Women can slash their risk of dying by around 50% from any cause if they consistently meet recommended physical activity levels during middle age, according to researchers from the University of Sydney, whose cohort study was recently published in PLOS Medicine.
The study, led by Dr Binh Nguyen from the Prevention Research Collaboration at the University of Sydney’s Charles Perkins Centre and the School of Public Health, tracked 11 169 Australian women over 15 years, offering rare insight into the long-term health effects of sustained physical activity across midlife.
They analysed data from women born between 1946 and 1951 (aged 47-52 at the beginning of the study) who took part in the Australian Longitudinal Study on Women’s Health.
Participants completed nine surveys between 1996 and 2019, reporting how often they met the World Health Organisation guideline of at least 150 minutes of moderate-to-vigorous physical activity each week, such as brisk walking, cycling or swimming.
Only 5.3% of women who remained active died during the study period, compared with 10.4% of those who remained inactive. This means women who met the guidelines consistently throughout midlife had about half the risk of death of those who did not.
The researchers evaluated the expected effects if all participants consistently met, or did not meet, WHO recommendations over 2001-2016 (surveys 3-8), using methods that modelled these hypothetical interventions across the entire sample, and also explored scenarios in which women started or stopped meeting the recommendations at different mid-life ages, although these latter analyses were inconclusive due to uncertainty in the findings.
“Staying active throughout midlife can make a real difference for women’s long-term health,” said Nguyen. “Maintaining recommended levels of physical activity over multiple years helps protect against early death.”
Unlike much previous research, this study followed the same women for more than 15 years, allowing researchers to examine how sustained physical activity and ongoing inactivity across midlife relates to long-term health outcomes.
Physical activity is well established as a key protective factor against chronic disease and premature death. For many women, staying active through midlife can be harder during peri-menopause and menopause, when physical changes can disrupt energy levels and make regular exercise more difficult to sustain.
This coincides with high rates of inactivity nationally: around 43% of Australian women aged 45-64 were insufficiently active in 2022, according to the Australian Institute of Health and Welfare.
The findings of Nguyen’s study suggest that supporting women to remain physically active during this life stage may be particularly important for long-term health.
“The study adds to growing evidence that an active lifestyle during midlife provides important health benefits,” said Nguyen. “A lot of research captures physical activity at just one time point. By following women across midlife, we can better see how sustained activity, or long periods of inactivity, relate to long-term health.”
Similar patterns were observed for deaths from cardiovascular disease and cancer, although estimates for these outcomes were less certain due to smaller numbers of deaths, making the findings less conclusive.
It was also unclear whether starting to meet recommended physical activity levels later in midlife – such as between the ages of 55 and 65 – offered the same level of protection as being active throughout midlife.
The researchers note that physical activity was self-reported, and that the study sample may not represent all mid-aged Australian women.
Study details
Physical activity across mid-life and mortality outcomes in Australian women: A target trial emulation using a prospective cohort
Published in PLOS Medicine on 26 March 2026
Binh Nguyen, Katherine Owen, Mengyun Luo, Ding Ding et al.
Abstract
Background
Long-term causal evidence comparing different physical activity patterns and mortality outcomes is needed. Using observational data to emulate an RCT, this study compared different physical activity patterns over 15 years in relation to mortality from all causes, cardiovascular disease (CVD) and cancer in mid-aged Australian women.
Methods and findings
A target trial emulation framework was used to emulate an RCT, based on data collected every 3 years (nine surveys between 1996 and 2019) from 11,169 women in the Australian Longitudinal Study on Women’s Health (ALSWH; 1946−51 cohort). Two emulated interventions were compared against consistent non-adherence (control) to WHO moderate-to-vigorous physical activity (MVPA) recommendations during the 15-year ‘exposure period’: (1) consistent adherence to recommendations (at least 150 min/week) over 15 years (2001−2016; women were 50−55–65−70 years); and (2) starting to meet the recommendations at age 55, 60, or 65 years. Analyses were adjusted for sociodemographic and health variables using marginal structural models with the assumptions of conditional exchangeability, positivity, consistency, and no interference. Mortality outcomes that occurred between surveys 4−9 (women were 53−58 to 68−73 years), were ascertained from Australian death registries. Comparing consistent adherence to MVPA recommendations with consistent non-adherence, there was evidence (Bayes factor [BF] = 5.71) for a protective effect for all-cause mortality (risk ratio [RR]: 0.50, 99.5% CI [0.27, 0.94]; risk difference [RD]: −5.2%, 99.5% CI [−10.5%, 0.1%]). Findings for CVD (BF = 2.05; RR: 0.50, 99.5% CI [0.19, 1.30]; RD: −2.1%, 99.5% CI [−5.3%, 1.1%]) and cancer mortality (BF = 2.26; RR: 0.35, 99.5% CI [0.10, 1.17]; RD: −3.3%, 99.5% CI [−8.4%, 1.9%]) were more uncertain and less conclusive, as were those for an effect of starting to meet MVPA recommendations in the mid-fifties on mortality outcomes. The main study limitations included reliance of self-reported physical activity and that findings may not be generalisable to all mid-aged Australian women.
Conclusions
Based on findings from this target trial emulation, women should be encouraged to meet physical activity recommendations throughout mid-age to derive mortality benefits.
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