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The Author 2011; all rights reserved. Advance Access publication 5 September 2011
Centre of Sports Science and University Sports, University of Vienna, Wien, Austria, 2Department of Social Medicine, University of
Bristol, Bristol, UK and 3Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
*Corresponding author. Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, CH-3012 Bern,
Switzerland. E-mail: zwahlen@ispm.unibe.ch
13 June 2011
Results
Data from 80 studies with 1 338 143 participants (118 121 deaths)
were included. Combined RRs comparing highest with lowest activity levels were 0.65 [95% confidence interval (95% CI) 0.600.71]
for total activity, 0.74 (95% CI 0.700.77) for leisure activity,
0.64 (95% CI 0.550.75) for activities of daily living and
0.83 (95% CI 0.710.97) for occupational activity. RRs per 1-h increment per week were 0.91 (95% CI 0.870.94) for vigorous exercise and 0.96 (95% CI 0.930.98) for moderate-intensity activities of
daily living. RRs corresponding to 150 and 300 min/week of moderate to vigorous activity were 0.86 (95% CI 0.800.92) and
0.74 (95% CI 0.650.85), respectively. Mortality reductions were
more pronounced in women.
1382
Accepted
Introduction
Methods
Search strategy and eligibility criteria
We searched MEDLINE (from 1966 to 1 September
2010) and Embase (from 1980 to 1 September 2010)
and the Cochrane Database of Systematic Reviews (up
to issue 8, 2010), with no language restrictions, for
studies in humans of the association between physical
activity and all-cause mortality. Our search consisted
of terms related to physical activity (for example,
motor activity, leisure activities, exercise, activities
of daily living, active transport) combined with
terms for mortality and prospective studies. The detailed MEDLINE search is given in Supplementary
Table 1 Public health statements on the recommended minimal levels of physical activity in adults
Year, Organization
1996, Surgeon Generals
Report Guidelines13
Recommendation (text)
The report recommends a moderate amount of
physical activity equivalent to physical activity
that uses 150 kcal of energy per day, or
1000 kcal per week.
1383
1384
status. Finally, we recorded the type of physical activity questionnaire used (complex questionnaire including quantitative history or simpler questionnaire),
how it was administered (interviewer or selfadministered) and how often the exposure variable
was assessed during the course of follow-up (only
once at baseline or at baseline and during follow-up).
First authors of eligible studies were contacted if further information or clarifications were needed.
Results
Identification and characteristics of studies
Our search identified 6933 potentially relevant reports, of which 180 were retrieved for detailed evaluation (Figure 1). Totally, 79 reports were excluded for
the reasons given in Supplementary Table S2, available as Supplementary Data at IJE online. A total of
101 study reports met the inclusion criteria, including
21 reports from the same study. A total of 80 studies
(1 338 143 study participants) were included in analyses, comparing highest with lowest levels of physical
activity.24103 A total of 47 studies had to be
excluded from the doseresponse analyses for the
reasons given in Supplementary Table S3, available
as Supplementary Data at IJE online; 33 studies
(844 026 participants) were included in these
analyses.32,35,40,43,46,48,49,5255,57,62,69,71,72,76,78,81,83,84,86,
8892,9597,100,102,103
total physical activity or leisure-time activity combined with routine activities of daily living. Only six
studies (7.5%) assessed physical activities of daily
living separately. A total of 70 studies (87.5%) assessed physical activity at baseline only and 10
(12.5%) performed repeat assessments. About half of
the studies used ordinal categories (e.g. low, moderate, high), 24 (30.0%) used time units per day or
week, 11 (13.8%) estimated MET-hours and 10
(12.5%) reported calorie expenditure. The 33 studies
included in the doseresponse analyses were published more recently, larger and of higher quality,
with greater completeness of follow-up and frequent
use of detailed questionnaires. Further details are
given in Supplementary Table S4, available as
Supplementary Data at IJE online.
Most studies adjusted for age, three-quarters of the
studies adjusted for cigarette smoking and half of the
studies adjusted for BMI and blood pressure
(Supplementary
Table
S5,
available
as
Supplementary Data at IJE online). Other confounders such as diabetes mellitus, lipid factors and alcohol consumption were considered in less than half of
the studies, and measures of socio-economic status
and marital status were included in less than
one-third of studies. Adjustment in maximally adjusted analyses ranged from 2 to 23 variables, with
a median of 7 variables.
