Moderate-to-vigorous physical activity, age-dependent adiposity, and obesity risk in older adults at high cardiovascular risk

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ABSTRACT Objective To 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/m 2 ) and central adiposity (WHtR ≥0.6), in older adults at high cardiovascular risk. Methods In 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·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. Results Participants reporting ≥100 MET·min/day showed lower BMI and WHtR values compared with less active individuals (differences ranging from-1.27 to-1.48 kg/m 2 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·min/day and plateaued thereafter. Conclusions Higher MVLTPA is associated with favourable adiposity trajectories and lower risk of central adiposity in older adults at high cardiovascular risk. Study Importance What is already known? Obesity, particularly central adiposity, is a major and modifiable cardiovascular risk factor, and regular physical activity is widely recommended as a cornerstone for obesity prevention. Evidence 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. What does this study add? In older adults at high cardiovascular risk, MVLTPA ≥100 MET·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. Dose-response analyses showed a significant, nonlinear inverse association between MVLTPA and central adiposity risk, with progressively lower risk up to approximately 400 MET·min/day and a plateau thereafter. How might your results change the direction of research or the focus of clinical practice? These 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. The 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.

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