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April 22, 2026Scientific ReportsOpen Access

Joint association of depression and physical activity with incident cardiometabolic multimorbidity (CMM) among middle-aged and older adults in China

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Key result

Coexisting depression and lack of vigorous physical activity linked to ~93% greater cardiometabolic multimorbidity risk.

  • HR 1.93
  • 95% CI 1.52-2.44
  • n=2,661

Why the study?

Depression and physical inactivity are linked to cardiometabolic disorders, but their joint effects on the development of cardiometabolic multimorbidity remained unclear.

Does the joint presence of depression and lack of vigorous physical activity increase the risk of incident cardiometabolic multimorbidity in middle-aged and older adults?

Population

2,661 adults aged ≥ 45 years without CMM at baseline in China

Comparison

Joint categories of depression and vigorous physical activity

Design

Prospective cohort study

Follow-up

Median 9 years

Authors

ZLZhaoxuan LiuJinan Central Hospital起起荣宇Shandong Center for Disease Control and PreventionLQLifeng QuJinan Central Hospital

Discussion

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Implication

Depressed adults without VPA warrant clinical attention for CMM but should not change practice; leaves open whether VPA prevents multimorbidity.

Key Points

  • To investigate the combined association of depression and vigorous physical activity (VPA) with incident cardiometabolic multimorbidity (CMM) and assess whether this relationship varies across metabolic status.
  • Prospective cohort study analyzing 2,661 adults aged ≥ 45 years free of CMM at baseline (2011) from the China Health and Retirement Longitudinal Study, with follow-up through 2020 (median follow-up: 9 years).
  • Depression (CESD-10 score ≥ 10) and self-reported VPA were categorized into four joint exposure groups.
  • Cox proportional hazards models with multiple imputation estimated hazard ratios (HRs) for incident CMM, with stratified analyses across estimated glucose disposal rate (eGDR) levels.
  • During follow-up, 797 incident cases of CMM occurred among 2,661 participants.
  • Compared with participants without depression who engaged in VPA, those with depression and no VPA had the highest CMM risk (HR 1.93, 95% CI 1.52–2.44), followed by depression with VPA (HR 1.84, 95% CI 1.41–2.39) and no depression without VPA (HR 1.52, 95% CI 1.22–1.89).
  • A dose–response relationship was observed across joint exposure categories (P for trend < 0.001), with no significant interaction between depression and VPA (P for interaction > 0.05), and results remained consistent across eGDR strata.

Study Design

Type

Cohort (n=2,661)

Multicenter

Yes

Structured PICO

Does the joint presence of depression and lack of vigorous physical activity increase the risk of incident cardiometabolic multimorbidity in middle-aged and older adults?

P
Population
2,661 adults aged ≥ 45 years without cardiometabolic multimorbidity (CMM) at baseline, from the China Health and Retirement Longitudinal Study (CHARLS).
I
Intervention
Joint exposure to depression (assessed via CESD-10 score ≥10) and lack of vigorous physical activity (VPA).
C
Comparator
Participants without depression who engaged in vigorous physical activity (VPA).
O
Outcome
Incident cardiometabolic multimorbidity (CMM), defined as the coexistence of ≥ 2 physician-diagnosed conditions (hypertension, diabetes mellitus, cardiovascular disease, and stroke) during follow-up.composite

Main Result

Effect estimate: HR 1.93 (95% CI 1.52-2.44)

Absolute Event Rate: 42.6% vs 17.5%

The joint presence of depression and physical inactivity significantly increases the risk of developing cardiometabolic multimorbidity in middle-aged and older adults, highlighting the need for integrated mental health and lifestyle interventions.

Limitations

  • Depression and physical activity were assessed using self-reported measures, which may introduce misclassification
  • Exposures were measured only at baseline and may not capture changes over time
  • Residual confounding, including the potential influence of medications, cannot be entirely excluded
  • The study population consisted of middle-aged and older Chinese adults, which may limit generalizability to other populations

Cite This Study

Liu et al. (2026) conducted a cohort in Cardiometabolic multimorbidity (CMM) (n=2,661). Depression and no vigorous physical activity (VPA) vs. No depression and engaging in VPA was evaluated on Incident cardiometabolic multimorbidity (CMM) (HR 1.93, 95% CI 1.52-2.44). Coexisting depression and lack of vigorous physical activity significantly increased the risk of incident cardiometabolic multimorbidity (HR 1.93) compared to individuals without depression who were physically active.

synapsesocial.com/papers/69e865d76e0dea528ddea539https://doi.org/10.1038/s41598-026-50014-2
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