1385
1386
80 studies included in
meta-analysis comparing
highest with lowest physical
activity levels
(1 338 143 participants)
33 studies included in
doseresponse meta-analysis
(844 026 participants)
47 studies excluded:
34 activity categories not described in
detail
3 less than three activity categories
6 incomplete details on number of
deaths, person or person-years
4 other reasons
1387
Table 2 Characteristics of studies of physical activity and all-cause mortality included in meta-analyses
Comparisons of highest vs
lowest level of physical
activity (n 80)
Analyses of increments
in physical activity (n 33)
56.4 (28.885.9)
Characteristic
Study population
Men only
Women only
Men and women
56.5 (33.885.9)
23 (28.8)
7 (21.2)
9 (11.3)
5 (15.2)
48 (60.0)
21 (63.6)
Study region
Europe
42 (52.5)
16 (48.5)
North America
26 (32.5)
10 (30.3)
Asia/Australia
12 (15.0)
7 (21.2)
Duration of follow-up
10.7 (2.055.3)
9.7 (2.024.0)
590%
24 (30.0)
24 (72.7)
56 (70.0)
9 (27.3)
<2000
30 (37.5)
8 (24.2)
200010
50 (62.5)
25 (75.8)
Detailed questionnaire
35 (43.8)
28 (84.8)
Brief questionnaire
43 (53.8)
5 (15.2)
Year of publication
2 (2.5)
0 (0.0)
Interviewer administered
39 (48.8)
12 (36.4)
Self-administered
38 (47.5)
21 (63.6)
3 (3.8)
0 (0.0)
21 (26.3)
6 (18.2)
14 (17.5)
4 (12.1)
41 (51.3)
4 (12.1)
13 (16.3)
8 (24.2)
Walking
11 (13.8)
10 (30.3)
6 (7.5)
4 (12.1)
6 (7.5)
5 (15.2)
8 (10.0)
1 (3.0)
41 (51.3)
0 (0.0)
24 (30.0)
22 (66.7)
10 (12.5)
8 (24.2)
11 (13.8)
6 (18.2)
4 (5.0)
2 (6.1)
2 (3.0)
0 (0.0)
1388
Table 3 Maximally adjusted combined RRs comparing groups with highest and lowest levels of physical activity
No. of
studies
21
No. of
participants/
deaths
395 655/31 169
RR (95% CI)
0.65 (0.600.71)
I2 (%)
79.4
14
0.66 (0.610.71)
48.8
0.010
41
0.74 (0.700.77)
68.1
0.018
P-valuea
<0.001
13
0.66 (0.610.71)
39.9
0.046
116 712/9065
0.64 (0.550.75)
77.0
0.039
0.88 (0.790.98)
76.8
0.016
82 412/17 069
0.83 (0.710.97)
87.6
<0.001
Results from random-effects meta-analyses, adjusted for a median of 7 variables (interquartile range 510 variables)
a
Represents P-value for heterogeneity,
b
Includes studies assessing leisure-time physical activity, routine activities of daily living and occupational physical activity.
c
Includes studies assessing leisure-time physical activity and one or more components of physical activities of daily living.
d
Includes studies assessing recreational activities including callisthenics, dancing, walking, hiking, golf, bicycling, swimming,
games, exercise and sports.
e
Includes studies assessing structured aerobic and muscle-strengthening exercise and sports.
f
Includes non-exercise activities including housework, gardening, stair climbing, walking and cycling as part of daily life.
g
Includes studies assessing walking and/or cycling to and from work.
h
Includes physical activities as part of occupation. Two studies30,42 did not report relative risks for occupational physical activity
because there was no association with all-cause mortality.
