Physical Activity and All-cause Mortality: An Updated Meta-analysis with Different Intensity Categories (original) (raw)
Abstract
In a meta-analysis we investigated the effect of physical activity with different intensity categories on all-cause mortality. Many studies have reported positive effects of regular physical activity on primary prevention. This recent meta-analysis analyzed all-cause mortality with special reference to intensity categories. A computerized systematic literature search was performed in EMBASE, PUBMED, and MEDLINE data bases (1990–2006) for prospective cohort studies on physical leisure activity. Thirty-eight studies were identified and evaluated. The presentation refers to studies with 3 or 4 different intensities of regular physical activity according to a standard questionnaire. There was a significant association of lower all-cause mortality for active individuals compared with sedentary persons. For studies with three activity categories (mildly, moderately, and highly active) and multivariate-adjusted models, highly active men had a 22% lower risk of all-cause mortality (RR=0.78; 95% CI: 0.72 to 0.84) compared to mildly active men. For women, the relative risk was 0.69 (95% CI: 0.53 to 0.90). We observed similar results in moderately active persons compared to mildly active individuals (RR=0.81 for men and RR=0.76 for women). This association of activity to all-cause mortality was similar and significant in older subjects. Regular physical activity over longer time is strongly associated with a reduction in all-cause mortality in active subjects compared to sedentary persons. There is a dose-response curve especially from sedentary subjects to those with mild and moderate exercise with only a minor additional reduction with further increase in activity level.
Key words
primary prevention - physical training - fitness - aging - gender
References
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Appendix A
Tables A1-A8
Table A1 Studies with two intensity groups of physical activity.
| First author (year) | Country | Follow-up (yrs) | Sex | Adjustment | Age group | Number of participants | RR in the active group+(95% CI) |
|---|---|---|---|---|---|---|---|
| Kaplan (1996) | USA | 28 | all | multivariate | 3 | 6 131 | 0.84 (0.77–0.92) |
| Knoops (2004) | Europe | 10 | all | multivariate | 2 | 2 339 | 0.63 (0.55–0.72) |
| Hedblad (1997) | S | 25 | men | age | 1 | 642 | 0.68 (0.49–0.94) |
| Hedblad (1997) | S | 25 | men | multivariate | 1 | 642 | 0.70 (0.50–0.98) |
| Villeneuve (1998) | CDN | 7 | men | multivariate | 1 | 6 246 | 0.82 (0.65–1.04) |
| Schnoor (2000) | DK | 22 | men | multivariate | 3 | 4 658 | 0.39 (0.19–0.73) |
| Panagiotakos (2004) | GR | 40 | men | multivariate | 1 | 529 | 0.83 (0.66–1.02) |
| Villeneuve (1998) | CDN | 7 | women | multivariate | 1 | 8 196 | 0.88 (0.68–1.04) |
| Definition of age group: 1=”<65 years”, 2=”≥65 years”, 3=”all ages” |
Table A2 Studies with three intensity groups of physical activity: Sex=all.
| First author (year) | Country | Follow-up (yrs) | Adjustment | Age group | Number of participants | RR in the moderate active group+(95% CI) | RR in the most active group+(95% CI) |
|---|---|---|---|---|---|---|---|
| LaCroix (1996) | USA | 5 | age | 2 | 1 645 | 0.69 (0.46–1.06) | 0.73 (0.48–1.10) |
| Kujala (1998) | FIN | 19 | age | 1 | 15 902 | 0.71 (0.62–0.81) | 0.57 (0.45–0.74) |
| Hillsdon (2003) | GB | 12 | age | 1 | 10 522 | 0.57 (0.42–0.79) | 0.72 (0.54–0.95) |
| LaCroix (1996) | USA | 5 | multivariate | 2 | 1 645 | 0.83 (0.53–1.29) | 0.91 (0.58–1.42) |
| Kujala (1998) | FIN | 19 | multivariate | 1 | 15 902 | 0.80 (0.69–0.91) | 0.76 (0.59–0.98) |
| Hillsdon (2003) | GB | 12 | multivariate | 1 | 10 522 | 0.63 (0.45–0.89) | 0.81 (0.60–1.09) |
Table A3 Studies with three intensity groups of physical activity: Sex=men.
