ArticleBritish journal of sports medicine2026
Joint non-linear dose-response associations of device-measured physical activity and cardiorespiratory fitness with cardiovascular disease: a cohort and Mendelian randomisation study.
Article in British journal of sports medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Leisure-time physical activity and metabolomic trajectories over the transition from late midlife to old age.The journals of gerontology. Series A, Biological sciences and medical sciences · 2026Article
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8 authors.
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Abstract
objectivesTo characterise the non-linear joint dose-response relationship of accelerometer-measured moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness (CRF, estimated as maximal oxygen uptake (VO₂max)) with incident cardiovascular disease (CVD), and to assess causal consistency using Mendelian randomisation (MR).
methodsWe conducted a cohort study in the UK Biobank using accelerometer data linked to hospital and death registries. A Cox generalised additive model characterised the joint MVPA-CRF association with incident CVD (atrial fibrillation, myocardial infarction, heart failure (HF) and stroke), adjusting for confounders. We derived a fitness-stratified matrix quantifying the weekly MVPA minutes associated with prespecified relative hazard reductions. Complementary two-sample MR analyses leveraged genome-wide association study summary statistics for device-measured physical activity (PA) traits and CRF to assess potential causal effects on cardiovascular outcomes.
resultsAmong 17 088 participants, 1233 incident CVD events occurred over a median follow-up of 7.85 years (IQR, 7.39-8.27). A significant non-linear interaction between MVPA and CRF was observed (p<0.001). Meeting the 150 min/week guideline yielded a modest ~8%-9% risk reduction across fitness levels, whereas achieving a >30% risk reduction required threefold to fourfold higher volumes (~560-610 min/week). Residual analysis indicated that fitness beyond what MVPA and covariates predicted retained a modest protective association with CVD risk (HR, 0.98 per 1 mL/kg/min; 95% CI 0.97 to 0.99; p<0.001). In MR analyses, genetically proxied higher CRF was associated with lower HF risk (OR, 0.79; 95% CI 0.63 to 0.99), whereas genetic evidence for PA traits was weaker and less consistent.
conclusionCurrent MVPA guidelines provide a universal but modest safety margin, whereas optimal cardiovascular protection may require substantially higher activity volumes. The fitness-stratified prescription matrix offers quantitative behavioural targets, and genetic findings reinforce the independent importance of CRF in cardiovascular risk reduction.
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