Trends in Adherence to Recommended Physical Activity and Its Association with Mortality and Disease Progression Among US Adults with Chronic Kidney Disease

Introduction: This study aimed to examine the trends in adherence to the Physical Activity Guidelines (PAG) for aerobic activity and sedentary time and their effects on mortality and disease progression among US adults with chronic kidney disease (CKD).

Methods: We studied individuals from the National Health and Nutrition Examination Survey 2007-08 to 2017-18 with a mortality file in 2015. Multivariate regression models were used to evaluate the association between adherence to PAG and sedentary time with mortality, estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio.

Results: For the CKD population, adherence rate increased from 48.2% in 2007-08 to 55.0% in 2017-18, and sedentary time peaked in 2013-14 (7.5 h/day) and then decreased afterward. There was no difference in the trends across the non-CKD and CKD population. For the CKD population, adherence to the PAG was significantly associated with all-cause mortality (HR, 0.49; 95% CI: 0.38-0.63), malignant neoplasm mortality (HR, 0.30; 95% CI: 0.17-0.52), and albumin-creatinine ratio (OR, -0.27; 95% CI: -0.39 to -0.15). Sedentary time was significantly associated with all-cause mortality (HR, 1.12; 95% CI: 1.08-1.15), heart disease mortality (HR, 1.13; 95% CI: 1.08-1.19), and eGFR (OR, -0.49; 95% CI: -0.72 to -0.26).

Conclusions: Favorable trends were observed in adherence to the PAG and sedentary time. Adherence to the PAG and reduction in sedentary time reduced all-cause and cause-specific mortality and prevented disease progression differently. Efforts are needed to decrease sedentary time rather than adhering to the PAG for aerobic activity alone.