Stratum
RR (95% CI)
1991
1991
1991
1991
1991
1995
1996
1997
1998
1999
2002
2002
2002
2002
2003
2005
2006
2008
2008
2009
0.66 (0.500.87)
0.76 (0.630.92)
0.89 (0.781.01)
1.03 (0.911.16)
1.19 (0.991.43)
0.59 (0.370.95)
0.78 (0.421.44)
0.63 (0.440.89)
0.77 (0.591.00)
0.58 (0.430.79)
0.55 (0.460.65)
0.41 (0.210.78)
0.35 (0.160.76)
0.75 (0.321.79)
0.83 (0.671.03)
0.63 (0.570.69)
0.68 (0.550.85)
0.73 (0.660.81)
0.65 (0.560.75)
0.75 (0.551.03)
0.72 (0.650.81)
1995
1996
1997
1998
1999
2002
2002
2002
2005
2005
2006
2006
2008
2009
0.77 (0.461.29)
1.29 (0.582.86)
0.48 (0.360.65)
0.71 (0.540.94)
0.61 (0.450.82)
0.44 (0.210.93)
0.37 (0.150.94)
0.34 (0.180.64)
0.58 (0.520.64)
0.46 (0.330.65)
0.39 (0.280.54)
0.68 (0.490.94)
0.61 (0.510.72)
0.83 (0.591.16)
0.58 (0.520.66)
2003
2003
2006
2008
2008
0.53 (0.290.97)
0.72 (0.550.94)
0.33 (0.150.73)
0.54 (0.450.64)
0.55 (0.480.63)
0.57 (0.500.64)
0.65 (0.600.71)
.3
.5
2
Favours less activity
Figure 2 Mortality from all causes in individuals with highest compared with lowest levels of total physical activity.
Results from random-effects meta-analysis of maximally adjusted RRs from 21 cohort studies (395 655 participants; 31 169
deaths). Arrows indicate that the plotted 95% CI is not showing the full width of the calculated 95% CI which is given in
the RR column. The open diamonds show the summary estimate from the meta-analysis, and the dashed line the value of
the summary estimate for all studies combined
Men
Lindsted
Age 5059
Age 6069
Lindsted
Lindsted
Age 7079
Age 8089
Lindsted
Lindsted
Age 9099
Ruigomez
Mensink
Morgan
Bijnen
Sherman
Crespo
ij
Glostrup
ij
Gteborg
Jyvskyl
ij
Panagiatakos
Hu
Khaw
Inoue
Orsini
Hayasaka
Subtotal (I 2 = 81.3%, P = 0.000)
.
Women
Ruigomez
Mensink
Morgan
Weller
Sherman
Glostrup
ij
ij
Gteborg
ij
Jyvskyl
Hu
Trolle-Lagerros
Carlsson
Khaw
Inoue
Hayasaka
Subtotal (I 2 = 49.6%, P = 0.018)
.
Both sexes
Lubin
Trichopoulou
Manini
Age 3559
Arrieta
Arrieta
Age 6074
Subtotal (I 2 = 24.9%, P = 0.256)
.
Overall (I 2 = 79.4%, P = 0.000)
Year
1389
1390
Author
Stratum
RR (95% CI)
Year
0.83
0.81
0.57
0.80
0.91
0.92
0.79
0.68
0.83
0.83
0.86
0.56
0.71
1.09
0.83
0.93
0.76
0.79
0.91
0.64
0.78
0.71
0.63
0.80
(0.700.97)
(0.621.07)
(0.211.54)
(0.531.21)
(0.830.99)
(0.292.90)
(0.481.31)
(0.470.99)
(0.710.97)
(0.770.90)
(0.591.26)
(0.370.83)
(0.650.78)
(0.631.88)
(0.770.91)
(0.801.08)
(0.561.04)
(0.700.90)
(0.801.04)
(0.500.82)
(0.690.88)
(0.600.85)
(0.520.76)
(0.760.84)
0.40
0.66
1.14
0.45
0.81
0.58
0.68
0.59
1.15
0.98
0.75
0.59
0.75
0.57
0.87
0.69
(0.260.61)
(0.182.43)
(0.274.81)
(0.240.85)
(0.441.49)
(0.360.93)
(0.600.77)
(0.520.67)
(0.721.83)
(0.831.16)
(0.620.90)
(0.480.72)
(0.501.13)
(0.490.65)
(0.731.03)
(0.600.79)
0.91
0.56
0.53
0.64
0.77
0.46
0.82
0.43
0.73
0.89
0.72
0.36
0.66
0.70
0.70
0.69
(0.581.42)
(0.430.73)
(0.390.74)
(0.450.92)
(0.680.87)
(0.360.58)
(0.631.06)
(0.210.88)
(0.670.80)
(0.721.10)
(0.620.84)
(0.131.03)
(0.460.95)
(0.590.83)
(0.560.88)
(0.630.75)
0.74 (0.700.77)
.3
.5
2
Favours less activity
Figure 3 Mortality from all causes in individuals with highest compared with lowest levels of leisure-time physical activity.
