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Original article| Volume 96, ISSUE 12, P3012-3020, December 2021

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U-Shaped Association Between Duration of Sports Activities and Mortality: Copenhagen City Heart Study



      To investigate the association between the duration of weekly leisure-time sports activity and all-cause mortality.


      As part of the prospective Copenhagen City Heart Study, 8697 healthy adults completed a comprehensive questionnaire about leisure-time sports activities. Duration (minutes per week) of leisure-time sports activities was recorded for tennis, badminton, soccer, handball, cycling, swimming, jogging, calisthenics, health club activities, weightlifting, and other sports. The primary end point was all-cause mortality, and the median follow-up was 25.6 years. The association between duration of leisure-time sports activities and all-cause mortality was studied using multivariable Cox proportional hazards regression analysis.


      Compared with the reference group of 2.6 to 4.5 hours of weekly leisure-time sports activities, we found an increased risk for all-cause mortality for those with 0 hours (hazard ratio [HR], 1.51; 95% CI, 1.29 to 1.76), for those with 0.1 to 2.5 hours (HR, 1.24; 95% CI, 1.05 to 1.46), and for those with more than 10 hours (HR, 1.18; 95% CI, 1.00 to 1.39) of weekly leisure-time sports activities. These relationships were generally consistent with additional adjustments for potential confounders among subgroups of age, sex, education, smoking, alcohol intake, and body mass index, when the first 5 years of follow-up were excluded, and for cardiovascular disease mortality.


      We observed a U-shaped association between weekly duration of leisure sports activities and cardiovascular and all-cause mortality, with lowest risk for those participating in 2.6 to 4.5 weekly hours, being consistent across subgroups. Participation in sport activities should be promoted, but the potential risk of very high weekly hours of sport participation should be considered for inclusion in guidelines and recommendations.

      Abbreviations and Acronyms:

      BMI (body mass index), BP (blood pressure), CRF (cardiorespiratory fitness), CVD (cardiovascular disease), HR (hazard ratio), MET (metabolic equivalent), PA (physical activity)
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      Linked Article

      • In Reply—Association Between Weekly Exercise Time and Mortality
        Mayo Clinic ProceedingsVol. 97Issue 2
        • Preview
          We would like to thank the esteemed Drs Aengevaeren, Eijsvogels, and Bakker for their insightful comments regarding our recently published manuscript.1 We chose the cohort doing 2.6 to 4.5 h/wk of exercise as the reference group because this approximates the 30 minutes daily of leisure-time physical activity recommended by national guidelines in Denmark.
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      • Association Between Weekly Exercise Time and Mortality
        Mayo Clinic ProceedingsVol. 97Issue 2
        • Preview
          We read with great interest the work of Schnohr et al1 about the association between weekly exercise time and cardiovascular disease (CVD) mortality. During ±25 years of follow-up, 4779 deaths (54.9% of study population) were recorded, of which 2054 (23.6%) were CVD related. The authors reported a U-shaped association between weekly exercise time and CVD mortality and all-cause mortality, with the lowest risk for individuals exercising 2.6 to 4.5 h/wk. These findings remained consistent after correction for competing risks, stratified analyses, and analyses to account for reverse causation.
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      • In the Limelight: December 2021
        Mayo Clinic ProceedingsVol. 96Issue 12
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          This month’s feature highlights three articles that appear in the current issue of Mayo Clinic Proceedings. These articles are also featured on the Mayo Clinic Proceedings’ YouTube Channel ( ).
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