24th April 2026, A/Prof Chee L Khoo
Australian and international guidelines recommend 150– 300 min of moderate physical activity (MPA), 75–150 min of vigorous physical activity (VPA), or a combination of both per week (1,2). Some people prefer slower but longer exercises while other prefer more intense for shorter periods of time. There is data suggesting that VPA leads to superior improvements in cardiorespiratory fitness, functional capacity, and several cardiometabolic risk factors compared to lower-intensity activities at equivalent volumes (3-5). Because everyone seems to be short of time, this intensity–benefit relationship has important public health implications, particularly regarding the potential to optimise the cost-effectiveness of physical activity (PA) interventions. Further, knowledge gaps remain regarding whether these intensity-specific benefits extend to chronic diseases beyond cardiovascular outcomes, and the relative im portance of exercise intensity vs total volume across different chronic diseases (6,7).
Wei J et al utilised accelerometer-measured PA data from the UK Biobank to investigate the associations of proportion of VPA (%VPA) with eight major chronic diseases—MACE, atrial fibrillation (AFib), type 2 diabetes (T2D), immune-mediated inflammatory diseases (IMIDs), metabolic dysfunction-associated steatotic liver disease (MASLD), chronic respiratory diseases (CRD), chronic kidney dis ease (CKD), and dementia as well as all-cause mortality (8). In particular, they looked at intensity vs volume of exercise in the contribution to these chronic diseases.
The Exercise
Between 2013 and 2015, a random subset of 103,619 UK Biobank participants was given to wear an Axivity AX3 wrist-worn accelerometer (Newcastle upon Tyne, UK) on their dominant wrist continuously for 7 days. Intensity of the exercises performed was categorised into light, moderate and vigorous according to the acceleration at 100 Hz with a dynamic range of ±8 g (unit of gravity). Total volume of PA was quantified in metabolic equivalent minutes per week (MET-min/week), with separate estimates calculated for each intensity (light, moderate and vigorous). Total volume of PA was calculated as the sum of time spent in light walking, moderate, and vigorous PA, and was also additionally expressed in MET-min/week.
PA was assessed using the modified short-form International PA Questionnaire (IPAQ) in 2006–2010, which captures information on three types of activity: walking, moderate-intensity, and vigorous-intensity. The calculation methods for %VPA and for converting intensity minutes into PA volume (MET-min) were similar to those used in the device-based assessment.
Outcomes
Participants with pre-existing diagnoses at baseline were excluded based on records obtained from self- report, primary care, or hospital admission sources. MACE was defined as the occurrence of ST-elevation or non-ST-elevation myocardial infarction, stroke, or heart failure. Mortality data, including dates and causes of death, were obtained from national death registries, while incident disease cases were identified via electronic health records from inpatient, outpatient, and primary care settings.
Results
There were 96 408 participants with device-measured PA. 56.3% were women, with a mean age of 61.9 ± 7.9 years. The median follow-up was 8.8–8.9 years. There were 375,730 participants with questionnaire-based PA. 52.2% were women, with a mean age of 56.2 ± 8.1 years. The mean follow-up period of 14.4–14.6 years.
Participants with higher %VPA were generally younger, more likely to be men, better educated, smoked less, and had lower obesity rates.
Outcomes comparison
Compared with participants with 0% VPA, participants with >4% VPA, there were significant reduction in the outcomes: 31% for MACE, 29% for AFib, 60% for T2D, 39% for IMIDs, 48% for MASLD, 44% for CRD, 41% for CKD, 63% for dementia, and 46% for all-cause mortality.
Higher %VPA levels were associated with lower cumulative risk across all outcomes, with the differences becoming more pronounced with advancing age. Higher % VPA levels were associated with lower 5-year absolute risks.
The reverse relationship between %VPA and outcomes were similarly observed for questionnaire- based %VPA, although with a smaller magnitude of associations.
Having any VPA (compared with 0% VPA group) could potentially prevent 20.3% of IMIDs, 21.4% of CRD, and 32.3% of dementia cases, whereas total PA volume (compared with the first tertile group) showed a much lower preventive potential—only 1.0%, 5.6%, and 8.1%, respectively.
In MACE, AFib, and all-cause mortality, the lower risk was primarily associated with %VPA. In contrast, for metabolism-related conditions such as T2D, MASLD, and CKD, the lower risk was associated with both total PA volume and %VPA.
In summary, while all forms of exercise show benefits in many chronic illnesses, incorporating some vigorous component brings in more benefits especially in cardiovascular disease.
References:
- Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020;54:1451–62
- Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA et al. The physical activity guidelines for Americans. JAMA 2018;320:2020–8
- Gebel K, Ding D, Bauman AE. Volume and intensity of physical activity in a large population-based cohort of middle-aged and older Australians: prospective relationships with weight gain, and physical function. Prev Med 2014;60:131–3
- Swain DP, Franklin BA. Vo(2) reserve and the minimal intensity for improving cardiorespiratory fitness. Med Sci Sports Exerc 2002;34:152–7
- Janssen I, Ross R. Vigorous intensity physical activity is related to the metabolic syndrome independent of the physical activity dose. Int J Epidemiol 2012;41:1132–40
- Rey Lopez JP, Sabag A, Martinez Juan M, Rezende LFM, Pastor-Valero M. Do vigorous-intensity and moderate-intensity physical activities reduce mortality to the same extent? A systematic review and meta-analysis. BMJ Open Sport Exerc Med 2020;6:e000775
- Wang D, Wu L, Yan L, Yang H, Huang X, Wang Z et al. Associations of the volume and proportion of vigorous-intensity physical activity with all-cause, cardiovascular, and cancer mortality: a systematic review and meta-analysis. PeerJ 2025;13:e19538
- Jiehua Wei, Minxue Shen, Shenxin Li, Yi Xiao, Dan Luo, Gerson Ferrari, Dong Hoon Lee, Leandro F M Rezende, Jason M R Gill, Matthew N Ahmadi, Emmanuel Stamatakis, Xiang Chen, Volume vs intensity of physical activity and risk of cardiovascular and non-cardiovascular chronic diseases, European Heart Journal, 2026;, ehag168