Refined physical activity recommendations considering cardiovascular disease risk stratification: a cohort study

AIMS: As 'one-size-fits-all' physical activity (PA) recommendations are increasingly challenged, the optimal PA patterns across different predicted cardiovascular disease (CVD) risk populations remain unclear. This study aimed to identify the optimized PA patterns for different risk populations, thereby refining current recommendations. METHODS AND RESULTS: We conducted a prospective cohort study involving 72 884 participants from the UK Biobank. Individuals with accelerometer-derived total volume of PA (TPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA), moderate-to-vigorous PA (MVPA), and sedentary time were categorized into low-to-moderate-, high-, or very high-risk groups by the updated Systemic Coronary Risk Estimation 2 (SCORE2), SCORE2-Older Persons, and SCORE2-Diabetes. Cox regressions and compositional data analysis modelled associations between PA and incident CVD and potential benefits of reallocating sedentary time to MVPA. An inverse association between TPA, as well as MVPA, and incident CVD was observed, with very high-risk populations benefiting most, showing a 20% (95% CI 14-26%) lower hazard for each 150-min/week increase in MVPA, compared with 16% (14-18%) in high-risk and 16% (13-19%) in low-to-moderate-risk individuals (Pinteraction < 0.0001). Further analyses suggested MVPA recommendations should be tailored to individual risk stratifications. For low-to-moderate-risk individuals, replacing 300 min/week of sedentary time with any MVPA combination provided benefits. However, high-risk and very high-risk individuals should limit their VPA to 60 and 42 min/week, respectively, beyond which benefits may diminish. CONCLUSION: The optimal VPA threshold should be underscored, especially for high- or very high-risk populations. This study advocates personalized PA recommendations by integrating risk assessment to maximize cardioprotective effects while minimizing potential harms.