Association Between Questionnaire- and Accelerometer-Based Physical Activity and Abdominal Aortic Aneurysm Incidence

While physical activity (PA) may influence abdominal aortic aneurysm (AAA) risk, prior studies relied on self-reported data, and genetic interactions remain unexplored. We investigated PA and AAA associations using accelerometer and questionnaire data and assessed genetic predisposition.

We included 392 737 UK Biobank participants with questionnaire-based PA data and 92 101 with accelerometer-based data, all free of baseline AAA. PA was categorized into light-intensity, moderate-intensity, vigorous-intensity, moderate- to vigorous-intensity, and total PA. Incident AAA was ascertained using International Classification of Diseases, Tenth Revision (ICD-10), and Office of Population, Censuses and Surveys Classification of Interventions and Procedures (OPCS-4) codes. Dose-response associations were examined using restricted cubic splines. Genetic susceptibility was assessed using polygenic risk scores. Associations were estimated using Cox proportional hazards models and isotemporal substitution models.

Among cohorts with questionnaire- (n=392 737; median follow-up, over 13.5 years) and accelerometer- (n=92 101; median follow-up, 7.9 years) based PA data, there were 2181 and 402 incident cases, respectively. Higher moderate-intensity PA, vigorous-intensity PA, and total PA were inversely associated with AAA risk. Protective associations were strongest in patients with low genetic risk and high PA. A nonlinear relationship was observed for moderate-intensity PA and moderate- to vigorous-intensity PA, with maximal risk reduction at 402.6 and 428.1 minutes per week, respectively, beyond which no additional benefit was observed. An isotemporal substitution model showed that replacing light-intensity PA with moderate-intensity PA/vigorous-intensity PA reduced AAA risk, with greater benefit for vigorous-intensity PA.

PA engagement is associated with a reduction in AAA burden, regardless of genetic risk. We identified distinct time thresholds for achieving maximum benefit among PA intensities, highlighting its potential role in exercise-based AAA prevention strategies.