Results from random-effects meta-analysis of maximally adjusted RRs from 41 cohort studies (544 056 participants; 61 465
deaths). Arrows indicate that the plotted 95% CI is not showing the full width of the calculated 95% CI which is given in
the RR column. The open diamonds show the summary estimate from the meta-analysis, and the dashed line the value of
the summary estimate for all studies combined
Men
Slattery
1989
Rakowsky
1992
Weyerer
1993
Rosolova
1994
Eaton
1995
Kampert
1996
Mensink
1996
Folsom
1997
Leon
1997
Rosengren
1997
Erikksen
1998
Hakim
1998
Andersen
2000
Hirvensalo
2000
Smith
2000
Meyer
2002
Yu
2003
Barengo
2004
Fujita
2004
Carlsson
2007
Inoue
2008
Byberg
2009
Park
2009
Subtotal (I 2 = 46.1%, P = 0.009)
.
Women
Rakowsky
1992
Weyerer
1993
Kampert
1996
Lissner
1996
Mensink
1996
Folsom
1997
Kushi
1997
Andersen
2000
Hirvensalo
2000
Barengo
2004
Fujita
2004
Carlsson
2006
Carlsson
2007
Ford
2008
Inoue
2008
2
Subtotal (I = 74.2%, P = 0.000)
.
Both sexes
La Croix
1996
Fried
1998
Johansson
1999
Seki
2001
Konlaan
2002
Woo
2002
Khaw
2006
Lan
2006
Schooling
2006
Arrieta
Age 3559
2008
Arrieta
2008
Age 6074
Landi
2008
Stessman
2009
Kvaavik
2010
Ueshima
2010
Subtotal (I 2 = 55.6%, P = 0.005)
.
Overall (I 2 = 68.1%, P = 0.000)
Author
Year
1391
Relative
Risk (95% CI)
Sex
.5
.8
Favours more activity
1.2
Figure 4 Meta-analysis of maximally adjusted RRs for all-cause mortality per increment of 1 h of physical activity per week
for different domains and subdomains of physical activity. Results from random-effects meta-analysis of maximally adjusted RRs from 22 cohort studies (638 871 participants; 50 563 deaths). The median dose of physical activity for the lowest
(reference) and highest activity category was 11 and 420 min/week, respectively. aIncluded studies that assessed mixed
leisure-time physical activities of moderate and vigorous intensity. bIncluded studies that assessed vigorous-intensity exercise and sports. cIncluded studies that assessed walking as part of daily life, for transportation and for exercise. dIncluded
studies that assessed walking and/or cycling to and from work. eIncluded studies that assessed moderate-intensity activities
including housework, gardening, stair climbing, walking and cycling as part of daily life. Arrows indicate that the plotted
95% CI is not showing the full width of the calculated 95% CI which is given in the RR column. The open diamonds show
the summary estimate from the meta-analysis, and the dashed line the value of the summary estimate for all studies
combined
1392
Table 4 Maximally adjusted RRs of all-cause mortality for 60, 150 and 300 min/week of physical activity compared with
lowest level of activity for different domains and types of moderate- and vigorous-intensity physical activity
No. of
studies
8
Walkingf
Physical activity for transportation
150 mina
0.78 (0.720.88)
300 minb
0.61 (0.510.74)
0.94 (0.920.97)
0.86 (0.800.92)
0.74 (0.650.85)
0.96 (0.930.98)
0.90 (0.840.96)
0.81 (0.710.92)
10
0.97 (0.950.99)
0.93 (0.870.97)
0.86 (0.790.95)
0.97 (0.941.00)
0.92 (0.860.99)
0.85 (0.740.99)
Year
RR (95% CI)
Villeneuve
1998
0.93 (0.811.08)
Haapanen-Niemi
2000
0.90 (0.731.11)
Lee
2000
0.93 (0.900.96)
Yu
2003
0.90 (0.801.02)
Bucksch
2005
0.96 (0.911.02)
Author
Men
0.93 (0.910.96)
.
