Physical activity intensity matters more for chronic disease prevention

Prioritizing physical activity (PA) intensity over volume may yield greater benefits for preventing most noncommunicable diseases (NCDs), a prospective study suggests.

“A higher proportion of vigorous PA (%VPA), independent of total activity volume, is inversely associated with eight major chronic diseases and all-cause mortality. Intensity consistently demonstrated a higher preventive potential than total PA volume,” the investigators said.

The eight diseases were major adverse cardiovascular events (MACE), atrial fibrillation (AF), type 2 diabetes (T2D), immune-mediated inflammatory diseases (IMIDs), metabolic dysfunction-associated steatotic liver disease (MASLD), chronic respiratory diseases (CRD), chronic kidney disease (CKD), and dementia. [Eur Heart J 2026;doi:10.1093/eurheartj/ehag168]

According to the investigators, these conditions were chosen because they represent the major categories of NCDs that collectively account for the leading global health burdens. [Lancet 2025;406:1873-1922]

Compared with no VPA, participants with >4 percent VPA had significantly lower risks of the eight diseases in model 1: Hazard ratios [HRs], 0.69 for MACE, 0.71 for AF, 0.40 for T2D, 0.61 for IMIDs, 0.52 for MASLD, 0.56 for CRD, 0.59 for CKD, and 0.37 for dementia. The same was true for all-cause mortality (HR, 0.54; p<0.001 for all).

“Although the association was attenuated after further adjustment in model 2, the inverse relationship remained statistically significant,” the researchers said.

Compared with 0% VPA, having any VPA may prevent 20.3 percent of IMIDs, 21.4 percent of CRD, and 32.3 percent of dementia cases; total PA volume, compared with the first tertile, showed a much lower preventive potential (1, 5.6, and 8.1 percent, respectively).

A similar pattern favouring %VPA over total PA volume was observed for MACE (17.8 percent vs 6 percent), AF (16.2 percent vs 5 percent), and all-cause mortality (31.4 percent vs 14.2 percent). For metabolism-related conditions, such as T2D (26.6 percent vs 17.7 percent), MASLD (22.1 percent vs 16.6 percent), and CKD (23 percent vs 15.3 percent), the lower risk was associated with both %VPA and total PA volume.

Public health implications

“The intensity–benefit relationship has important public health implications, particularly regarding the potential to optimize the cost-effectiveness of PA interventions—a critical consideration given that time constraints remain a primary barrier to PA adherence,” the researchers explained.

However, key gaps remain regarding the relative importance of exercise intensity vs total volume across different chronic diseases, and whether these benefits extend beyond cardiovascular outcomes. [BMJ Open Sport Exerc Med 2020;6:e000775; PeerJ 2025;13:e19538]

This study included 96,408 individuals (mean age 61.9 years, 56.3 percent women) with device-measured data (wrist-worn accelerometers) and 375,730 (mean age 56.2 years, 52.2 percent women) with self-reported PA data from the UK Biobank.

Taken together, the results support prioritizing higher-intensity activities whenever possible in clinical and public health interventions aimed at preventing NCDs, the researchers said. “From a public health perspective, our findings support the promotion of strategies focused on time-efficient exercise and incidental PA that emphasize intensity rather than just duration.”

“While meeting recommended PA volumes remains important, prioritizing intensity—even in smaller amounts—can provide substantial population health benefits and reduce healthcare burden across multiple chronic diseases,” they added.

It is important to note that these results do not negate the benefits of lower-intensity PA. For instance, light-to-moderate PA may still confer meaningful health benefits in older or frail adults for whom VPA may not be feasible. [Eur J Prev Cardiol 2025;doi.org/10.1093/eurjpc/zwaf409; Lancet 2026;407:339-349; Eur J Prev Cardiol 2023;30:1975-1985]