The optimal combination of moderate aerobic physical activity (MPA), vigorous aerobic physical activity (VPA), and muscle-strengthening activity (MSA) is still a question mark to reduce the risk of all-cause, cardiovascular, and cancer mortality. Overdoing and underdoing of exercise still remains a major concern.
This current study of 500,000 participants showed that balanced levels of moderate aerobic physical activity, vigorous aerobic physical activity, and muscle strengthening activity combined may be associated with optimal reductions of mortality risk. Higher-than-recommended levels of moderate aerobic physical activity and vigorous aerobic physical activity may further lower the risk of cancer and all-cause mortality, respectively.

Several studies examining the associations of different combinations of intensity-specific aerobic and muscle strengthening activity (MSA) with all-cause and cause-specific mortality are scarce. To examine the same researchers conducted a study and its findings are published in JAMA Internal Medicine.
The nationwide prospective cohort study used data from the US National Health Interview Survey. A total of 500 705 eligible US adults were included in the study and followed up during a median of 10.0 years (5.6 million person-years) from 1997 to 2018. Data were analyzed from September 1 to September 30, 2022. Self-reported cumulative bouts (75 weekly minutes) of MPA and VPA with recommended MSA guidelines (yes or no) to obtain 48 mutually exclusive exposure categories. All-cause, CVD, and cancer mortality. Participants were linked to the National Death Index through December 31, 2019.
The key findings of the study are
• A total of 500 705 participants (mean [SD] age, 46.4 [17.3] years; 210 803 [58%] female; 277 504 [77%] White) were included in the study.
• Compared with the reference group (doing no MPA or VPA and less than recommended MSA), the category associated with the lowest hazard ratio (HR) for all-cause mortality was more than 0 to 75 minutes of MPA combined with more than 150 minutes of VPA and 2 or more MSA sessions per week (HR, 0.50; 95% CI, 0.42-0.59).
• The optimal combinations for CVD and cancer mortality risk reduction were more than 150 to 225 minutes of MPA, more than 0 to 75 minutes of VPA, and 2 or more MSA sessions per week (HR, 0.30; 95% CI, 0.15-0.57), and more than 300 minutes of MPA, more than 0 to 75 minutes of VPA, and 2 or more MSA sessions per week (HR, 0.44; 95% CI, 0.23-0.82), respectively.
• Adjusted mortality rates represented an approximately 50% lower mortality rate for all-cause and cancer mortality and an approximately 3-fold lower mortality rate for CVD mortality.
Researchers concluded that “ This cohort study demonstrated that balanced levels of MPA, VPA, and MSA combined may be associated with optimal reductions of mortality risk. Higher-than-recommended levels of MPA and VPA may further lower the risk of cancer and all-cause mortality, respectively.”
Reference: López-Bueno R, Ahmadi M, Stamatakis E, Yang L, del Pozo Cruz B. Prospective Associations of Different Combinations of Aerobic and Muscle-Strengthening Activity With All-Cause, Cardiovascular, and Cancer Mortality. JAMA Intern Med. Published online August 07, 2023. doi:10.1001/jamainternmed.2023.3093.