A major study from UK Biobank suggests that for the same total amount of activity, doing more activity at a vigorous intensity is associated with a lower risk of heart disease, diabetes, dementia and other chronic diseases.
Research: Amount and intensity of physical activity and risk of cardiovascular and non-cardiovascular chronic diseases. Image credit: muse studio / Shutterstock
In a recent study published in european heart journalresearchers evaluated the association between percentage of vigorous physical activity (%VPA) and incidence of chronic disease outcomes.
PA is a modifiable lifestyle factor that can reduce the risk of chronic disease and mortality. Guidelines recommend 150 to 300 minutes of moderate PA, 75 to 150 minutes of vigorous PA (VPA), or both per week. Studies have shown that VPA produces greater improvements in functional capacity, cardiorespiratory fitness, and cardiometabolic risk factors than the same amount of low-intensity activity.
Additionally, even moderate VPA, 15 to 20 minutes per week, is associated with a lower risk of death. Cohort studies also found that higher %VPA as a percentage of total activity was associated with lower mortality for an equal amount of PA. The relationship between PA intensity and benefits has important implications for public health. However, it is still unclear whether the benefits extend to chronic diseases.
UK Biobank Physical Activity Research Design
In this study, researchers investigated the association between %VPA and chronic disease and mortality. They used data from UKB, a large prospective cohort study of over 500,000 people. The International PA Questionnaire (IPAQ) was used from 2006 to 2010 to assess self-reported PA. In addition, some UKB participants wore accelerometers for 7 days between 2013 and 2015 and provided PA data measured by the device.
The results of this study were eight chronic diseases and all-cause mortality. Chronic disease outcomes were MACE, AFib, T2D, CKD, CRD, dementia, MASLD, and IMID. Total PA content was quantified as metabolic equivalents per week.
Furthermore, we estimated the %VPA relative to the total PA amount. %VPA was categorized into four levels. For accelerometer-based data, the levels were 0%, max 2%, > 2% to ≤ 4%, > > 4%. For IPAQ-based data, %VPA levels were 0%, > 0% to ≤ 25%, > 25% to ≤ 50%, and > 50%. Cox proportional hazards models were used to estimate hazard ratios for chronic disease incidence and mortality. Model 1 was adjusted for total PA, sociodemographic, and lifestyle factors.
Model 2 was further adjusted for supplement intake, drug use, blood pressure, estimated glomerular filtration rate, BMI, frailty index score, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. Exploratory analyzes assessed dose-response relationships and calculated preventable population proportions.
Higher %VPA is associated with lower disease risk
Accelerometer-based PA data were available from 96,408 UKB participants with a mean age of 61.9 years. Of these, 9,366 had MACE, 4,123 had AFib, 2,210 had T2D, 942 had dementia, 2,565 had CKD, 2,873 had CRD, 1,706 had MASLD, 1,721 had IMID, and 4,129 died during follow-up. IPAQ data were available for 375,730 participants with a mean age of 56.2 years.
Among patients with IPAQ data, there were 58,644 MACE cases, 25,103 AFib cases, 13,163 IMID cases, 22,442 T2D cases, 10,747 MASLD cases, 17,061 CKD cases, 20,173 CRD cases, 7,290 dementia cases, and 30,335 deaths. In model 1, participants with VPA >4% had a 29% to 61% lower risk of all outcomes than participants with VPA 0%. In Model 2, the association weakened but remained significant.
For example, the 5-year MACE risk was 10.16% and 6.42% in the 0% VPA and >4% VPA groups, respectively. A similar association was observed for IPAQ-based %VPA, although the effect size was smaller, likely reflecting measurement error in self-reported data. We observed a nonlinear relationship between %VPA and outcome incidence, with higher %VPA consistently associated with lower risk.
Additionally, any VPA could prevent 21.4% of CRD, 32.3% of dementia, and 20.3% of IMID cases compared to 0% of VPA. IMID showed a strong dependence on PA intensity, whereas CKD, MASLD, and T2D showed contributions from both intensity and quantity.
Public health impact of %VPA
Taken together, we found that for a given total PA dose, higher %VPA levels were associated with lower risk of several chronic diseases and mortality. %VPA showed higher preventive potential than total PA across outcomes. These findings support prioritizing high-intensity activities in public health strategies, while acknowledging that observational programs do not establish causality.
