Reallocating movement behaviors in relation to mortality in middle-aged and older adults: The ELSA-Brasil study

Background: Movement behaviors (MB) are linked to mortality. However, few studies using device-measured MB were conducted in low-and-middle-income countries (LMICs), and previous investigations did not account for their joint composition.
Purpose: Investigate associations of moderate-and-vigorous physical activity (MVPA), light intensity physical activity (LPA), sedentary behavior (SB), and sleep duration with all-cause mortality in Brazilian adults estimating the change in risk by reallocating time between MB.
Methods: ELSA-Brasil cohort 3rd wave (2017-2019) participants wore an ActiGraph wGT3X-BT for seven days, filled in a sleep diary, and were followed until July 1st, 2023. We used compositional Cox models adjusted for sociodemographic, behavioral, and health covariates to estimate hazard ratios (HR) associated with reallocating MB.
Results Of 12636 participants, 8855 (70%) provided data on exposure and covariates. Mean age was 59.1 years (±8.2), with 55.7% women. We observed 202 deaths (2,3%) during a median follow-up of 4.9 y. Participants showed on average: 47.4 (±25.3) min/day MVPA, 3.44 (±1.14) h/day LPA, 12.25 (±1.7) h/day SB, and 7.52 (±1.27) h/day sleep. The HR associated with reallocating 10 min/day from SB to MVPA was 0.88 (95%CI 0.85-0.92); MVPA to SB 1.17 (95%CI 1.12-1.23); LPA to MVPA 0.89 (95%CI 0.84-0.93); MVPA to LPA 1.17 (95%CI 1.10-1.24); and Sleep to MVPA 0.89 (95%CI 0.85-0.92), MVPA to Sleep 1.17 (95%CI 1.11-1.23). Other reallocations were not significant.
Conclusion In Brazilian adults, reallocating any amount of time from other MB to MVPA was consistently associated with lower mortality. This supports the message that “every move counts” and highlights the role of higher-intensity activity in reducing mortality.
Practical implications: Enhancing physical activity intensity may be linked to a reduction in mortality.
Funding Brazilian Ministry of Health (Department of Science and Technology); Brazilian Ministry of Science, Technology and Innovation (Financiadora de Estudos e Projetos, FINEP; Conselho Nacional de Desenvolvimento Científico e Tecnológico, CNPq).