Changes in Leisure-Time Physical Activity and All-Cause Mortality in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BACKGROUND: Leisure-time physical activity offers protection against the risk of death. However, most studies have considered only one measure of lifetime exposure, and there is a lack of cohort studies in low- and middle-income countries. We aimed to evaluate the prospective effect of leisure-time physical activity and its changes in the mortality risk among adults from Brazil. METHODS: We analyzed leisure-time physical activity data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Changes from the first wave (2008-2010) to the second wave (2012-2014) were assessed by the International Physical Activity Questionnaire. Mortality data were updated on January 1, 2024. Cox regression estimated hazard ratios (HR). RESULTS: Overall, 13,589 individuals had valid data for physical activity in both waves. The mean age at baseline was 52.2 (9.1), varying from 34 to 75 years old. There were 553 deaths, with a crude mortality rate of 3.3 per 1000. The mean follow-up time for the risk of dying was 12 years. The risk of death was lower for individuals who had: (1) high levels of moderate to vigorous physical activity at wave 1 and maintained or increased at wave 2 (HR = 0.59; 95% CI, 0.37-0.92), (2) incident vigorous physical activity at wave 2 (HR = 0.47; 95% CI, 0.32-0.70), and (3) maintained or increased their walking level (HR = 0.75; 95% CI, 0.57-0.99) as compared with those inactive at both waves. CONCLUSIONS: We found a greater protective effect of vigorous physical activity on mortality risk. However, maintaining leisure-time walking was also associated with a lower mortality risk. Performing physical activity above the recommended threshold could provide more benefits.