Key result
Consistently high leisure-time physical activity is linked to ~39% lower risk of incident CVD.
Why the study?
Leisure-time physical activity behaviors in later life are highly dynamic, and the cardiovascular impact of these longitudinal trajectories in middle-aged and older adults was unclear.
Does maintaining or increasing leisure-time physical activity trajectories reduce the risk of incident cardiovascular disease compared with a stable low physical activity trajectory in middle-aged and older adults?
Cohort (n=5,412)
Yes
Does maintaining or increasing leisure-time physical activity trajectories reduce the risk of incident cardiovascular disease compared with a stable low physical activity trajectory in middle-aged and older adults?
In middle-aged and older adults, maintaining high or increasing leisure-time physical activity over time is associated with a 36% to 39% lower risk of incident cardiovascular disease compared with sustained inactivity, while declining activity negates prior benefits.
Maintaining or increasing activity trajectories may lower CVD risk in older adults; extends prior associations but leaves causality open for trials.
Leisure-time physical activity (LTPA) behaviors in later life are highly dynamic, yet the cardiovascular impact of these longitudinal trajectories remains unclear. This study aimed to characterize distinct trajectories of LTPA behaviors and investigate their association with incident cardiovascular disease (CVD) among middle-aged and older adults. This longitudinal study included 5,412 participants from the English Longitudinal Study of Ageing. LTPA was assessed via a questionnaire at Wave 1 (2002-03), Wave 2 (2004-05), and Wave 3 (2006-07). Trajectories of LTPA behavior were identified using Group-Based Trajectory Modeling. Multivariable Cox proportional hazards models estimated the associations between these trajectories and Incident CVD. A total of 5,412 participants (mean age 65.9 ± 9.31 years; 41.4% male) were followed for a median of 11.8 years, and 571 incident CVD events were recorded. Compared with the Stable Low trajectory, the Increasing group (HR 0.64, 95% CI 0.44–0.92) and the Stable High group (HR 0.61, 0.43–0.86) were associated with lower CVD risk. Conversely, the Decreasing group was not associated with lower CVD risk (HR 1.03, 0.74–1.44). Notably, maintaining moderate activity was associated with lower CVD risk among those with hypertension (HR 0.65, 0.47–0.91) and ever-smokers (HR 0.67, 0.49–0.93). In this national, long-term cohort study of middle-aged and older adults, stable high or increasing trajectories of LTPA behavior were associated with a lower risk of Incident CVD compared with persistently low activity. Among participants with hypertension or a history of smoking, sustaining even moderate levels of LTPA was associated with a reduced CVD risk.
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Li et al. (2026) conducted a cohort in Cardiovascular disease risk in middle-aged and older adults (n=5,412). Stable high leisure-time physical activity trajectory vs. Stable low leisure-time physical activity trajectory was evaluated on Incident cardiovascular disease (composite of angina, myocardial infarction, congestive heart failure, or stroke) (HR 0.61, 95% CI 0.43-0.86, p=0.005). Stable high (HR 0.61) and increasing (HR 0.64) leisure-time physical activity trajectories were associated with a significantly lower risk of incident CVD compared with a stable low trajectory.
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