Device-measured vigorous intermittent lifestyle physical activity and major cardiovascular events

Importance Vigorous physical activity is a time-efficient and potent preventive intervention for major adverse cardiovascular events (MACE), although longer traditional exercise sessions are unappealing or inaccessible to most adults. Objective We examined the dose-response associations of device-measured vigorous intermittent lifestyle physical activity (VILPA, brief sporadic bouts of higher intensity occurring during daily living) with MACE and its sub-types in women and men. We also undertook analogous analyses in a sample of exercisers. Design, Setting, and Participants Prospective cohort analysis of 13,018 women and 9,350 men non-exercisers from the UK Biobank accelerometry sub-study; the contextual analyses involved 34,364 female/24,284 male exercisers from the same sub-study. Exposures Wrist accelerometer assessed daily VILPA duration of bouts lasting up to 1 and up to 2 minutes. Outcomes and Measures Overall and sex-specific dose-response associations of daily VILPA with MACE and its subtypes (incident myocardial infarction, heart failure and stroke). Results Among female/male non-exercisers there were 331/488 all-MACE events (129/250 myocardial infarction, 96/119 heart failure,106/119 stroke events) over a mean 7.9-year follow-up. Daily VILPA duration exhibited a near-linear dose-response association with all MACE, myocardial infarction, and heart failure in women but not in men. Compared to women with no VILPA, the median daily VILPA duration of 3.4 minutes per day was associated with HRs of 0.55 (0.41, 0.75) for all MACE; and 0.33 (0.18, 0.59) for heart failure. Women’s minimum doses (the dose associated with 50% of the optimal risk reduction) of 1.2-1.6 minutes of VILPA per day were associated with HRs of 0.70 (0.58, 0.86) for all-MACE, 0.67 (0.50, 0.91) for myocardial infarction and 0.60 (0.45, 0.81) for heart failure, respectively. The equivalent analyses in exercisers in the UK Biobank showed comparable beneficial associations of vigorous intensity activity with all MACE, myocardial infarction and heart failure in both sex groups. Conclusions and Relevance Amongst non-exercisers, small amounts of VILPA were associated with substantially lower risk of myocardial infarction and heart failure in women but not in men. No such sex differences were evident among exercisers. VILPA may be a promising physical activity target for CVD prevention in women not willing or able to exercise. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study is funded by an Australian National Health and Medical Research Council (NHMRC) Investigator Grant (APP 1194510) and Ideas Grant (APP1180812). The funder had no specific role in any of the following study aspects: the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The UK National Research Ethics Service gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes * MACE : major adverse cardiovascular events CVD : cardiovascular disease VILPA : vigorous intermittent lifestyle physical activity