Association of domain-specific physical activity with nocturia: a population- based study

Association of domain-specific physical activity with nocturia: a population- based study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Association of domain-specific physical activity with nocturia: a population- based study Yangtao Jia, Rui Shen, Xinke Dong, Fangzheng Yang, Libin Zhou, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5275372/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Jan, 2025 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Background Nocturia is the most prevalent lower urinary tract symptom (LUTS) and is closely associated with various diseases and social burdens. This study aimed to investigate the relationship between different domains of physical activity (e.g., occupation-related physical activity [OPA], transportation-related physical activity [TPA], and leisure-time physical activity [LTPA]) and nocturia. Methods This study included 5516 participants from the cross-sectional National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2012. We employed survey-weighted logistic regression, restricted cubic splines (RCS), subgroup analysis, and sensitivity analysis to assess the relationship between different domains of physical activity and nocturia. Results Multivariable logistic regression analysis revealed a significant negative correlation between PA, LTPA, and nocturia. Specifically, PA (OR: 0.7523, 95% CI: 0.6307–0.8974, P = 0.002) and LTPA (OR: 0.7664, 95% CI: 0.6314–0.9304, P = 0.007) were negatively associated with nocturia. The RCS curve demonstrated non-linear relationships between PA, LTPA, and nocturia. Additionally, subgroup analyses and sensitivity analyses further validated this association. Conclusion Based on this cross-sectional study, we hypothesize that PA and LTPA are associated with a reduced risk of nocturia in adults aged 20 years and older in the United States. This underscoring the importance of physical activity in preventing and managing nocturia may provide valuable guidance for clinical practice. Health sciences/Urology/Bladder Health sciences/Urology/Urethra Health sciences/Urology/Urological manifestations Health sciences/Health care/Disease prevention Health sciences/Health care/Geriatrics Health sciences/Health care/Public health Health sciences/Health care/Quality of life NHANES nocturia physical activity U.S. adults Cross-sectional analysis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Nocturia is the most common and bothersome lower urinary tract symptom (LUTS), accounting for 33% of all LUTS-related complaints 1 . This symptom may be associated with multiple factors, including excessive urine production, increased nocturnal urine output, bladder storage issues, and reduced bladder capacity 2 . The International Continence Society defined nocturia as "the need to routinely void one or more times during the night, with each void preceded and followed by sleep, with two or more voids per night considered an average threshold for bothersomeness 3 ." Typically, two or more voids per night are associated with decreased quality of life and increased mortality 4-6 . Previously, nocturia was not defined as an independent symptom; instead, it was considered a manifestation of overactive bladder (OAB) and benign prostatic hyperplasia (BPH) 7,8 . With continued research, nocturia has been identified as an independent symptom strongly associated with various chronic diseases and contributes to significant societal burdens, garnering widespread research interest 8-10 . Nocturia is not only highly prevalent — for example, among individuals aged 0-40 years, nocturia prevalence ranges from 11.0% to 35.2% in men and 20.4% to 43.9% in women, and in individuals aged 40-65 years, prevalence can reach 50% — but is also often challenging to treat in men 11-13 . Furthermore, studies have shown that nocturia is associated with several adverse health outcomes, such as depression, sleep disturbances, diabetes, and elevated mortality 14-16 . Physical activity (PA) is a complex behavior that generates energy expenditure and is typically classified by light, moderate, or vigorous intensity. It can also be categorized by domain into occupation-related PA (OPA), transportation-related PA (TPA), and leisure-time PA (LTPA). Previous studies have suggested that PA can reduce the risk of various diseases, such as diabetes, depression, and colorectal cancer, through multiple mechanisms 17-19 . Specifically, several studies have indicated that physical activity and moderate exercise can significantly reduce nocturnal urine output 20-22 . This effect may occur through mechanisms such as reducing sympathetic nervous system activity and lowering systemic inflammation levels 1,23 . However, a study has also shown that increased physical activity significantly increases nighttime and 24-hour urine output, conflicting with the previously mentioned findings 24 . In summary, whether all domains of PA (e.g., OPA, TPA, LTPA, and total PA) exert equally beneficial effects on nocturia remains unclear and controversial. Few studies have investigated the relationship between PA and nocturia, with most previous research focusing on total PA and little attention given to the correlation between different domains of PA and nocturia. Given the above discussion, it is necessary to study the relationship between different domains of PA and nocturia through a large population study. Thus, in this paper, we explored the relationship between different domains of physical activity (including OPA, TPA, LTPA, and total PA) and nocturia risk in adults of all ages by analyzing data from the National Health and Nutrition Examination Survey (NHANES), suggested that physical activity is associated with a reduced risk of nocturia, thereby filling the existing knowledge gap. Materials And Methods 2.1 Data source The study population was derived from the NHANES, a nationally representative cross-sectional survey of the civilian, noninstitutionalized population residing in the United States. This survey collected comprehensive data on the health and nutritional status of U.S. citizens to assess the population's overall well-being. All data are accessible through the NHANES website (https://www.cdc.gov/nchs/nhanes/index.htm). 