| First author (year) | Country | Follow-up (yrs) | Adjustment | Age group | Number of participants | RR in the moderate active group+(95% CI) | RR in the most active group+(95% CI) |
|---|---|---|---|---|---|---|---|
| Leon (1991) | USA | 10.5 | age | 1 | 12 138 | 0.85 (0.73–0.99) | 0.87 (0.74–1.01) |
| Paffenbarger (1993) | USA | 9 | age | 3 | 10 269 | 0.70 (0.54–0.88) | 0.68 (0.54–0.95) |
| LaCroix (1996) | USA | 5 | age | 2 | 615 | 0.78 (0.43–1.45) | 0.89 (0.49–1.62) |
| Morgan (1997) | GB | 10 | age | 2 | 635 | 0.62 (0.38–1.00) | 0.36 (0.26–0.51) |
| Rosengren (1997) | S | 20 | age | 1 | 7 142 | 0.74 (0.68–0.82) | 0.73 (0.68–0.79) |
| Bijnen (1998) | NL | 10 | age | 2 | 802 | 0.67 (0.52–0.85) | 0.64 (0.50–0.83) |
| Hakim (1998) | USA | 12 | age | 2 | 707 | 0.64 (0.38–1.12) | 0.53 (0.34–0.77) |
| Andersen (2000) | DK | 14.5 | age | 3 | 17 265 | 0.71 (0.66–0.76) | 0.65 (0.59–0.70) |
| Yu (2003) | GB | 11 | age | 1 | 1 975 | 0.88 (0.66–1.18) | 0.58 (0.41–0.82) |
| Barengo (2004) | FIN | 20 | age | 1 | 15 853 | 0.85 (0.79–0.92) | 0.60 (0.53–0.68) |
| Leon (1991) | USA | 10.5 | multivariate | 1 | 12 138 | 0.89 (0.77–1.04) | 0.92 (0.79–1.07) |
| Lindsted (1991) | USA | 26 | multivariate | 1 | 9 484 | 0.68 (0.59–0.78) | 0.76 (0.63–0.92) |
| Mensink (1996) | D | 8 | multivariate | 1 | 954 | 0.61 (0.35–1.05) | 0.79 (0.48–1.31) |
| Morgan (1997) | GB | 10 | multivariate | 2 | 635 | 0.85 (0.52–1.39) | 0.63 (0.44–0.89) |
| Rosengren (1997) | S | 20 | multivariate | 1 | 7 142 | 0.84 (0.77–0.93) | 0.83 (0.77–0.90) |
| Bijnen (1998) | NL | 10 | multivariate | 2 | 802 | 0.80 (0.63–1.02) | 0.77 (0.59–1.00) |
| Hakim (1998) | USA | 12 | multivariate | 2 | 707 | 0.62 (0.36–1.08) | 0.56 (0.37–0.83) |
| Sherman (1999) | USA | 16 | multivariate | 3 | 962 | 0.85 (0.77–0.94) | 0.80 (0.70–0.89) |
| Andersen (2000) | DK | 14.5 | multivariate | 3 | 17 265 | 0.72 (0.66–0.78) | 0.71 (0.65–0.78) |
| Yu (2003) | GB | 11 | multivariate | 1 | 1 975 | 0.87 (0.65–1.17) | 0.61 (0.43–0.86) |
| Barengo (2004) | FIN | 20 | multivariate | 1 | 15 853 | 0.91 (0.85–0.98) | 0.80 (0.71–0.90) |
Table A4 Studies with three intensity groups of physical activity: Sex=women.
| First author (year) | Country | Follow-up (yrs) | Adjustment | Age group | Number of participants | RR in the moderate active group+(95% CI) | RR in the most active group+(95% CI) |
|---|---|---|---|---|---|---|---|
| LaCroix (1996) | USA | 5 | age | 2 | 1 030 | 0.50 (0.28–0.90) | 0.45 (0.25–0.83) |
| Kushi (1997) | USA | 7 | age | 1 | 40 417 | 0.66 (0.60–0.73) | 0.58 (0.52–0.65) |
| Morgan (1997) | GB | 10 | age | 2 | 635 | 0.61 (0.40–0.92) | 0.36 (0.27–0.48) |
| Andersen (2000) | DK | 14.5 | age | 3 | 13 375 | 0.64 (0.59–0.69) | 0.55 (0.49–0.62) |
| Barengo (2004) | FIN | 20 | age | 1 | 16 824 | 0.85 (0.77–0.94) | 0.87 (0.74–1.02) |
| Lissner (1996) | S | 20 | multivariate | 1 | 1 405 | 0.56 (0.39–0.82) | 0.45 (0.24–0.86) |
| Mensink (1996) | D | 8 | multivariate | 1 | 1 142 | 0.94 (0.51–1.75) | 0.81 (0.44–1.49) |
| Kushi (1997) | USA | 7 | multivariate | 1 | 40 417 | 0.77 (0.69–0.86) | 0.68 (0.60–0.77) |
| Morgan (1997) | GB | 10 | multivariate | 2 | 635 | 0.73 (0.48–1.12) | 0.48 (0.36–0.65) |
| Sherman (1999) | USA | 16 | multivariate | 3 | 1 410 | 0.84 (0.76–0.93) | 0.83 (0.75–0.90) |
| Andersen (2000) | DK | 14.5 | multivariate | 3 | 13 375 | 0.65 (0.60–0.71) | 0.59 (0.52–0.67) |
| Barengo (2004) | FIN | 20 | multivariate | 1 | 16 824 | 0.90 (0.82–0.99) | 0.98 (0.83–1.15) |
_Table A5_ Studies with four intensity groups of physical activity: _Sex_=all.
