# Association of physical activity and sedentary behavior with stages of cardiovascular–kidney–metabolic syndrome among U.S. adults: NHANES 2007–2020

## TL;DR

This study shows that more physical activity is linked to lower risk of a syndrome combining heart, kidney, and metabolic issues in U.S. adults.

## Contribution

The study provides new evidence that physical activity reduces CKM syndrome stages across diverse populations.

## Key findings

- MVPA of ≥150 min/week was associated with significantly lower odds of CKM stages 1–4.
- Protective effects of MVPA were consistent across age and socioeconomic groups.
- Sedentary behavior had weaker associations with CKM severity after adjusting for other factors.

## Abstract

Cardiovascular–kidney–metabolic (CKM) syndrome, newly defined by the American Heart Association, integrates metabolic risk factors, chronic kidney disease, and cardiovascular dysfunction. Although clinically important, evidence-based prevention strategies remain limited. This study examined associations of moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB) with CKM stage in a representative U.S. adult sample.

We used survey-weighted multinomial logistic regression and restricted cubic splines (RCS). MVPA was classified as 0, 1–149, and ≥ 150 min/week; SB as <5, 5–8, and ≥ 8 h/day; CKM was staged 0–4 (stage 0 as reference). Predefined subgroups were age (20–59 vs 60–79 years), sex (female vs male) and PIR (high >3.49; medium >1.49–<3.49; low ≤1.49).

Compared with individuals reporting no MVPA, those achieving ≥150 min/week had approximately 33 % lower odds of CKM stage 1 (OR 0.67, 95 % CI 0.46–0.97), 44 % lower odds of stage 2 (OR 0.56, 95 % CI 0.38–0.83), 92 % lower odds of stage 3 (OR 0.09, 95 % CI 0.02–0.32), and 65 % lower odds of stage 4 (OR 0.35, 95 % CI 0.19–0.63). Subgroup analyses by age, sex, poverty–income ratio, and SB indicated that the protective impact of MVPA was evident across age and socioeconomic subgroups, with relatively stronger associations among younger adults and benefits at both low and high socioeconomic strata. By contrast, SB showed weaker independent associations with CKM severity after full adjustment.

Greater MVPA was associated with lower odds of advanced CKM stage. These findings highlight the role of physical activity in CKM prevention and support public health strategies to reduce lifestyle-related risks.