2.2 Study population We selected cross-sectional data from three NHANES cycles: 2007-2008, 2009-2010, and 2011-2012. A total of 30442 participants were included in the study, from which those meeting the following exclusion criteria were removed: (1) under the age of 20; (2) participants with missing nocturia data (3) participants with missing physical activity data; (4) participants with missing covariate data (5) those diagnosed with prostate cancer; (6) those who had undergone prostate surgery; (7) those with prostate infection or inflammation; (8) those who had undergone a digital rectal exam within the past seven days; (9) those who had undergone a prostate biopsy within the past four weeks; (10) those who had undergone cystoscopy within the past four weeks; (11) those who had used diuretics within the past month; (12) pregnant or breastfeeding women. Following this rigorous screening process, the final sample consisted of 5516 participants. The participant selection process was illustrated in Figure 1. Figure 1 The flowchart of the selection process for participants from 2007 to 2012. 2.3 Exposure and outcome Nocturia screening was conducted using a questionnaire that asked, "During the past 30 days, how many times per night did you most typically get up to urinate from the time you went to bed until waking up in the morning?" Responses were categorized into six groups: 0 times/night, 1 time/night, 2 times/night, 3 times/night, 4 times/night, and 5 or more times/night. Participants reporting urinating ≥2 times per night were defined as having nocturia. Physical activity data were collected using the Global Physical Activity Questionnaire (GPAQ). This questionnaire categorized physical activity into OPA, TPA, and LTPA and recorded the frequency (number of times per week) and duration (time per session) of these activities. OPA and LTPA were further subdivided into vigorous and moderate activities based on intensity. The formula for calculating the weekly duration of OPA and LTPA (in minutes) is as follows: Duration of OPA and LTPA per week (min) = (number of vigorous physical activity sessions per week × duration of each vigorous session × 2) + (number of moderate-intensity sessions per week × duration of each moderate-intensity session). Duration of TPA per week (min) = number of moderate-intensity sessions per week × duration of each moderate-intensity session 25 . Total physical activity is the sum of OPA, TPA, and LTPA. Participants were classified as having diabetes if they met any of the following criteria: (1) previously diagnosed with diabetes, (2) taking prescription diabetes medications, (3) fasting blood glucose level ≥12.6 mmol/L, or (4) hemoglobin A1c level ≥6.5% 26 . Hypertension was diagnosed in participants who met any of the following criteria: (1) previously diagnosed with hypertension, (2) taking prescription hypertension medications, (3) systolic blood pressure ≥130 mmHg, or diastolic blood pressure ≥80 mmHg during physical examination 27 . According to the Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program (NCEP), hyperlipidemia was defined by any of the following criteria: total cholesterol level ≥200 mg/dL, triglyceride level ≥150 mg/dL, high-density lipoprotein (HDL) level ≤40 mg/dL in men or ≤50 mg/dL in women, or low-density lipoprotein (LDL) level ≥130 mg/dL 28 . 2.4 Covariates This study included three types of covariates: sociodemographic factors (age, gender, race/ethnicity, education level, PIR, marital status), lifestyle behaviors (serum cotinine concentration, alcohol consumption), and chronic diseases (hypertension, diabetes, hyperlipidemia). Participants were divided into two age groups (20-50 years, ≥50 years), and race was categorized into five groups (non-Hispanic White, non-Hispanic Black, Mexican American, other Hispanic, and other races). Educational attainment was classified as less than high school, high school graduate, and more than high school. PIR (4) and serum cotinine concentration (3 ng/mL) were divided into three categories. Gender (male, female), marital status (married/living with partner, widowed/divorced/separated/never married), diabetes history (yes, no), hypertension history (yes, no), alcohol consumption history (yes, no), and hyperlipidemia history (yes, no) were also categorized into two groups. 2.5 Statistical analysis Given the complex stratified and cluster sampling design of NHANES, we performed weighted analyses in this study. Since data from three cycles were included, the combined weight was expressed as WEIGHT 07-12 = (1/3) × WTMEC2YR 07-08 + (1/3) × WTMEC2YR 09-10 + (1/3) × WTMEC2YR 11-12 . Initially, we utilized t-tests or ANOVA to compare differences between groups and assess the characteristics of nocturia and non-nocturia participants, with continuous variables expressed as mean ± standard deviation and categorical variables presented as counts and percentages. Subsequently, we employed survey-weighted logistic regression models to evaluate the relationship between different domains of physical activity and nocturia risk. Model 1 was unadjusted; Model 2 adjusted for age, gender, and race; and Model 3 further adjusted for marital status, education level, serum cotinine concentration, alcohol consumption, PIR, diabetes, hypertension, and hyperlipidemia, based on Model 2. Additionally, weighted restricted cubic splines (RCS) were applied to analyze the non-linear relationship between various domains of physical activity and nocturia, adjusting for all covariates. Finally, interaction and stratified analyses were conducted considering the listed covariates, and propensity score matching (PSM) was performed to verify the stability of the relationship between physical activity domains and nocturia risk. All statistical analyses were conducted using R software (version 4.2.2) and STATA v16.0, with a significance threshold set at P < 0.05. Results 3.1 Prevalence analysis We first analyzed the prevalence of nocturia across three NHANES cycles from 2007 to 2012 and created a bar-line chart to present the results intuitively. (Figure 2) The findings indicated a high prevalence of nocturia in the overall population, with a notable increase in prevalence as age increased. Figure 2 The prevalence of nocturia in the NHANES database. A: The prevalence of nocturia from 2007 to 2012. B: The prevalence of nocturia from 2007 to 2008. C: The prevalence of nocturia from 2009 to 2010. D: The prevalence of nocturia from 2011 to 2012. 