Physical activity trajectories and accumulation over adulthood and their associations with all-cause and cause-specific mortality: a systematic review and meta-analysis

Abstract

Objective To understand the associations of trajectories and accumulation of physical activity (PA) over adulthood with all-cause, cardiovascular disease (CVD), and cancer mortality. Design Systematic review and meta-analyses. Data sources PubMed, Embase, Scopus, Cochrane Library, Web of Science, CINAHL, MEDLINE, SPORTDiscus, and reference lists of included studies. Eligibility criteria Population-based prospective studies with (1) non-clinical adult population, (2) PA assessed ≥2 timepoints as exposure, (3) all-cause, CVD or cancer mortality as outcomes with risk measures, and (4) publication up to 9 April 2024 and in English. Results 85 studies with three main types of PA exposure (ie, trajectory, time-varying, and cumulative/average) were included. Of these, 77 assessed all-cause mortality, 34 assessed CVD mortality, and 15 assessed cancer mortality. Overall, higher PA was associated with lower risks of all outcomes. Consistently and increasingly active individuals had around 20–40% lower risk of all-cause mortality and 30-40% lower risk of CVD mortality; however, the associations with decreasing PA patterns were less evident. Time-varying and cumulative/average PA illustrated similar inverse associations between higher PA levels and all-cause and CVD mortality. The associations were weaker and less robust for cancer mortality. Non-linear dose-response associations suggested risk reductions in all-cause and CVD mortality for meeting PA guidelines, but consistent/increasing PA below the guidelines also provided health benefits. Conclusions Consistently/increasingly accumulated PA over adulthood can reduce the risk of all-cause and CVD mortality, while the health benefits from decreasing PA patterns require further exploration. Data are available upon reasonable request. Data and codes are available from authors upon reasonable request.