Exceeding Exercise Guidelines Boosts Survival, to a Point


A new study suggests that exceeding current recommendations for moderate to vigorous levels of physical activity could add years to life.

According to the US Department of Health and Human Services Physical Activity Guidelines, Americans are recommended to get at least 150 to 300 minutes per week of moderate exercise, or 75 to 150 minutes per week of vigorous exercise, or an equivalent combination of both.

Results from more than 100,000 US adults followed over 30 years showed that people who did twice the currently recommended range of moderate to vigorous physical activity weekly had the lowest long-term risk of death.


Adults who reported four times the minimum recommended activity levels saw no clear increase in mortality, but also no harm, according to a study published July 25 in the journal Circulation.

“I think we’re more concerned about the lower limit and people who don’t even do the bare minimum, but that should reassure people who like to exercise a lot,” senior author Edward Giovannucci, MD, from the Harvard School of Public Health. T. H. Chana, Boston, Massachusetts, reported | Medscape Cardiology.

Some studies have shown that long-term, high-intensity exercise (eg, marathons, triathlons, and long-distance cycling) may be associated with an increased risk of atrial fibrillation, coronary artery calcification, and sudden cardiac death.


A recent analysis by the Copenhagen City Heart Study also showed a U-shaped relationship between long-term all-cause mortality and duration of 0 to 2.5 hours and more than 10 hours of weekly leisure sports.

Most of the studies suggesting harm have used only one measure of physical activity, Giovannucci said, covering people who consistently exercise at a high level and those who do so occasionally, which can be harmful. “We were able to better look at ongoing long-term activity and saw that there was no harm.”

The study included 116,221 participants in the Nurses’ Health Study and the subsequent Health Workers Study between 1988 and 2018, who completed up to 15 (mean 11) questionnaires about their health and leisure time physical activity, which were updated every 2 years.


Most of them were white (96%), 63% were women, and the mean age and body mass index during the follow-up period were 66 years and 26 kg/m2. During 30 years of observation, 47,596 people died.

“Effort makes sense”

The analysis showed that people who followed the recommendations for prolonged vigorous physical activity (75-150 minutes per week) reduced their adjusted risk of death from cardiovascular disease (CVD) by a whopping 31%, from non-cardiovascular causes. , by 15%. , and all causes by 19%, compared with persons without long-term vigorous activity.

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Those who did 2–4 times the recommended minimum (150–299 min/week) had a 27–33% lower risk of cardiovascular death, and a 27–33% lower risk of non-cardiovascular death. 19%, and the risk of all diseases by 21-23%. -cause mortality.

Higher levels did not appear to result in a further reduction in the risk of mortality. For example, 300-374 minutes/week of vigorous physical activity was associated with a 32% reduction in risk of death from cardiovascular disease, an 18% reduction in risk of non-cardiovascular death, and a 22% reduction in risk of death from any cause.

The analysis also showed that people who met the recommendations for moderate physical activity had a lower risk of CVD, non-CVD, and all-cause mortality, regardless of whether they were active 150-244 minutes per week (22%, 19% and 20% respectively). ) or 225-299 minutes/week (21%, 25% and 20%, respectively), compared with those who had virtually no long-term moderate activity.


Those who met the recommended minimum by 2–4 times (300–599 min/week) had a 28–38% lower risk of cardiovascular death, a 25–27% lower risk of non-cardiovascular death, and lower by 26–31%. for all-cause mortality.

The mortality advantage appears to have plateaued, with 600 minutes of moderate physical activity per week showing associations similar to 300-599 minutes per week.

“The optimal value seems to be two to four times the recommended level, but for people who lead a sedentary lifestyle, I think one of the key messages I give to my patients is that any effort is worth any physical activity. activity, even less than recommended, has some reduction in mortality,” said Erin Michos, MD, associate director of preventive cardiology at the Johns Hopkins University School of Medicine in Baltimore, Maryland, in an interview.

Indeed, people who engaged in moderate exercise for just 20–74 minutes per week had a 19% lower risk of death from any cause, and a 13% lower risk of death from cardiovascular disease, than those who did less. .

Current American Heart Association (AHA) recommendations include at least 150 minutes per week of moderate-intensity aerobic exercise or 75 minutes per week of vigorous aerobic exercise, or a combination of the two.

“It’s saying that more is better, in the range of two to four times more, so maybe we should move our targets a little higher, which is sort of what the Department of Health and Human Services has already done,” he said. he. Mishos, who did not participate in the study.

Former AHA President Donna Arnett, Ph.D., MSPH, who was not involved in the study, said in a statement that “we have long known that moderate to vigorous levels of exercise can reduce the risk of both atherosclerotic cardiovascular disease and mortality.” “.

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“We have also seen that doing more than 300 minutes of moderate-intensity aerobic physical activity or more than 150 minutes of vigorous-intensity aerobic exercise each week can further reduce the risk of atherosclerotic cardiovascular disease, so it makes sense that these extra minutes of exercise may also reduce mortality.” she added.

Mix and match

Giovannucci noted that the combined effect of the two types of exercise on mortality has not been explored in previous studies, and “there are some questions, such as whether doing a lot of moderate activity is enough or you can get more benefit by doing vigorous exercise.” activity too.

A joint analysis of the intensity of both exercises showed that additional intense physical activity was associated with lower mortality among participants with insufficient (<300 minutes per week) levels of moderate exercise, but not among those who did at least 300 minutes of moderate exercise per week.

“The main takeaway is that you can get almost all of the benefits just by doing moderate exercise,” Giovanucci said. “There is no magical benefit to doing energetic [exercise]. But if someone wants to exercise vigorously, they can benefit about twice as fast. So if you only have 2-3 hours a week for exercise and can run for, say, 2-3 hours, you can get the most benefit.”

Sensitivity analysis also showed a consistent association between long-term leisure time physical activity and mortality, without adjusting for BMI/caloric intake.

“Some people think that the effect of exercise is weight loss or weight maintenance, which can be one of the benefits, but even so, you get benefits even if they don’t affect your weight,” he said. “So it’s definitely important.”

Meekhos noted that intense physical activity can be intimidating for many people, but moderate exercise can include activities such as brisk walking, ballroom dancing, active yoga and recreational swimming.

“The good thing is that you can actually combine or substitute both and get the same reduction in mortality with moderate physical activity, because many patients may not want to be active,” she said. “They don’t want to run on the treadmill, it’s too intimidating or stressful.”

The study was supported by the National Institutes of Health. The authors and Mihos do not report any related financial relationships.

Circulation. Posted on July 25, 2022 Abstract

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