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Associations of vigorous physical activity with all-cause, cardiovascular and cancer mortality among 64 913 adults
  1. Juan Pablo Rey Lopez1,
  2. Klaus Gebel2,3,
  3. Debbie Chia1,
  4. Emmanuel Stamatakis1,4
  1. 1 Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  2. 2 School of Behavioural and Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia
  3. 3 Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
  4. 4 Charles Perkins Centre, Epidemiology Unit, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Juan Pablo Rey Lopez; juan.reylopez{at}


Background Physical activity recommendations state that for the same energy expenditure, moderate-to-vigorous physical activities (MVPAs) produce similar health benefits. However, few epidemiological studies have tested this hypothesis.

Design We examined whether, compared with moderate, vigorous activity was associated with larger mortality risk reductions.

Methods Data from 11 cohorts of the Health Survey for England and the Scottish Health Survey, collected from 1994 to 2011 (mean (SD) follow-up, 9.0 (3.6) years). Adults aged ≥30 years reported MVPA and linkage to mortality records. Exposure was the proportion of self-reported weighted MVPA through vigorous activity. Outcomes were all-cause, cardiovascular disease (CVD) and cancer mortality.

Results Among 64 913 adult respondents (44% men, 56% women, mean (SD) age, 49.8 (13.6) years), there were 5064 deaths from all-causes, 1393 from CVD and 1602 from cancer during 435 743 person-years of follow-up. Compared with those who reported no vigorous physical activity, and holding constant the volume of weighted MVPA, vigorous activity was associated with additional reductions in mortality risk. For all-cause mortality, the adjusted HR was HR=0.84 (95% CI 0.71, 0.99) and HR=0.84 (95% CI 0.76, 0.94) among those who reported between >0% and<30%, or ≥30% of their activity as vigorous, respectively. For CVD and cancer mortality, point estimates showed similar beneficial associations yet CIs were wider and crossed unity.

Conclusion Vigorous activities were associated with larger reductions in mortality risk than activities of moderate intensity, but no evidence of dose–response effects was found.

  • physical activity
  • exercise
  • longevity
  • cardio-protection
  • non-communicable diseases

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  • Contributors ES conceived and designed the study. JPRL conducted the literature search, performed the statistical analyses and wrote the first draft of the paper. All authors interpreted the data, and contributed to the draft of the paper, revised the subsequent drafts, and read and approved the final manuscript. JPRL takes primary responsibility for the accuracy of the data analysis.

  • Funding JPRL is funded through a University of Sydney Deputy-Vice Chancellor Post-doctoral Research Fellowship (Project Code: U2334) and has received a grant of the University of Sydney-University of Glasgow Early Career Mobility Scheme in January 2018; ES is funded by the National Health and Medicine Research Council (Australia).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Local research ethics committees approved the data collection of each survey.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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