Objective To examine whether vigorous-intensity physical activity confers additional reductions on all-cause and cause-specific mortality compared with moderate-intensity physical activity. Design A systematic review (registered in PROSPERO CRD42019138995) and meta-analysis. Data sources Three electronic databases up to April 14 2020. Eligibility criteria Inclusion criteria were prospective studies that contained information about (1) moderate-intensity (3–5.9 metabolic equivalent tasks (METs)) and vigorous-intensity (≥6 METs) physical activities and (2) all-cause and/or cause-specific mortality. Exclusion criteria were prospective studies that (1) exclusively recruited diseased patients (eg, hypertensive patients and diabetics) or (2) did not account for total physical activity in their multivariable models (3) or did not adjust or exclude individuals with comorbidities at baseline or (4) used physically inactive participants as reference group. Results Five studies (seven cohorts using sex-specific results) were pooled into a meta-analysis. For all-cause mortality and controlling by total physical activity, vigorous-intensity physical activity (vs moderate) was not associated with a larger reduction in mortality (HR 0.95, 95% CI 0.83 to 1.09). After the exclusion of one study judged with critical risk of bias (Risk Of Bias in Non randomized Studies, ROBINS tool) from meta-analysis, results remained similar (HR 0.98, 95% CI 0.85 to 1.12). Due to the limited number of studies, meta-analyses for cancer and cardiovascular mortality were not performed. Conclusions Prospective studies suggest that, for the same total physical activity, both vigorous-intensity and moderate-intensity physical activities reduce all-cause mortality to the same extent. However, absence of evidence must not be interpreted as evidence of absence due to the existing methodological flaws in the literature.

中文翻译：

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剧烈运动和中等强度的体育锻炼是否能在相同程度上降低死亡率？系统评价和荟萃分析

目的研究与中等强度的体育锻炼相比，剧烈强度的体育锻炼是否可以进一步降低全因和特定原因的死亡率。设计系统评价（在PROSPERO CRD42019138995中注册）和荟萃分析。数据来源截至2020年4月14日的三个电子数据库。入选标准入选标准为前瞻性研究，其中包含有关（1）中强度（3–5.9代谢当量任务（MET））和剧烈强度（≥6 MET）身体活动的信息（2）所有原因和/或特定原因的死亡率。排除标准是前瞻性研究，这些研究（1）仅招募患病的患者（例如，高血压患者和糖尿病患者）或（2）在其多变量模型中未考虑总的体育活动（3）或未调整或排除基线时有合并症的个体，或（4）以无运动能力的参与者作为参考组。结果将五项研究（使用针对特定性别的结果的七个队列）纳入荟萃分析。对于全因死亡率和通过总体体育锻炼进行控制，剧烈强度的体育锻炼（相对于中等强度）与更大的死亡率降低无关（HR 0.95，95％CI 0.83至1.09）。从荟萃分析中排除一项判断为有严重偏倚风险的研究（非随机研究的偏倚风险，ROBINS工具）后，结果仍相似（HR 0.98，95％CI 0.85至1.12）。由于研究数量有限，没有进行癌症和心血管疾病死亡率的荟萃分析。结论前瞻性研究表明，对于相同的总体体育锻炼，剧烈运动和中等强度的体育锻炼都可以将全因死亡率降低到相同程度。但是，由于文献中存在方法上的缺陷，因此没有证据不能解释为没有证据。