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This study investigates how different types of physical activity are linked to the development of cardio-renal-metabolic multimorbidity.

May 17, 2026BMC Public Health0 citationsOpen Access

Device-measured and self-reported physical activity and the trajectory of cardio-renal-metabolic multimorbidity: a prospective cohort study in UK Biobank

JHJuda Hu HWHongguang Wu PLPeiyao Li

Key Points

This study investigates how different types of physical activity are linked to the development of cardio-renal-metabolic multimorbidity.
Two prospective UK Biobank cohorts without CRMDs at baseline analyzed for PA using device-measured and self-reported methods.
Cohorts included 73,952 individuals with accelerometer data and 328,147 with questionnaire data.
Multi-state models estimated associations between physical activity and transitions in the CRMM trajectory.
In the accelerometer cohort, participants with the highest vigorous physical activity had an adjusted hazard ratio of 0.69 (95% CI 0.64-0.74) for transition to first CRMD.
Overall, 9.9% from the accelerometer cohort and 17.5% from the questionnaire cohort developed first CRMD during follow-up.
Higher physical activity was consistently associated with lower risks for disease onset and progression before established CRMM, though mortality associations varied.

Abstract

BACKGROUND: Cardio-renal-metabolic diseases (CRMDs), including cardiovascular disease, chronic kidney disease, and type 2 diabetes, often co-occur and progress from a healthy state to first CRMD (FCRMD), cardio-renal-metabolic multimorbidity (CRMM), and death. We investigated the associations of physical activity (PA), assessed using accelerometer-based and questionnaire-based measures, with the CRMM trajectory. METHODS: Two prospective UK Biobank sub-cohorts free of CRMDs at baseline were analyzed. The accelerometer-based cohort (n = 73,952) provided device-measured light (LPA), moderate (MPA), vigorous (VPA), moderate-to-vigorous (MVPA), and total PA (TPA), whereas the questionnaire-based cohort (n = 328,147) classified self-reported PA as low, moderate, or high. Multi-state models were used to estimate associations between PA and transitions along the CRMM trajectory. RESULTS: Over median follow-up periods of 7.0 years (accelerometer-based) and 13.6 years (questionnaire-based), 7,303 (9.9%) and 57,389 (17.5%) participants developed FCRMD, respectively. In the accelerometer-based cohort, inverse associations were observed for several transitions originating from baseline or FCRMD states. For example, participants in the highest versus lowest quartile of VPA had lower risks of transitions from baseline to FCRMD (adjusted hazard ratio aHR 0.69, 95% confidence interval CI 0.64-0.74) and from baseline to death (aHR 0.47, 95% CI 0.39-0.56). In the questionnaire-based cohort, higher PA levels were also associated with lower transition risks (aHRs 0.78-0.93, all P < 0.05). Similar patterns were observed in disease-specific transition analyses. Overall, inverse associations were observed for the onset of FCRMD, subsequent progression to CRMM, and death before established CRMM, whereas associations with mortality after established CRMM were less consistent, particularly in accelerometer-based analyses. CONCLUSIONS: Higher PA levels were associated with lower risks across several transitions from baseline or FCRMD states, including the onset of FCRMD, subsequent progression to CRMM, and death before established CRMM. These findings support the relevance of PA promotion and maintenance in strategies addressing CRMM development, while associations with mortality after established CRMM require cautious interpretation.

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