Bakker EA, Lee DC, Hopman MTE, et al. - Findings demonstrate the usefulness of moderate to vigorous physical activity (MVPA) in reducing adverse outcomes, but the shape of the relationship relies on cardiovascular health status. MVPA was found to be linked with risk reductions in all groups, but, particularly, cardiovascular disease (CVD) patients should be motivated that “more is better” regarding physical activity.

• In this cohort study (median follow-up 6.8 years), comparisons were made between healthy persons (n = 112,018), those with cardiovascular risk factors (CVRF) (n = 27,982), and CVD (n = 2,493), with respect to the link between MVPA and incident major adverse cardiovascular events and all-cause death.

• For healthy people and those with CVRF, a curvilinear dose–response link between MVPA and cardiovascular events and death was found, whereas a linear association was evident in individuals with CVDs.

• In healthy individuals, adjusted hazard ratios (HRs) for MVPA Q1 to Q4 [4 quartiles of least (Q1) to most (Q4) active] were estimated to be 0.81, 0.71, 0.72, and 0.76, respectively, vs inactive individuals.

• For MVPA Q1 to Q4, the estimated HRs were 0.69, 0.66, 0.64, and 0.69, respectively, in participants with CVRF and were 0.80, 0.82, 0.74, and 0.70, respectively, in CVD patients, compared to inactive individuals.

• The relationship between MVPA and the risk of CVD or mortality was identified to be domain specific because most benefits were derived from leisure activities, nonleisure activities conferred little benefits, and occupational activities were associated with no benefits.