3.2 Characteristics of the study population The research included 5516 participants from the NHANES cycles between 2007 and 2012. (Table 1) In this study, 48.15% of the participants were male, 51.85% were female, and the mean age was 46.26 years (± 0.6 years). Participants were further divided into two groups based on nocturia status: the non-nocturia group comprised 3923 participants (71.12%), while 1593 participants (28.88%) reported nocturia. Significant differences were observed between the two groups in most characteristics, particularly in PA, LTPA, and OPA, which were significantly lower in the nocturia group. However, no significant difference was found in TPA or cotinine levels. Table 1 Characteristics of study population. Nocturia No Yes All P-vaule N 3923 (71.12%) 1593(28.88) 5516(100%) Age(years) 44.04±0.29 53.85±0.49 46.26±0.60 <0.0001 OPA 696.77±28.82 576.82±45.48 669.57±24.56 0.004 TPA 91.01±5.14 80.32±8.06 88.59±4.37 0.176 LTPA 236.77±8.06 151.08±13.21 217.33±6.93 <0.0001 PA 1024.55±31.26 808.22±48.95 975.49±26.62 <0.0001 Age, n (%) <0.0001 20-50 2370 (60.41%) 544 (34.15%) 2914 (52.83%) ≥50 1553 (39.59%) 1049 (65.85%) 2602 (47.17%) Gender, n (%) <0.0001 Female 2120 (54.04%), 740 (46.45%), 2860 (51.85%) Male 1803 (45.96%), 853 (53.55%), 2656 (48.15%) Race, n (%) <0.0001 Mexican American 633 (16.14%) 299 (18.77%) 932 (16.90%) Other Hispanic 395 (10.07%) 195 (12.24%) 590 (10.70%) Non-Hispanic White 1928 (49.15%) 644 (40.43%) 2572 (46.63%) Non-Hispanic Black 621 (15.83%) 370 (23.23%) 991 (17.97%) Other Race - Including Multi-Racial 346 (8.82%) 85 (5.34%) 431 (7.81%) Education, n (%) <0.0001 Less than high school 885 (22.56%) 616 (38.67%) 1501 (27.21%) High school 862 (21.97%) 374 (23.48%) 1236 (22.41%) More than high school 2176 (55.47%) 603 (37.85%) 2779 (50.38%) Marital status, n (%) 0.001 Widowed/Divorced/Separated/Never married 1561 (39.79%) 709 (44.51%) 2270 (41.15%) Married/Living with partner 2362 (60.21%) 884 (55.49%) 3246 (58.85%) PIR, n (%) 4 1077 (27.45%) 285 (17.89%) 1362 (24.69%) Cotinine(ng/mL), n (%) 0.225 3 1132 (28.86%) 426 (26.74%) 1558 (28.25%) Drink at least 12 drinks/year, n (%) <0.0001 No 923 (23.53%) 496 (31.14%) 1419 (25.73%) Yes 3000 (76.47%) 1097 (68.86%) 4097 (74.27%) Diabetes history, n (%) <0.0001 No 3221 (82.11%) 1049 (65.85%) 4270 (77.41%) Yes 702 (17.89%) 544 (34.15%) 1246 (22.59%) Hypertension history, n (%) <0.0001 No 2050 (52.26%) 529 (33.21%) 2579 (46.75%) Yes 1873 (47.74%) 1064 (66.79%) 2937 (53.25%) Hyperlipidemia history, n (%) 0.001 No 1246 (31.76%) 434 (27.24%) 1680 (30.46%) Yes 2677 (68.24%) 1159 (72.76%) 3836 (69.54%) 3.3 Linear association between physical activity and nocturia We utilized a survey-weighted logistic regression model to assess the associations between different domains of physical activity and the risk of nocturia. As shown in Table 2, total PA (OR: 0.5176, 95% CI: 0.4418-0.6064, P < 0.0001), OPA (OR: 0.8056, 95% CI: 0.6832-0.9500, P = 0.01), and LTPA (OR: 0.5227, 95% CI: 0.4382-0.6235, P < 0.0001) were negatively associated with nocturia risk. After adjusting for all confounders, the association between OPA and nocturia was no longer significant, while total PA (OR: 0.7523, 95% CI: 0.6307-0.8974, P = 0.002) and LTPA (OR: 0.7664, 95% CI: 0.6314-0.9304, P = 0.007) remained negatively associated with nocturia risk. We further examined the dose-response relationship between PA and nocturia by categorizing PA into four groups (0 min/week, 1-149 min/week, 150-299 min/week, and ≥300 min/week). (Figure 3) Even in fully adjusted models, total PA in the 150-299 min/week (OR: 0.7121, 95% CI: 0.5296-0.9575, P = 0.025) and ≥300 min/week (OR: 0.7279, 95% CI: 0.5937-0.8925, P = 0.002) groups showed a significant negative association with nocturia risk. LTPA ≥300 min/week (OR: 0.7368, 95% CI: 0.5796-0.9365, P = 0.013) also demonstrated a significant negative correlation. Table 2 Multivariable OR for nocturia based on the meeting PA guideline. Model 1 Model 2 Model 3 Total PA OR （ 95%CI ） P-value Total PA OR （ 95%CI ） P-value Total PA OR （ 95%CI ） P-value No Reference Reference No Reference Reference No Reference Reference Yes 0.5176 (0.4418, 0.6064) <0.0001 Yes 0.6441 (0.5448, 0.7615) <0.0001 Yes 0.7523 (0.6307, 0.8974) 0.002 Occupation-related PA Occupation-related PA Occupation-related PA No Reference Reference No Reference Reference No Reference Reference Yes 0.8056 (0.6832, 0.9500) 0.01 Yes 0.9365 (0.7858, 1.1162) 0.464 Yes 0.9416 (0.7863, 1.1276) 0.513 Transportation-related PA Transportation-related PA Transportation-related PA No Reference Reference No Reference Reference No Reference Reference Yes 0.8409 (0.6719, 1.0524) 0.13 Yes 0.9181 (0.7255, 1.1617) 0.477 Yes 0.9437 (0.7387, 1.2058) 0.643 Leisure-time PA Leisure-time PA Leisure-time PA No Reference Reference No Reference Reference No Reference Reference Yes 0.5227 (0.4382, 0.6235) <0.0001 Yes 0.6131 (0.5099, 0.7372) <0.0001 Yes 0.7664 (0.6314, 0.9304) 0.007 Model 1 adjusts for none. Model 2 adjusts for age, ethnicity, and gender. Model 3 adjusts for age, gender, ethnicity, education, marital status, PIR status, serum cotinine, alcohol status, hypertension history, diabetes history and hyperlipemia history Figure 3 Odds ratios for the nocturia based on the amount of PA in model 1 (A), model 2 (B) and model 3 (C). 3.4 Non-Linear relationship between physical activity and nocturia We employed the RCS curve to describe the non-linear relationships between various physical activity domains and nocturia. (Figure 4) In the RCS model, total PA (P for non-linear < 0.0001) and LTPA (P for non-linear = 0.0486) exhibited significant non-linear relationships with nocturia. Total PA initially decreased to a nadir at 7.143 h/week, then slightly increased and peaked at 47.619 h/week before gradually decreasing again. LTPA decreased to a low point at 5.364 h/week, followed by a slight rise and stabilization. No significant non-linear relationship was identified between TPA, OPA, and nocturia. Figure 4 Non-linear association between PA (A), OPA (B), TPA (C), LTPA (D) and nocturia. 3.5 Propensity score matching and subgroup analyses To further assess the robustness of the association between PA and nocturia, we performed sensitivity analyses using PSM. The characteristics of the study population regarding PSM analysis were displayed in Table S1. After applying the same survey-weighted logistic regression model, the results still indicated a negative association between total PA (OR: 0.8393, 95% CI: 0.6901-1.020, P = 0.039) and nocturia. (Table 3) Furthermore, we conducted subgroup analyses stratified by all confounders, revealing that PA was significantly associated with nocturia across most strata, including age ≥50, female, Non-Hispanic White, education level (more than high school), marital status (married/living with partner), PIR between 1 and 4, cotinine concentration between 0.015ng/mL and 3ng/mL, alcohol consumption, hypertension, diabetes, and hyperlipidemia. (Figure 5) However, no significant interaction effects were observed. In the subgroup analysis of the association between total PA and nocturia frequency, we identified a significant interaction effect in the hyperlipidemia (P = 0.006). (Figure S1) Table 3 Multivariable OR for nocturia based on the meeting PA guideline in the propensity score matching. Model 1 Model 2 Model 3 Total PA OR （ 95%CI ） P-value Total PA OR （ 95%CI ） P-value Total PA OR （ 95%CI ） P-value No Reference Reference No Reference Reference No Reference Reference Yes 0.5226 (0.4326, 0.6313) <0.0001 Yes 0.7476 (0.6080, 0.9191) 0.006 Yes 0.8393 (0.6901, 1.0208) 0.039 Occupation-related PA Occupation-related