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Physical Activity and Bidirectional Stage Transitions in Cardiovascular-Kidney-Metabolic Syndrome: A Cohort Study
Chuan Mou1, Xinrui Miao2, Zhihua Wang1
1Institute of Physical Education, Sichuan University, Chengdu 610065, China.
Insights
Engaging in moderate-to-high physical activity significantly lowers the risk of progressing through Cardiovascular-Kidney-Metabolic (CKM) syndrome stages. Higher activity levels also promote improvement between CKM stages, aiding in prevention and management.
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.
Background:
Cardiovascular-Kidney-Metabolic (CKM) syndrome involves interconnected cardiovascular, renal, and metabolic conditions. The dose-response relationship between physical activity and bidirectional CKM stage transitions remains unclear.
Methods:
Using data from the China Health and Retirement Longitudinal Study (CHARLS), cross-sectional analysis pooled 14,310 observations from 10,868 participants. Logistic regression with clustered robust standard errors accounted for intra-individual correlation. Longitudinal analysis (n = 3442) employed continuous-time multi-state Markov models with a 5-state structure (Stages 0-4). To evaluate physical activity effects, stages were regrouped into low-risk (Stages 0-2) and high-risk states (Stages 3-4) using a 2 × 2 transition intensity matrix. Physical activity was measured in MET-min/week and categorized into quartiles (Q1-Q4).
Results:
Compared with Q1, Q2, Q3, and Q4 were associated with 43.1%, 52.5%, and 53.1% lower risk of high-risk CKM stages, respectively. RCS analysis demonstrated nonlinear dose-response relationships between physical activity and CKM stage progression. Subgroup analyses showed more pronounced protective effects in older adults and single individuals. During 4-year follow-up, 31.6% experienced progression and 6.8% showed improvement. Stage 4 acted as a complete absorbing state without any reversal. Transition intensity analysis revealed that transitions between adjacent stages were notably higher than cross-stage transitions. The Q4 physical activity level significantly reduced transitions from low-risk to high-risk states (HR = 0.598, 95% CI: 0.459-0.777) and promoted transitions from high-risk to low-risk states (HR = 2.995, 95% CI: 1.257-7.134).
Conclusions:
Moderate-to-high physical activity effectively reduces CKM progression risk and promotes improvement, providing evidence for CKM prevention and management.
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