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

Authors

  • Yide Wang Department of Rehabilitation, The Fourth Clinical Medical College of Xinjiang Medical University, Urumqi, Xinjiang, China
  • Hongxia Duan School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
  • Yingqi Wang School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
  • Yidie Bao School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
  • Linhong Jiang School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
  • Xiaoyu Han Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
  • Fengsen Li Department of Integrated Pulmonology, Fourth Clinical Medical College of Xinjiang Medical University, Urumqi, China
  • Peijun Li School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
  • Weibing Wu Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
  • Xiaodan Liu School 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, China

DOI:

https://doi.org/10.2340/jrm.v57.43377

Keywords:

Airflow limitation, Mortality risk, Physical activity dosage, Prospective cohort

Abstract

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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Published

2025-06-16

How to Cite

Wang, Y., Duan, H., Wang, Y., Bao, Y., Jiang, L., Han, X., … Liu, X. (2025). 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, 57, jrm43377. https://doi.org/10.2340/jrm.v57.43377

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Vol. 57 (2025)

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Original Report

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Copyright (c) 2025 Yide Wang, Hongxia Duan, Yingqi Wang, Yidie Bao, Linhong Jiang, Xiaoyu Han, Fengsen Li, Peijun Li, Weibing Wu, Xiaodan Liu

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