PA Occupation-related PA No Reference Reference No Reference Reference No Reference Reference Yes 0.7897 (0.6517, 0.9569) 0.016 Yes 1.0393 (0.8420, 1.2829) 0.719 Yes 0.9536 (0.7763, 1.1714) 0.651 Transportation-related PA Transportation-related PA Transportation-related PA No Reference Reference No Reference Reference No Reference Reference Yes 0.8880 (0.6833, 1.1540) 0.374 Yes 1.0653 (0.8022, 1.4148) 0.662 Yes 0.9168 (0.6947, 1.2100) 0.54 Leisure-time PA Leisure-time PA Leisure-time PA No Reference Reference No Reference Reference No Reference Reference Yes 0.5504 (0.4495, 0.6738) <0.0001 Yes 0.7089 (0.5712, 0.8798) 0.002 Yes 0.8412 (0.6731, 1.0514) 0.129 Model 1 adjusts for none. Model 2 adjusts for age, ethnicity, and gender. Model 3 adjusts for age, gender, ethnicity, education, marital status, PIR status, serum cotinine, alcohol status, hypertension history, diabetes history and hyperlipemia history Figure 5 Subgroup analysis of the association between physical activity and nocturia. Discussion Although some studies have explored the association between physical activity and LUTS, nocturia—recognized as the most prevalent and bothersome LUTS in men—has received limited attention 1 . In this nationally representative cross-sectional study, we refined the classification of PA domains and found that total PA and LTPA were associated with a reduced risk of nocturia. These findings align with PA guidelines, which recommend that adults engage in 150-300 minutes of moderate-intensity PA or 75-150 minutes of vigorous-intensity PA per week, or a combination of both. However, no significant associations were observed for OPA or TPA. Previous limited studies have suggested a relationship between PA and nocturia. This study further investigated the association between different PA domains and nocturia. After adjusting for age, gender, and race, we observed a negative correlation between LTPA and total PA with nocturia. This negative correlation remained significant after adjusting for all covariates. Additionally, the RCS curve also suggests a non-linear negative correlation between PA, LTPA, and nocturia over a certain duration. Furthermore, sensitivity analyses validated the stability of this association. In summary, this study elucidated the correlation between PA across various domains and the risk of nocturia, highlighting that managing appropriate durations of PA may help mitigate the risk of nocturia. There is increasing recognition that nocturia is a common chronic condition closely associated to a significant decline in quality of life 29,30 . Previous studies have identified several factors associated with nocturia, including reduced bladder capacity, bladder storage issues, and excessive urine production. As research on nocturia advances, some studies have focused on the impact of PA and demonstrated that appropriate PA serves as a protective factor in preventing nocturia 13,20,21 . However, few studies have investigated whether all PA domains (such as OPA, TPA, and LTPA) affect nocturia equally. For this reason, we conducted a study using the NHANES database to explore the relationship between PA, its various domains, and nocturia. Our findings were consistent with previous reports, suggesting that PA may be an effective strategy for preventing nocturia. A study from the PLCO screening trial cohort indicated a significant negative correlation between PA and severe nocturia in men, with this correlation being more pronounced in individuals with nocturia 15 . Additionally, Sugaya et al. conducted an 8-week walking exercise program involving 30 older men, significantly reducing both nighttime and daytime urination compared to pre-exercise levels 22 . Furthermore, two studies investigated the potential of PA interventions to reduce nocturia in older women found similar results. Yuko et al. recruited 35 older women for a 52-week exercise program, observing significant improvements in overactive bladder symptoms, particularly in frequency and nocturia 15 . Surveys from community-dwelling older women also indicated that lower levels of PA were associated with more frequent nocturia episodes and more severe urinary incontinence symptoms 20 . Meanwhile, our study identified a correlation between the duration of PA and LTPA with nocturia, and the RCS analysis provided an optimal weekly PA duration. Based on our results and previous studies, we hypothesize that PA may influence nocturia and guide clinical treatment. To further explore how appropriate PA prevents nocturia, we reviewed the existing literature to examine its potential mechanisms. One study hypothesized that sustained physical fitness reduces systemic sympathetic nervous system activity at rest and decreases prostatic smooth muscle tension, thereby alleviating lower urinary tract symptoms 31 . Interestingly, studies have found that patients with nocturia significantly reduce nighttime urination frequency and daytime serum catecholamine levels after exercise 22 . The findings further supported previous hypotheses. Additionally, other studies have indicated that elderly individuals with nocturia have significantly lower serum melatonin levels compared to those without nocturia 32 . Melatonin, one of the most potent natural antioxidants, has been reported to treat nocturia effectively when administered before sleep 33 . It has also been found that adjusting PA can enhance melatonin secretion 34 . Based on these findings, we hypothesized that PA might regulate nocturia by promoting melatonin secretion. Furthermore, PA and exercise were well-established for their roles in weight loss, reducing body fat, preventing type 2 diabetes, and maintaining reduced body weight after weight loss 35 . Previous studies have shown that obesity influences the development of nocturia through various mechanisms, such as obesity-induced atherosclerosis in the pelvic arteries, which may result in ischemia-driven collagen deposition and bladder fibrosis. 36,37 . Obesity can also increase intra-abdominal pressure and promote prostate enlargement 38 . Moreover, obesity-related insulin resistance and hyperinsulinemia may activate hypothalamic centers that regulate sympathetic activity, leading to elevated catecholamine levels and promoting prostate enlargement. 