Women
Villeneuve
1998
0.88 (0.731.05)
Haapanen-Niemi
2000
0.83 (0.551.27)
Gregg
2003
0.85 (0.800.90)
Bucksch
2005
0.83 (0.750.92)
0.85 (0.810.89)
.
Both sexes
Fried
1998
0.83 (0.750.91)
Lan
2006
0.77 (0.610.98)
0.82 (0.750.89)
.
Overall (I 2 = 49.7%, P = 0.030)
.5
0.89 (0.850.93)
.8
Favours more activity
1.2
Favours less activity
Figure 5 Meta-analysis of maximally adjusted RRs of all-cause mortality for 1000 kcal in energy expenditure per week
compared with lowest level of activity. Results from random-effects meta-analysis from eight cohort studies (56 773 study
participants; 7742 deaths) of moderate- and vigorous-intensity leisure-time activities and moderate-intensity activities of
daily living. The median level of energy expenditure for the lowest (reference) and highest activity category was 114 and
2490 kcal/week, respectively. Arrows indicate that the plotted 95% CI is not showing the full width of the calculated 95% CI
which is given in the RR column. The open diamonds show the summary estimate from the meta-analysis, and the dashed
line the value of the summary estimate for all studies combined
The median amount of physical activity for the lowest activity category (reference) was 11 min/week.
a
The US Department of Health and Human Services (HHS) Guidelines 200816 recommend at least 150 min/week of
moderate-intensity aerobic physical activity or 75 min of vigorous-intensity aerobic physical activity.
b
For additional and more extensive health benefits, the HHS recommends that adults should increase their aerobic physical activity
to 300 min/week of moderate-intensity or 150 min/week of vigorous-intensity aerobic physical activity.
c
Included studies assessed vigorous-intensity exercise and sports.
d
Included studies assessed mixed leisure-time physical activity of moderate and vigorous intensity.
e
Included studies assessed moderate-intensity activities including housework, gardening, stair climbing, walking and cycling as part
of daily life.
f
Included studies assessed walking as part of daily life, for transportation and for exercise.
g
Included studies assessed walking and/or cycling to and from work.
1393
Table 5 Maximally adjusted RRs of all-cause mortality for 500, 1000, 2000 and 3000 kcal/week of physical activity compared with lowest level of activity
Combined RR (95% CI)
Sex
Men
No. of
studies
5
500 kcal
0.97 (0.950.98)
1000 kcalb
0.93 (0.910.96)
2000 kcal
0.87 (0.830.92)
3000 kcal
0.81 (0.750.88)
Women
0.92 (0.900.94)
0.85 (0.810.89)
0.72 (0.650.79)
0.61 (0.530.70)
Overall
0.94 (0.920.96)
0.89 (0.850.93)
0.78 (0.720.86)
0.69 (0.610.79)
The median level of energy expenditure for the lowest activity category (reference) was 114 kcal/week
a
A consensus statement on doseresponse issues concerning physical activity and health suggested that volumes of physical activity
as low as 500 kcal/week might demonstrate a slight favourable effect on all-cause mortality10.
b
The Surgeon Generals Report Guidelines13 recommend a moderate amount of physical activity that uses 1000 kcal/week as
minimum level for achieving substantial health benefits. This amount is roughly equivalent to 150200 min of moderate-intensity
physical activity per week.
Discussion
This systematic review and meta-analysis of cohort
studies in general populations supports an inverse relationship between increasing levels of total and
domain-specific physical activity and all-cause mortality, with stronger associations for women than for
men, and for exercise and sports, leisure-time activities and activities of daily living than for occupational
and transport-related activity. Reductions in mortality
per increment of time of physical activity were larger
for vigorous exercise and moderate to vigorous leisure
activities than for moderate activities of daily living,
physical activity for transportation and walking.
