Intensity But Not Duration and Frequency of Physical Activity Is Associated With 20-Year Cardiovascular Disease Incidence: Insights From the ATTICA Study (2002–2022)

OBJECTIVE: To evaluate the independent contribution of intensity, duration, and frequency of physical activity (PA) and lifelong risk of cardiovascular disease (CVD). METHODS: ATTICA is a population-based cohort study that was conducted in the Attica region (Greece) in 2002, and included 3042 adults (45 [11] y, 50% males). Participants' PA levels, together with information regarding CVD incidence during 2002-2022, were available from 1988 participants (45 [12] y old, 987 males and 1001 females). PA volume (intensity, duration, and frequency) was evaluated using the validated International Physical Activity Questionnaire, in consecutive follow-up examinations (2006, 2012, and 2022). RESULTS: Over 20 years, 36% of participants experienced a CVD event. Moderate and high PA volume was linked to 48% and 37% lower CVD risk, respectively, versus low volume (P < .05). Intensity of PA was the strongest protective factor. Benefits were more evident in nonobese individuals and those with fewer CVD risk factors. CONCLUSIONS: Long-term, moderate to vigorous PA is associated with lower CVD risk. Intensity and duration matter more than frequency. These findings support intensity-focused, individualized PA recommendations for cardiovascular prevention.