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Primary Prevention – Live longer

All–cause mortality

Evidence summary

A large body of evidence has consistently demonstrated a clear inverse relationship between levels of physical activity and all-cause mortality (1,2). Up to a 30% risk reduction has been noted for all-cause mortality in physical activity (1,2). A large cohort study attributed low cardiorespiratory fitness as causal to 16% of deaths (3). In addition, a recent systematic review of systematic reviews noted there is irrefutable evidence that routine physical activity reduces the risk for premature mortality and is an effective primary and secondary preventive strategy for at least 25 chronic medical conditions (4).

The review also noted that clinically relevant health benefits can be accrued at volumes of physical activity that are well below current international recommendations. There is a suggestion that clinicians should avoid threshold based physical activity messaging (4). Another review of 16 high quality cohorts with over 1 million participants further proved a dose dependant relationship between physical activity and risk of all-cause mortality (5)

When considering the maximal effect of physical activity in primary prevention of all-cause mortality a recent  systematic review of 9 cohort studies with a mean follow-up of 9.8 years (6) and 2 recent prospective studies on large population cohorts followed for 14 and 8 years, respectively) demonstrated clear dose–response effects of physical activity to overall mortality (7,8); each 10 minutes of physical activity accumulated per day led to an approximately 10% relative risk reduction in mortality, up to 32% to 44% relative risk reduction at 150 minutes of moderate to vigorous physical activity per week, depending on the amount of vigorous activity as part of the physical activity. The dose–response effect seems to plateau at a 50% to 60% reduction at 3 to 5 times the stated Guidelines (ie, 750 min/wk).

Quality of evidence

High quality

Strength of recommendation



  1. Start active, stay active: report on physical activity in the UK

[Internet]. GOV.UK. 2018 [cited 28 June 2018]. Available from:

  1. Physical inactivity: the biggest public health problem of the 21st century.

Br J Sports Med. 2009 Jan;43(1):1-2.Blair S

  1. Health benefits of physical activity: a systematic review of current systematic reviews. Warburton DER, Bredin SSD. Curr Opin Cardiol. 2017 Sep;32(5):541-556. doi: 10.1097/HCO.0000000000000437. Review.
  1. Does physical activity attenuate, or even eliminate,the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet 2016;388:1302–1310 Ekelund U, Steene-Johannessen J, Brown WJ,etal.,Lancet SedentaryBehaviour Working Group.
  1. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship.

JAMA Intern Med. 2015;175:959–967. Arem H, Moore SC, Patel A, et al.

  1. Effect of moderate to vigorous physical activity on all-cause mortality in middle-aged and older Australians.

JAMA Intern Med. 2015;175:970–977. SFX Bibliographic Links [Context Link] Gebel K, Ding D, Chey T, et al.

  1. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study.

Lancet. 2011;378:1244–1253. Wen CP, Wai JP, Tsai MK, et al.