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Review
Do vigorous-intensity and moderate-intensity physical activities reduce mortality to the same extent? A systematic review and meta-analysis
  1. Juan Pablo Rey Lopez1,2,
  2. Angelo Sabag3,
  3. Maria Martinez Juan4,
  4. Leandro F M Rezende5,
  5. Maria Pastor-Valero4,6
  1. 1 Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, Australia
  2. 2 i+HEALTH Research Group, Department of Health Sciences, Universidad Europea Miguel de Cervantes, Valladolid, Spain
  3. 3 NICM Health Research Institute, Western Sydney University, Sydney, Australia
  4. 4 Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández, Elche, Spain
  5. 5 Universidade Federal de Sao Paulo, Escola Paulista de Medicina, Departamento de Medicina Preventiva, Sao Paulo, Brazil
  6. 6 Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
  1. Correspondence to Juan Pablo Rey-Lopez;jprey{at}uemc.es

Abstract

Objective To examine whether vigorous-intensity physical activity confers additional reductions on all-cause and cause-specific mortality compared with moderate-intensity physical activity.

Design A systematic review (registered in PROSPERO CRD42019138995) and meta-analysis.

Data sources Three electronic databases up to April 14 2020.

Eligibility criteria Inclusion criteria were prospective studies that contained information about (1) moderate-intensity (3–5.9 metabolic equivalent tasks (METs)) and vigorous-intensity (≥6 METs) physical activities and (2) all-cause and/or cause-specific mortality. Exclusion criteria were prospective studies that (1) exclusively recruited diseased patients (eg, hypertensive patients and diabetics) or (2) did not account for total physical activity in their multivariable models (3) or did not adjust or exclude individuals with comorbidities at baseline or (4) used physically inactive participants as reference group.

Results Five studies (seven cohorts using sex-specific results) were pooled into a meta-analysis. For all-cause mortality and controlling by total physical activity, vigorous-intensity physical activity (vs moderate) was not associated with a larger reduction in mortality (HR 0.95, 95% CI 0.83 to 1.09). After the exclusion of one study judged with critical risk of bias (Risk Of Bias in Non randomized Studies, ROBINS tool) from meta-analysis, results remained similar (HR 0.98, 95% CI 0.85 to 1.12). Due to the limited number of studies, meta-analyses for cancer and cardiovascular mortality were not performed.

Conclusions Prospective studies suggest that, for the same total physical activity, both vigorous-intensity and moderate-intensity physical activities reduce all-cause mortality to the same extent. However, absence of evidence must not be interpreted as evidence of absence due to the existing methodological flaws in the literature.

  • Epidemiology
  • physical activity
  • prevention
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjsem-2020-000775

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    Footnotes

    • Contributors All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by JPRL and AS. The first draft of the manuscript was written by JPRL and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. The authors declare that they have no conflict of interest.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval No ethical approval was required for this investigation. The opinions and assertions contained herein are the private views of the author (s) and are not to construed as official or as reflecting views of the Universities of Sydney, NSW (Australia), Western Sydney University (Australia), European University Miguel de Cervantes, Valladolid (Spain), University Miguel Hernandez, Alicante (Spain) and Universidade Federal de São Paulo, SP (Brazil).

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

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplemental information.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.