Association of Accelerometer-Measured Physical Activity and Sedentary Behaviour with Incident Cardiovascular Disease: The Maastricht Study

Purpose: To investigate the associations of volume and pattern of physical activity (PA) and sedentary behavior (SB) with incident cardiovascular disease (CVD), and the modifying effects of sociodemographic and health factors. Methods: 5,186 participants (mean age 59.3 years; 52.4% women) were included from The Maastricht Study. PA and SB were obtained with thigh-worn accelerometers. Annual questionnaires and government registration assessed CVD events (myocardial infarction, cerebrovascular disease, and/or peripheral vascular disease). Cox regression examined associations and effect modification by age, sex, socioeconomic position, body mass index, mobility limitation, and diabetes. Results: 654 events occurred within a 6.1-year median follow-up (IQR: 3.2-9.1 years). Individuals with >69.8 min/day moderate-to-vigorous physical activity (MVPA) [HR (95%CI): 0.68 (0.54–0.85)] and >11.9 min/day vigorous-intensity physical activity (VPA) [HR (95%CI): 0.69 (0.54–0.87)] had lower CVD risk compared with Q1 (lowest). Moderate sedentary breaks (32.0-42.6 n/day) were associated with a lower risk [Q2, HR (95%CI): 0.75 (0.61–0.92); Q3, HR (95%CI): 0.69 (0.55–0.87)] relative to Q1. Weekend warriors [MVPA ≥ 150 min/week with ≥50% in 1–2 days, HR (95%CI): 0.60 (0.44-0.82)] and regularly active individuals [HR (95%CI): 0.66 (0.50-0.88)] had lower risks relative to inactive/insufficiently active individuals. Stronger associations were observed between MVPA and CVD in women, and in limited-mobility individuals (both P-interaction < 0.05). Sedentary time, light-intensity PA, prolonged sedentary bouts, and average sedentary bout duration were not associated with CVD. Conclusions: Higher MVPA (particularly in women and limited-mobility individuals) and VPA are associated with lower CVD risk. Overall, higher-intensity PA could be relevant for cardiovascular protection.