Gender disparity in physical activity and mortality risk

Physical activity (PA) leads to greater reductions in all-cause and cardiovascular mortality risk among women compared to men, according to a recent study published in the Journal of the American College of Cardiology.

Under 25% of US citizens meet the minimum amount of PA recommended by the Centers for Disease Control and Prevention (CDC) and American Heart Association despite associated all-cause and cardiovascular risk reductions. The minimum recommended PA is 150 minutes per week of moderate activity or 75 minutes per week of vigorous activity.

Two days of muscle strengthening activities per week are also recommended, and guidelines do not differ between male and female individuals. However, data has indicated decreased PA among female patients compared to male patients, with little information on how this gap impacts outcomes.

Investigators conducted a study to determine how health benefits from the frequency, duration, intensity, and type of exercise differ between sexes. Data was obtained from the CDC National Center for Health Statistics and included 646,279 participants across 50 states and the District of Columbia.

Exclusion criteria included coronary heart disease, stroke, myocardial infarction, chronic bronchitis, emphysema, cancer, limitations in activities of daily living, missing PA data, and missing follow-up or covariate data.

The frequency, duration, and type of regular PA engagement was determined through surveys with standardized questions. Aerobic PA was measured as minutes per week, calculated by multiplying activity frequency by activity duration.

The duration of moderate intensity was summed with vigorous intensity multiplied by 2 to determine total weighted moderate-to-vigorous intensity aerobic physical activity (MVPA). Additional data obtained included sociodemographic characteristics, medical comorbidities, and self-rated health status.

There were 412,413 participants included in the final analysis, 54.7% of whom were women, 14.4% Black, and 18.4% Hispanic. Patients were aged a mean 43.9 ± 16.6 years, and there were 39,935 all-cause deaths and 11,670 cardiovascular deaths. These equated to 8.1 per 1,000 person-years and 2.4 per 1,000 person-years, respectively.

Regular engagement in aerobic PA was reported by 32.5% of women vs 43.1% of men, with all measures of PA significantly more frequent in men. This included moderate PA in 10.3% of women vs 15.2% of men and vigorous PA in 28.3% of women and 38.9% of men.

Compared to inactivity, regular PA reduced all-cause mortality by 24% in women vs 15% in men. The magnitude of benefit was also significantly lower among men than women.

A peak in benefit was observed for 300 minutes of MVPA per week. Among men, this benefit was associated with an 18% reduction in all-cause mortality, which could be reached by 140 minutes per week of MVPA among women. At 300 minutes per week, women had a 24% reduction in all-cause mortality.

VPA was also associated with significant differences in benefits among women compared to men. All-cause mortality was reduced by 19% among men with 110 minutes per week of VPA, compared to only 57 minutes per week among women. For MPA, a 20% reduction of all-cause mortality was seen in men after 90 minutes per week and in women after 50 minutes per week.

Muscle strengthening PA was reported by 19.9% of women and 27.8% of men, with an average of 0.85 and 1.25 sessions per week, respectively. Mortality risk reduction from regular muscle strengthening PA among these populations was 19% and 11%, respectively.

For cardiovascular mortality, aerobic PA reduced risk by 14% in men and 36% in women. Regular muscle strengthening PA reduced the risk by 11% and 30%, respectively.

These results indicated increased benefits from PA among women compared to men. Investigators concluded these findings can close the gender gap by motivating women to engage in regular leisure-time PA.

Reference

Ji H, Gulati M, Yu Huang T, et al. Sex differences in association of physical activity with all-cause and cardiovascular mortality. J Am Coll Cardiol. 2024;83(8):783–793. doi:10.1016/j.jacc.2023.12.019