Volume vs intensity of physical activity and risk of cardiovascular and non-cardiovascular chronic diseases.
Using wrist-accelerometer data from 96,408 UK Biobank participants, a higher share of vigorous activity (%VPA) showed a non-linear inverse association with MACE, atrial fibrillation, type 2 diabetes, CKD, dementia and all-cause mortality — independent of total activity volume. Participants exceeding 4% VPA had 29–61% lower risk of these outcomes. The study suggests exercise intensity deserves more weight in prevention counselling, alongside the traditional focus on weekly duration.
Methods
This prospective population-based cohort study included 96,408 participants (mean age 61.9 years, women: 56.3%) with device-measured data (wrist-worn accelerometers) and 375,730 participants (mean age 56.2 years, women: 52.2%) with self-reported PA data (IPAQ) from the UK Biobank. Main outcomes included incidence of eight chronic diseases: major adverse cardiovascular events (MACE), atrial fibrillation (AFib), type 2 diabetes (T2D), immune-mediated inflammatory diseases, metabolic dysfunction-associated steatotic liver disease (MASLD), chronic respiratory diseases (CRD), chronic kidney disease (CKD), and dementia, as well as all-cause mortality. Cox proportional hazards models were used to estimate adjusted hazard ratios and 95% confidence interval.
Results
In the device-measured data, non-linear inverse dose-response relationships were observed between %VPA and all outcomes (all P < .001), and these patterns remained consistent across strata of total PA volume. In multivariable models adjusted for total PA volume, participants with >4% VPA had 29%-61% lower risks of these outcomes compared with those with 0% VPA. Joint analyses and population attributable fraction revealed distinct disease-specific patterns: immune-mediated inflammatory diseases showed very strong intensity-dependence with minimal contribution from PA volume (20.3% for intensity vs 1.0% for volume), while MACE (17.8% vs 6.0%), AFib (16.2% vs 5.0%), CRD (21.4% vs 5.6%), and dementia (32.3% vs 8.1%) demonstrated intensity predominance with modest contribution from PA volume, and T2D (26.6% vs 17.7%), MASLD (22.1% vs 16.6%), CKD (23.0% vs 15.3%), and all-cause mortality (31.4% vs 14.2%) showed more balanced contributions from both intensity and volume.
Conclusions
A higher %VPA, independent of total activity volume, is inversely associated with eight major chronic diseases and all-cause mortality. Intensity consistently demonstrated a higher preventive potential than total PA volume. These findings support, whenever possible, prioritizing higher-intensity activities in clinical and public health interventions aimed at preventing non-communicable diseases.
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