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Sex Differences in Physical Activity and CV Mortality Risk
Quick Takes
- Regular leisure-time physical activity compared to inactivity was associated with a 24% lower risk for all-cause mortality for women and 15% lower risk for men.
- Males reached their maximal survival benefit from 300 min/wk of moderate-to-vigorous physical activity, while females achieved similar benefit at 140 min/wk and then continued to reach a maximum survival benefit at ~300 min/wk.
- Sex-specific findings were similar for CV death and consistent across all measures of aerobic activity as well as muscle strengthening activity.
Study Questions:
Do health benefits derived from physical activity differ by sex?
Methods:
Data were collected by the Centers for Disease Control and Prevention and the National Center for Health Statistics from all 50 states and the District of Columbia. Pooled data from records of 646,279 adult participants of the National Health Interview Survey for years 1997–2017 were linked to the National Death Index records through December 31, 2019. Participants with pre-existing diagnoses of coronary heart disease, myocardial infarction, stroke, emphysema, chronic bronchitis, or cancer; limitations in activities of daily living; missing data on physical activity; or missing data on follow-up status or key covariates were excluded. Participants with outcomes occurring within the first 2 years of follow-up were also excluded. The remaining 412,413 participants (55% female, ages 44 ± 17 years) comprised the study sample. Leisure-time physical activity was collected via surveys. Physical activity was examined by frequency, duration, intensity, and type. The primary outcomes were all-cause and cardiovascular (CV) mortality, from 1997–2019.
Results:
Of the 412,413 participants in this study, 54.7% were female, 14.4% identified as Black, and 18.4% identified as Hispanic. The baseline mean age was 43.9 ± 16.6 years. Over a total 4,911,178 person-years of follow-up, 39,935 all-cause deaths occurred (8.1 per 1,000 person-years) including 11,670 CV deaths (2.4 per 1,000 person-years). Regular leisure-time physical activity compared to inactivity was associated with a 24% (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.73-0.80) and 15% (HR, 0.85; 95% CI, 0.82-0.89) lower risk of all-cause mortality in females and males, respectively (Wald F = 12.0, sex interaction p < 0.001). Males reached their maximal survival benefit of HR 0.81 from 300 min/wk of moderate-to-vigorous physical activity, while females achieved similar benefit at 140 min/wk and then continued to reach a maximum survival benefit of HR 0.76 also at approximately 300 min/wk. Sex-specific findings were similar for CV death (Wald F = 20.1, sex interaction p < 0.001) and consistent across all measures of aerobic activity as well as muscle strengthening activity (Wald F = 6.7, sex interaction p = 0.009).
Conclusions:
The authors conclude that females compared to males derived greater gains in all-cause and CV mortality risk reduction from equivalent doses of leisure-time physical activity. These findings could enhance efforts to close the “gender gap” by motivating especially females to engage in any regular leisure-time physical activity.
Perspective:
These data support the significant benefits from physical activity among women and men, suggesting that clinical providers counsel both men and women to obtain regular activity. In addition, public health interventions are needed to assist equity in access to venues for physical activity.
Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Exercise
Keywords: Exercise, Sex Characteristics
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