Regular physical exercise has been highly recommended for the prevention and rehabilitation, but there is still controversy over the optimal dose to produce maximal cardiovascular and renal benefits.¹ Former athletes were reported to have longer lifespans² but also more susceptible to coronary artery calcification³ and atrial fibrillation.⁴ In this study, we aimed to examine the relationship between exercise dose and the risk of coronary artery disease (CAD), chronic heart failure (CHF), myocardial infarction (MI), and chronic renal failure (CRF) in adults from National Health and Nutrition Examination Surveys (NHANES) 2011–2018 and attempted to identify the respective optimal doses for health prevention.

We analyzed data from NHANES 2011–2018, when the questionnaires on physical activity were basically the same. Physical activity data were collected using self-reported questionnaires. A typical recording of weekly exercise activity in daily life was used to define the exercise habit. Metabolic equivalent hours (h) (MET·h = MET score × exercise time) were calculated as a quantitative index of exercise. Participants without exercise (MET·h/week = 0) were allocated to the never exercise group (NE group). Given that the accurate cutoff value for the optimal exercise dose is unknown, the remaining participants were assigned to four exercise groups with exercise doses of 0 < MET·h/week≤10 (low exercise group, LE group), 10 < MET·h/week≤50 [moderate exercise group (ME) group], 50 < MET·h/week≤100 [vigorous exercise group (VE) group], and MET·h/week > 100 (ultra-vigorous exercise group (UVE) group].

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