Moderate-to-vigorous physical activity trajectories and newly reported cardiovascular disease in middle-aged and older chinese adults: A CHARLS cohort study

Evidence remains limited regarding the longitudinal patterns of moderate-to-vigorous physical activity (MVPA) among middle-aged and older adults and their associations with subsequent cardiovascular outcomes. This study was based on data from the China Health and Retirement Longitudinal Study (CHARLS). Participants were included if they were aged ≥ 45 years at Wave 1 (W1), had calculable MVPA data across W1–W4, and did not report physician-diagnosed heart disease or stroke at any wave during W1–W4. Group-based trajectory modeling (GBTM) was used to identify longitudinal MVPA trajectories according to whether participants met the recommended MVPA level of 600 metabolic equivalent of task minutes per week (MET-min/week) at each wave. Newly reported overall cardiovascular disease (CVD) was defined as the first self-reported physician diagnosis of heart disease or stroke at W5 among participants who had reported neither condition during W1–W4; newly reported heart disease and stroke were analyzed separately. Multivariable logistic regression was used to evaluate the associations between MVPA trajectories and cardiovascular outcomes at W5. Because of the small number of stroke events, Firth penalized logistic regression was used for the stroke analysis. Missing covariate data were handled using multiple imputation. A total of 1,286 participants were included in the trajectory analysis. Two MVPA trajectories were identified: a low-declining MVPA trajectory comprising 292 participants (22.71%) and a high-declining MVPA trajectory comprising 994 participants (77.29%). In both groups, the predicted probability of meeting the recommended MVPA level declined over time. A total of 1,210 participants were included in the W5 outcome analysis, among whom 94 had newly reported overall CVD (7.8%), including 72 with newly reported heart disease (6.0%) and 27 with newly reported stroke (2.2%); five participants reported both conditions. Using the low-declining trajectory as the reference, the high-declining trajectory was not significantly associated with overall CVD (odds ratio [OR] = 0.72, 95% confidence interval [CI]: 0.43–1.19, P = 0.200), heart disease (OR = 0.77, 95% CI: 0.43–1.38, P = 0.382), or stroke (OR = 0.92, 95% CI: 0.39–2.37, P = 0.853) after adjustment for sociodemographic characteristics, lifestyle factors, and health-related factors. The complete-case analysis did not materially alter the conclusions of the adjusted analyses, and sensitivity analyses using Firth penalized logistic regression for overall CVD and heart disease yielded similar inferences. Among the middle-aged and older CHARLS participants included in the analysis, MVPA was predominantly characterized by declining trajectories at different levels. No statistically significant associations were observed between MVPA trajectories during W1–W4 and newly reported overall CVD, heart disease, or stroke at W5. However, the limited number of outcome events, particularly stroke events, reduced the precision of the estimates. Future studies using objectively measured continuous physical activity data, longer follow-up periods, and cardiovascular outcomes validated against medical records are needed to further examine these associations.