39,40 . Therefore, we hypothesized that PA might alleviate nocturia by reducing obesity and regulating it through the abovementioned mechanisms. Based on these findings, the influence of PA on the risk of nocturia is plausible and may serve as a potential indicator for assessing nocturia risk. PA interventions may also help prevent or slow the progression of nocturia. However, the specific mechanisms by which PA influences nocturia warrant further exploration. Our study had several strengths. First, since it was unclear whether all PA domains were equally beneficial for nocturia, we evaluated the associations of total PA, OPA, TPA, and LTPA with nocturia, addressing a gap in the research. Second, NHANES was a nationally representative cross-sectional survey targeting the civilian, noninstitutionalized population residing in the United States. Our results may have had practical implications for guiding nocturia patients with various occupational backgrounds to engage in appropriate PA. Lastly, this was the first attempt to explore the relationship between nocturia and PA using the NHANES database. However, our study had several limitations. First, because NHANES data were cross-sectional, our study only explored associations and could not infer causality. Second, the exact mechanisms by which PA affected nocturia remained unclear. More prospective and experimental studies were needed to evaluate the potential effects of PA on nocturia, verify our hypotheses, and further investigate the underlying mechanisms. Additionally, the domains of physical activity and nocturia were assessed through self-reported questionnaires rather than objective measurements. PA data were limited to one week, making it challenging to capture PA's long-term stability or trends. Finally, despite incorporating various potential confounding factors and applying exclusion criteria, there may have still been unaddressed confounders that could have impacted the precision of our findings. Conclusion This study established a direct association between physical activity and the risk of nocturia, suggesting that total PA and LTPA—but not OPA or TPA—were linked to a reduced risk of nocturia. These findings may guide preventive strategies for nocturia; however, the underlying mechanisms require further exploration. Future studies should expand the study population and further differentiate physical activity by intensity (vigorous, moderate, or combined) and domain (LTPA, TPA, and OPA) to provide clinical insights for nocturia patients across different age groups and severity levels. Additionally, more longitudinal studies and objective measurement data are essential to confirm our hypotheses. Declarations Author contributions JY: Data analysis; writing – original draft, writing – review and editing. SR: supervision or mentorship. DX and YF: Data analysis; validation. LM: Research idea; funding acquisition. ZL: Study design; writing – review and editing. All authors made contributions to the manuscript and have given their approval for the submitted version. Funding The financial support received for this article was provided by the Natural Science Foundation of Ningbo Municipality (2021J281), the Key Cultivating Discipline of LihHuiLi Hospital (2022-P09), and the Ningbo Key Clinical Specialty Construction Project (2023-BZZ). Data availability statement All original data can be accessed publicly through the NHANES database at the following link: https://www.cdc.gov/nchs/nhanes/index.htm. Ethical approval All data in this study were derived from the National Health and Nutrition Examination Survey, the survey was approved by the Research Ethics Review Board of the National Center for Health Statistics (NCHS), and all participants provided written informed consent. Conflict of interest The authors declare that they have no conflicts of interest. References Wolin, K. Y. et al. 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(2005) Association of cigarette smoking, alcohol consumption and physical activity with lower urinary tract symptoms in older American men: findings from the third National Health And Nutrition Examination Survey. BJU Int . 96, 77-82. Kupelian, V. et al. (2012) Nocturia and quality of life: results from the Boston area community health survey. Eur Urol . 61, 78-84. Johnson, T. M., 2nd et al. (2016) Pilot Results from a Randomized Trial in Men Comparing Alpha-Adrenergic Antagonist versus Behavior and Exercise for Nocturia and Sleep. Clin Ther . Fan, Y., Wei, F., Lang, Y. & Qi, W. (2015) Meta-analysis of nocturia and risk of all-cause mortality in adult population. Int J Cardiol . 195, 120-122. Divney, A. A. et al. (2019) Diabetes Prevalence by Leisure-, Transportation-, and Occupation-Based Physical Activity Among Racially/Ethnically Diverse U.S. Adults. Diabetes Care . 42, 1241-1247. He, F., Li, Y., Hu, Z. & Zhang, H. (2022) Association of domain-specific physical activity with depressive symptoms: A population-based study. Eur Psychiatry . 66, e5. An, S. & Park, S. (2022) Association of Physical Activity and Sedentary Behavior With the Risk of Colorectal Cancer. J Korean Med Sci . 37, e158. Chu, C. M. et al. (2019) Physical Activity Patterns and Sedentary Behavior in Older Women With Urinary Incontinence: an Accelerometer-based Study. Female Pelvic Med Reconstr Surg . 25, 318-322. Ko, I. G., Lim, M. H., Choi, P. B., Kim, K. H. & Jee, Y. S. (2013) Effect of Long-term Exercise on Voiding Functions in Obese Elderly Women. Int Neurourol J . 17, 130-138. Sugaya, K. et al. (2007) Effects of walking exercise on nocturia in the elderly. Biomed Res . 28, 101-105. Abramson, J. L. & Vaccarino, V. (2002) Relationship between physical activity and inflammation among apparently healthy middle-aged and older US adults. Arch Intern Med . 162, 1286-1292. Deger, M. et al. (2021) The impact of movement, physical activity and position on urine production: A pilot study. Int J Clin Pract . 75, e14743. Kim, D., Vazquez-Montesino, L. M., Li, A. A., Cholankeril, G. & Ahmed, A. (2020) Inadequate Physical Activity and Sedentary Behavior Are Independent Predictors of Nonalcoholic Fatty Liver Disease. Hepatology . 72, 1556-1568. ElSayed, N. A. et al. (2023) 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023. Diabetes Care . 46, S19-S40. Whelton, P. K. et al. (2018) 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation . 138, e426-e483. National Cholesterol Education Program Expert Panel on Detection, E. & Treatment of High Blood Cholesterol in, A. (2002) Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation . 106, 3143-3421. Vaughan, C. P. & Bliwise, D. L. (2018) Sleep and Nocturia in Older Adults. Sleep Med Clin . 13, 107-116. Agarwal, A. et al. (2014) What is the most bothersome lower urinary tract symptom? Individual- and population-level perspectives for both men and women. Eur Urol . 65, 1211-1217. Hart, L. E. (1999) Physical activity and benign prostatic hyperplasia. Clin J Sport Med . 9, 106. Sugaya, K. et al. (2008) Biochemical and body composition analysis of nocturia in the elderly. Neurourol Urodyn . 27, 205-211. Drake, M. J., Mills, I. W. & Noble, J. G. (2004) Melatonin pharmacotherapy for nocturia in men with benign prostatic enlargement. J Urol . 171, 1199-1202. Kruk, J., Aboul-Enein, B. H. & Duchnik, E. (2021) Exercise-induced oxidative stress and melatonin supplementation: current evidence. J Physiol Sci . 