Reductions in all-cause mortality rates corresponding
to recommended minimum levels of physical activity
or energy expenditure ranged from 7 to 14%.
1394
RR (95% CI)
Crespo
2002
0.93 (0.910.95)
Author
Men
Orsini
2008
0.96 (0.940.97)
Inoue
2008
0.96 (0.950.97)
Hayasaka
2009
0.93 (0.890.98)
0.95 (0.930.97)
.
Women
Carlsson
2006
0.93 (0.910.95)
Inoue
2008
0.93 (0.920.95)
Hayasaka
2009
0.98 (0.931.03)
0.94 (0.920.95)
.
0.96 (0.940.99)
2008
Subtotal (I 2 = .%, P = .)
0.96 (0.940.99)
.
Overall (I 2 = 68.7%, P = 0.002)
.5
0.95 (0.930.96)
.8
Favours more activity
1
1.2
Favours less activity
Figure 6 Meta-analysis of maximally adjusted RRs for all-cause mortality per increment of 2 MET-h/day. Results from
random-effects meta-analysis from six cohort studies (183 271 participants; 13 289 deaths) of total physical activity. The
median level for the lowest (reference) and highest activity category was 27.3 and 44.4 MET-h/day, respectively. 1 MET
represents an individuals energy expenditure while sitting quietly, which is 3.5 ml O2/kg/min.17 Activities <3 METs are
generally defined as light, activities 36 METs are considered as moderate and activities 46 METs are defined as vigorous.15,17 MET-hours per day are estimated by multiplying the time score spent at each activity per day by its MET value.
About 24 MET-h correspond to sitting quietly for 24 h. For example, an office worker with no outside exercise could have a
score of 27 MET-h. A labourer who is involved in heavy activity in his job could have a score of 440 MET-h. An increment
of 2 MET-h/day is 1 h of light-intensity activity based on a MET value of 2.0 or 30 min of moderate-intensity activity based
on a MET value of 4.5
Table 6 Maximally adjusted RRs of all-cause mortality associated with an increment of 2, 4 and 7 MET-h in total physical
activity per day compared with lowest level of activity
Combined RR (95% CI)
Sex
Men
No. of
studies
4
2 MET-h/day
(850 MET-min/week)a
0.95 (0.930.97)
4 MET-h/day
(1800 MET-min/week)a,b
0.90 (0.870.93)
7 MET-h/day
(3000 MET-min/week)b
0.83 (0.780.89)
Women
0.94 (0.920.95)
0.88 (0.870.93)
0.79 (0.740.85)
Overall
0.95 (0.930.96)
0.90 (0.870.92)
0.83 (0.790.87)
The median level for the lowest activity category (reference) was 27.3 MET-h/day. Twenty-four MET-hours correspond to sitting
quietly for 24 h.
a
The International Physical Activity questionnaire131 uses 6002999 MET-min/week as the range for classifying total activity as
moderate and 3000 MET-min/week as the cut point for classifying total activity as high.
b
In The Eurobarometer study,110 <600 MET-min/week of total activity were classified as sedentary, 6002999 MET-min/week
were classified as low total activity (some activity but not sufficient for health) and 43000 MET-min/week were classified as
sufficient total activity, this is in addition to 24 MET-h/day.
Both sexes
Besson
1395
1396
Supplementary Data
Supplementary Data are available at IJE online.
Funding
Intramural resources of the University of Vienna and
Bern.
Acknowledgements
All authors contributed to the design of the study.
G.S. conducted the literature search. G.S. and M.Z.
decided on inclusion of studies and study reports,
consulting with M.E. in case of disagreements. G.S.
and M.Z. extracted the data and did the data management. M.Z. did the statistical analyses in consultation with M.E. G.S. wrote the first draft of the
report, which was subsequently revised by M.E. and
M.Z. All authors contributed to the final version of
the manuscript. All authors had full access to all the
data in the study and can take responsibility for the
integrity of the data and the accuracy of the data
analysis.
Conflict of interest: None declared.
