Association rule analysis of physical activity and multimorbidity in middle-aged Korean adults with diabetes: an evidence to promote active lifestyles

Diabetes mellitus is a prevalent chronic disease that often coexists with other conditions, especially in middle-aged adults, complicating disease management and increasing health risks. As physical inactivity is a known contributor to both diabetes and related comorbidities, this study examines how physical activity (PA) influences the clustering of chronic diseases in middle-aged Korean adults with diabetes. Using data from 15,517 individuals aged 40-64 from the Korean National Health and Nutrition Examination Survey (2016-2021), participants were categorized as physically active or inactive based on the WHO guidelines. In this cross-sectional study, association rule analysis was conducted to identify patterns of comorbidity. The most common co-occurring conditions were obesity, hypertension, hypercholesterolemia, and hypertriglyceridemia. Association rule identified more diabetes-related comorbidity rules in physically inactive individuals than in physically active individuals (20 vs. 14), with generally stronger rule metrics in the inactive subgroup (maximum lift: 2.7 vs. 2.4). Unique associations also emerged, such as cataract with diabetes in inactive individuals and depression with diabetes in active individuals. These findings suggest that regular PA may help prevent or weaken harmful disease clusters, reducing the overall burden of multimorbidity. Promoting physical activity should be a central strategy in public health efforts to improve health outcomes and support healthy aging in diabetic populations.