Phenome-wide association of physical activity with morbidity and mortality risk in China: A prospective cohort study

Research in high-income countries has established the health benefits of physical activity (PA), but evidence from low- and middle-income countries, including China, where PA patterns vary from those in high-income countries, remains limited. Moreover, previous research, mainly focused on specific diseases, failing to fully capture the health impacts of PA. We investigated the associations of PA with 425 distinct diseases and 53 causes of death using data from 511,088 participants aged 30-79 years in the China Kadoorie Biobank. Baseline PA was assessed using a questionnaire between 2004 and 2008, and usual PA levels were estimated using the resurvey data in 2013-2014. Cox regression was employed to estimate the associations between PA and outcomes, adjusting for potential confounders. During a median follow-up time of 12 years, 722,183 incident events and 39,320 deaths were recorded across 18 chapters of the International Classification of Diseases, 10th Revision (ICD-10). Total PA was significantly and inversely associated with incidence risks of 14 ICD-10 chapters, specifically 65 diseases and 19 causes of death, with the highest quintile group of PA showing a 14% lower disease incidence and 40% lower all-cause mortality compared with the lowest group. Of these diseases, 54 were not highlighted in World Health Organization PA guidelines. Dose-response analyses revealed L-shaped associations for most PA types, except moderate-to-vigorous intensity PA, which showed a U-shaped relationship. In this population, physical inactivity accounted for 12.8% of PA-related deaths. The findings underscore the broad health benefits of PA across a variety of body systems and the significant disease burden due to inactivity in China, highlighting the urgent need for PA promotion.