KEY MESSAGES
This meta-analysis is the first to quantify the reduction in all-cause mortality associated with increments in total and domain-specific physical activity and energy expenditure.
Reduction in mortality risk was greatest for increments of vigorous exercise and sports and smaller
for moderate-intensity activities of daily living.
The relative reduction in mortality risk was consistently greater in women than in men.
Relative mortality reductions corresponding to 150 and 300 min of moderate to vigorous physical
activity per week were 14 and 26%, respectively, supporting the some is good; more is better
message
References
1
Casperson CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep
1985;100:12631.
Lee I-M, Skerrett PJ. Physical activity and all-cause mortality: what is the dose-response relation? Med Sci Sports
Exerc 2001;33:S45971.
Oguma Y, Sesso HD, Paffenbarger RS, Lee I-M. Physical
activity and all cause mortality in women: a review of the
evidence. Br J Sports Med 2002;36:16272.
Berlin JA, Colditz GA. A meta-analysis of physical activity in the prevention of coronary heart disease. Am J
Epidemiol 1990;132:61228.
Sofi F, Capalbo A, Cesari F, Abbate R, Gensini GF.
Physical activity during leisure time and primary prevention of coronary heart disease: an updated meta-analysis
of cohort studies. Eur J Cardiovasc Prev Rehabil 2008;15:
24757.
Lee CD, Folsom AR, Blair SN. Physical activity and stroke
risk. A meta-analysis. Stroke 2003;34:247582.
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Lindsted KD, Tonstad S, Kuzma JW. Self-report of physical activity and patterns of mortality in seventh-day
adventist men. J Clin Epidemiol 1991;44:35564.
Rakowski W, Mor V. The association of physical activity
with mortality among older adults in the Longitudinal
Study of Aging (1984-1988). J Gerontol A Biol Sci Med Sci
1992;47:12229.
Chang-Claude J, Frentzel-Beyme R. Dietary and lifestyle
determinants of mortality among german vegetarians. Int
J Epidemiol 1993;22:22836.
Simonsick EM, Lafferty ME, Phillips CL et al. Risk due to
inactivity in physically capable older adults. Am J Public
Health 1993;83:144350.
Weyerer S. Effects of physical inactivity on all-cause mortality risk in upper Bavaria. Percept Mot Skills 1993;77:
499505.
Rosolova H, Simon J, Sefrna F. Impact of cardiovascular
risk factors on morbidity and mortality in Czeck
middle-aged men: Pilsen Longitudinal Study. Cardiology
1994;85:6168.
Eaton CB, Medalie JH, Flocke SA, Zyzanski SJ, Yaari S,
Goldbourt U. Self-reported physical activity predicts
long-term coronary heart disease and all-cause
mortalities. Twenty-one-year follow-up of the Isreali
Ischemic Heart Disease Study. Arch Fam Med 1995;4:
32329.
LaCroix AZ, Leveille SG, Hecht JA, Grothaus LC,
Wagner EH. Does walking decrease the risk of cardiovascular disease hospitalizations and death in older adults?
J Am Geriatr Soc 1996;44:11320.
Kampert JB, Blair SN, Barlow CE, Kohl HW, 3rd. Physical
activity, physical fitness, and all-cause and cancer mortality: a prospective study in men and women. Ann
Epidemiol 1996;6:45257.
Ruigomez A, Alonso J, Anto JM. Relationship of health
behaviours to five-year mortality in an elderly cohort. Age
Ageing 1995;24:11319.
Mensink GBM, Deketh M, Mul MDM, Schuit AJ,
Hoffmeister H. Physical activity and its association with
cardiovascular risk factors and mortality. Epidemiology
1996;7:39197.
Lissner L, Bengtsson C, Bjorkelund C, Wedel H. Physical
activity levels and changes in relation to longevity. A prospective study of Swedish women. Am J Epidemiol 1996;
143:5462.
Kaplan GA, Strawbridge WJ, Cohen RD, Hungerford LR.
Natural history of leisure-time physical activity and its
correlates: associations with mortality from all-causes
and cardiovascular disease over 28 years. Am J Epidemiol
1996;144:79397.
