Associations Between Leisure-Time Physical Activity and Mortality by Sociodemographic Factors

Background: The 2018 Physical Activity Guidelines 2nd Edition Advisory Committee Scientific Report recommended research to understand whether the health benefits of physical activity (PA) differed by sociodemographic factors. This study examined associations between meeting PA guidelines in leisure time and all-cause, heart disease, and cancer mortality across sociodemographic characteristics. Methods: Nationally representative data on 567,483 eligible US adults from the 1998-2018 US National Health Interview Survey and 2019 public-use linked mortality files were used. Participants self-reported leisure-time aerobic and muscle-strengthening PA. Meeting PA guidelines was defined as meeting both aerobic and muscle-strengthening activity recommendations. Multivariate Cox regression was used to estimate hazard ratios and 95% confidence intervals comparing all-cause, heart disease, and cancer mortality risk across PA categories, with a focus on adults meeting guidelines. Results: Across sociodemographic groups, associations comparing mortality risk among adults meeting guidelines versus those meeting neither recommendation in leisure time ranged from no significant associations to significant risk reductions in mortality ranging from 14% to 36% for all-cause, 25% to 52% for heart disease, and 20% to 32% for cancer. Risk reductions were larger for women versus men (all cause and heart disease), non-Hispanic or non-Latino/a White adults compared with Hispanic or Latino/a adults (all cause), adults with college education or higher versus those with less than high school education (all cause), and adults with high school education versus those with some college education (cancer). Conclusions: Meeting PA guidelines provides a substantial reduction in mortality risk from all causes, heart disease, and cancer, but the magnitude of reduction may differ across sociodemographic groups.