{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:48:51Z","timestamp":1791600531457,"version":"4.3.4"},"reference-count":38,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Sichuan Regional Innovation Cooperation Program","award":["2026YFHZ0171"],"award-info":[{"award-number":["2026YFHZ0171"]}]},{"DOI":"10.13039\/501100001809","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2023YFC3604701"],"award-info":[{"award-number":["2023YFC3604701"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Objectives: Left atrial (LA) strain reflects early cardiac dysfunction preceding structural remodeling and clinical disease. Data on the association between physical activity (PA) and LA function are limited. In this study, we aim to explore the association of PA with LA strain, and to test the indirect effect of skeletal muscle mass in the PA-LA association. Methods: Data from the Healthy Lifestyle Promotion Cohort involving 407 participants were analyzed. Multivariate linear regression models were used to estimate the associations of leisure-time PA with LA function, and indirect associations through skeletal muscle mass were determined using a regression-based mediation analysis. Results: PA was significantly associated with LA reservoir strain (\u03b2 = 2.907, p &lt; 0.001) and with pump strain (\u03b2 = \u22121.674, p &lt; 0.001). PA had a significant effect on the skeletal muscle mass index (SMI) (\u03b2 = 0.230, p &lt; 0.001), while the SMI had a significant impact on LA reservoir strain (\u03b2 = 2.619, 95% CI 1.425\u20133.813, p &lt; 0.001) and pump strain (\u03b2 = \u22122.621, 95% CI \u22123.472\u2013\u22121.771, p &lt; 0.001). The SMI partially mediated the effect of PA on LA reservoir strain by 21% (95% CI: 9\u201338%, p &lt; 0.001) and LA pump strain by 36% (95% CI: 20\u201359%, p &lt; 0.001). Subgroup analysis revealed that this statistical mediation effect of the SMI demonstrated a stronger trend in women compared to men and in participants \u226560 years old compared to their younger counterparts. Conclusions: The SMI partially mediates the association between PA and LA function in the community-dwelling Chinese participants. Sustaining a higher level of leisure-time PA was associated with better LA function. These possible beneficial effects may be partially explained through favorable changes in the SMI.<\/jats:p>","DOI":"10.3390\/jcm15197744","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T01:40:17Z","timestamp":1791596417000},"page":"7744","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Skeletal Muscle Mass as a Potential Mediator of the Physical Activity\u2013Left Atrial Function Relationship: A Community-Based Cross-Sectional Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Yue","family":"Zhong","sequence":"first","affiliation":[{"name":"Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Kai","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6690-1114","authenticated-orcid":false,"given":"Lijun","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, West China Second Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"}]},{"given":"Xue","family":"Yang","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China"},{"name":"Outpatient Department, West China Tianfu Hospital, Sichuan University, Chengdu 621203, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Changwei","family":"Cai","sequence":"additional","affiliation":[{"name":"The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 610036, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"software","vocabulary":"credit"}]},{"given":"Bin","family":"Yu","sequence":"additional","affiliation":[{"name":"West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"software","vocabulary":"credit"}]},{"given":"Shujuan","family":"Yang","sequence":"additional","affiliation":[{"name":"West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8849-3716","authenticated-orcid":false,"given":"Qingyu","family":"Dou","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1093\/eurheartj\/ehs188","article-title":"Left atrial structure and function and clinical outcomes in the general population","volume":"34","author":"Gupta","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1093\/ehjci\/jey181","article-title":"Prognostic value of left atrial strain in predicting cardiovascular morbidity and mortality in the general population","volume":"20","author":"Modin","year":"2019","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2376","DOI":"10.1161\/STROKEAHA.123.044143","article-title":"Role of Cardiac Biomarkers in Stroke and Cognitive Impairment","volume":"55","author":"Johansen","year":"2024","journal-title":"Stroke"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.jcmg.2020.07.040","article-title":"Prediction of AF in heart failure with preserved ejection fraction: Incremental value of left atrial strain","volume":"14","author":"Marwick","year":"2021","journal-title":"JACC Cardiovasc. Imag."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1097\/HJH.0000000000002572","article-title":"Subclinical left atrial dysfunction profiles for prediction of cardiac outcome in the general population","volume":"38","author":"Cauwenberghs","year":"2020","journal-title":"J. Hypertens."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1136\/heartjnl-2021-320013","article-title":"Association of physical activity trajectories with major cardiovascular diseases in elderly people","volume":"108","author":"Trevisan","year":"2022","journal-title":"Heart"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/j.jcmg.2022.10.026","article-title":"Association of physical activity with left atrial function in older adults: The ARIC Study","volume":"16","author":"Parikh","year":"2023","journal-title":"JACC Cardiovasc. Imag."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1038\/oby.2010.110","article-title":"Regular multicomponent exercise increases physical fitness and muscle protein anabolism in frail, obese, older adults","volume":"19","author":"Villareal","year":"2011","journal-title":"Obesity"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1093\/cvr\/cvae073","article-title":"Biological basis and treatment of frailty and sarcopenia","volume":"120","author":"Sato","year":"2024","journal-title":"Cardiovasc. