Epidemiologists agree that physical activity has a protective role in morbidity and mortality mainly through its positive impact on risk factors. So far, most studies have confirmed that CVD risk decreases with an increasing physical activity level, but it is not known what level of physical activity is already sufficient for mortality risk reduction. Thus, the aim of this study was to explore long-term associations between leisure-time physical activity and mortality risk in the Lithuanian urban population. The MONICA study (1992-1993) and the repeated health examination survey in 2001-2002 were organized as a cohort study of 2642 middle-aged inhabitants from the general Lithuanian population of Kaunas. Two random samples aged 35-64 years were examined in 1992-2002. Leisure-time physical activity was assessed by an interview method, asking about physically demanding activities at leisure time measured in hours. The study sample was pooled into 2 groups: inactive (first quartile) and active (second to fourth quartiles). Follow-up was carried out in terms of the endpoints reached from the baseline until December 31, 2010. Mortality data from the National Death Register were obtained. Multivariate adjusted Cox proportional hazards analyses revealed an HR of 1.46 (95% CI, 1.15-1.85) for all-cause mortality and 1.73 (95% CI, 1.23-2.45) for CVD mortality in the lowest quartile of leisure-time physical activity compared with the higher ones. As much as 16.2% of all-cause mortality and 22.2% of CVD mortality was attributable to the lowest quartile of leisure-time physical activity. This study demonstrated a beneficial effect of leisure time physical activity on predicting all-cause and CVD mortality risk.