Evidence mapPaperPMID 40913129Full record

ArticleEuropean journal of applied physiology2026

Mediation analysis of metabolic and inflammatory markers in the association between physical activity and musculoskeletal disease: Findings from NHANES 2013-2018.

Jieping Zhu, Ting Zhu, Kangli Lai, Chengyuan Hu, Zixin Lv, Chunyuan Lai, Zhixiang Xu, Liqiang Su

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Article in European journal of applied physiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

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2citing papers in PubMed
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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

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3 · Its place in the literature

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2 citing papers in PubMed.

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5 · Who and what money

Authors and funding

8 authors.

Jieping Zhu *School of Physical Education, Jiangxi Normal University, 99 Ziyang Avenue, Nanchang, 330022, China.
Ting Zhu *Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, 100191, China.
Kangli LaiSchool of Finance, Taxation and Public Administration, Jiangxi University of Finance and Economics, Nanchang, 330013, China.
Chengyuan HuSchool of Physical Education, Jiangxi Normal University, 99 Ziyang Avenue, Nanchang, 330022, China.
Zixin LvSchool of Physical Education, Jiangxi Normal University, 99 Ziyang Avenue, Nanchang, 330022, China.
Chunyuan LaiSchool of Physical Education, Jiangxi Normal University, 99 Ziyang Avenue, Nanchang, 330022, China.
Zhixiang XuSchool of Physical Education, Jiangxi Normal University, 99 Ziyang Avenue, Nanchang, 330022, China.
Liqiang SuSchool of Physical Education, Jiangxi Normal University, 99 Ziyang Avenue, Nanchang, 330022, China. s-2005100153@163.com.ORCID http://orcid.org/0000-0002-3460-780X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMusculoskeletal disease (MSD), including osteoarthritis, rheumatoid arthritis, osteoporosis, and sarcopenia, poses a serious social burden. While physical activity (PA) benefits musculoskeletal health, the optimal PA level for MSD prevention remains unclear. Clarifying risk factors and biological mechanisms is essential.

methodsThis study included 9,113 adults aged 20-60 years from NHANES 2013-2018. Blood and urine specimens were used to analyze metabolic and inflammatory markers. PA was assessed using the Global Physical Activity Questionnaire. Multivariate logistic regression, generalized additive models and mediation analysis were used to evaluate the relationships among PA, biomarkers and MSD.

resultsAmong 9113 participants, 2685 (29.5%) had MSD. PA levels of 600-1200 MET-min/week were associated with the greatest MSD risk reduction (24%; 95% CI 0.62-0.93) compared with inactivity after full adjustment. Participants with MSD showed higher levels of metabolic and inflammatory markers and lower PA levels (P < 0.05). Mediation analysis revealed that atherogenic index of plasma (AIP), triglycerides (TG), neutrophils (NEU), total cholesterol (TC), and triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) acted as complementary mediators at the highly active PA level only, with mediation proportions of 12.4%, 7.6%, 6.1%, 6.0%, and 5.7%. While, lymphocytes (LYM) served as an indirect-only mediator across both active and highly active PA levels, accounting for 21.8% of the total effect.

conclusionIn individuals aged 20-60 years, 600-1200 MET-min/week most effectively reduces MSD risk, with these associations likely mediated by metabolic and inflammatory markers. This study elucidates underlying biological mechanisms linking PA and MSD, highlighting potential metabolic and inflammatory pathways for prevention strategies.

Indexed as

ExerciseInflammationMusculoskeletal DiseasesAdultBiomarkersFemaleHumansMaleMediation AnalysisMiddle AgedNutrition SurveysYoung AdultBiomarkersInflammationMediationMetabolicMusculoskeletal diseaseNHANESPhysical activity

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.