Physical activity patterns and all-cause mortality in U.S. adults with osteopenia or osteoporosis: A prospective cohort study

The aim of this study is to examine the association between physical activity patterns and all-cause mortality among U.S. adults with osteopenia or osteoporosis. Data from adults with osteopenia or osteoporosis were obtained from the National Health and Nutrition Examination Survey 2007 to 2018, a nationally representative survey of U.S. adults, with mortality follow-up through 2019. Bone mineral density was assessed at 4 femoral sites using dual-energy X-ray absorptiometry. Physical activity was self-reported and categorized as physically inactive (<150 minutes/week) or active (≥150 minutes/week). Active participants were further classified as weekend warriors (1–2 sessions/week) or regularly active (≥3 sessions/week). Cox proportional hazards models estimated hazard ratios (HRs) for all-cause mortality. Among 5522 participants (mean age: 61.74 years), 991 (17.95%) died during a mean follow-up of 85.0 months. Compared to regularly active participants, weekend warriors had no statistically significant difference in all-cause mortality risk (HR: 1.12; 95% confidence interval (CI): 0.62–2.03). Further subdivision of weekend warriors by frequency (1 vs 2 days/week) yielded similar results. In contrast, physical inactivity was associated with significantly higher mortality risk (HR: 1.78; 95% CI: 1.38–2.28). Among adults with osteopenia or osteoporosis, meeting physical activity guidelines, even over 1 or 2 days per week, was associated with lower mortality risk. These findings support the weekend warrior pattern as a viable strategy for improving longevity in this at-risk population.