Women derive greater gains in all-cause and cardiovascular mortality risk reduction from physical activity compared with men as shown by a prospective study in a large US cohort.

This summary is based on the publication of Ji H, Gulati M, Huang TY, et al. - Sex Differences in Association of Physical Activity With All-Cause and Cardiovascular Mortality. J Am Coll Cardiol. 2024 Feb 27;83(8):783-793. doi: 10.1016/j.jacc.2023.12.019.

Introduction and methods

Background

The Centers for Disease Control and Prevention (CDC) and AHA/ACC guidelines recommend the same amount of physical activity for both women and men [1-2]. However, women generally engage in lower amount of physical activity engagement compared with men, leading to the so-called “gender gap” that starts early in life and continues throughout adulthood [3-4]. It remains unclear whether this gap in physical activity engagement translates into differences in physical activity-related outcomes between women and men.

Aim of the study

The aim of this study was to evaluate whether the health benefits of physical activity may differ between women and men.

Methods

The authors used data from 412,413 US participants of the National Health Interview Survey (NHIS) study. Adults without preexisting CHD, MI, stroke, emphysema, chronic bronchitis or cancer who participated in the NHIS study from 1997 through 2017 were included in this analysis. All-cause and cardiovascular mortality records were obtained till December 31, 2019. At each survey data on physical activity, sociodemographic characteristics, medical comorbidities, and self-reported health status were collected.

Outcomes

The primary outcomes were all-cause mortality and cardiovascular mortality.

Main results

All-cause mortality

• The benefits of regular physical activity versus inactivity on all-cause mortality were greater in women compared with men (HR: 0.76; 95%CI: 0.73-0.80 for women and HR: 0.85; 95%CI: 0.82-0.89 for men; Wald test, F=12.0; P for interaction<0.001). This was also the case for regular muscle strengthening activity versus inactivity (HR: 0.81; 95%CI: 0.76-0.85 for woman and HR: 0.89; 95%CI: 0.85-0.94 for men; Wald test, F=7.9; P for interaction=0.005).
• The greatest benefit of physical activity on-all cause mortality was achieved at 300 min/wk of moderate-to-vigorous intensity of aerobic physical activity (MVPA) in men (HR: 0.82), after which it plateaued. Women achieved a similar benefit on all-cause mortality at 140 min/wk of MVPA. Women continued to benefit of increasing amount beyond this level, and reached peak benefit at ~300 min/wk (HR: 0.76; 95%CI: 0.72-0.80).
• Woman also experienced more benefit from vigorous intensity aerobic physical activity and moderate intensity aerobic physical activity on all-cause mortality compared with men.
• After engaging in muscle strengthening physical activity, the greatest risk reduction in all-cause mortality were observed in men who engaged in 3 sessions/wk of muscle strength activity (HR: 0.86). Women derived a similar benefit after 1.1 sessions/wk of muscle strengthening physical activity.
• The most beneficial frequency of muscle strengthening physical activity was around 3 sessions/wk in women (women had ~2-fold increase in risk reduction compared with men). Increasing the number of weekly sessions of muscle strengthening activity above this number attenuated the beneficial effects on all-cause mortality in women.

Cardiovascular mortality

• The benefits of regular aerobic physical activity versus inactivity on cardiovascular mortality were greater in women compared with men (HR: 0.64; 95%CI: 0.58-0.71 for women and HR: 0.86; 95%CI: 0.80-0.93 for men; Wald test, F=18.8; P for interaction<0.001).
• Greater benefits of regular muscle strengthening activities versus inactivity were also observed in women compared with men (HR: 0.70; 95%CI: 0.62-0.78 for women; and HR: 0.89; 95%CI: 0.80-0.98 for men; Wald test, F=9.9; P for interaction=0.001).

Conclusion

In a large prospective study of US adults, women experienced a greater survival benefit from physical activity compared with men. The benefits of regular aerobic or muscle strengthening physical activities versus inactivity were greater in women compared with men. Moreover, at the same degree of MVPA, women experienced greater mortality reductions.According to the authors, “[t]hese findings could motivate efforts to close the “gender gap” by encouraging especially women to engage in any regular leisure-time PA.”

Find this article online at J Am Coll Cardiol.

References

1. Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. JAMA. 2018;320(19):2020–2028.

2. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;74(10):1376–1414.

3. Guthold R, Willumsen J, Bull FC. What is driving gender inequalities in physical activity among adolescents? J Sport Health Sci. 2022;11(4):424–426.

4. The Lancet Public Health. Time to tackle the physical activity gender gap. Lancet Public Health. 2019;4(8):e360.