Associations of Combined Moderate and Vigorous Physical Activity With All‐Cause, Cardiovascular, and Cancer Mortality: A Cohort Study of 586 936 US Adults

BACKGROUND: Although both moderate-intensity physical activity (MPA) and vigorous-intensity physical activity (VPA) are recommended, the optimal combination of intensities for maximal health benefits remains uncertain. This study examined the associations of MPA, VPA, and combined moderate-to-vigorous physical activity (MVPA) with all-cause, cardiovascular disease, and cancer mortality. METHODS: We analyzed data from 586 936 adults, aged ≥18 years, in the US National Health Interview Survey (1997-2018), linked to mortality through 2019. Participants were categorized as inactive, MPA only, VPA only, or MVPA. Among those engaging in MVPA, we further classified participants by activity frequency and the proportion of VPA. Cox proportional hazards models estimated hazard ratios (HRs) and 95% CIs for all-cause, cardiovascular disease, and cancer mortality, adjusting for sociodemographic, lifestyle, and clinical factors. Sensitivity analyses excluded individuals with baseline chronic diseases or deaths within the first 2 years. RESULTS: Over a median 10.0-year follow-up, 82 959 deaths occurred. Compared with inactivity, MPA only (HR, 0.74 [95% CI, 0.72-0.76]), VPA only (HR, 0.56 [95% CI, 0.54-0.59]), and MVPA (HR, 0.50 [95% CI, 0.48-0.52]) were associated with progressively lower all-cause mortality. Similar patterns were observed for cardiovascular disease and cancer mortality. Across all MVPA volumes, individuals with >25% of MVPA from VPA had the lowest mortality risks. Findings were consistent across subgroups and sensitivity analyses. CONCLUSIONS: VPA was associated with greater mortality reduction than MPA, and combining both intensities conferred the strongest survival benefits. These results support current guidelines and highlight the importance of incorporating VPA, when feasible, into public health strategies.