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Laurie Barclay, MD
Freelance writer and reviewer, Medscape, LLC
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Brande Nicole Martin
CME Clinical Editor, Medscape, LLC
Disclosure: Brande Nicole Martin has disclosed no relevant financial relationships.

Charles P. Vega, MD
Associate Clinical Professor, Residency Program Director, Prime-LC, University of California-Irvine, Orange, California; Department of Family Medicine, University of California-Irvine, Orange, California
Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.

Sarah Fleischman
CME Program Manager, Medscape, LLC
Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

Laurie E. Scudder, DNP, NP
Nurse Planner, Continuing Professional Education Department, Medscape, LLC; Clinical Assistant Professor, School of Nursing and Allied Health, George Washington University, Washington, DC
Disclosure: Laurie E. Scudder, DNP, NP, has disclosed no relevant financial relationships.

Learning Objectives

Upon completion of this activity, participants will be able to:

1. Assess trends in physical activity levels among adults in Taiwan.
2. Distinguish a low threshold of physical activity required to reduce the risk for mortality.

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Clinical Context

Although many adults worldwide fail to meet stated recommendations for physical activity, the approach to physical activity can vary from culture to culture. The authors of the current study note that East Asians tend to be less physically active vs adults in Western countries. A previous study by Ku and colleagues, which appeared in the December 2006 issue of Preventive Medicine, found that only 14% of Taiwanese adults met national recommendations for physical activity levels. In contrast to Western countries, adults 45 years and older were more likely to be active vs young people. Limited formal education and a paying job were risk factors for physical inactivity.

Given this background, can at least a modest amount of physical activity promote significant reductions in mortality risk? A minimal amount of exercise necessary to improve life expectancy has not yet been identified. The current study by Wu and colleagues, which was also based in Taiwan, examines the effects of different levels of physical activity on the risk for mortality.

Study Synopsis and Perspective

The minimal amount of physical activity to reduce mortality risk is 15 minutes a day of moderate-intensity exercise, according to the results of a prospective cohort study reported online August 16 in The Lancet.

"Exercising at very light levels reduced deaths from any cause by 14 percent," said senior author Xifeng Wu, MD, PhD, professor and chair of the University of Texas MD Anderson Cancer Center Department of Epidemiology, in a news release. "The benefits of exercise appear to be significant even without reaching the recommended 150 minutes per week based on results of previous research."

The study cohort consisted of 416,175 persons in Taiwan (199,265 men and 216,910 women) who were evaluated between 1996 and 2008 in a standard medical screening program. Average duration of follow-up was 8.05 ± 4.21 years. Participants were categorized according to the amount of weekly exercise self-reported on a questionnaire as inactive, low, medium, high, or very high activity. For each group, life expectancy and hazard ratios (HRs) were calculated for mortality risk, with use of the inactive group as the standard.

The average amount of exercise in the low-volume activity group was 92 minutes per week (95% confidence interval [CI], 71 - 112) or 15 ± 18 minutes per day. Risk for all-cause mortality was 14% lower (HR, 0.86; 95% CI, 0.81 - 0.91), and life expectancy was 3 years longer in the low-volume activity group vs the inactive group.

Beyond the minimal amount of 15 minutes of daily exercise, each additional 15 minutes was associated with a further reduction in all-cause mortality risk by 4% (95% CI, 2.5 - 7.0) and in all-cancer mortality risk by 1% (95% CI, 0.3 - 4.5). These benefits of exercise were seen in all age groups, in both sexes, and in persons at risk for cardiovascular disease. Compared with individuals in the low-volume group, inactive persons had a 17% increased risk for mortality (HR, 1.17; 95% CI, 1.10 - 1.24).

"15 min a day or 90 min a week of moderate-intensity exercise might be of benefit, even for individuals at risk of cardiovascular disease," the study authors write.

Limitations of this study include observational design with possible confounding, reliance on self-report to determine exercise amount, lack of generalizability to other populations, and possible loss to follow-up.

In an accompanying editorial, Anil Nigam and Martin Juneau, from Montreal Heart Institute and Université de Montréal in Quebec, Canada, note that "this is the first observational study of this size to report important and global health benefits at such a low volume of leisure-time physical activity [LTPA] with this degree of precision."

"The knowledge that as little as 15 min per day of exercise on most days of the week can substantially reduce an individual's risk of dying could encourage many more individuals to incorporate a small amount of physical activity into their busy lives," Drs. Nigam and Juneau write. "Governments and health professionals both have major roles to play to spread this good news story and convince people of the importance of being at least minimally active."

The exercise project was funded by the Taiwan Department of Health Clinical Trial and Research Center of Excellence, and the Taiwan National Health Research Institutes supported this study. The study authors and editorialists have disclosed no relevant financial relationships.

Lancet. Published online August 16, 2011.