Associations of total physical activity with all-cause and cardiovascular disease mortality in Chinese adults: a prospective study

BACKGROUND: Evidence regarding the associations of total physical activity with all-cause and cardiovascular disease (CVD) mortality in Chinese adults is limited. The study aimed to evaluate the relationships between them. METHODS: Baseline data on physical activity and demographic characteristics of 24,288 Chinese adults were collected from the Chronic Disease and Risk Factor Surveillance 2010-2015 in Jiangsu Province. The mortality data were obtained using a combination of the Jiangsu Province Cause of Death Registry and active follow-up in 2021. The two databases were matched to form a cohort. Cox proportional hazards regression models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the associations of total physical activity with all-cause and CVD mortality. Restricted cubic splines were used to investigate the dose‒response relationship between total physical activity and all-cause and CVD mortality. RESULTS: Among the 22,680 registered individuals (aged 52.7 ± 14.8 years; female 55.9%), 1,596 adults died in total, and 630 died from CVD during a median follow-up of 8.2 years. Multivariable Cox models showed that compared to individuals in the lowest quartile of total physical activity, HRs (95% CI) for those in the highest quartile were 0.82 (95% CI: 0.71-0.94) for all-cause mortality, 0.77 (95% CI: 0.61-0.98) for CVD mortality, and 0.49 (95% CI: 0.28-0.86) for ischemic stroke mortality. The restricted cubic spline revealed a nonlinear association between total physical activity and all-cause mortality. Subgroup analysis showed that physical activity was significantly associated with lower mortality among women, never‑smokers, and never‑drinkers (HRs [95% CI]:0.87[0.77-0.98], 0.88[0.80-0.97], 0.87[0.80-0.95], respectively), but this association was not significant in men, smokers, or drinkers. CONCLUSIONS: Our prospective analysis indicated that total physical activity was inversely associated with the risk of all-cause, CVD, and ischemic stroke death. The current data suggest a potential beneficial effect of physical activity for reducing premature death risk.