| First author (year) | Country | Follow-up (yrs) | Adjustment | Age group | Number of participants | RR in the light active group+(95% CI) | RR in the moderate active group+(95% CI) | RR in the most active group+(95% CI) |
|---|---|---|---|---|---|---|---|---|
| Andersen (2000) | DK | 14.5 | age | 3 | 30 640 | 0.68 (0.64–0.71) | 0.61 (0.57–0.66) | 0.53 (0.41–0.68) |
| Hillsdon (2003) | GB | 12 | age | 1 | 7 704 | 0.68 (0.45–1.05) | 0.40 (0.27–0.58) | 0.40 (0.28–0.57) |
| Hillsdon (2003) | GB | 12 | multivariate | 1 | 7 704 | 1.14 (0.74–1.78) | 0.53 (0.35–0.82) | 0.52 (0.35–0.78) |
_Table A6_ Studies with four intensity groups of physical activity: _Sex_=men.
| First author (year) | Country | Follow-up (yrs) | Adjustment | Age group | Number of participants | RR in the light active group+(95% CI) | RR in the moderate active group+(95% CI) | RR in the most active group+(95% CI) |
|---|---|---|---|---|---|---|---|---|
| Morris (1990) | GB | 9.5 | age | 1 | 9 376 | 0.88 (0.66–1.17) | 0.78 (0.54–1.12) | 0.34 (0.18–0.66) |
| Eaton (1995) | ISR | 21 | age | 3 | 8 463 | 0.84 (0.74–0.94) | 0.81 (0.73–0.90) | 0.84 (0.72–0.98) |
| Leon (1997) | USA | 16 | age | 1 | 12 138 | 0.78 (0.67–0.91) | 0.77 (0.66–0.90) | 0.74 (0.63–0.86) |
| Wannamethee (1998) | GB | 4 | age | 3 | 5 934 | 0.57 (0.40–0.78) | 0.39 (0.25–0.62) | 0.48 (0.34–0.68) |
| Morris (1990) | GB | 9.5 | multivariate | 1 | 4 824 | 0.90 (0.57–1.44) | 0.59 (0.34–1.05) | 0.53 (0.21–1.32) |
| Sandvik (1993) | N | 16 | multivariate | 1 | 1 960 | 0.92 (0.66–1.28) | 1.00 (0.71–1.41) | 0.54 (0.32–0.89) |
| Haapanen (1996) | FIN | 11 | multivariate | 1 | 1 072 | 0.40 (0.21–0.75) | 0.64 (0.34–1.20) | 0.37 (0.19–0.68) |
| Folsom (1997) | USA | 7 | multivariate | 1 | 6 188 | 0.83 (0.60–1.14) | 0.97 (0.65–1.45) | 0.68 (0.47–0.99) |
| Leon (1997) | USA | 16 | multivariate | 1 | 12 138 | 0.85 (0.73–0.99) | 0.87 (0.75–1.02) | 0.83 (0.71–0.97 |
| Erikssen (1998) | N | 13 | multivariate | 1 | 1 428 | 0.72 (0.52–0.99) | 0.48 (0.33–0.71) | 0.45 (0.29–0.69) |
| Villeneuve (1998) | CDN | 7 | multivariate | 1 | 6 246 | 0.81 (0.59–1.11) | 0.79 (0.54–1.13) | 0.86 (0.61–1.22) |
| Wannamethee (1998) | GB | 4 | multivariate | 3 | 5 934 | 0.61 (0.43–0.86) | 0.50 (0.31–0.79) | 0.65 (0.45–0.94) |
| Breckenkamp (2004) | D | 14 | multivariate | 1 | 2 320 | 0.62 (0.35–1.08) | 0.76 (0.45–1.29) | 0.44 (0.30–0.65) |
_Table A7_ Studies with four intensity groups of physical activity: _Sex_=women.
