{
  "abstract": "Background: Prior studies have linked physical activity to cardiovascular-kidney-metabolic (CKM) prevalence or mortality and sedentary behavior to CKM severity, and both behaviors are established mortality risk factors in the general population; however, prospective evidence on their joint associations with cause-specific mortality across CKM stages 0–3 remains limited.\n\nMethods: We analyzed 8,556 NHANES 2007–2018 participants aged ≥20 years with CKM stages 0–3, complete prespecified covariates, and a positive fasting-subsample weight. Leisure-time physical activity (LTPA) was categorized as inactive (0 min/week), insufficient (>0 to <150 min/week), or sufficient (≥150 min/week); daily sitting time was categorized as <6, 6 to <8, or ≥8 h/day. The primary outcome was all-cause mortality; cardiovascular disease (CVD) and non-CVD mortality were secondary outcomes. Survey-design-based Cox models incorporated the 12-year fasting weight, strata, and primary sampling units. Multiplicative and additive interactions were assessed.\n\nResults: During a median follow-up of 6.75 years, 670 deaths occurred, including 175 CVD and 495 non-CVD deaths. In fully adjusted models, sufficient versus no LTPA was associated with lower all-cause (hazard ratio [HR], 0.630; 95% confidence interval [CI], 0.483–0.822), CVD (HR, 0.536; 95% CI, 0.297–0.969), and non-CVD mortality (HR, 0.662; 95% CI, 0.478–0.916). Sitting ≥8 versus <6 h/day was associated with higher all-cause (HR, 1.506; 95% CI, 1.253–1.810), CVD (HR, 1.845; 95% CI, 1.246–2.732), and non-CVD mortality (HR, 1.406; 95% CI, 1.109–1.782). Compared with sufficient LTPA and sitting <6 h/day, <150 min/week of LTPA combined with sitting ≥8 h/day was associated with all-cause (HR, 1.972; 95% CI, 1.429–2.721), CVD (HR, 2.493; 95% CI, 1.232–5.045), and non-CVD mortality (HR, 1.806; 95% CI, 1.202–2.712). Multiplicative interaction was not detected for all-cause (P = 0.951) or non-CVD mortality (P = 0.274); the CVD interaction signal (P = 0.016) was exploratory because it depended on a joint category with few events.\n\nConclusion: Higher LTPA and shorter sitting time were independently associated with lower mortality among US adults with CKM stages 0–3. Joint categories identified a higher-risk behavioral pattern, but did not establish that LTPA offsets the risk of prolonged sitting.\n\nSupplementary information: The online version contains supplementary material available at https://doi.org/10.1265/ehpm.26-00088.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "name": "Sufang Xu"
    },
    {
      "name": "Jiaming Huang"
    },
    {
      "name": "Lingrong Hu"
    },
    {
      "name": "Xiaoming Li"
    },
    {
      "name": "Shumin Zhao"
    },
    {
      "name": "Kaihong Chen"
    },
    {
      "name": "Liling Chen"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/aqkc6crmzx546.bib",
  "cited_by": 0,
  "doi": "10.1265/ehpm.26-00088",
  "fulltext_url": "https://www.jstage.jst.go.jp/article/ehpm/31/0/31_26-00088/_article",
  "id": "aqkc6crmzx546",
  "issns": [
    "1347-4715",
    "1342-078X"
  ],
  "landing_url": "https://www.jstage.jst.go.jp/article/ehpm/31/0/31_26-00088/_article",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research Article"
    ],
    [
      "jstage-journal",
      "medicine/epidemiology-public-health"
    ],
    [
      "openalex",
      "2737|Physical Activity and Health"
    ]
  ],
  "openalex": "W7222934240",
  "pdf_url": "https://www.jstage.jst.go.jp/article/ehpm/31/0/31_26-00088/_pdf",
  "pmcid": "PMC13719245",
  "pmid": "42907355",
  "published": "2026-10-20",
  "publisher": "Japanese Society for Hygiene",
  "ris": "https://research.draconitic.com/paper/aqkc6crmzx546.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:18Z",
      "native_id": "10.1265/ehpm.26-00088",
      "source": "jstage",
      "url": "https://www.jstage.jst.go.jp/article/ehpm/31/0/31_26-00088/_article"
    },
    {
      "first_seen": "2026-11-02T12:23:06Z",
      "native_id": "PMC13719245",
      "source": "pmc",
      "url": "https://doi.org/10.1265/ehpm.26-00088"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2737|Physical Activity and Health",
      "subfield": "physiology"
    }
  ],
  "title": "Joint associations of leisure-time physical activity and daily sitting time with mortality among US adults classified as CKM stages 0–3: a prospective cohort study of NHANES 2007–2018",
  "title_text": "Joint associations of leisure-time physical activity and daily sitting time with mortality among US adults classified as CKM stages 0–3: a prospective cohort study of NHANES 2007–2018",
  "type": "peer-reviewed",
  "updated_at": "2026-11-02T12:23:06Z",
  "url": "https://research.draconitic.com/paper/aqkc6crmzx546",
  "venue": "Environmental Health and Preventive Medicine",
  "versions": []
}