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. 2025 May 28;25(1):1965.
doi: 10.1186/s12889-025-23157-6.

Nonlinear association of physical activity with early cardiovascular-kidney-metabolic syndrome risk: a comprehensive analysis of NHANES data from 2007 to 2018

Haozhe Wang #  1 , Yike Zhang #  1 , Meimei Sun  2 , Zhou Chen  3
Affiliations

Nonlinear association of physical activity with early cardiovascular-kidney-metabolic syndrome risk: a comprehensive analysis of NHANES data from 2007 to 2018

Haozhe Wang et al. BMC Public Health. .

Abstract

Background: Cardiovascular-kidney-metabolic (CKM) syndrome, a newly defined cluster of interrelated cardiometabolic disorders, poses a global health burden. While physical activity (PA) is a cornerstone of metabolic health, its relationship with early CKM progression remains unclear. This study aims to explore the nonlinear dose-response evidence between PA and early CKM syndrome and highlights the potential PA thresholds to maximise metabolic health benefits, providing theoretical support for personalized PA guidelines.

Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) 2007-2018, we analyzed 12,068 participants with early CKM (stages 0-2). Moderate-to-vigorous physical activity (MVPA) was quantified as metabolic equivalent of task (MET)*min/week. Restricted cubic splines, weighted logistic regression, and mediation analyses were employed to assess MVPA-CKM relationships and mediating roles of obesity-related indicators. Subgroup analyses evaluated heterogeneity across demographics and other core covariates.

Results: A L-shaped association between MVPA and early CKM risk was identified (p-non-linear < 0.001). Before the lowest point (6872 MET*min/week), any incremental increase in MVPA was associated with a reduction in early CKM risk, and moderate MVPA (600 - 12,600 MET*min/week) exerts a protective effect. Up to the threshold of 12,600 MET*min/week, MVPA continued to exhibit protective effects. The mediating effect of all the obesity-related indicators was not significant (p > 0.05). Protective effects of moderate PA were consistent across the majority subgroups, whereas an attenuation or even reversal of this protective effect was observed at excessive MVPA levels (> 12,600 MET*min/week), where outcomes statistically indistinguishable from those observed at MVPA levels below 600 MET*min/week.

Conclusions: This study reveals an L-shaped association between MVPA and early CKM risk. The findings highlight the protective effects of moderate MVPA (600 - 12,600 MET*min/week) while demonstrating that higher MVPA (> 12,600 MET*min/week) may attenuate or even reverse these benefits.

Keywords: Cardiovascular-kidney-metabolic syndrome; National health and nutrition examination survey (NHANES); Physical activity.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Data collection for the NHANES was approved by the NCHS Research Ethics Review Board (ERB). An individual investigator utilizing the publicly available NHANES data does not need to file the institution internal review board (IRB). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of NHANEs participants screening. Abbreviation: NHANES, National Health and Nutrition Examination Survey; PA, Physical activity; CKM, Cardiovascular-kidney-metabolic syndrome; MET, metabolic equivalent of task
Fig. 2
Fig. 2
Restricted cubic spline analysis of the association between PA and early CKM
Fig. 3
Fig. 3
The relationship between tri-classified PA and early CKM in subgroups
See this image and copyright information in PMC

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