Adherence to the 24-Hour Movement Guidelines is related to a lower risk of all-cause mortality: A prospective cohort study of 14,288 participants from the SUN Project

PURPOSE: The purpose of this study was to examine the associations between adherence to the 24-Hour Movement Guidelines and all-cause and cause-specific mortality in a large Spanish prospective cohort. METHODS: We analyzed data from 14,288 participants of the Seguimiento Universidad de Navarra (SUN) Project, followed for a mean of 12.8 years (mean baseline age = 38.3 years; 60.1% women). Data were collected at baseline and through biennial follow-up questionnaires (up to 10 waves, depending on year of entry). The participants self-reported 24-h movement behaviors at baseline and were categorized based on the number of guidelines met (0-3). Behaviors were assessed at baseline only; changes in adherence during follow-up were not accounted for. Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause and cause-specific mortality, adjusting for sociodemographic, lifestyle, and clinical covariates. RESULTS: Meeting a greater number of 24-Hour Movement Guidelines at baseline was associated with a progressively lower risk of all-cause mortality. Compared with those meeting none, the multivariable-adjusted HRs were 0.52 (95% confidence interval (95%CI): 0.33-0.82) for meeting 1 guideline, 0.47 (95%CI: 0.30-0.73) for meeting 2 guidelines, and 0.44 (95%CI: 0.28-0.71) for meeting all 3 guidelines. Only adherence to the physical activity guidelines was independently associated with a significantly lower mortality risk (HR = 0.70; 95%CI: 0.55-0.89). A reduced risk was also observed for cancer and other-cause mortality among those meeting 2 or more guidelines. CONCLUSION: Adherence to the 24-Hour Movement Guidelines at baseline, particularly physical activity, was associated with a lower risk of mortality. Promoting an integrated approach to movement behaviors may be an effective strategy for improving population health and longevity.