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

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. 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. 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:0.870.77–0.98, 0.880.80–0.97, 0.870.80–0.95, respectively), but this association was not significant in men, smokers, or drinkers. 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.