Moderate-to-vigorous physical activity, age-dependent adiposity, and obesity risk in older adults at high cardiovascular risk
- 1Hospital del Mar Research Institute
Abstract
ObjectiveTo investigate the association between usual moderate-to-vigorous leisure-time physical activity (MVLTPA) and longitudinal trajectories of BMI and waist-to-height ratio (WHtR), as well as the incidence of obesity (BMI [≥]30 kg/m2) and central adiposity (WHtR [≥]0.6), in older adults at high cardiovascular risk.
MethodsIn PREDIMED participants aged 60-80 years (61% women; n=5,273 for BMI, n=4,940 for WHtR), MVLTPA was assessed using the Minnesota questionnaire (MET{middle dot}min/day, cumulative mean). Mixed-effects models with cubic splines were used to estimate BMI and WHtR trajectories according to MVLTPA levels ([≥]100 [adequate] vs <100 [insufficient]). Incident obesity outcomes were assessed with Cox models.
ResultsParticipants reporting [≥]100 MET{middle dot}min/day showed lower BMI and WHtR values compared with less active individuals (differences ranging from-1.27 to-1.48 kg/m2 and-0.021 to-0.026, respectively), and slower declines in BMI. Adequate MVLTPA was associated with a 34% lower risk of central adiposity (HR 0.66 [0.56; 0.77]) and a 24% lower risk of obesity only in women (HR 0.76 [0.57; 1.00], p-interaction = 0.084). Nonlinear analyses suggested that central adiposity risk decreased up to 400 MET{middle dot}min/day and plateaued thereafter.
ConclusionsHigher MVLTPA is associated with favourable adiposity trajectories and lower risk of central adiposity in older adults at high cardiovascular risk.
Study ImportanceO_ST_ABSWhat is already known?C_ST_ABSO_LIObesity, particularly central adiposity, is a major and modifiable cardiovascular risk factor, and regular physical activity is widely recommended as a cornerstone for obesity prevention. C_LIO_LIEvidence in older adults remains limited, particularly regarding long-term adiposity trajectories, as most available data come from short-term randomized controlled trials focused on changes in BMI and waist circumference. There is little evidence from longer follow-up studies examining complementary biomarkers such as waist-to-height ratio (WHtR), sex-specific associations, clinically relevant incident obesity-related outcomes, or the dose of moderate-to-vigorous leisure-time physical activity (MVLTPA) associated with the lowest adiposity risk. C_LI
What does this study add?O_LIIn older adults at high cardiovascular risk, MVLTPA [≥]100 MET{middle dot}min/day was associated with lower predicted BMI and WHtR values between 60 and 80 years of age, slower late-life BMI decline, and a 34% lower risk of incident central adiposity. C_LIO_LIDose-response analyses showed a significant, nonlinear inverse association between MVLTPA and central adiposity risk, with progressively lower risk up to approximately 400 MET{middle dot}min/day and a plateau thereafter. C_LI
How might your results change the direction of research or the focus of clinical practice?O_LIThese findings support sustained MVLTPA as part of cardiovascular prevention in older adults at high risk and highlight WHtR as a useful waist-based marker for monitoring adiposity-related benefits of physical activity. C_LIO_LIThe results support promoting achievable increases in physical activity, particularly among inactive or insufficiently active older adults and women, while suggesting that higher MVLTPA volumes may be relevant for central adiposity. C_LI
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BibTeX
@misc{fornara2026moderatetovigorous,
title = {{Moderate-to-vigorous physical activity, age-dependent adiposity, and obesity risk in older adults at high cardiovascular risk}},
author = {E. Fornara and M. H. Hernandez and A. Goday and A. Camps-Vilaro and M. A. Martinez-Gonzalez and J. Salas-Salvado and R. Estruch and E. Ros and R. Cueto-Galan and M. Fiol and J. Lapetra and J. Timiraos and L. Serra-Majem and X. Pinto and Z. Vazquez-Ruiz and F. J. Martin-Lujan and M. Fito and A. Hernaez},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.14.26362982},
