Physical activity and the prevalence of hypertension, hyperglycaemia, hyperlipidaemia, and their co-occurrence among middle-aged and older Chinese adults

Hypertension, hyperglycaemia, and hyperlipidaemia, collectively referred to as the “three highs” (3H), pose significant health risks globally. Physical activity (PA) is associated with cardiometabolic health; however, the associations of PA with individual and concurrent 3H conditions remain incompletely understood. This study aimed to examine the associations of total PA score with hypertension, hyperglycaemia, hyperlipidaemia, and their co-occurrence among middle-aged and older Chinese adults. Multivariable Logistic regression models (MLR) were used to analyze associations between total PA score and the prevalence of hypertension, hyperglycaemia, hyperlipidaemia, and concurrent 3H conditions. Restricted cubic spline (RCS) analysis explored potential non-linear associations. Subgroup and interaction analyses were performed to examine whether the associations between total PA score and 3H conditions differed across age, sex, smoking status, drinking status, stroke, arthritis or rheumatism, and asthma. Exploratory structural equation models were additionally used to examine statistical pathways among PA and the 3H conditions. The study found significant differences in the prevalence of 3H conditions among the total PA score tertiles, with the lowest prevalence in the high total PA score group. In multivariable-adjusted models, total PA score was negatively associated with hypertension (0.907 [0.869, 0.946], p < 0.001), hyperlipidaemia (0.863 [0.822, 0.906], p < 0.001), hyperglycaemia (0.823 [0.772, 0.878], p < 0.001), and 3H diseases (0.778 [0.703, 0.862], p < 0.001). RCS analysis showed overall negative associations between total PA score and hypertension, hyperglycaemia, hyperlipidaemia, and concurrent 3H conditions; when total PA score was higher than 93.3, the ORs were generally below 1.0. Mediation analyses suggested that PA may influence 3H conditions by affecting hyperglycaemia, hyperlipidaemia, and hypertension. Higher total PA score was associated with a lower prevalence of hypertension, hyperglycaemia, hyperlipidaemia, and concurrent 3H conditions among middle-aged and older Chinese adults.