The Impact of Different Combinations of Aerobic and Muscle-Strengthening Activities on Mortality Rates

This summary, published in JAMA Internal Medicine, explores a significant study investigating the association between various physical activity combinations and mortality rates. The key takeaway is that engaging in a balanced combination of moderate-intensity aerobic activity (MPA), vigorous aerobic activity (VPA), and muscle-strengthening activity (MSA) appears to be most effective in reducing the risk of death from various causes. While the benefits of physical activity on health are well-established, understanding the optimal combination of different exercise intensities for mortality reduction remains a subject of ongoing research. This large-scale, nationwide prospective cohort study utilized data from the US National Health Interview Survey. The study included over half a million participants (500,705), a substantial sample size that strengthens the findings' generalizability. The participants were followed for an average of 10 years, accumulating over 5.6 million person-years of data (accounting for individual follow-up duration). The study relied on self-reported physical activity data. Participants reported the cumulative duration of their weekly MPA and VPA sessions. Additionally, information regarding adherence to recommended MSA guidelines (meeting or not meeting) was collected. Combining this information, researchers categorized participants into 48 distinct groups based on their unique exercise patterns. The primary focus of the study was mortality rates. Researchers tracked deaths from all causes, including cardiovascular diseases (CVD), and cancer. Mortality data were obtained by linking participant information with the National Death Index.

Key Findings:

• Overall Mortality: Compared to individuals who engaged in no MPA or VPA and didn't meet the recommended MSA guidelines, the group with the lowest risk of death from all causes reported exceeding the recommended VPA (>150 minutes weekly) alongside some MPA (0–75 minutes weekly) and at least two MSA sessions per week. This combination was associated with an approximately 50% lower mortality rate.

• Cardiovascular Disease Mortality: The optimal combination for reducing CVD mortality risk involved exceeding recommended levels of MPA (150–225 minutes weekly) with some VPA (0–75 minutes) and at least two MSA sessions per week. This resulted in a substantial decrease in CVD mortality risk, with a three-fold reduction.

• Cancer Mortality: The study suggests that exceeding the recommended MPA (>300 minutes weekly), combined with some VPA (0–75 minutes) and at least two MSA sessions per week, might be most beneficial for reducing cancer mortality risk. This combination was linked to a 50% lower risk of death from cancer.

Limitations and Considerations:

• As with any observational study, this research cannot definitively establish a cause-and-effect relationship between specific exercise combinations and mortality rates.

• The study relied on self-reported activity levels, which may be prone to inaccuracies due to recall bias.

• The optimal activity dosages identified for reduced mortality risk, particularly for MPA and VPA, exceed current exercise recommendations. It's crucial to consult with a healthcare professional before significantly increasing your activity level, especially if you have any underlying health conditions.

Conclusion and Significance:

This large cohort study provides compelling evidence that a balanced exercise routine incorporating all three types of activities—MPA, VPA, and MSA—may be most effective in promoting longevity and reducing the risk of death from various causes. While the study highlights potential benefits associated with higher-than-recommended activity levels for MPA and VPA, consulting a doctor before modifying your exercise program is essential, particularly for individuals with pre-existing health concerns. Overall, these findings contribute valuable insights into the importance of a comprehensive exercise approach for promoting overall health and well-being.

The Imperative of Physical Activity

Physical activity has long been regarded as a cornerstone of good health. It is no secret that engaging in regular exercise can bolster our physical and mental well-being. From reducing the risk of chronic diseases to enhancing mood and cognitive function, the benefits of exercise are vast and undeniable. However, how we structure our exercise routines can make a significant difference in their effectiveness, particularly concerning mortality rates.

Aerobic Activities: The Heart's Best Friend

Aerobic activities, often referred to as cardiovascular exercises, are crucial for maintaining a healthy heart and respiratory system. These exercises get your heart rate up, increase lung capacity, and improve the overall efficiency of your circulatory system. Common aerobic activities include brisk walking, running, cycling, swimming, and dancing. Engaging in regular aerobic exercise has been linked to a reduced risk of heart disease, stroke, and type 2 diabetes. But what about its impact on mortality?

Muscle-Strengthening Activities: The Foundation of Strength

On the other hand, muscle-strengthening activities focus on building and maintaining muscle mass and strength. These activities, which typically involve resistance or weight training, are essential for overall physical function and are particularly valuable as we age. Strong muscles support joint health, improve posture, and assist in daily tasks. Additionally, they play a pivotal role in metabolic health and may contribute to a longer life. However, their direct relationship with mortality rates remains a subject of extensive research.

