Physical Activity, Sleep Health, and Kidney Stone Disease: Analysis of All of Us Research Program

Background: Kidney stone disease (KSD) is a prevalent urologic condition with multiple risk factors. Prior studies suggest physical activity and sleep may influence its development; however, it relied on self-reported data. The All of Us (AoU) platform integrates electronic health records (EHR) with wearable-derived Fitbit data, enabling large-scale epidemiologic research. This study examines the associations between physical activity, step count, and sleep with KSD incidence in the AoU cohort. Methods: We included All of Us participants who shared their EHR and Fibit accelerometry data. We calculated fitbit derived daily steps, weekly moderate-to-vigorous physical activity (MVPA), and daily sleep metrics using the first year of accelerometer wear. Incident KSD was identified using validated ICD-10 codes over a 10-year follow-up starting at the end of the 1-year period. Cox proportional hazards regression model evaluated the associations between each metric (continuous and categorical) and incident KSD, adjusting for age, sex, race/ethnicity, BMI and history of smoking, hypertension and diabetes. Results: Baseline characteristics were similar across cohorts, with 60–70% of participants having hypertension, 25–30% diabetes and an average BMI >30. Higher physical activity levels were associated with a reduced risk of KSD incidence. Each additional hour of moderate-to-vigorous physical activity per week was linked to a 9% lower risk (HR = 0.91, 95% CI: 0.85–0.97, p = 0.003), with each extra daily hour of very active physical activity conferred a substantial protective effect (HR = 0.24, 95% CI: 0.11–0.53, p = 0.0005). Additionally, a higher daily step count was beneficial, with every extra daily 1,000 steps reducing KSD incidence risk by 6% (HR = 0.94, 95% CI: 0.90–0.98, p = 0.003). Although total sleep duration was not associated with KSD (HR = 0.95, 95% CI: 0.84–1.06, p = 0.34), greater sleep variability increased its risk (HR = 1.02, 95% CI: 1.01–1.03, p = 0.003). Male sex, high BMI, hypertension, and Hispanic ethnicity were identified as significant risk factors. Conclusion: Objective wearable data confirm that increased physical activity and step count are protective against KSD, while greater sleep variability is associated with higher risk. These findings highlight modifiable lifestyle factors that may inform KSD prevention strategies. Funding: NIDDK Support