Association Of Physical Activity By Volumes,components,and Patterns With Mortality Risk Among Chinese Adults

Background:Scientifically conducted physical activity(PA)is associated with the risk of chronic non-communicable diseases such as cardiovascular disease(CVD)and mortality.Previous evidence was mostly limited to leisure-time PA,while evidence on non-leisure-time PA(such as household,occupational,and transport PA)and total PA(both leisure-time and non-leisure-time PA)is inconsistent and relatively limited.Besides,guidelines recommend at least 75-150 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic activity per week for adults but have not recommended the frequency of PA.It is unclear whether achieving the guideline-recommended PA by the"weekend warrior" pattern(concentrating PA once or twice per week)would provide health benefits,compared with inactive PA.It is also unclear how the health benefits of the "weekend warrior" pattern differ from the "regularly active" pattern(regularly PA ≥3 times per week).Objectives:This study aims to investigate(1)the association between different volumes and components of PA and mortality risk,and the dose-response relationship between total PA and mortality risk;(2)the association of the "weekend warrior" and "regularly active" patterns with mortality risk compared with inactive PA,and the difference in the association of the "weekend warrior" and "regularly active" patterns with mortality risk among Chinese adults.Methods:China Health Evaluation And risk Reduction through nationwide Teamwork(ChinaHEART)is a cohort study covering 31 provincial regions in China.This study was based on ChinaHEART and included community-dwelling participants aged 35-75 with detailed PA information from 2015 to 2021.PA was quantified by multiplying its intensity(metabolic equivalent[MET])by time.(1)According to the volume of total PA,participants were divided into "insufficient"(<3 000 MET-minutes/week)and "sufficient"groups.The "sufficient" group was further divided into "moderate"(3000-4500 METminutes/week)and "high"(≥4500 MET-minutes/week)groups by volumes;and "leisure"(≥50%)and "non-leisure"(<50%)groups by components(proportion of leisure-time PA in total PA).(2)According to the recommendation of PA guidelines(at least 75-150 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic activity per week),participants were divided into "inactive" and "active" groups;the "active"group was further divided into "weekend warrior"(1-2 times/week)and "regularly active"(≥3 times/week)groups based on the frequency of PA.Data on mortality were derived from the National Mortality Surveillance System and Vital Registration of the Chinese Center for Disease Control and Prevention.Cox proportional hazard models(allcause mortality)and competing risk models(cardiovascular mortality)were used to estimate hazard ratios(HRs)and 95%confidence intervals(CIs);restricted cubic spline regression analyses were performed to examine the dose-response association between PA and mortality.Models were adjusted for age,gender,household income,occupation,education,current alcohol use,current smoking,unhealthy diet,and sedentary behavior time(the volume of moderate-to-vigorous intensity aerobic activity was further adjusted when comparing the association of the "weekend warrior" and "regularly active" patterns with mortality risk).Results:A total of 1,071,776 participants were included in this study,with a median age of 56(interquartile range 48-64),and 60.4%female.During a median follow-up of 3.6 years(interquartile range 2.1 years to 4.8 years),16,356 all-cause deaths occurred,including 6,248 cardiovascular deaths.(1)Compared with the "insufficient" group,the "sufficient" group was associated with significantly lower all-cause mortality risk(HR 0.82,95%CI 0.79-0.85,P<0.001).Both"moderate"(HR 0.88,95%CI 0.84-0.92,P<0.001)and "high"(HR 0.79,95%CI 0.760.82,P<0.001)groups were associated with a lower risk of all-cause mortality.The"sufficient" group with different components of PA was also associated with a lower risk of all-cause mortality("non-leisure" group:HR 0.83,95%CI 0.80-0.86,P<0.001;"high"group:HR 0.76,95%CI 0.71-0.81,P<0.001).A non-linearly "L-shaped" dose-response relationship was observed between total PA and all-cause mortality(overall P<0.001,non-linear,P<0.001).(2)Compared with the "inactive" group,both "weekend warrior"(HR 0.80,95%CI 0.730.87,P<0.001)and "regularly active"(HR 0.78,95%CI 0.75-0.81,P<0.001)groups were associated with a significantly lower risk of all-cause mortality.Compared with the"regularly active" group,there was no significant difference in the association of the"weekend warrior" and "regularly active" groups with all-cause mortality(HR 1.02,95%CI 0.93-1.12,P=0.655).The results were consistent for cardiovascular mortality.Conclusions:Among Chinese adults,sufficient total PA(including moderate and high volumes,as well as leisure-time and non-leisure-time PA as the main components)was associated with significantly lower mortality risk,compared with insufficient PA;there was a non-linear dose-response relationship between total PA and mortality risk.Both"weekend warrior" and "regularly active" patterns of active PA were associated with lower mortality risk compared with inactive PA.There was no significant difference between the association of the "weekend warrior" and the "regularly active" pattern with mortality.