{
  "abstract": "Background The 2023 American Heart Association cardiovascular-kidney-metabolic (CKM) staging framework supports risk stratification, but evidence on guideline-level physical activity across stages remains limited. Methods We emulated a target-trial protocol using NHANES 2007-2018 and National Death Index linkage through December 31, 2019. Adults aged 20 to 79 years with CKM stages 1 to 4, estimated glomerular filtration rate of at least 15 mL/min/1.73 m2, complete activity data, no cancer history, and eligible follow-up were included. Baseline activity was classified as meeting or not meeting the guideline. Within-stage propensity-score weights were used in weighted Cox models. All-cause and cardiovascular mortality were the primary and secondary outcomes; 5-year risks used weighted survival curves, with competing-risk cumulative incidence also estimated for cardiovascular mortality. Results Among 19,654 participants, 1,190 all-cause deaths occurred during 134,037 person-years. Baseline attainment was associated with lower all-cause mortality overall (HR, 0.774; 95% CI, 0.675-0.888). Stage-specific HRs were 1.030, 0.803, 0.642, and 0.727 for stages 1 to 4, respectively; estimates were nonmonotonic. Five-year risk differences were +0.040, -0.830, -1.790, and -3.840 percentage points; only the stage 4 interval excluded the null. Cardiovascular mortality showed a similar overall cause-specific association (HR, 0.707; 95% CI, 0.547-0.914). Conclusions Observed baseline guideline attainment was associated with mortality in this observational target-trial emulation. The findings are consistent with current physical activity recommendations but do not estimate the effect of an activity-promotion intervention; prospective trials are needed to establish clinical benefit.",
  "abstract_shown": true,
  "affiliations": [
    "The 72nd Group Army Hospital"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "name": "X. Luo"
    },
    {
      "name": "Y. Wang"
    },
    {
      "name": "W. Zhou"
    },
    {
      "name": "F. Yu"
    },
    {
      "name": "J. Sun"
    },
    {
      "name": "K.-F. Xiang"
    },
    {
      "name": "F. Wang"
    },
    {
      "name": "Z. Yuan"
    },
    {
      "name": "J. Bao"
    },
    {
      "name": "S. Zhang"
    },
    {
      "name": "Y. Zheng"
    },
    {
      "affs": [
        0
      ],
      "name": "F. Wu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/d8dbv4xgaes4x.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.28.26366776",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.28.26366776v1.full",
  "id": "d8dbv4xgaes4x",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.28.26366776v1",
  "language": null,
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "epidemiology"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.28.26366776v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-28",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/d8dbv4xgaes4x.ris",
  "sources": [
    {
      "first_seen": "2026-11-01T00:20:39Z",
      "native_id": "10.64898/2026.10.28.26366776",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.28.26366776v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:epidemiology",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Baseline Physical Activity Guideline Attainment and Mortality Across Cardiovascular-Kidney-Metabolic Syndrome Stages",
  "title_text": "Baseline Physical Activity Guideline Attainment and Mortality Across Cardiovascular-Kidney-Metabolic Syndrome Stages",
  "type": "preprint",
  "updated_at": "2026-11-02T00:20:12Z",
  "url": "https://research.draconitic.com/paper/d8dbv4xgaes4x",
  "venue": "medRxiv",
  "versions": []
}