{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T20:30:30Z","timestamp":1793133030044,"version":"4.5.0"},"reference-count":58,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,7,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Cardiovascular\u2013kidney\u2013metabolic (CKM) syndrome integrates cardiovascular, renal, and metabolic dysfunction and is associated with high mortality. Stage\u2010stratified evidence linking physical activity (PA) to mortality remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We analyzed 19\u2009930 adults with CKM stages 0 to 4 from the NHANES (National Health and Nutrition Examination Survey, 1999\u20132018), with mortality follow\u2010up through 2019. PA was assessed by duration (minute\/week) and volume (metabolic equivalent of task\u2010min\/week) across recreational, transport, and occupational domains. Survey\u2010weighted Cox models with restricted cubic splines characterized dose\u2013response associations, defined restricted cubic spline\u2010derived reference ranges, and tested interactions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">During follow\u2010up, 2759 deaths occurred (997 CKM related). Mortality increased sharply with CKM stage (all cause: 2.7% in CKM 0\u20131, 7.0% in CKM 2, and 33.5%\u201339.2% in CKM 3\u20134; CKM\u2010related: &lt;2% in CKM 0\u20132 and 14.2%\u201315.5% in CKM 3\u20134). Higher PA was associated with lower mortality across stages, with the largest absolute differences in CKM 3\u20134. Associations were nonlinear and L\u2010shaped. In CKM 3\u20134, total PA near the reference range (\u2248500 min\/week or \u22482000 metabolic equivalent of task\u2010min\/week) was associated with lower all\u2010cause mortality (hazard ratio [HR], 0.745\u20130.700) and CKM\u2010related mortality (HR, 0.739\u20130.690), whereas recreational PA (\u2248250 min\/week or \u22481000 metabolic equivalent of task\u2010min\/week) showed the strongest inverse associations (all\u2010cause HR, 0.740\u20130.702; CKM\u2010related HR, 0.568\u20130.550). Occupational PA displayed a U\u2010\/J\u2010shaped pattern. Interactions were strongest for renal dysfunction, particularly proteinuria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Modest, attainable PA\u2014especially recreational activity\u2014was associated with lower all\u2010cause and CKM\u2010related mortality, with the greatest differences in CKM stages 3 to 4.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.047359","type":"journal-article","created":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T03:26:16Z","timestamp":1783740376000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Associations of Physical Activity With Mortality Across Cardiovascular\u2013Kidney\u2013Metabolic Syndrome Stages: Evidence From NHANES 1999 to 2018"],"prefix":"10.1161","volume":"15","author":[{"given":"Yangjie","family":"Xiao","sequence":"first","affiliation":[{"name":"Shengjing Hospital of China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Cheng","sequence":"additional","affiliation":[{"name":"Shengjing Hospital of China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5745-8317","authenticated-orcid":false,"given":"Le","family":"Zhang","sequence":"additional","affiliation":[{"name":"Shengjing Hospital of China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3570-3710","authenticated-orcid":false,"given":"Jinling","family":"Hu","sequence":"additional","affiliation":[{"name":"Shengjing Hospital of China Medical University","place":["Shenyang, 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