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1161\/CIRCULATIONAHA.123.064071","article-title":"Sarcopenia and Cardiovascular Diseases","volume":"147","author":"Damluji","year":"2023","journal-title":"Circulation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"4528","DOI":"10.1002\/ehf2.13656","article-title":"Relation of left atrial function with exercise capacity and muscle endurance in patients with heart failure","volume":"8","author":"Bekfani","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1038\/s41522-025-00721-x","article-title":"Mediation effect and metabolic pathways of gut microbiota in the associations between lifestyles and dyslipidemia","volume":"11","author":"Zeng","year":"2025","journal-title":"NPJ Biofilms. Microbi"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1249\/01.MSS.0000078924.61453.FB","article-title":"International physical activity questionnaire: 12-country reliability and validity","volume":"35","author":"Craig","year":"2003","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_14","first-page":"255","article-title":"Validation of the Simplified Chinese-character Version of the International Physical Activity Questionnaire-Long Form in Urban Community-dwelling Adults: A Cross-sectional Study in Hangzhou, China","volume":"30","author":"Ren","year":"2017","journal-title":"Biomed. Environ. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1249\/mss.0b013e31815b0db5","article-title":"Reliability and Validity of the IPAQ-Chinese: The Guangzhou Biobank Cohort Study","volume":"40","author":"Deng","year":"2008","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.jshs.2023.10.010","article-title":"2024 Adult compendium of physical activities: A third update of the energy costs of human activities","volume":"13","author":"Herrmann","year":"2024","journal-title":"J. Sport Health Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jshs.2023.10.007","article-title":"Older adult compendium of physical activities: Energy costs of human activities in adults aged 60 and older","volume":"13","author":"Willis","year":"2024","journal-title":"J. Sport Health Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.echo.2021.08.008","article-title":"Normal values of left atrial size and function and the impact of age: Results of the World Alliance Societies of Echocardiography Study","volume":"35","author":"Singh","year":"2022","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1093\/ehjci\/jeab201","article-title":"Normal values and reference ranges for left atrial strain by speckle-tracking echocardiography: The Copenhagen City Heart Study","volume":"23","author":"Nielsen","year":"2021","journal-title":"Eur. Heart J. Cardiovasc. Imag."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3473","DOI":"10.1016\/j.ijcard.2013.04.167","article-title":"Left atrial regional phasic strain, strain rate and velocity by speckle-tracking echocardiography: Normal values and effects of aging in a large group of normal subjects","volume":"168","author":"Sun","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1037\/a0020761","article-title":"A general approach to causal mediation analysis","volume":"15","author":"Imai","year":"2010","journal-title":"Psychol. Methods"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"879","DOI":"10.3758\/BRM.40.3.879","article-title":"Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models","volume":"40","author":"Preacher","year":"2008","journal-title":"Behav. Res. Methods"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.ahj.2020.05.015","article-title":"High-intensity endurance training is associated with left atrial fibrosis","volume":"226","author":"Peritz","year":"2020","journal-title":"Am. Heart J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e001928","DOI":"10.1136\/openhrt-2021-001823","article-title":"Associations between physical activity, left atrial size and incident atrial fibrillation: The Troms\u00f8 Study 1994\u20132016","volume":"9","author":"Heitmann","year":"2022","journal-title":"Open Heart"},{"key":"ref_26","first-page":"295","article-title":"The fat cell senescence hypothesis: A mechanism responsible for abrogating the resolution of inflammation in chronic disease","volume":"17","author":"Newsholme","year":"2014","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e70019","DOI":"10.1002\/jcsm.70019","article-title":"Assessing the Skeletal Muscle Pump During Lower Limb Counterpressure: Lags and Causality in Cardiovascular Regulation","volume":"16","author":"Knight","year":"2025","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1016\/j.amjcard.2018.11.035","article-title":"Effect of obesity on left atrial strain in persons aged 35\u201355 Years (The Asklepios Study)","volume":"123","author":"Chirinos","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/s12968-021-00793-6","article-title":"Incremental value of left atrial booster and reservoir strain in predicting atrial fibrillation in patients with hypertrophic cardiomyopathy: A cardiovascular magnetic resonance study","volume":"23","author":"Raman","year":"2021","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1136\/jech-2019-212268","article-title":"Skeletal muscle mass in relation to 10-year cardiovascular disease incidence among middle aged and older adults: The ATTICA study","volume":"74","author":"Tyrovolas","year":"2020","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1038\/s41569-025-01237-9","article-title":"Redefining heart failure subtypes according to skeletal muscle mass","volume":"23","author":"Suthahar","year":"2026","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_32","first-page":"1113","article-title":"Osteosarcopenia and mortality in older adults undergoing transcatheter aortic valve replacement","volume":"9","author":"Arif","year":"2024","journal-title":"JAMA Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1519\/JPT.0000000000000302","article-title":"Skeletal muscle adaptations following 80 weeks of resistance exercise in older adults","volume":"45","author":"Miller","year":"2022","journal-title":"J. Geriatr. Phys. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1093\/eurheartj\/ehz897","article-title":"Association between physical activity and risk of incident arrhythmias in 402 406 individuals: Evidence from the UK Biobank cohort","volume":"41","author":"Elliott","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.jacc.2023.12.019","article-title":"Sex differences in association of physical activity with all-cause and cardiovascular mortality","volume":"83","author":"Ji","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"eabo2641","DOI":"10.1126\/scitranslmed.abo2641","article-title":"Lean body mass and the cardiovascular system constitute a female-specific relationship","volume":"14","author":"Pentz","year":"2022","journal-title":"Sci. Transl. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e219","DOI":"10.1016\/S2468-2667(21)00302-9","article-title":"Daily steps and all-cause mortality: A meta-analysis of 15 international cohorts","volume":"7","author":"Paluch","year":"2022","journal-title":"Lancet Public Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"108049","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.108049","article-title":"Site-specific skeletal muscle mass and functional prognosis in geriatric stroke patients","volume":"33","author":"Maekawa","year":"2024","journal-title":"J. Stroke Cerebrovasc. 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