Sex differences in the association of physical activity patterns with all-cause and cardiovascular mortality: a prospective cohort study from NHANES 2007–2018

Physical activity is widely promoted to reduce mortality risks from all-cause and cardiovascular diseases, yet current guidelines rarely address sex-specific differences or distinguish between occupational (OPA) and non-occupational PA (Non-OPA). This study leverages NHANES 2007–2018 data to evaluate sex differences in mortality benefits from OPA and Non-OPA, with a specific focus on implications for women’s health. Participants were categorized into three activity levels: below (< 150 min/week), at (150–300 min/week), and above (> 300 min/week) the recommended guidelines. Multivariable Cox models yielded sex-specific hazard ratios (HRs), with nonlinear dose-response relationships explored through subgroup analyses by age and BMI. Our results reveal that females derive greater survival benefits than males at equivalent PA levels, particularly from Non-OPA, which supporting the “physical activity paradox”. For instance, Non-OPA showed stronger protective effects, with females achieving significant risk reductions at lower activity volumes than males. Notably, older adults (≥ 65 years) and individuals with obesity experienced enhanced benefits from Non-OPA. These findings underscore the need for sex-specific PA guidelines and highlight the importance of promoting Non-OPA to maximize health benefits across diverse populations, with specific implications for women’s health.