The Synergy of Exercise Combinations

Now, let's delve into the crux of the matter: the potential associations between different combinations of aerobic and muscle-strengthening activities and mortality rates. The research in this field is ongoing and continually evolving, but several key insights have emerged.

1. Aerobic Dominance: Studies have suggested that emphasizing aerobic activities in your exercise routine may be particularly beneficial for reducing all-cause mortality. Engaging in activities such as running, cycling, or swimming for extended durations, while still incorporating some muscle-strengthening exercises, could be an optimal strategy.

2. Balanced Approach: Striking a balance between aerobic and muscle-strengthening activities is often recommended for overall health. A well-rounded fitness routine that combines both elements can improve cardiovascular health, enhance muscle mass, and potentially lower mortality rates across the board.

3. Age and Goals Matter: It's crucial to tailor your exercise routine to your age and specific health goals. Younger individuals may focus more on building muscle, while older adults might prioritize aerobic fitness. Consulting with a fitness professional can help you determine the right balance for your needs.

4. Consistency is Key: Regardless of the specific combination, the key to reaping the benefits of exercise lies in consistency. Regular physical activity, sustained over time, is more likely to have a positive impact on mortality rates than sporadic or occasional workouts.

Understanding the Benefits of MPA

Professor Emmanuel Stamatakis, a distinguished expert in the field and co-author of the study, offers insights into the benefits of moderate physical activity. He suggests that MPA can be sustained for longer periods compared to VPA and muscle-strengthening activity (MSA). This sustained activity level can contribute significantly to energy expenditure, aiding in weight maintenance or loss. Additionally, MSA plays a crucial role in preserving muscle mass as we age. The maintenance of muscle mass is pivotal for preventing a myriad of chronic conditions, including type 2 diabetes, cardiovascular disease, and the risk of debilitating falls in older adults. These conditions, often perceived as age-related, are, in fact, a consequence of chronic inactivity and a decline in muscle mass, leading to metabolic issues and sarcopenia.

Unveiling the Benefits of VPA and MSA

While MPA has its advantages, VPA and MSA offer unique benefits. VPA, for instance, can significantly improve cardiorespiratory fitness. This is crucial for enhancing overall cardiovascular health and reducing the risk of heart-related issues.

Dr. Rubén López-Bueno, the corresponding author of the study, emphasizes that MSA has also been linked to a reduction in cancer incidence, although the exact mechanisms behind this phenomenon are still under investigation. Professor Stamatakis proposes that strength training, a key component of MSA, may lower circulating levels of sex hormones, subsequently decreasing the risk of breast and endometrial cancer in women, and prostate cancer in men. For cancer patients with cachexia, a condition characterized by muscle loss, strength training may aid in managing muscle dysfunction. Dr. López-Bueno raises an important question: Could there be a synergistic effect among moderate physical activity (MPA), vigorous physical activity (VPA), and muscle-strengthening activity (MSA)? Unfortunately, the study's design does not allow us to confirm whether such synergistic effects exist, underscoring the need for more in-depth research in this area.

Every Type of Exercise Matters

The key takeaway from these findings is clear: every type of physical activity plays a crucial role in optimizing mortality risk reductions. There is no isolated form of exercise that stands out as superior in reducing mortality risk compared to others when combined effectively.Dr. Ding emphasizes the importance of variety in one's fitness routine, recommending participation in a range of activities, such as MPA, VPA, and MSA, according to individual capacity. She cautions against raising the bar too high, as it may discourage people from meeting recommended activity levels.

The Paradoxical Findings

The study's most intriguing finding is a seemingly paradoxical one: while two times the amount of vigorous physical activity (VPA) was associated with a reduction in all-cause mortality risk, doubling the amount of moderate physical activity (MPA) reduced the risk of cardiovascular and cancer mortality.

In conclusion, the prospective associations between different combinations of aerobic and muscle-strengthening activities and mortality risk are shedding new light on the importance of a well-rounded fitness routine. To optimize your health and longevity, consider incorporating a mix of MPA, VPA, and MSA into your exercise regimen, tailored to your fitness level. These findings underscore the significance of embracing diversity in your workouts and highlight the potential benefits each type of exercise can offer.

Reference Article:

López‐Bueno, R., Ahmadi, M., Stamatakis, E., Yang, L., & Del Pozo Cruz, B. (2023, September 1). Prospective Associations of Different Combinations of Aerobic and Muscle-Strengthening Activity With All-Cause, Cardiovascular, and Cancer Mortality. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2023.3093

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