Joint associations of leisure-time physical activity and daily sitting time with mortality among US adults classified as CKM stages 0-3: a prospective cohort study of NHANES 2007-2018.

Authors

Sufang Xu, Jiaming Huang, Lingrong Hu, Xiaoming Li, Shumin Zhao, Kaihong Chen, Liling Chen

Published in

Environmental health and preventive medicine. Volume 31. Pages 69.

Abstract

Prior studies have linked physical activity to cardiovascular-kidney-metabolic (CKM) prevalence or mortality and sedentary behavior to CKM severity, and both behaviors are established mortality risk factors in the general population; however, prospective evidence on their joint associations with cause-specific mortality across CKM stages 0-3 remains limited.
We analyzed 8,556 NHANES 2007-2018 participants aged ≥20 years with CKM stages 0-3, complete prespecified covariates, and a positive fasting-subsample weight. Leisure-time physical activity (LTPA) was categorized as inactive (0 min/week), insufficient (>0 to <150 min/week), or sufficient (≥150 min/week); daily sitting time was categorized as <6, 6 to <8, or ≥8 h/day. The primary outcome was all-cause mortality; cardiovascular disease (CVD) and non-CVD mortality were secondary outcomes. Survey-design-based Cox models incorporated the 12-year fasting weight, strata, and primary sampling units. Multiplicative and additive interactions were assessed.
During a median follow-up of 6.75 years, 670 deaths occurred, including 175 CVD and 495 non-CVD deaths. In fully adjusted models, sufficient versus no LTPA was associated with lower all-cause (hazard ratio [HR], 0.630; 95% confidence interval [CI], 0.483-0.822), CVD (HR, 0.536; 95% CI, 0.297-0.969), and non-CVD mortality (HR, 0.662; 95% CI, 0.478-0.916). Sitting ≥8 versus <6 h/day was associated with higher all-cause (HR, 1.506; 95% CI, 1.253-1.810), CVD (HR, 1.845; 95% CI, 1.246-2.732), and non-CVD mortality (HR, 1.406; 95% CI, 1.109-1.782). Compared with sufficient LTPA and sitting <6 h/day, <150 min/week of LTPA combined with sitting ≥8 h/day was associated with all-cause (HR, 1.972; 95% CI, 1.429-2.721), CVD (HR, 2.493; 95% CI, 1.232-5.045), and non-CVD mortality (HR, 1.806; 95% CI, 1.202-2.712). Multiplicative interaction was not detected for all-cause (P = 0.951) or non-CVD mortality (P = 0.274); the CVD interaction signal (P = 0.016) was exploratory because it depended on a joint category with few events.
Higher LTPA and shorter sitting time were independently associated with lower mortality among US adults with CKM stages 0-3. Joint categories identified a higher-risk behavioral pattern, but did not establish that LTPA offsets the risk of prolonged sitting.

PMID:
42907355
Bibliographic data and abstract were imported from PubMed on 23 Oct 2026.

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