mortality
Compared with participants who were consistently inactive throughout adulthood, participants who maintained the highest amount of leisure-time physical activity (LTPA) in each age period were at lower risks for all-cause, CVD-related, and cancer-related mortality
Compared with participants who were consistently inactive, maintaining higher amounts of LTPA was associated with lower all-cause, CVD-related (HR, 0.58; 95% CI, 0.53-0.64), and cancer-related (HR, 0.86; 95% CI, 0.77-0.97) mortality
Summary
National guidelines for aerobic physical activity recommend adults should participate in at least 150 minutes per week of moderate intensity aerobic activity or 75 minutes per week of vigorous intensity activity or an equivalent combination of both.[1,2,3] Levels of physical activity equivalent to meeting this guideline have been associated with substantial health benefits, including reductions in all-cause,[4,5] cardiovascular disease (CVD)–related,[4,6] and cancer-related[4,7,8] mortality. There have been studies conducted on mortality risk from maintaining or changing LTPA during adulthood,[9,10,11,12,13,14] those studies primarily examined changes in physical activity occurring during midlife for short periods of time (eg, 2-7 years), but not from adolescence into middle and older ages. The goal of this study was to examine how patterns in LTPA occurring over a wide age range, that is, adolescence (15-18 years) and early (19-29 years), middle (35-39 years), and later adulthood (40-61 years), are associated with all-cause and cause-specific (ie, CVD and cancer) mortality. We hypothesized that participants who maintained the highest levels of activity in all age groups would have the lowest risk for mortality
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