BMC Public Health. 2026 May 14. doi: 10.1186/s12889-026-27724-3. Online ahead of print.
ABSTRACT
BACKGROUND: Cardio-renal-metabolic diseases (CRMDs), including cardiovascular disease, chronic kidney disease, and type 2 diabetes, often co-occur and progress from a healthy state to first CRMD (FCRMD), cardio-renal-metabolic multimorbidity (CRMM), and death. We investigated the associations of physical activity (PA), assessed using accelerometer-based and questionnaire-based measures, with the CRMM trajectory.
METHODS: Two prospective UK Biobank sub-cohorts free of CRMDs at baseline were analyzed. The accelerometer-based cohort (n = 73,952) provided device-measured light (LPA), moderate (MPA), vigorous (VPA), moderate-to-vigorous (MVPA), and total PA (TPA), whereas the questionnaire-based cohort (n = 328,147) classified self-reported PA as low, moderate, or high. Multi-state models were used to estimate associations between PA and transitions along the CRMM trajectory.
RESULTS: Over median follow-up periods of 7.0 years (accelerometer-based) and 13.6 years (questionnaire-based), 7,303 (9.9%) and 57,389 (17.5%) participants developed FCRMD, respectively. In the accelerometer-based cohort, inverse associations were observed for several transitions originating from baseline or FCRMD states. For example, participants in the highest versus lowest quartile of VPA had lower risks of transitions from baseline to FCRMD (adjusted hazard ratio [aHR] 0.69, 95% confidence interval [CI] 0.64-0.74) and from baseline to death (aHR 0.47, 95% CI 0.39-0.56). In the questionnaire-based cohort, higher PA levels were also associated with lower transition risks (aHRs 0.78-0.93, all P < 0.05). Similar patterns were observed in disease-specific transition analyses. Overall, inverse associations were observed for the onset of FCRMD, subsequent progression to CRMM, and death before established CRMM, whereas associations with mortality after established CRMM were less consistent, particularly in accelerometer-based analyses.
CONCLUSIONS: Higher PA levels were associated with lower risks across several transitions from baseline or FCRMD states, including the onset of FCRMD, subsequent progression to CRMM, and death before established CRMM. These findings support the relevance of PA promotion and maintenance in strategies addressing CRMM development, while associations with mortality after established CRMM require cautious interpretation.
PMID:42135687 | DOI:10.1186/s12889-026-27724-3