Skip to content

Primary Prevention – Live longer

Evidence summary (Updated 2022)

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]; 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 vigorous intensity guidelines (ie, 75min/wk).
At recent review, there is an abundance of evidence demonstrating the inverse relationship between physical activity and all-cause mortality with further recent high-quality research cementing this [8-11]. Various guidelines including the UK CMO guidelines[1] and the updated (2020) WHO guidelines on physical activity and sedentary behaviour support this strong association and recommend that all adults should undertake 150–300 minutes of moderate or 75–150 minutes of vigorous-intensity physical activity per week [8]. In keeping with previous statistics, a recent large prospective cohort study reported that adults who engaged in the recommended aerobic activity had a 29% reduced risk of all-cause mortality with an 11 % reduction in those undertaking muscle strengthening exercise [9]. Benefits however can be obtained even a lower level of activity and it should be noted that any physical activity is better than none [10]. This can be achieved in any way possible with a large recent systematic review concluding that all-cause mortality is reduced even with physical activity accumulated in bouts of < 10 minutes [12].

The findings hold true across different population cohorts. A systematic review and meta- analysis including 59 studies specifically looking at middle aged and elderly women found that physical activity was associated with a 29% decreased risk of all-cause mortality [13]. Another prospective population study exploring the association between level of daily physical activity, all- cause mortality and cardiovascular disease outcome at different levels of blood pressure, showed that higher levels of physical activity were associated with lower all-cause mortality in a dose response pattern [14].
Quality of evidence
Grade A – High quality

Strength of recommendation
Grade 1 – Strong

Consistent, reliable evidence suggests that all adults should engage in physical activity to reduce all- cause mortality; any exercise is better than none.

[1] The UK Chief Medical Officers physical activity guidelines report. (cited 2019 Sept 9)
[2] Blair S (2009) Physical inactivity: the biggest public health problem of the 21st century. Br J Sports Med. 2009 Jan;43(1):1-2.
[3] Warburton DER, Bredin SSD (2017) Health benefits of physical activity: a systematic review of current systematic reviews. Curr Opin Cardiol. 2017 Sep;32(5):541-556. doi: 10.1097/HCO.0000000000000437. Review.
[4] Ekelund U, Steene-Johannessen J, Brown WJ,et al (2016) 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,Lancet Sedentary Behaviour Working Group.
[5] Arem H, Moore SC, Patel A, et al. (2015) Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship.
JAMA Intern Med. 2015;175:959–967.
[6] Gebel K, Ding D, Chey T, et al.(2015) 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]
[7] Wen CP, Wai JP, Tsai MK, et al Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet. 2011;378:1244–1253.
[8] Bull FC, Al- Ansari S S, Biddle S, et al. (2020) World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br.J.Sports Med., 54(24), pp.1451-1462.
[9] Zhao M, Veeranki SP, Magnussen CG. (2020) Recommended physical activity and all cause and cause specific mortality in US adults: prospective cohort study, BMJ 2020; 370.
[10] Kraus WE, Powell KE, Haskell WL et al. (2019) PHYSICAL ACTIVITY ADVISORY GUIDELINES COMMITTEE Physical Activity, All -Cause and Cardiovascular Mortality and Cardiovascular Disease Med Sci Sports Exerc Jun;51(6):1270-1281.
[11] Nordengen S, Andersen LB, Solbraa AK et al. (2019) Cycling is associated with a lower incidence of cardiovascular diseases and death: Part 1- systematic review of cohort studies with meta-analysis. Br J Sports Med Jul;53(14): 870-878.doi:
[12] Jakicic JM, Kraus WE, Powell KE et al. (2018) PHYSICAL ACTIVITY GUIDELINES COMMITTEE. Association between Bout Duration of Physical Activity and Health: Systematic Review. Med Sci Sports Exerc. Jun;51(6)1213-1219.
[13] Colpani V, Baena CP, Jaspers L, et al. (2018) Lifestyle factors, cardiovascular disease and all-cause mortality in middle-aged and elderly women: a systematic review and meta-analysis. Eur.J.Epidemiol., 33(9), pp.831-845.
[14] Joseph, G. et al. (2019) ‘Dose-response association between level of physical activity and mortality in normal, elevated, and high blood pressure’, Hypertension, 74(6), pp. 1307–1315. doi: 10.1161/HYPERTENSIONAHA.119.13786.