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Juciany RO Ramalho,1 Juliana VM Mambrini,1 Cibele C César,1,2 César M de Oliveira,3 Josélia OA Firmo,1 Maria Fernanda Lima-Costa,1 Sérgio V Peixoto1,4 1Rene Rachou Research Center, Oswaldo Cruz Foundation, 2Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Brazil; 3Research Department of Epidemiology and Public Health, University College London, London, UK; 4Nursing School, Federal University of Minas Gerais, Belo Horizonte, Brazil Objective: To investigate the association between physical activity (eg, energy expenditure) and survival over 11 years of follow-up in a large representative community sample of older Brazilian adults with a low level of education. Furthermore, we assessed sex as a potential effect modifier of this association.Materials and methods: A population-based prospective cohort study was conducted on all the ≥60-year-old residents in Bambuí city (Brazil). A total of 1,606 subjects (92.2% of the population) enrolled, and 1,378 (85.8%) were included in this study. Type, frequency, and duration of physical activity were assessed in the baseline survey questionnaire, and the metabolic equivalent task tertiles were estimated. The follow-up time was 11 years (1997–2007), and the end point was mortality. Deaths were reported by next of kin during the annual follow-up interview and ascertained through the Brazilian System of Information on Mortality, Brazilian Ministry of Health. Hazard ratios (95% confidence intervals [CIs]) were estimated by Cox proportional-hazard models, and potential confounders were considered.Results: A statistically significant interaction (P