Wearable accelerometer-derived physical activity and incident disease

Abstract

Physical activity is regarded as favorable to health but effects across the spectrum of human disease are poorly quantified. In contrast to self-reported measures, wearable accelerometers can provide more precise and reproducible activity quantification. Using wrist-worn accelerometry data from the UK Biobank prospective cohort study, we test associations between moderate-to-vigorous physical activity (MVPA) - both total MVPA minutes and whether MVPA is above a guideline-based threshold of ≥150 min/week-and incidence of 697 diseases using Cox proportional hazards models adjusted for age, sex, body mass index, smoking, Townsend Deprivation Index, educational attainment, diet quality, alcohol use, blood pressure, anti-hypertensive use. We correct for multiplicity at a false discovery rate of 1%. We perform analogous testing using self-reported MVPA. Among 96,244 adults wearing accelerometers for one week (age 62 ± 8 years), MVPA is associated with 373 (54%) tested diseases over a median 6.3 years of follow-up. Greater MVPA is overwhelmingly associated with lower disease risk (98% of associations) with hazard ratios (HRs) ranging 0.70-0.98 per 150 min increase in weekly MVPA, and associations spanning all 16 disease categories tested. Overall, associations with lower disease risk are enriched for cardiac (16%), digestive (14%), endocrine/metabolic (10%), and respiratory conditions (8%) (chi-square p < 0.01). Similar patterns are observed using the guideline-based threshold of ≥150 MVPA min/week. Some of the strongest associations with guideline-adherent activity include lower risks of incident heart failure (HR 0.65, 95% CI 0.55-0.77), type 2 diabetes (HR 0.64, 95% CI 0.58-0.71), cholelithiasis (HR 0.61, 95% CI 0.54-0.70), and chronic bronchitis (HR 0.42, 95% CI 0.33-0.54). When assessed within 456,374 individuals providing self-reported MVPA, effect sizes for guideline-adherent activity are substantially smaller (e.g., heart failure HR 0.84, 95% CI 0.80-0.88). Greater wearable device-based physical activity is robustly associated with lower disease incidence. Future studies are warranted to identify potential mechanisms linking physical activity and disease, and assess whether optimization of measured activity can reduce disease risk.

Fig. 1. Study overview.

Depicted is a graphical overview of the study. Within 96,244 UK Biobank participants who wore a wrist-worn accelerometer for one week, we tested for associations between objectively measured moderate-to-vigorous physical activity and 697 incident diseases. We performed analogous association testing in 456,374 UK Biobank participants who provided self-reported activity data. There was overlap between the two analysis samples, as depicted by the Venn diagram in the center.

Fig. 2. Accelerometer-measured physical activity and incident disease.

a Plots the negative log10 p value for the association between accelerometer-measured moderate-to-vigorous physical activity (MVPA) and incident disease (grouped by category on the x-axis) in Cox proportional hazards models adjusted for age, sex, body mass index, Townsend Deprivation Index, smoking status, alcohol use, anti-hypertensive medication use, systolic blood pressure, and diastolic blood pressure, with darker shaded points meeting significance at a false discovery rate (FDR) of 1% (horizontal red line). Upward-facing triangles represent higher risk (hazard ratios >1), while downward-facing triangles represent lower risk (hazard ratio <1). P values smaller than 1 × 10⁻²⁰ are displayed as 1 × 10⁻²⁰ for graphical purposes. b Shows the distribution of hazard ratios per 150-min increase in MVPA per week observed across each disease category (x-axis), with the center line depicting the within-category median hazard ratio, the bounds of the box representing quartile 1 to quartile 3, and the whiskers extending 1.5 interquartile ranges beyond the box. Categories are arranged by increasing median hazard ratio, from lowest (left) to highest (right). c Compares the median within-category hazard ratio observed with guideline-adherent activity (i.e., ≥150 min of MVPA per week^,,) defined using accelerometer-measured (circles) versus self-reported (triangles) MVPA. Included in the comparison are 323 diseases for which there was a nominally significant association (p < 0.05) with both exposure definitions and an effect size suggesting a lower risk of disease.

Fig. 3. Cumulative risk of disease stratified by guideline-adherent physical activity.

Depicted is the 5-year cumulative risk of heart failure, type 2 diabetes, cholelithasis, and chronic bronchitis, stratified guideline-adherent activity according to accelerometer-measured moderate-to-vigorous physical activity (MVPA, top panels) and self-reported MVPA (bottom panels). In each plot, individuals are grouped into binary categories according to the guideline-based threshold of ≥150 min of MVPA/week. Red, pink, blue, and purple strata represent individuals meeting guideline-based levels, and the teal stratum represents individuals not meeting guideline-based levels^,,. In each plot, the number remaining at risk over time is depicted below. Representative diseases were selected from the four categories having the greatest enrichment for associations with activity, where each disease was significantly associated with both accelerometer-measured and self-reported activity at a false discovery rate of 1%.

Fig. 4. Associations between quintile of measured MVPA and incident disease.

Depicted is the relative hazard of incident disease according to quintile of accelerometer-measured moderate-to-vigorous physical activity (MVPA) and grouped by disease category. Each disease is represented by four points, with each point representing the hazard ratio associated with a given quintile of MVPA (quintile 2 = red, quintile 3 = orange, quintile 4 = light green, quintile 5 = dark green), as compared to the lowest quintile (quintile 1) as the referent. MVPA volumes corresponding to each quintile are shown in the legend. The hashed horizontal line depicts a hazard ratio of one (i.e., equal hazard to quintile 1). A single value below 0.1 was rounded to 0.1 for graphical purposes (bottom right).