Key result
High MVPA movement phenotype is linked to ~19% lower incident CVD risk vs high sedentary behavior.
Why the study?
Daily movement behaviors form an interdependent 24-hour system, yet cardiovascular prevention strategies focus primarily on isolated activity metrics, leaving it unclear whether device-derived behavioral phenotypes better capture cardiovascular risk.
Do device-derived 24-hour movement phenotypes with higher light or moderate-to-vigorous physical activity reduce the risk of incident cardiovascular disease and cardiovascular mortality compared to a high sedentary profile in adults free of baseline cardiovascular disease?
Cohort (n=76,778)
Do device-derived 24-hour movement phenotypes with higher light or moderate-to-vigorous physical activity reduce the risk of incident cardiovascular disease and cardiovascular mortality compared to a high sedentary profile in adults free of baseline cardiovascular disease?
Device-derived 24-hour movement profiles demonstrate that while moderate-to-vigorous physical activity provides the greatest cardiovascular survival benefit, high volumes of light physical activity or replacing 30 minutes of daily sedentary time with light activity also confer clinically meaningful reductions in cardiovascular disease and mortality.
Background Daily movement behaviors form an interdependent 24-hour system, yet cardiovascular prevention strategies focus primarily on isolated activity metrics. Whether device-derived behavioral phenotypes better capture cardiovascular risk remains unclear. Methods This prospective cohort study included adult UK Biobank participants free of baseline cardiovascular disease. Valid 7-day wrist accelerometer data were processed using a validated machine learning framework to classify sleep, sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Latent profile analysis derived distinct 24-hour movement phenotypes based on time-use composition. Multivariable Cox proportional hazards models, adjusted for sociodemographic, lifestyle, and clinical covariates, alongside compositional data analysis, were utilized to assess associations with incident CVD, mortality, and theoretical time reallocations. Results The final analysis comprised 76,778 participants. Over a median follow-up of 9.9 years, 5,504 incident CVD events and 541 cardiovascular deaths were documented. Five distinct movement phenotypes were identified. Compared with the "High Sedentary" referent group, the "High LPA Movers" exhibited a significantly lower risk of incident CVD (HR 0.89; 95% CI 0.81–0.99) despite engaging in minimal vigorous exertion. Furthermore, the "High MVPA Warriors" demonstrated further risk reductions for incident CVD (HR 0.81; 95% CI 0.71–0.93) and conferred the greatest survival advantage for cardiovascular mortality (HR 0.47; 95% CI 0.29–0.77). Compositional isotemporal substitution confirmed that replacing 30 minutes/day of SB with LPA was associated with reduced risks of incident CVD (HR 0.98; 95% CI 0.97–0.99) and cardiovascular mortality (HR 0.94; 95% CI 0.92–0.96). Conclusion Device-derived 24-hour movement phenotypes reveal profound heterogeneity in cardiovascular risk that is not captured by isolated activity metrics. While moderate-to-vigorous activity remains the most potent driver of cardiovascular survival, achieving high volumes of light-intensity activity or simply reallocating 30 minutes of sedentary time offers clinically meaningful protection. These findings advocate for a shift in preventive cardiology towards personalized, whole-day movement strategies.Figure 1Figure 2
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Zhao et al. (2026) conducted a cohort in Cardiovascular disease prevention in adults free of baseline cardiovascular disease (n=76,778). Device-derived 24-hour movement phenotypes (e.g., High MVPA Warriors, High LPA Movers) vs. High Sedentary referent group was evaluated on Incident cardiovascular disease (CVD) and cardiovascular mortality (HR 0.81, 95% CI 0.71-0.93). High MVPA and High LPA 24-hour movement phenotypes lowered incident CVD risk vs High Sedentary behavior (HR 0.81, 95% CI 0.71-0.93; and HR 0.89, 95% CI 0.81-0.99, respectively).
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