Association of chronic disease risk and physical activity measured by wearable devices in the All of Us program

Physical activity plays an important role in preventing chronic diseases, but most studies rely on self-reported or short-term data that fail to capture habitual behavior. This study utilizes Fitbit data to investigate the relationship between physical activity and various chronic diseases.

We analyzed data from 22,019 participants in the All of Us Research Program who shared at least six months of Fitbit activity data linked with electronic health records. Various physical activity patterns were evaluated using Cox proportional hazards and logistic regression models, adjusting for age, sex, and body mass index (BMI). To test robustness, sensitivity analyses were conducted using obesity defined by BMI, applying a two-year exclusion window for outcome diagnoses to mitigate potential reverse causation, and incorporating lifestyle covariates (smoking and alcohol use) under a simplified directed acyclic graph (DAG) framework to address residual confounding.

Here, we show that higher physical activity levels are associated with lower risks of multiple chronic conditions. Higher daily step counts were negatively associated with obesity and type 2 diabetes, while greater elevation gains and longer vigorous activity are associated with lower risks of conditions such as morbid obesity, obstructive sleep apnea, and major depressive disorder. All sensitivity analyses yield consistent results, supporting the robustness of findings against reverse causation and lifestyle confounding.

Higher physical activity and lower sedentary time may help prevent diverse chronic diseases. These findings demonstrate the potential of large-scale wearable data to inform personalized prevention and population health strategies.