Hedblad B, Ogren M, Isacsson S-O, Janzon L.
Reduced cardiovascular mortality risk in male smokers
who are physically active. Arch Intern Med 1997;157:
89399.
Rosengren A, Wilhelmsen L. Physical activity protects
against coronary death and deaths from all causes in
middle-aged men. Evidence from a 20-year follow-up of
teborg. Ann Epidemiol
the Primary Prevention Study in Go
1997;7:6975.
Kushi LH, Fee RM, Folsom AR, Mink PJ, Anderson KE,
Sellers TA. Physical activity and mortality in postmenopausal women. JAMA 1997;277:128792.
1397
1398
41
42
43
44
45
46
48
49
50
51
52
53
54
55
56
Morgan K, Clarke D. Customary physical activity and survival in later life: a study in Nottingham, UK. J Epidemiol
Community Health 1997;51:49093.
Folsom AR, Arnett DK, Hutchinson RG, Liao F, Clegg LX,
Cooper LS. Physical activity and incidence of coronary
heart disease in middle-aged women and men. Med Sci
Sports Exerc 1997;29:90109.
Leon AS, Myers MJ, Connett J. Leisure time physical activity and the 16-year risks of mortality from coronary
heart disease and all-causes in the Multiple Risk Factor
Intervention Trial (MRFIT). Int J Sports Med 1997;
18(Suppl 3):20815.
Hakim AA, Petrovitch H, Burchfiel CM et al. Effects of
walking on mortality among nonsmoking retired men.
N Engl J Med 1998;338:9499.
Erikssen G, Liestol K, Bjornholt J, Thaulow E, Sandvik L,
Erikssen J. Changes in physical fitness and changes in
mortality. Lancet 1998;352:79562.
Villeneuve PJ, Morrison HI, Craig CL, Schaubel DE.
Physical activity, physical fitness, and risk of dying.
Epidemiology 1998;9:62631.
Weller I, Corey P. The impact of excluding non-leisure
energy expenditure on the relation between physical activity and mortality in women. Epidemiology 1998;9:
63235.
Fried LP, Kronmal RA, Newman AB et al. Risk factors for
5-year mortality in older adults. The Cardiovascular
Health Study. JAMA 1998;279:58592.
Bijnen FCH, Caspersen CJ, Feskens EJM, Saris WHM,
Mosterd WL, Kromhout D. Physical activity and 10-year
mortality from cardiovascular diseases and all causes. The
Zutphen Elderly Study. Arch Intern Med 1998;158:
1499505.
Johansson S-E, Sundquist J. Change in lifestyle factors
and their influence on health status and all-cause mortality. Int J Epidemiol 1999;28:107380.
Sherman SE, DAgostino RB, Silbershatz H, Kannel WB.
Comparison of past versus recent physical activity in the
prevention or premature death and coronary artery disease. Am Heart J 1999;138:9007.
Stessman J, Maaravi Y, Hammerman-Rozenberg R,
Cohen A. The effects of physical activity on mortality in
the Jerusalem 70-Year-Olds Longitudinal Study. J Am
Geriatr Soc 2000;48:499504.
Andersen LB, Schnohr P, Schroll M, Hein HO. All-cause
mortality associated with physical activity during leisure
time, work, sports, and cycling to work. Arch Intern Med
2000;160:162128.
Haapanen-Niemi N, Miilunpalo S, Pasanen M, Vuori I,
Oja P, Malmberg J. Body mass index, physical inactivity
and low level of physical fitness as determinants of
all-cause and cardiovascular disease mortality 16 y
follow-up of middle-aged and elderly men and women.
Int J Obes 2000;24:146574.
Lee I-M, Paffenbarger RS. Associations of light, moderate,
and vigorous intensity physical activity with longevity.
The Harvard Alumni Health Study. Am J Epidemiol 2000;
151:29399.
Hirvensalo M, Rantanen T, Heikkinen E. Mobility difficulties and physical activity as predictors of mortality and
loss of independence in the community-living older population. J Am Geriatr Soc 2000;48:49398.
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
47
75
76
77
78
80
81
82
83
84
85
86
87
88
89
90
79
1399
1400
107
108
109
110
111
112
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
113