71, 27. Oppert, J. M., Bellicha, A. & Ciangura, C. (2021) Physical activity in management of persons with obesity. Eur J Intern Med . 93, 8-12. Laven, B. A. et al. (2008) Birth weight, abdominal obesity and the risk of lower urinary tract symptoms in a population based study of Swedish men. J Urol . 179, 1891-1895; discussion 1895-1896. Tarcan, T., Azadzoi, K. M., Siroky, M. B., Goldstein, I. & Krane, R. J. (1998) Age-related erectile and voiding dysfunction: the role of arterial insufficiency. Br J Urol . 82 Suppl 1, 26-33. Lee, S. H. et al. (2009) Effects of obesity on lower urinary tract symptoms in Korean BPH patients. Asian J Androl . 11, 663-668. Hammarsten, J. & Hogstedt, B. (2001) Hyperinsulinaemia as a risk factor for developing benign prostatic hyperplasia. Eur Urol . 39, 151-158. Alvarez, G. E., Beske, S. D., Ballard, T. P. & Davy, K. P. (2002) Sympathetic neural activation in visceral obesity. Circulation . 106, 2533-2536. Additional Declarations No competing interests reported. Supplementary Files TableS1.docx FigureS1.tiff Cite Share Download PDF Status: Published Journal Publication published 22 Jan, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 23 Dec, 2024 Reviews received at journal 20 Dec, 2024 Reviewers agreed at journal 20 Dec, 2024 Reviews received at journal 02 Nov, 2024 Reviewers agreed at journal 30 Oct, 2024 Reviewers invited by journal 30 Oct, 2024 Editor assigned by journal 30 Oct, 2024 Editor invited by journal 30 Oct, 2024 Submission checks completed at journal 29 Oct, 2024 First submitted to journal 16 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5275372","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":373794769,"identity":"cf914801-3da3-4689-82d7-37dce55d9998","order_by":0,"name":"Yangtao Jia","email":"","orcid":"","institution":"The Affiliated Lihuili hospital of Ningbo University","correspondingAuthor":false,"prefix":"","firstName":"Yangtao","middleName":"","lastName":"Jia","suffix":""},{"id":373794771,"identity":"4ba7918f-1951-4e0c-b77c-1a0414e6c347","order_by":1,"name":"Rui Shen","email":"","orcid":"","institution":"The Affiliated Lihuili hospital of Ningbo University","correspondingAuthor":false,"prefix":"","firstName":"Rui","middleName":"","lastName":"Shen","suffix":""},{"id":373794772,"identity":"f7bc0ee7-e860-4ecd-ac41-628ae224f7cc","order_by":2,"name":"Xinke Dong","email":"","orcid":"","institution":"The Affiliated Lihuili hospital of Ningbo University","correspondingAuthor":false,"prefix":"","firstName":"Xinke","middleName":"","lastName":"Dong","suffix":""},{"id":373794773,"identity":"9bf16b5c-8e53-46ba-a006-8483aea3c549","order_by":3,"name":"Fangzheng Yang","email":"","orcid":"","institution":"The Affiliated Lihuili hospital of Ningbo University","correspondingAuthor":false,"prefix":"","firstName":"Fangzheng","middleName":"","lastName":"Yang","suffix":""},{"id":373794774,"identity":"61bdb6c5-a4ab-4e7e-830a-6408f91f9090","order_by":4,"name":"Libin Zhou","email":"","orcid":"","institution":"The Affiliated Lihuili hospital of Ningbo University","correspondingAuthor":false,"prefix":"","firstName":"Libin","middleName":"","lastName":"Zhou","suffix":""},{"id":373794775,"identity":"77ab0b44-5e8b-4f3c-924d-9eb58f943c50","order_by":5,"name":"Huimin Long","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIie3OsQrCMBCA4ZNCF1NdK/oQAUEQwWcxdC9IFweViNDRvSA+Q0EojgkHdlFcBR10cXIRwdlGHLq01k0w/5DccB8JgE73g1VsYyKSuwcGgIBBMiTZecS0SzxFNl8RVckvQuoTLm6rkUvjMsP+4uhSYcgDga6bSRqSy2ATexStEIPo4lFhOh0Cjpf9McbR8tcsVMSKkIWCtOoEBOPFyFyR6qMIGb4Jf71ifiQy8AULFCFr9GpoNttz6mSSqu3I080fs9luu7yTIbqVeHreXwfdTPIOU7OhDpq/nzT+uKHT6XR/3BPDPGNP/1sbtQAAAABJRU5ErkJggg==","orcid":"","institution":"The Affiliated Lihuili hospital of Ningbo University","correspondingAuthor":true,"prefix":"","firstName":"Huimin","middleName":"","lastName":"Long","suffix":""}],"badges":[],"createdAt":"2024-10-16 11:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5275372/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5275372/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-86182-w","type":"published","date":"2025-01-22T15:57:34+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":69437912,"identity":"41b3a480-13e4-4290-8569-6f100ee8dde7","added_by":"auto","created_at":"2024-11-20 10:53:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1077386,"visible":true,"origin":"","legend":"\u003cp\u003eThe flowchart of the selection process for participants from 2007 to 2012.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-5275372/v1/21b02ddf7338278290dfbaf7.png"},{"id":69437202,"identity":"7b21b738-a2f9-43e0-a3ba-342dcd48990f","added_by":"auto","created_at":"2024-11-20 10:45:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1049335,"visible":true,"origin":"","legend":"\u003cp\u003eThe prevalence of nocturia in the NHANES database. A: The prevalence of nocturia from 2007 to 2012. B: The prevalence of nocturia from 2007 to 2008. C: The prevalence of nocturia from 2009 to 2010. D: The prevalence of nocturia from 2011 to 2012.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-5275372/v1/5046a5cf38a69f75f5877da0.png"},{"id":69437205,"identity":"111c4950-88e7-4196-b36f-09b5f0dbaa5d","added_by":"auto","created_at":"2024-11-20 10:45:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":860745,"visible":true,"origin":"","legend":"\u003cp\u003eOdds ratios for the nocturia based on the amount of PA in model 1 (A), model 2 (B) and model 3 (C).\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-5275372/v1/0732b786b8c7f4258797e900.png"},{"id":69437911,"identity":"c5819d9b-74fe-4ceb-aab4-0f1fd3e16efd","added_by":"auto","created_at":"2024-11-20 10:53:00","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1859132,"visible":true,"origin":"","legend":"\u003cp\u003eNon-linear association between PA (A), OPA (B), TPA (C), LTPA (D) and nocturia.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-5275372/v1/0598a0037c5fe181dca67e8d.png"},{"id":69437208,"identity":"8e8cb524-f3ee-4d6c-b32e-940cba7d0cb2","added_by":"auto","created_at":"2024-11-20 10:45:00","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":3526868,"visible":true,"origin":"","legend":"\u003cp\u003eSubgroup analysis of the association between physical activity and nocturia.