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Trajectories of physical activity from midlife to old age and associations with subsequent cardiovascular disease and all-cause mortality
  1. Daniel Aggio1,
  2. Efstathios Papachristou2,
  3. Olia Papacosta1,
  4. Lucy T Lennon1,
  5. Sarah Ash1,
  6. Peter Whincup3,
  7. S Goya Wannamethee1,
  8. Barbara J Jefferis1
  1. 1 Primary Care and Population Health, University College London, London, UK
  2. 2 Department of Psychology & Human Development, University College London, London, UK
  3. 3 Population Health Research Institute, St George’s University of London, London, UK
  1. Correspondence to Daniel Aggio, Primary Care and Population Health, University College London, London NW3 2PF, UK; d.aggio{at}


Introduction It is well established that physical activity (PA) protects against mortality and morbidity, but how long-term patterns of PA are associated with mortality and cardiovascular disease (CVD) remains unclear.

Methods 3231 men recruited to the British Regional Heart Study, a prospective cohort study, reported usual PA levels at baseline in 1978–1980 (aged 40–59 years) and at 12-year, 16-year and 20-year follow ups. Twenty-year trajectories of PA, spanning from 1978/1980 to 2000, were identified using group-based trajectory modelling. Men were subsequently followed up until 30 June 2016 for mortality through National Health Service central registers and for non-fatal CVD events through primary and secondary care records. Data analyses were conducted in 2019.

Results Three PA trajectories were identified: low/decreasing (22.7%), light/stable (51.0%) and moderate/increasing (26.3%). Over a median follow-up of 16.4 years, there were 1735 deaths. Compared with the low/decreasing group, membership of the light/stable (HR 0.83, 95% CI 0.74 to 0.94) and moderate/increasing (HR 0.76, 95% CI 0.66 to 0.88) groups was associated with a lower risk of all-cause mortality. Similar associations were observed for CVD mortality, major coronary heart disease and all CVD events. Associations were only partially explained by a range of confounders. Sensitivity analyses suggested that survival benefits were largely driven by most recent/current PA.

Conclusions A dose-response relationship was observed, with higher levels of PA from midlife to old age associated with additional benefits. However, even fairly modest and sustained PA was protective and may be more achievable for the most inactive.

  • ageing
  • cardiovascular disease
  • CHD/coronorary heart
  • life course epidemiology
  • physical activity

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  • Contributors SGW and PW designed and conceived the study. DA analysed and interpreted the data and drafted the initial manuscript. LTL collected the data. OP generated the database. BJJ and SGW interpreted the data and revised the manuscript. OP, SGW, PW, LTL, BJJ and DA approved the final manuscript.

  • Funding This work was supported by a British Heart Foundation PhD studentship [FS/15/70/32044] awarded to DA, a National Institute for Health Research Post-Doctoral Fellowship awarded to B.J.J. [2010–03–023] and by a British Heart Foundation project grant [PG/13/86/30546] to B.J.J. The British Regional Heart study is funded by a British Heart Foundation grant, which supported all authors in their work relating to the study [RG/13/16/30528].

  • Competing interests None declared.

  • Patient consent for publication Participants provided informed written consent to the investigation.

  • Ethics approval Ethical approval was obtained from the National Research Ethics Service Committee London.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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