Summary
A medRxiv preprint links moderate-to-vigorous leisure-time activity with lower BMI, waist-to-height ratio and central-adiposity risk in adults aged 60 to 80 at high cardiovascular risk. The analysis found the strongest reduction in central-adiposity risk up to about 400 MET·min/day.
A preprint analysis of older adults at high cardiovascular risk found that higher levels of usual moderate-to-vigorous leisure-time physical activity were associated with more favourable body-size trajectories and a lower risk of developing central adiposity. The study analysed participants in the PREDIMED cohort aged 60 to 80 years; it included 5,273 people in the BMI analysis and 4,940 in the waist-to-height ratio analysis, with women making up 61% of the participants.
The findings are reported in a medRxiv preprint posted on September 15, 2026. They describe associations from a longitudinal cohort analysis rather than results from a randomised exercise intervention.
What the preprint studied
The researchers assessed moderate-to-vigorous leisure-time physical activity using the Minnesota questionnaire and calculated a cumulative mean in MET·min/day. A metabolic equivalent, or MET, is a standard way of expressing activity intensity; MET·min/day combines intensity and time rather than representing a fixed number of minutes of exercise.
The main comparison was between participants reporting at least 100 MET·min/day and those reporting less than 100 MET·min/day. The researchers modelled BMI and waist-to-height ratio trajectories using mixed-effects models with cubic splines. They also used Cox models to examine newly occurring obesity outcomes.
Obesity was defined as a BMI of at least 30 kg/m². Central adiposity was defined as a waist-to-height ratio of at least 0.6. Waist-to-height ratio is calculated by dividing waist circumference by height and provides a waist-based measure of body fat distribution relative to stature.
Lower BMI and central-adiposity risk among more active participants
Participants reporting at least 100 MET·min/day had lower predicted BMI and waist-to-height ratio values between ages 60 and 80 than participants reporting lower activity. The differences ranged from 1.27 to 1.48 kg/m² for BMI and from 0.021 to 0.026 for waist-to-height ratio. The more active group also showed slower declines in BMI across the modelled later-life trajectories.
The clearest outcome difference concerned central adiposity. Adequate moderate-to-vigorous activity was associated with a 34% lower risk of developing central adiposity, corresponding to a hazard ratio of 0.66 with a 95% confidence interval of 0.56 to 0.77.
The study reported a 24% lower risk of obesity among women in the higher-activity group, with a hazard ratio of 0.76 and a 95% confidence interval of 0.57 to 1.00. The reported interaction p value for the sex comparison was 0.084.
Dose-response modelling indicated a nonlinear relationship for central adiposity: risk fell progressively as activity increased up to approximately 400 MET·min/day, then levelled off at higher activity volumes.
How to interpret the findings
The results support sustained physical activity as part of cardiovascular-risk prevention for older adults, particularly because waist-to-height ratio captured an outcome that BMI alone may not describe. They also suggest that increases from low activity levels could be relevant, while substantially higher activity volumes may offer little additional reduction in central-adiposity risk after the approximate 400 MET·min/day point identified in this analysis.
The activity measure came from a questionnaire describing usual leisure-time behaviour, and participants were not assigned to exercise programmes. The associations may therefore also reflect differences between more-active and less-active participants. The cohort consisted of adults already at high cardiovascular risk, so the results may not apply in the same way to all older adults. The work is a medRxiv preprint and has not yet undergone peer review.
The authors conclude that higher moderate-to-vigorous leisure-time activity is associated with more favourable adiposity trajectories and a lower incidence of central adiposity in this high-risk older population.