\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-5275372/v1/7febb983764cdfe8bc060d81.png"},{"id":74858589,"identity":"6149f8a3-e344-4947-954c-b00c96a1f49b","added_by":"auto","created_at":"2025-01-27 16:11:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":11079394,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5275372/v1/39adb6d2-3e1f-42fd-b65a-99666a853b16.pdf"},{"id":69437204,"identity":"701449c3-bec6-4666-99d5-fb4256088a18","added_by":"auto","created_at":"2024-11-20 10:45:00","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":21442,"visible":true,"origin":"","legend":"","description":"","filename":"TableS1.docx","url":"https://assets-eu.researchsquare.com/files/rs-5275372/v1/5dc757e719416fa6d05fa9bb.docx"},{"id":69439191,"identity":"eded66ac-a561-4fa2-bd83-fc43082383e9","added_by":"auto","created_at":"2024-11-20 11:01:00","extension":"tiff","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":786052,"visible":true,"origin":"","legend":"","description":"","filename":"FigureS1.tiff","url":"https://assets-eu.researchsquare.com/files/rs-5275372/v1/719c4060a299974fe2d609f4.tiff"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association of domain-specific physical activity with nocturia: a population- based study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNocturia is the most common and bothersome lower urinary tract symptom (LUTS), accounting for 33% of all LUTS-related complaints\u003csup\u003e1\u003c/sup\u003e. This symptom may be associated with multiple factors, including excessive urine production, increased nocturnal urine output, bladder storage issues, and reduced bladder capacity\u003csup\u003e2\u003c/sup\u003e. The International Continence Society defined nocturia as \u0026quot;the need to routinely void one or more times during the night, with each void preceded and followed by sleep, with two or more voids per night considered an average threshold for bothersomeness\u003csup\u003e3\u003c/sup\u003e.\u0026quot; Typically, two or more voids per night are associated with decreased quality of life and increased mortality\u003csup\u003e4-6\u003c/sup\u003e. Previously, nocturia was not defined as an independent symptom; instead, it was considered a manifestation of overactive bladder (OAB) and benign prostatic hyperplasia (BPH)\u003csup\u003e7,8\u003c/sup\u003e.\u0026nbsp;\u0026nbsp;With continued research, nocturia has been identified as an independent symptom strongly associated with various chronic diseases and contributes to significant societal burdens, garnering widespread research interest\u003csup\u003e8-10\u003c/sup\u003e. \u0026nbsp; Nocturia is not only highly prevalent \u0026mdash; for example, among individuals aged 0-40 years, nocturia prevalence ranges from 11.0% to 35.2% in men and 20.4% to 43.9% in women, and in individuals aged 40-65 years, prevalence can reach 50% \u0026mdash; but is also often challenging to treat in men\u003csup\u003e11-13\u003c/sup\u003e. Furthermore, studies have shown that nocturia is associated with several adverse health outcomes, such as depression, sleep disturbances, diabetes, and elevated mortality\u003csup\u003e14-16\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003ePhysical activity (PA) is a complex behavior that generates energy expenditure and is typically classified by light, moderate, or vigorous intensity. It can also be categorized by domain into occupation-related PA (OPA), transportation-related PA (TPA), and leisure-time PA (LTPA). Previous studies have suggested that PA can reduce the risk of various diseases, such as diabetes, depression, and colorectal cancer, through multiple mechanisms\u003csup\u003e17-19\u003c/sup\u003e. Specifically, several studies have indicated that physical activity and moderate exercise can significantly reduce nocturnal urine output\u003csup\u003e20-22\u003c/sup\u003e. This effect may occur through mechanisms such as reducing sympathetic nervous system activity and lowering systemic inflammation levels\u003csup\u003e1,23\u003c/sup\u003e. However, a study has also shown that increased physical activity significantly increases nighttime and 24-hour urine output, conflicting with the previously mentioned findings\u003csup\u003e24\u003c/sup\u003e. In summary, whether all domains of PA (e.g., OPA, TPA, LTPA, and total PA) exert equally beneficial effects on nocturia remains unclear and controversial. Few studies have investigated the relationship between PA and nocturia, with most previous research focusing on total PA and little attention given to the correlation between different domains of PA and nocturia.\u003c/p\u003e\n\u003cp\u003eGiven the above discussion, it is necessary to study the relationship between different domains of PA and nocturia through a large population study. Thus, in this paper, we explored the relationship between different domains of physical activity (including OPA, TPA, LTPA, and total PA) and nocturia risk in adults of all ages by analyzing data from the National Health and Nutrition Examination Survey (NHANES), suggested that physical activity is associated with a reduced risk of nocturia, thereby filling the existing knowledge gap.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Data source\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population was derived from the NHANES, a nationally representative cross-sectional survey of the civilian, noninstitutionalized population residing in the United States. This survey collected comprehensive data on the health and nutritional status of U.S. citizens to assess the population's overall well-being. All data are accessible through the NHANES website (https://www.cdc.gov/nchs/nhanes/index.htm).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Study population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe selected cross-sectional data from three NHANES cycles: 2007-2008, 2009-2010, and 2011-2012. A total of 30442 participants were included in the study, from which those meeting the following exclusion criteria were removed: (1) under the age of 20; (2) participants with missing nocturia data (3) participants with missing physical activity data; (4) participants with missing covariate data (5) those diagnosed with prostate cancer; (6) those who had undergone prostate surgery; (7) those with prostate infection or inflammation; (8) those who had undergone a digital rectal exam within the past seven days; (9) those who had undergone a prostate biopsy within the past four weeks; (10) those who had undergone cystoscopy within the past four weeks; (11) those who had used diuretics within the past month; (12) pregnant or breastfeeding women. Following this rigorous screening process, the final sample consisted of 5516 participants. The participant selection process was illustrated in Figure 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure \u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e The flowchart of the selection process for participants from 2007 to 2012.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Exposure and outcome\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNocturia screening was conducted using a questionnaire that asked, \"During the past 30 days, how many times per night did you most typically get up to urinate from the time you went to bed until waking up in the morning?