HOW SAFE IS EXERCISE? A CROSS-SECTIONAL ANALYSIS BETWEEN MID-LIFE PHYSICAL ACTIVITY AND FRACTURES IN UK BIOBANK
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Objective
To examine associations between volume and intensity of leisure time physical activity (LTPA) and fracture risk during mid-life and determine whether adherence to World Health Organization (WHO) physical activity recommendations was associated with fracture risk.
Methods
Cross-sectional analysis of UK Biobank participants aged 40–65 years using self-reported physical activity and fracture data. LTPA volume (LTPA V ) was derived from walking, moderate and vigorous activity. Participants were categorised into LTPA V quintiles and by adherence to WHO physical activity recommendations. Multivariable logistic regression examined associations with self-reported fracture within the previous five years, with sex stratified analyses.
Results
Among 322,749 participants, 53% were female with a mean age of 47 years. Fracture risk increased with higher LTPA V , although the association was non-linear and varied by age and sex. The strongest associations were in the highest quintile among men and women aged 40–49 years (OR 1.81, 95% CI 1.64–1.99 and OR 1.42, 95% CI 1.28–1.58 respectively). In mutually adjusted models, vigorous activity demonstrated the strongest independent association with fracture risk. Meeting WHO physical activity recommendations, without exceeding them, was not associated with increased fracture risk.
Conclusions
Higher fracture risk was observed in individuals undertaking higher volumes of leisure-time physical activity, with the association largely driven by vigorous-intensity activity. The association was strongest in adults aged 40–49 years and in men. Physical activity consistent with current WHO recommendations was not associated with increased fracture risk, supporting continued promotion of physical activity during mid-life.
Summary Box
What is already known on this topic
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Leisure-time physical activity (LTPA) has established health benefits but may also increase fracture risk, particularly at higher activity levels.
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Whether fracture risk differs according to age, sex, activity volume and intensity remains unclear.
What this study adds
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Higher volumes of LTPA were associated with increased fracture risk, but this was confined to individuals undertaking the highest activity volumes and was strongest in men.
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Vigorous activity showed the strongest independent association with fracture risk, whereas activity levels consistent with current WHO recommendations were not associated with increased fracture risk in either sex.
How this study might affect research, practice or policy
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These findings support continued promotion of WHO-recommended physical activity during mid-life, including around the menopause.
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For highly active individuals, future guidance may need to consider not only activity volume but also how vigorous activity is accumulated to reduce injury and fracture risk.
