Achieving Guidelines Within a 24-Hour Movement Paradigm and Risk of Mortality in US Adults

To examine the association of meeting the 24-hour movement guidelines and risk of cardiovascular disease (CVD) and all-cause mortality in a national representative sample of US adults.

The study included US adults (N=41,930) from the 2005 and 2010 waves of the National Health Interview Survey. Self-reported moderate to vigorous physical activity (guideline: ≥150 minutes per week of moderate, ≥75 minutes per week of vigorous, or equivalent of both), total sitting time (guideline: leisure sedentary time <8 hours per day for nonworking adults; <4 hours per day for working adults), and total sleep duration (guideline: 7 to 9 hours per day). All-cause and CVD mortality data were obtained from the National Death Index.

During a median follow-up of 9.9 years, 3786 participants died of all causes; of those, 835 died of CVD. Meeting a greater number of 24-hour movement guidelines was associated with lower all-cause mortality risk (hazard ratios, 0.81 [95% CI, 0.71 to 0.93], 0.75 [95% CI, 0.65 to 0.87], and 0.63 [95% CI, 0.53 to 0.75] for meeting 1, 2, or 3 guidelines, respectively) vs meeting 0 guidelines (P_trend<.001). Meeting a greater number of 24-hour movement guidelines was associated with a reduced CVD mortality risk (hazard ratios, 0.93 [95% CI, 0.69 to 1.25], 0.90 [95% CI, 0.67 to 1.20], and 0.53 [95% CI, 0.37 to 0.76] for meeting 1, 2, or 3 guidelines, respectively) vs meeting 0 guidelines (P_trend<.001).

A dose-response relationship was observed for participants meeting all 3 guidelines, with a 37% and 47% reduced risk of all-cause mortality and CVD mortality, respectively. These findings support promoting a healthy 24-hour behavior pattern to reduce mortality risk.