Associations Between Exercise Training, Physical Activity, Sedentary Behaviour and Mortality: An Umbrella Review of Meta-Analyses.

Pinar Soysal, Djandan Tadum Arthur Vithran, Hyeri Lee, Hayeon Lee, Abdolreza Kazemi, Nicola Veronese, Lee Smith, Laurent Boyer, Marco Solmi, Elena Dragioti, Samuele Cortese, Jiseung Kang, Guillaume Fond, Dong Keon Yon, Masoud Rahmati, Jaeyu Park, Yusheng Li

Journal: Journal of cachexia, sarcopenia and muscle 2025;16(2):e13772

PMID: 40042073

Free Full Text on PubMed Central View on PubMed

Abstract

BACKGROUND

Numerous studies support the association of exercise training, physical activity (PA) and sedentary behaviour (SB) with both mortality and morbidity outcomes. The results across studies have been inconsistent, and no umbrella reviews have yet been conducted on this topic.

METHODS

We conducted an umbrella review of meta-analyses of observational studies by screening articles in PubMed/MEDLINE, EMBASE and Web of Science databases from inception to 30 April 2024. Quality appraisal of each included meta-analysis was done using the AMSTAR 2 tool, with evidence certainty evaluated based on statistical significance, study size, heterogeneity, small-study effects, prediction intervals (PI) and potential biases.

RESULTS

Frothy-eight meta-analyses were included (AMSTAR 2 ratings: high 25, moderate 10, low 2 and critically low 11). No evidence was highly suggestive or convincing. Suggestive evidence linked any PA and SB to lower and higher risks of all-cause, cardiovascular and cancer mortality. Suggestive evidence indicated a significant association between self-reported and device-measured total PA (equivalent odds ratio [eOR] 0.78 [0.70-0.86] and eHR = 0.50 [0.38-0.65], respectively), self-reported leisure time PA (eHR = 0.73 [0.66-0.80]), device-measured daily steps (eHR = 0.44 [0.35-0.56]) and aerobic plus resistance training (eHR = 0.60 [0.56-0.64]) with lower all-cause mortality. Weak evidence supported links between self-reported and device-measured SB and higher mortality (eHR = 1.3 [1.22-1.38] and eHR = 2.16 [1.09-4.28], respectively). Suggestive evidence was noted for the association between self-reported leisure time PA (eHR = 0.74 [0.69-0.80]) and resistance training (eHR = 0.82 [0.81-0.84]) with cardiovascular mortality. Suggestive evidence was also found for the association between self-reported leisure time PA (eHR = 0.87 [0.83-0.91]) with cancer mortality. Associations between self-reported running time and mortality from all causes, cardiovascular diseases (CVD) and cancer did not reach statistical significance nor did the association between low skeletal muscle mass and all-cause mortality. Meta-regression analyses showed that physical activity reduces mortality risk, with age reducing the protective effects against all-cause, CVD and cancer mortality. We also found that combined exercise training (aerobic plus resistance) most effectively reduces all-cause and CVD mortality.

CONCLUSIONS

Converging evidence supports that physical activity and sedentary behaviour are associated with lower and higher rates of all-cause, cardiovascular and cancer mortality. More high-quality prospective studies are needed for a better understanding of the associations between running time and also TV-viewing time and health-related outcomes.

Address: CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France.; CRSMP, Center for Mental Health and Psychiatry Research - PACA, Marseille, France.; Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran.; Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran.; Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea.; Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China.; Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran.; CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France.; CRSMP, Center for Mental Health and Psychiatry Research - PACA, Marseille, France.; Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK.; Saint Camillus International University of Health Sciences, Rome, Italy.; Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.; Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden.; Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece.; Developmental EPI (Evidence synthesis, Prediction, Implementation) Lab, Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK.; Hampshire and Isle of Wight Healthcare NHS Foundation Trust, Southampton, UK.; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, New York, USA.; DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy.; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA.; School of Health and Environmental Science, College of Health Science, Korea University, Seoul, South Korea.; Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea.; Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Republic of Korea.; On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada.; Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, Ontario, Canada.; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.; Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada.

DOI: 10.1002/jcsm.13772