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

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.