Differential patterns of the relationship between exercise dose and mortality risk across severities of airflow limitation: a prospective cohort study with a 5-year follow-up period

Objective: This study examines the dose–response relationship between physical activity (PA) and all-cause mortality across different severities of airflow limitation, identifying threshold effects that yield new insights into the PA–mortality association. Design: A prospective cohort study with a...

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Main Authors: Yide Wang, Hongxia Duan, Yingqi Wang, Yidie Bao, Linhong Jiang, Xiaoyu Han, Fengsen Li, Peijun Li, Weibing Wu, Xiaodan Liu
Format: Article
Language:English
Published: Medical Journals Sweden 2025-06-01
Series:Journal of Rehabilitation Medicine
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Online Access:https://medicaljournalssweden.se/jrm/article/view/43377
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author Yide Wang
Hongxia Duan
Yingqi Wang
Yidie Bao
Linhong Jiang
Xiaoyu Han
Fengsen Li
Peijun Li
Weibing Wu
Xiaodan Liu
author_facet Yide Wang
Hongxia Duan
Yingqi Wang
Yidie Bao
Linhong Jiang
Xiaoyu Han
Fengsen Li
Peijun Li
Weibing Wu
Xiaodan Liu
author_sort Yide Wang
collection DOAJ
description Objective: This study examines the dose–response relationship between physical activity (PA) and all-cause mortality across different severities of airflow limitation, identifying threshold effects that yield new insights into the PA–mortality association. Design: A prospective cohort study with a 5-year follow-up (2018–2023), employing multivariate Cox models and penalized spline smoothing to assess non-linear associations. Subjects/Patients: A total of 2,975 individuals from a cohort categorized by airflow limitation severity (normal, GOLD 1–4). Methods: PA levels were quantified in metabolic equivalent hours per week (MET·h/week). Cox proportional hazards models were used to evaluate PA–mortality associations, with penalized spline analysis detecting threshold effects. Results: Identified thresholds were 41.50 MET·h/week (95% CI: 23.03–64.22) for normal lung function and 13.21 MET·h/week (95% CI: 9.67–16.14) for GOLD 1. Below these thresholds, higher PA levels were associated with a significant reduction in mortality risk (HR = 0.66, HR = 0.41, respectively). In GOLD 2, PA levels below the threshold were associated with a lower mortality risk (HR=0.85), whereas PA exceeding the threshold was associated with a higher mortality risk (HR = 1.23). No significant associations were observed in GOLD 3–4. Conclusion: PA demonstrates a non-linear, threshold-dependent association with mortality. These findings underscore the importance of individualized PA recommendations for optimizing health outcomes in individuals with chronic respiratory conditions.
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spelling doaj-art-38c88fc3aebf4629971572a35f3366ca2025-08-20T02:39:28ZengMedical Journals SwedenJournal of Rehabilitation Medicine1651-20812025-06-015710.2340/jrm.v57.43377Differential patterns of the relationship between exercise dose and mortality risk across severities of airflow limitation: a prospective cohort study with a 5-year follow-up periodYide Wang0Hongxia Duan1Yingqi Wang2Yidie Bao3Linhong Jiang4Xiaoyu Han5Fengsen Li6Peijun Li7Weibing Wu8Xiaodan Liu9Department of Rehabilitation, The Fourth Clinical Medical College of Xinjiang Medical University, Urumqi, Xinjiang, ChinaSchool of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, ChinaSchool of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, ChinaSchool of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, ChinaSchool of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, ChinaDepartment of Sports Rehabilitation, Shanghai University of Sport, Shanghai, ChinaDepartment of Integrated Pulmonology, Fourth Clinical Medical College of Xinjiang Medical University, Urumqi, ChinaSchool of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, ChinaDepartment of Sports Rehabilitation, Shanghai University of Sport, Shanghai, ChinaSchool of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Institute of Rehabilitation Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China; Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, ChinaObjective: This study examines the dose–response relationship between physical activity (PA) and all-cause mortality across different severities of airflow limitation, identifying threshold effects that yield new insights into the PA–mortality association. Design: A prospective cohort study with a 5-year follow-up (2018–2023), employing multivariate Cox models and penalized spline smoothing to assess non-linear associations. Subjects/Patients: A total of 2,975 individuals from a cohort categorized by airflow limitation severity (normal, GOLD 1–4). Methods: PA levels were quantified in metabolic equivalent hours per week (MET·h/week). Cox proportional hazards models were used to evaluate PA–mortality associations, with penalized spline analysis detecting threshold effects. Results: Identified thresholds were 41.50 MET·h/week (95% CI: 23.03–64.22) for normal lung function and 13.21 MET·h/week (95% CI: 9.67–16.14) for GOLD 1. Below these thresholds, higher PA levels were associated with a significant reduction in mortality risk (HR = 0.66, HR = 0.41, respectively). In GOLD 2, PA levels below the threshold were associated with a lower mortality risk (HR=0.85), whereas PA exceeding the threshold was associated with a higher mortality risk (HR = 1.23). No significant associations were observed in GOLD 3–4. Conclusion: PA demonstrates a non-linear, threshold-dependent association with mortality. These findings underscore the importance of individualized PA recommendations for optimizing health outcomes in individuals with chronic respiratory conditions. https://medicaljournalssweden.se/jrm/article/view/43377Airflow limitationMortality riskPhysical activity dosageProspective cohort
spellingShingle Yide Wang
Hongxia Duan
Yingqi Wang
Yidie Bao
Linhong Jiang
Xiaoyu Han
Fengsen Li
Peijun Li
Weibing Wu
Xiaodan Liu
Differential patterns of the relationship between exercise dose and mortality risk across severities of airflow limitation: a prospective cohort study with a 5-year follow-up period
Journal of Rehabilitation Medicine
Airflow limitation
Mortality risk
Physical activity dosage
Prospective cohort
title Differential patterns of the relationship between exercise dose and mortality risk across severities of airflow limitation: a prospective cohort study with a 5-year follow-up period
title_full Differential patterns of the relationship between exercise dose and mortality risk across severities of airflow limitation: a prospective cohort study with a 5-year follow-up period
title_fullStr Differential patterns of the relationship between exercise dose and mortality risk across severities of airflow limitation: a prospective cohort study with a 5-year follow-up period
title_full_unstemmed Differential patterns of the relationship between exercise dose and mortality risk across severities of airflow limitation: a prospective cohort study with a 5-year follow-up period
title_short Differential patterns of the relationship between exercise dose and mortality risk across severities of airflow limitation: a prospective cohort study with a 5-year follow-up period
title_sort differential patterns of the relationship between exercise dose and mortality risk across severities of airflow limitation a prospective cohort study with a 5 year follow up period
topic Airflow limitation
Mortality risk
Physical activity dosage
Prospective cohort
url https://medicaljournalssweden.se/jrm/article/view/43377
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