Evidence map›Paper›PMID 42432447›Full record

ArticleJournal of the American Heart Association2026

Associations of Physical Activity With Mortality Across Cardiovascular-Kidney-Metabolic Syndrome Stages: Evidence From NHANES 1999 to 2018.

Yangjie Xiao, Cheng Cheng, Le Zhang, Jinling Hu, Lei Wang, Cong Shang, Song Gao, Bing Ma, Hao Sun, Jing Zhang

Abstract read
In one paragraph

Article in Journal of the American Heart Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Yangjie Xiao *Department of Ultrasound Shengjing Hospital of China Medical University Shenyang Liaoning China.
Cheng Cheng *Department of Cardiology Shengjing Hospital of China Medical University Shenyang Liaoning China.
Le Zhang *Department of Endocrinology Shengjing Hospital of China Medical University Shenyang Liaoning China.ORCID 0000-0002-5745-8317
Jinling Hu *Department of Ultrasound Shengjing Hospital of China Medical University Shenyang Liaoning China.ORCID 0000-0003-3570-3710
Lei Wang *Department of Ultrasound Shengjing Hospital of China Medical University Shenyang Liaoning China.
Cong Shang *Department of Ultrasound Shengjing Hospital of China Medical University Shenyang Liaoning China.ORCID 0000-0001-6550-4566
Song Gao *Department of Oncology Shengjing Hospital of China Medical University Shenyang Liaoning China.ORCID 0000-0002-7759-4404
Bing MaDepartment of Clinical Epidemiology and Evidence-Based Medicine The First Hospital of China Medical University Shenyang China.ORCID 0000-0003-3607-9702
Hao SunDepartment of Clinical Epidemiology and Evidence-Based Medicine The First Hospital of China Medical University Shenyang China.ORCID 0000-0003-3860-7820
Jing ZhangDepartment of Ultrasound Shengjing Hospital of China Medical University Shenyang Liaoning China.ORCID 0000-0002-6178-8220

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCardiovascular-kidney-metabolic (CKM) syndrome integrates cardiovascular, renal, and metabolic dysfunction and is associated with high mortality. Stage-stratified evidence linking physical activity (PA) to mortality remains limited.

methodsWe analyzed 19 930 adults with CKM stages 0 to 4 from the NHANES (National Health and Nutrition Examination Survey, 1999-2018), with mortality follow-up through 2019. PA was assessed by duration (minute/week) and volume (metabolic equivalent of task-min/week) across recreational, transport, and occupational domains. Survey-weighted Cox models with restricted cubic splines characterized dose-response associations, defined restricted cubic spline-derived reference ranges, and tested interactions.

resultsDuring follow-up, 2759 deaths occurred (997 CKM related). Mortality increased sharply with CKM stage (all cause: 2.7% in CKM 0-1, 7.0% in CKM 2, and 33.5%-39.2% in CKM 3-4; CKM-related: <2% in CKM 0-2 and 14.2%-15.5% in CKM 3-4). Higher PA was associated with lower mortality across stages, with the largest absolute differences in CKM 3-4. Associations were nonlinear and L-shaped. In CKM 3-4, total PA near the reference range (≈500 min/week or ≈2000 metabolic equivalent of task-min/week) was associated with lower all-cause mortality (hazard ratio [HR], 0.745-0.700) and CKM-related mortality (HR, 0.739-0.690), whereas recreational PA (≈250 min/week or ≈1000 metabolic equivalent of task-min/week) showed the strongest inverse associations (all-cause HR, 0.740-0.702; CKM-related HR, 0.568-0.550). Occupational PA displayed a U-/J-shaped pattern. Interactions were strongest for renal dysfunction, particularly proteinuria.

conclusionsModest, attainable PA-especially recreational activity-was associated with lower all-cause and CKM-related mortality, with the greatest differences in CKM stages 3 to 4.

Indexed as

Cardio-Renal SyndromeCardiovascular DiseasesExerciseMetabolic SyndromeAdultAgedFemaleHumansMaleMiddle AgedNutrition SurveysRisk AssessmentRisk FactorsUnited Statescardiovascular‐kidney‐metabolic syndromemortalityNHANESnonlinear dose–responsephysical activity

Identifiers

PMID42432447
PMCPMC13477353

What Socratic holds

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Registered trials

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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.