Daily steps, activity, sedentary and sleep behaviors associations with all-cause mortality: The ELSA-Brasil study

Although movement behaviors are linked to mortality risk, few studies investigated the associations between daily steps and movement behaviors and all-cause mortality in low- and middle-income countries.

We investigated associations of step count, total activity volume, moderate-and-vigorous physical activity (MVPA), light-intensity physical activity (LPA), sedentary behavior, sleep duration, and various isotemporal substitutions with all-cause mortality in middle-aged and older Brazilian adults.

ELSA-Brasil cohort study 3rd wave (2017-2019) participants wore an ActiGraph wGT3X-BT on the waist for seven days and completed a sleep diary. We followed participants to January 1st, 2024. Using Cox regression models, we estimated adjusted hazard ratios (HR). Using compositional data analysis, we examined changes in mortality associated with isotemporal substitutions.

Overall, 8832 participants (55.8 % female, age 59.2 ± 8.6) were followed for a median of 5.43 person-years (total 46,793.2), with 216 deaths. All behaviors except sleep showed curvilinear associations with mortality. Mortality declined with a plateauing effect at a daily total activity volume of 15.9 millii-g (HR 0.36, reference 7.83), 7300 steps (HR 0.48, reference 3881), 49.4 MVPA minutes (HR 0.28, reference 11.34), and 245.8 LPA minutes (HR 0.67, reference 135.6). Engaging in less than 842 sedentary behavior minutes/day was linked with an HR of 0.67. Reallocating 10 daily minutes from other behaviors to MVPA showed a consistent 10 % decrease in mortality.

In Brazilian adults, step count, total activity volume, MVPA, LPA, and sedentary behavior were non-linearly associated with lower mortality. Reallocating any time from other behaviors to MVPA predicted lower mortality.