Physical activity and risk of cardiovascular disease by weight status among U.S adults

We sought to determine whether the association between physical activity and 10-year cardiovascular disease (CVD) risk varies among normal weight, overweight, and obese adults in a nationally-representative sample of the United States.

Data were from the National Health and Nutrition Examination Survey 2007-2016. A subset of 22,476 participants aged 30-64 years was included with no CVD history. Physical activity level was self-reported and stratified into sedentary (0 min/week), inactive (1-149 mins/week), or active (≥150 mins/week) of moderate or vigorous activities. Framingham risk scores were classified as low/intermediate (<20%) or high 10-year CVD risk (≥20%).

The average age of the population was 45.9 years, 52.3% were female, 33.6% were overweight (BMI 25.0-29.9kg/m2), and 35.7% were obese (BMI≥30kg/m2). Individuals who were overweight and obese had a higher 10-year CVD risk compared to those with normal weight (9.5 vs. 10.1 vs. 6.3%, P<0.001). The association of physical activity and high 10-year CVD risk differed by weight status. Among overweight and obese adults, individuals engaged in any physical activity had lower odds ofhigh 10-year CVD risk compared to sedentary individuals (overweight: OR active = 0.48, 95% CI: 0.36-0.64; OR inactive = 0.53, 95% CI: 0.45-0.86; obese: OR active = 0.50, 95% CI: 0.37-0.68; OR inactive = 0.66, 95% CI: 0.49-0.89). Among normal weight adults, individuals who were physically active had lower odds of high 10-year CVD risk (OR = 0.59, 95% CI: 0.28-0.87). When compared the joint effects of physical activity level and weight status, physical activity was associated with a larger magnitude of reduced odds of 10-year CVD risk than weight status.

Participation in any level of physical activity is associated with a lower 10-year CVD risk for overweight and obese adults. Future studies are needed to identify effective modes and doses of exercise that offer optimal CVD benefits for populations with different weight statuses.