Chandelier
Senior Member (Voting Rights)
Joint non-linear dose–response associations of device-measured physical activity and cardiorespiratory fitness with cardiovascular disease: a cohort and Mendelian randomisation study
To characterise the non-linear joint dose–response relationship of accelerometer-measured moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness (CRF, estimated as maximal oxygen uptake (VO₂max)) with incident cardiovascular disease (CVD), and to assess causal consistency using Mendelian randomisation (MR).
Methods
We conducted a cohort study in the UK Biobank using accelerometer data linked to hospital and death registries.
A Cox generalised additive model characterised the joint MVPA–CRF association with incident CVD (atrial fibrillation, myocardial infarction, heart failure (HF) and stroke), adjusting for confounders.
We derived a fitness-stratified matrix quantifying the weekly MVPA minutes associated with prespecified relative hazard reductions.
Complementary two-sample MR analyses leveraged genome-wide association study summary statistics for device-measured physical activity (PA) traits and CRF to assess potential causal effects on cardiovascular outcomes.
Results
Among 17 088 participants, 1233 incident CVD events occurred over a median follow-up of 7.85 years (IQR, 7.39–8.27).
A significant non-linear interaction between MVPA and CRF was observed (p<0.001).
Meeting the 150 min/week guideline yielded a modest ~8%–9% risk reduction across fitness levels, whereas achieving a >30% risk reduction required threefold to fourfold higher volumes (~560–610 min/week).
Residual analysis indicated that fitness beyond what MVPA and covariates predicted retained a modest protective association with CVD risk (HR, 0.98 per 1 mL/kg/min; 95% CI 0.97 to 0.99; p<0.001).
In MR analyses, genetically proxied higher CRF was associated with lower HF risk (OR, 0.79; 95% CI 0.63 to 0.99), whereas genetic evidence for PA traits was weaker and less consistent.
Conclusion
Current MVPA guidelines provide a universal but modest safety margin, whereas optimal cardiovascular protection may require substantially higher activity volumes.
The fitness-stratified prescription matrix offers quantitative behavioural targets, and genetic findings reinforce the independent importance of CRF in cardiovascular risk reduction.
Web | DOI | British Journal of Sports Medicine
BMJ Article: 560-610 minutes of exercise a week needed for substantial heart benefits | Link
Liang, Zhide; Du, Senyao; Zhao, Shiao; Wang, Xianfei; Yan, Qiang; Xu, Baichao; Ng, Sanfan; Ning, Ziheng
Abstract
ObjectivesTo characterise the non-linear joint dose–response relationship of accelerometer-measured moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness (CRF, estimated as maximal oxygen uptake (VO₂max)) with incident cardiovascular disease (CVD), and to assess causal consistency using Mendelian randomisation (MR).
Methods
We conducted a cohort study in the UK Biobank using accelerometer data linked to hospital and death registries.
A Cox generalised additive model characterised the joint MVPA–CRF association with incident CVD (atrial fibrillation, myocardial infarction, heart failure (HF) and stroke), adjusting for confounders.
We derived a fitness-stratified matrix quantifying the weekly MVPA minutes associated with prespecified relative hazard reductions.
Complementary two-sample MR analyses leveraged genome-wide association study summary statistics for device-measured physical activity (PA) traits and CRF to assess potential causal effects on cardiovascular outcomes.
Results
Among 17 088 participants, 1233 incident CVD events occurred over a median follow-up of 7.85 years (IQR, 7.39–8.27).
A significant non-linear interaction between MVPA and CRF was observed (p<0.001).
Meeting the 150 min/week guideline yielded a modest ~8%–9% risk reduction across fitness levels, whereas achieving a >30% risk reduction required threefold to fourfold higher volumes (~560–610 min/week).
Residual analysis indicated that fitness beyond what MVPA and covariates predicted retained a modest protective association with CVD risk (HR, 0.98 per 1 mL/kg/min; 95% CI 0.97 to 0.99; p<0.001).
In MR analyses, genetically proxied higher CRF was associated with lower HF risk (OR, 0.79; 95% CI 0.63 to 0.99), whereas genetic evidence for PA traits was weaker and less consistent.
Conclusion
Current MVPA guidelines provide a universal but modest safety margin, whereas optimal cardiovascular protection may require substantially higher activity volumes.
The fitness-stratified prescription matrix offers quantitative behavioural targets, and genetic findings reinforce the independent importance of CRF in cardiovascular risk reduction.
Data availability statement
Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Individual-level data from the UK Biobank are available to bona fide researchers upon application through the UK Biobank Access Management System (https://www.ukbiobank.ac.uk). This research was conducted under Application Number 1050630. Genome-wide association study summary statistics used in the Mendelian randomisation analyses were obtained from publicly available sources; full details including dataset identifiers and URLs are provided in online supplemental eTable 10. Summary-level analytical data and statistical code supporting the findings of this study are available from the corresponding author upon reasonable request and with permission of UK Biobank.Web | DOI | British Journal of Sports Medicine
BMJ Article: 560-610 minutes of exercise a week needed for substantial heart benefits | Link
