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Physical activity can attenuate the higher risk of death resulting from excess adiposity

Comment by Eugenio Greco, EACPR Prevention, Epidemiology and Population Science Section


Studies that have examined the combined associations between physical activity, body mass index (BMI), and mortality suggest that physical activity protects again premature death but does not eliminate the increased risk associated with high BMI; most have also examined the combined associations between physical activity, adiposity, and mortality using a dichotomous categorisation of physical activity and BMI, leaving uncertainty about whether physical activity protects against premature deaths across established BMI and waist circumference categories.

This multicenter prospective cohort study, which recruited 519,978 volunteers aged 25–70 years from 23 centres in 10 countries between 1992 and 2000 - the European Prospective Investigation into Cancer and Nutrition Study (EPIC) – examined the associations between physical activity and all cause mortality and whether BMI and waist circumference modified these associations.

The authors examined whether overall and abdominal adiposity modified the association between physical activity and all-cause mortality and estimated the population attributable fraction and the years of life gained for these exposures.
Height, weight, and waist circumference were measured in the clinic. Physical activity was assessed with a validated self-report instrument, and participants reported their level of occupational physical activity as either sedentary (e.g., office work), standing (e.g., hairdresser, guard), physical work (e.g., plumber, nurse), or heavy manual work (e.g., construction worker, bricklayer).

The results of the study was that physical activity is inversely associated with all-cause mortality at all levels of BMI and waist circumference.
The greatest reduction in risk was observed when comparing the inactive and moderately active groups. The most pronounced risk reductions with increasing levels of physical activity were observed in those categorised as normal weight and abdominally lean.

Physical inactivity may theoretically be responsible for twice as many total deaths as high BMI (>30) in this population, similar to the number of deaths averted if abdominal adiposity were eliminated.

The greatest reductions in all-cause mortality risk were observed between the inactive and the moderately inactive groups across levels of general and abdominal adiposity, which suggests that efforts to encourage even small increases in activity in inactive individuals may be of public health benefit. The hypothetical number of deaths reduced by avoiding inactivity in this population may be double that of an approach that avoided high BMI and similar to that of an approach that avoided high waist circumference.