Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis

Abstract

ObjectiveTo examine the dose-response associations between accelerometer assessed total physical activity, different intensities of physical activity, and sedentary time and all cause mortality.DesignSystematic review and harmonised meta-analysis.Data sourcesPubMed, PsycINFO, Embase, Web of Science, Sport Discus from inception to 31 July 2018.Eligibility criteriaProspective cohort studies assessing physical activity and sedentary time by accelerometry and associations with all cause mortality and reported effect estimates as hazard ratios, odds ratios, or relative risks with 95% confidence intervals.Data extraction and analysisGuidelines for meta-analyses and systematic reviews for observational studies and PRISMA guidelines were followed. Two authors independently screened the titles and abstracts. One author performed a full text review and another extracted the data. Two authors independently assessed the risk of bias. Individual level participant data were harmonised and analysed at study level. Data on physical activity were categorised by quarters at study level, and study specific associations with all cause mortality were analysed using Cox proportional hazards regression analyses. Study specific results were summarised using random effects meta-analysis.Main outcome measureAll cause mortality.Results39 studies were retrieved for full text review; 10 were eligible for inclusion, three were excluded owing to harmonisation challenges (eg, wrist placement of the accelerometer), and one study did not participate. Two additional studies with unpublished mortality data were also included. Thus, individual level data from eight studies (n=36 383; mean age 62.6 years; 72.8% women), with median follow-up of 5.8 years (range 3.0-14.5 years) and 2149 (5.9%) deaths were analysed. Any physical activity, regardless of intensity, was associated with lower risk of mortality, with a non-linear dose-response. Hazards ratios for mortality were 1.00 (referent) in the first quarter (least active), 0.48 (95% confidence interval 0.43 to 0.54) in the second quarter, 0.34 (0.26 to 0.45) in the third quarter, and 0.27 (0.23 to 0.32) in the fourth quarter (most active). Corresponding hazards ratios for light physical activity were 1.00, 0.60 (0.54 to 0.68), 0.44 (0.38 to 0.51), and 0.38 (0.28 to 0.51), and for moderate-to-vigorous physical activity were 1.00, 0.64 (0.55 to 0.74), 0.55 (0.40 to 0.74), and 0.52 (0.43 to 0.61). For sedentary time, hazards ratios were 1.00 (referent; least sedentary), 1.28 (1.09 to 1.51), 1.71 (1.36 to 2.15), and 2.63 (1.94 to 3.56).ConclusionHigher levels of total physical activity, at any intensity, and less time spent sedentary, are associated with substantially reduced risk for premature mortality, with evidence of a non-linear dose-response pattern in middle aged and older adults.Systematic review registrationPROSPERO CRD42018091808.

Device‐measured light‐intensity physical activity and mortality: A meta‐analysis

“…The subgroup analyses and metaregression analyses both confirmed that more time spent in LPA was inversely associated with mortality risks, supporting previous systematic reviews and meta-analysis for general populations. 5,8,9,47 The present meta-analyses showed progressive decreases in mortality risk as people spend more time in LPA. Compared with the lowest LPA group, the risk of death decreased approximately 35% and 50% for participants spending between 5 and 7 h/d and more than 7 hours a day in LPA, respectively (Model 2 in Table 1).…”

High leisure‐time physical activity reduces the risk of long‐term sickness absence

“…A large body of literature has shown the effects of LTPA over general adult´s health worldwide in a dose‐response manner, reducing the risk of suffering a wide range of chronic diseases and all‐cause as well as case‐specific mortality . Further, even when adjusted for sedentary time, another critical risk factor for both chronic disease and mortality, physical activity showed to be a reliable predictor of all‐cause mortality . Thus, those LTPA protective properties might contribute to diminishing the risk of LTSA, since that has been highly associated with chronic conditions and early mortality Because aerobic capacity (ie, maximal oxygen consumption), as well as muscular strength, has been inversely associated with, respectively, cardiovascular disease morbidity and all‐cause mortality among adults, the LTSA risk might decrease when performing either endurance or strength training during leisure.…”

“…29 Further, even when adjusted for sedentary time, another critical risk factor for both chronic disease and mortality, 30 physical activity showed to be a reliable predictor of all-cause mortality. 31 Thus, those LTPA protective properties might contribute to diminishing the risk of LTSA, since that has been highly associated with chronic conditions 32 and early mortality 9 Because aerobic capacity (ie, maximal oxygen consumption), as well as muscular strength, has been inversely associated with, respectively, cardiovascular disease morbidity 33 and all-cause mortality among adults, 33,34 the LTSA risk might decrease when performing either endurance or strength training during leisure. Therefore, encouraging workers to move more as a general notion, regardless of the type of physical activity, might contribute to reducing LTSA levels in a general population of workers.…”

Compositional analysis of the associations between 24-h movement behaviours and cardio-metabolic risk factors in overweight and obese adults with pre-diabetes from the PREVIEW study: cross-sectional baseline analysis

“…Although physical activity research has typically focused on MVPA, emerging evidence suggests that light intensity physical activity (LIPA) is associated with better cardiometabolic health, lower incidence of type 2 diabetes and all-cause mortality after adjusting for MVPA [2][3][4]. On the other hand, sedentary time is adversely associated with cardio-metabolic health [5,6], incidence of type 2 diabetes, cardiovascular disease [7] and all-cause mortality [8] independent of MVPA. Additionally, there is some evidence that both short and long sleep duration are adversely associated with body mass index (BMI), impaired glucose metabolism and blood pressure [9].…”