Aerobic, Muscle-Strengthening, and Flexibility Physical Activity in Relation to All-Cause and Cancer Mortality: A Population-Based Prospective Cohort Study in Korea

OBJECTIVES: We examined the independent associations of aerobic, muscle-strengthening, and flexibility physical activity with all-cause and cancer mortality. We also compared the mortality risk between participants meeting national guidelines for both aerobic and muscle-strengthening activities and those who do not meet any of the guidelines. METHODS: This analysis included 35,794 participants (aged 19–80 years) in the Korea National Health and Nutrition Examination Survey (KNHANES) 2007–2013 who agreed to mortality follow-up through December 31, 2019 (mean follow-up: 8.1 years). Levels of aerobic, muscle-strengthening, and flexibility physical activity were self-reported at baseline. Participants engaging in ≥10 MET-hr/wk of moderate- and vigorous-intensity aerobic activity and ≥2 d/wk of muscle-strengthening activity were considered as meeting the guidelines. Cox proportional hazards model was used to estimate hazard ratios (HR) and 95% confidence intervals (CI), adjusting for potential confounders. RESULTS: Aerobic activity was inversely associated with both all-cause (≥20 vs. 0 MET-hr/wk: HR [95% CI]: 0.79 [0.70–0.89]) and cancer mortality (0.83 [0.68–1.00]), adjusting for other activity types. Muscle-strengthening (≥5 vs. 0 d/wk: 0.86 [0.71–1.04]) and flexibility activities (≥5 vs. 0 d/wk: 0.84 [0.73–0.96]) were inversely associated with all-cause mortality but were not associated with cancer mortality. Compared to participants who did not meet any guidelines (54%), those meeting both aerobic and muscle-strengthening guidelines (12%) had the lowest all-cause mortality (0.75 [0.62, 0.92]) but the interaction between two activity types was not statistically significant. CONCLUSIONS: Our data suggest that engaging in higher levels of aerobic, muscle-strengthening, and flexibility physical activity are all independently associated with lower all-cause mortality. FUNDING SOURCES: This work was supported by Korea University and National Research Foundation of Korea.