Do vigorous-intensity and moderate-intensity physical activities reduce mortality to the same extent? A systematic review and meta-analysis

Juan Pablo Rey Lopez; Angelo Sabag; Maria Martinez Juan; Leandro F M Rezende; Maria Pastor-Valero

doi:10.1136/bmjsem-2020-000775

Do vigorous-intensity and moderate-intensity physical activities reduce mortality to the same extent? A systematic review and meta-analysis

BMJ Open Sport Exerc Med. 2020 Oct 5;6(1):e000775. doi: 10.1136/bmjsem-2020-000775. eCollection 2020.

Authors

Juan Pablo Rey Lopez^{1

2}, Angelo Sabag³, Maria Martinez Juan⁴, Leandro F M Rezende⁵, Maria Pastor-Valero^{4

6}

Affiliations

¹ Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, Australia.
² i+HEALTH Research Group, Department of Health Sciences, Universidad Europea Miguel de Cervantes, Valladolid, Spain.
³ NICM Health Research Institute, Western Sydney University, Sydney, Australia.
⁴ Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández, Elche, Spain.
⁵ Universidade Federal de Sao Paulo, Escola Paulista de Medicina, Departamento de Medicina Preventiva, Sao Paulo, Brazil.
⁶ Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.

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.

Keywords: Epidemiology; physical activity; prevention.

Publication types

Review