| First author (year) | Country | Follow-up (yrs) | Adjustment | Age group | Number of participants | RR in the light active group+(95% CI) | RR in the moderate active group+(95% CI) | RR in the most active group+(95% CI) |
|---|---|---|---|---|---|---|---|---|
| Weller (1998) | CDN | 7 | age | 3 | 6 620 | 0.91 (0.66–1.25) | 0.94 (0.72–1.23) | 0.89 (0.67–1.17) |
| Folsom (1997) | USA | 7 | multivariate | 1 | 7 852 | 0.79 (0.53–1.18) | 1.05 (0.66–1.66) | 0.58 (0.36–0.92) |
| Villeneuve (1998) | CDN | 7 | multivariate | 1 | 8 196 | 0.94 (0.69–1.30) | 0.92 (0.64–1.34) | 0.71 (0.45–1.11) |
| Breckenkamp (2004) | D | 14 | multivariate | 1 | 2 320 | 0.34 (0.14–0.81) | 0.39 (0.17–0.91) | 0.23 (0.12–0.42) |
Table A8 Studies with five intensity groups of physical activity.
| First author (year) | Country | Follow-up (year) | Sex | Adjustment | Age group |
|---|---|---|---|---|---|
| Fried (1998) | USA | 5 | all | age | 2 |
| Fried (1998) | USA | 5 | all | multivariate | 2 |
| Sundquist (2004) | S | 12 | all | multivariate | 2 |
| Sundquist (2004) | S | 12 | men | age | 2 |
| Lee (1995) | USA | 26 | men | multivariate | 1 |
| Sundquist (2004) | S | 12 | women | age | 2 |
| Rockhill (2001) | USA | 20 | women | age | 1 |
| Rockhill (2001) | USA | 20 | women | multivariate | 1 |
| First author (year) | Number of participants | RR in the light active group+(95% CI) | RR in the moderate active group+(95% CI) | RR in the active group+(95% CI) | RR in the most active group+(95% CI) |
| Fried (1998) | 5 201 | 0.62 | 0.55 | 0.43 | 0.29 |
| (0.49–0.80) | (0.43–0.70) | (0.34–0.55) | (0.23–0.38) | ||
| Fried (1998) | 5 201 | 0.78 | 0.81 | 0.72 | 0.56 |
| (0.60–1.00) | (0.63–1.05) | (0.55–0.93) | (0.43–0.74) | ||
| Sundquist (2004) | 3 206 | 0.72 | 0.60 | 0.50 | 0.60 |
| 0.64–0.81) | (0.50–0.71) | (0.42–0.59) | (0.46–0.79) | ||
| Sundquist (2004) | 1 414 | 0.74 | 0.57 | 0.51 | 0.60 |
| (0.62–0.87) | (0.44–0.73) | (0.41–0.64) | (0.44–0.82) | ||
| Lee (1995) | 17 321 | 0.88 | 0.92 | 0.87 | 0.87 |
| (0.82–0.96) | (0.82–1.02) | (0.77–0.99) | (0.78–0.97) | ||
| Sundquist (2004) | 1 792 | 0.70 | 0.59 | 0.47 | 0.54 |
| (0.59–0.82) | (0.46–0.77) | (0.35–0.62) | (0.31–0.94) | ||
| Rockhill (2001) | 4 746 | 0.76 | 0.66 | 0.64 | 0.62 |
| (0.70–0.82) | (0.61–0.71) | (0.58–0.70) | (0.54–0.72) | ||
| Rockhill (2001) | 4 746 | 0.82 | 0.75 | 0.74 | 0.71 |
| (0.76–0.89) | (0.69–0.81) | (0.68–0.81) | (0.61–0.82) | ||
| (Above: Authors,Country,Follow-up,Sex,Adjustment, Age; Below:No of participants,RR according to the groups compared to sedentary group) |
Correspondence
Prof. H. Löllgen
Department of Medicine
Ruhr-University
Bermesgasse 32 b
42897 Remscheid
Germany
Phone: +49/21916 53 54
Fax: +49/21916 106 71
Email: loellgen@dgsp.de