Joint associations of accelerometer-measured physical activity and cardiovascular-kidney-metabolic syndrome stages with the risks of cancer and all-cause mortality

Abstract Background Cardiovascular-kidney-metabolic (CKM) syndrome significantly increases cancer and mortality risks, but the combined effects of CKM syndrome and physical activity (PA) on these outcomes remain poorly understood. Methods This prospective study included 66,650 UK Biobank participants with accelerometry data. CKM syndrome was classified into five stages based on metabolic, kidney, and cardiovascular health. PA was categorized by intensity into light (LPA), moderate (MPA), vigorous (VPA), and moderate-to-vigorous (MVPA) levels, and further divided into tertiles by daily duration. Multivariable Cox models were used to estimate hazard ratios. Results Over a median follow-up of 8.03 years, 4,301 incident cancer cases and 2,442 deaths occurred. Advancing CKM stages were associated with elevated risks of both cancer incidence and all cause mortality, while increasing PA levels reduced these risks. Significant interactions were observed between CKM syndrome and both MPA and MVPA on cancer and mortality risks (P interaction < 0.05). In participants with the lowest tertile of MPA or MVPA, those in stages 2 and 4 had higher cancer risk, while in the highest tertile, this risk was no longer elevated. For all-cause mortality, in participants with the lowest tertile of MPA or MVPA, CKM stage 3 exhibited higher risks, while those in the highest tertile did not. CKM stage 4 remained associated with higher mortality across all PA intensity levels, but risks decreased with increasing MVPA levels. Conclusions Higher levels of MPA and MVPA may mitigate the elevated risks of both cancer incidence and all-cause mortality associated with CKM stages 2 to 4.