Physical Activity and Bidirectional Stage Transitions in Cardiovascular-Kidney-Metabolic Syndrome: A Cohort Study

Area of Science:

• Cardiovascular health
• Renal function
• Metabolic disorders
• Public health

Background:

• Cardiovascular-Kidney-Metabolic (CKM) syndrome encompasses interconnected cardiovascular, renal, and metabolic conditions.
• The precise dose-response relationship between physical activity and CKM stage transitions is not well-established.

Purpose of the Study:

• To investigate the association between physical activity levels and the risk of progression and improvement in Cardiovascular-Kidney-Metabolic (CKM) syndrome stages.
• To explore the dose-response relationship between physical activity and bidirectional CKM stage transitions.

Main Methods:

• Utilized data from the China Health and Retirement Longitudinal Study (CHARLS) with 14,310 observations from 10,868 participants.
• Employed continuous-time multi-state Markov models with a 5-state structure for longitudinal analysis (n = 3442).
• Categorized physical activity into quartiles (Q1-Q4) based on MET-min/week and analyzed transitions between low-risk (Stages 0-2) and high-risk (Stages 3-4) states.

Main Results:

• Higher physical activity quartiles (Q2-Q4) were associated with significantly lower risks of high-risk CKM stages (43.1%–53.1% reduction vs. Q1).
• Restricted cubic spline (RCS) analysis revealed a nonlinear dose-response relationship between physical activity and CKM stage progression.
• Physical activity at the highest quartile (Q4) reduced transitions to high-risk states (HR=0.598) and promoted transitions to low-risk states (HR=2.995).

Conclusions:

• Moderate-to-high levels of physical activity are effective in reducing the risk of Cardiovascular-Kidney-Metabolic (CKM) syndrome progression.
• Physical activity promotes improvement between CKM stages, offering a viable strategy for CKM prevention and management.