Long-term leisure-time physical activity and risk of all-cause and cardiovascular mortality: dose-response associations in a prospective cohort study of 210 327 Taiwanese adults

Objectives We aimed to investigate the dose-response associations of long-term leisure-time physical activity (LTPA) obtained from repeated measures with all-cause and cardiovascular disease (CVD) mortality outcomes in Taiwanese adults. Methods We included 210 327 participants with self-reported LTPA at least in two medical examinations (867 968 data points) for up to 20 years (median, IQR: 4.8 years, 2.3-9.0). Dose-response relationships were modelled with restricted cubic spline functions and Cox regressions HRs (95% CIs) adjusted for main covariates. Results During up to 23 years of follow-up (3 655 734 person-years), 10 539 participants died, of which 1919 of CVD. We observed an inverse, non-linear dose-response association between long-term LTPA and all-cause and CVD mortality. Compared with the referent (0 metabolic equivalent of task (MET) hours/week), insufficient (0.01-7.49 MET hours/week), recommended (7.50-15.00 MET hours/week) and additional (>15 MET hours/week) amounts of LTPA had a lower mortality risk of 0.74 (0.69-0.80), 0.64 (0.60-0.70) and 0.59 (0.54-0.64) for all-cause mortality and 0.68 (0.60-0.84), 0.56 (0.47-0.67) and 0.56 (0.47-0.68) for CVD mortality. When using only baseline measures of LTPA, the corresponding mortality risk was 0.88 (0.84-0.93), 0.83 (0.78-0.88) and 0.78 (0.73-0.83) for all-cause and 0.91 (0.81-1.02), 0.78 (0.68-0.89) and 0.80 (0.70-0.92) for CVD mortality. Conclusion Long-term LTPA was associated with lower risks of all-cause and CVD mortality. The magnitude of risk reductions was larger when modelling repeated measures of LTPA compared with one measure of LTPA at baseline.