url = {https://www.medrxiv.org/content/10.64898/2026.09.14.26362982v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Moderate-to-vigorous physical activity, age-dependent adiposity, and obesity risk in older adults at high cardiovascular risk
AU - E. Fornara
AU - M. H. Hernandez
AU - A. Goday
AU - A. Camps-Vilaro
AU - M. A. Martinez-Gonzalez
AU - J. Salas-Salvado
AU - R. Estruch
AU - E. Ros
AU - R. Cueto-Galan
AU - M. Fiol
AU - J. Lapetra
AU - J. Timiraos
AU - L. Serra-Majem
AU - X. Pinto
AU - Z. Vazquez-Ruiz
AU - F. J. Martin-Lujan
AU - M. Fito
AU - A. Hernaez
PY - 2026
DA - 2026/09/14
PB - medRxiv
DO - 10.64898/2026.09.14.26362982
UR - https://www.medrxiv.org/content/10.64898/2026.09.14.26362982v1
AB - ObjectiveTo investigate the association between usual moderate-to-vigorous leisure-time physical activity (MVLTPA) and longitudinal trajectories of BMI and waist-to-height ratio (WHtR), as well as the incidence of obesity (BMI [≥]30 kg/m2) and central adiposity (WHtR [≥]0.6), in older adults at high cardiovascular risk. MethodsIn PREDIMED participants aged 60-80 years (61% women; n=5,273 for BMI, n=4,940 for WHtR), MVLTPA was assessed using the Minnesota questionnaire (MET{middle dot}min/day, cumulative mean). Mixed-effects models with cubic splines were used to estimate BMI and WHtR trajectories according to MVLTPA levels ([≥]100 [adequate] vs <100 [insufficient]). Incident obesity outcomes were assessed with Cox models. ResultsParticipants reporting [≥]100 MET{middle dot}min/day showed lower BMI and WHtR values compared with less active individuals (differences ranging from-1.27 to-1.48 kg/m2 and-0.021 to-0.026, respectively), and slower declines in BMI. Adequate MVLTPA was associated with a 34% lower risk of central adiposity (HR 0.66 [0.56; 0.77]) and a 24% lower risk of obesity only in women (HR 0.76 [0.57; 1.00], p-interaction = 0.084). Nonlinear analyses suggested that central adiposity risk decreased up to 400 MET{middle dot}min/day and plateaued thereafter. ConclusionsHigher MVLTPA is associated with favourable adiposity trajectories and lower risk of central adiposity in older adults at high cardiovascular risk. Study ImportanceO_ST_ABSWhat is already known?C_ST_ABSO_LIObesity, particularly central adiposity, is a major and modifiable cardiovascular risk factor, and regular physical activity is widely recommended as a cornerstone for obesity prevention. C_LIO_LIEvidence in older adults remains limited, particularly regarding long-term adiposity trajectories, as most available data come from short-term randomized controlled trials focused on changes in BMI and waist circumference. There is little evidence from longer follow-up studies examining complementary biomarkers such as waist-to-height ratio (WHtR), sex-specific associations, clinically relevant incident obesity-related outcomes, or the dose of moderate-to-vigorous leisure-time physical activity (MVLTPA) associated with the lowest adiposity risk. C_LI What does this study add?O_LIIn older adults at high cardiovascular risk, MVLTPA [≥]100 MET{middle dot}min/day was associated with lower predicted BMI and WHtR values between 60 and 80 years of age, slower late-life BMI decline, and a 34% lower risk of incident central adiposity. C_LIO_LIDose-response analyses showed a significant, nonlinear inverse association between MVLTPA and central adiposity risk, with progressively lower risk up to approximately 400 MET{middle dot}min/day and a plateau thereafter. C_LI How might your results change the direction of research or the focus of clinical practice?O_LIThese findings support sustained MVLTPA as part of cardiovascular prevention in older adults at high risk and highlight WHtR as a useful waist-based marker for monitoring adiposity-related benefits of physical activity. C_LIO_LIThe results support promoting achievable increases in physical activity, particularly among inactive or insufficiently active older adults and women, while suggesting that higher MVLTPA volumes may be relevant for central adiposity. C_LI
ER -