\" Responses were categorized into six groups: 0 times/night, 1 time/night, 2 times/night, 3 times/night, 4 times/night, and 5 or more times/night. Participants reporting urinating \u0026ge;2 times per night were defined as having nocturia.\u003c/p\u003e\n\u003cp\u003ePhysical activity data were collected using the Global Physical Activity Questionnaire (GPAQ). This questionnaire categorized physical activity into OPA, TPA, and LTPA and recorded the frequency (number of times per week) and duration (time per session) of these activities. OPA and LTPA were further subdivided into vigorous and moderate activities based on intensity. The formula for calculating the weekly duration of OPA and LTPA (in minutes) is as follows: Duration of OPA and LTPA per week (min) = (number of vigorous physical activity sessions per week \u0026times; duration of each vigorous session \u0026times; 2) + (number of moderate-intensity sessions per week \u0026times; duration of each moderate-intensity session). Duration of TPA per week (min) = number of moderate-intensity sessions per week \u0026times; duration of each moderate-intensity session\u003csup\u003e25\u003c/sup\u003e. Total physical activity is the sum of OPA, TPA, and LTPA.\u003c/p\u003e\n\u003cp\u003eParticipants were classified as having diabetes if they met any of the following criteria: (1) previously diagnosed with diabetes, (2) taking prescription diabetes medications, (3) fasting blood glucose level \u0026ge;12.6 mmol/L, or (4) hemoglobin A1c level \u0026ge;6.5%\u003csup\u003e26\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eHypertension was diagnosed in participants who met any of the following criteria: (1) previously diagnosed with hypertension, (2) taking prescription hypertension medications, (3) systolic blood pressure \u0026ge;130 mmHg, or diastolic blood pressure \u0026ge;80 mmHg during physical examination\u003csup\u003e27\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAccording to the Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program (NCEP), hyperlipidemia was defined by any of the following criteria: total cholesterol level \u0026ge;200 mg/dL, triglyceride level \u0026ge;150 mg/dL, high-density lipoprotein (HDL) level \u0026le;40 mg/dL in men or \u0026le;50 mg/dL in women, or low-density lipoprotein (LDL) level \u0026ge;130 mg/dL\u003csup\u003e28\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Covariates\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study included three types of covariates: sociodemographic factors (age, gender, race/ethnicity, education level, PIR, marital status), lifestyle behaviors (serum cotinine concentration, alcohol consumption), and chronic diseases (hypertension, diabetes, hyperlipidemia). Participants were divided into two age groups (20-50 years, \u0026ge;50 years), and race was categorized into five groups (non-Hispanic White, non-Hispanic Black, Mexican American, other Hispanic, and other races). Educational attainment was classified as less than high school, high school graduate, and more than high school. PIR (\u0026lt;1, 1-4, \u0026gt;4) and serum cotinine concentration (\u0026lt;0.015 ng/mL, 0.015\u0026ndash;3 ng/mL, \u0026gt;3 ng/mL) were divided into three categories. Gender (male, female), marital status (married/living with partner, widowed/divorced/separated/never married), diabetes history (yes, no), hypertension history (yes, no), alcohol consumption history (yes, no), and hyperlipidemia history (yes, no) were also categorized into two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGiven the complex stratified and cluster sampling design of NHANES, we performed weighted analyses in this study. Since data from three cycles were included, the combined weight was expressed as WEIGHT\u003csub\u003e07-12\u003c/sub\u003e = (1/3) \u0026times; WTMEC2YR\u003csub\u003e07-08\u003c/sub\u003e + (1/3) \u0026times; WTMEC2YR\u003csub\u003e09-10\u003c/sub\u003e + (1/3) \u0026times; WTMEC2YR\u003csub\u003e11-12\u003c/sub\u003e. Initially, we utilized t-tests or ANOVA to compare differences between groups and assess the characteristics of nocturia and non-nocturia participants, with continuous variables expressed as mean \u0026plusmn; standard deviation and categorical variables presented as counts and percentages. Subsequently, we employed survey-weighted logistic regression models to evaluate the relationship between different domains of physical activity and nocturia risk. Model 1 was unadjusted; Model 2 adjusted for age, gender, and race; and Model 3 further adjusted for marital status, education level, serum cotinine concentration, alcohol consumption, PIR, diabetes, hypertension, and hyperlipidemia, based on Model 2. Additionally, weighted restricted cubic splines (RCS) were applied to analyze the non-linear relationship between various domains of physical activity and nocturia, adjusting for all covariates. Finally, interaction and stratified analyses were conducted considering the listed covariates, and propensity score matching (PSM) was performed to verify the stability of the relationship between physical activity domains and nocturia risk. All statistical analyses were conducted using R software (version 4.2.2) and STATA v16.0, with a significance threshold set at P \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Prevalence analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe first analyzed the prevalence of nocturia across three NHANES cycles from 2007 to 2012 and created a bar-line chart to present the results intuitively. (Figure 2) The findings indicated a high prevalence of nocturia in the overall population, with a notable increase in prevalence as age increased.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure \u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e The prevalence of nocturia in the NHANES database. A: The prevalence of nocturia from 2007 to 2012. B: The prevalence of nocturia from 2007 to 2008. C: The prevalence of nocturia from 2009 to 2010. D: The prevalence of nocturia from 2011 to 2012.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Characteristics of the study population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research included 5516 participants from the NHANES cycles between 2007 and 2012. (Table 1) In this study, 48.15% of the participants were male, 51.85% were female, and the mean age was 46.26 years (\u0026plusmn; 0.6 years). Participants were further divided into two groups based on nocturia status: the non-nocturia group comprised 3923 participants (71.12%), while 1593 participants (28.88%) reported nocturia. Significant differences were observed between the two groups in most characteristics, particularly in PA, LTPA, and OPA, which were significantly lower in the nocturia group. However, no significant difference was found in TPA or cotinine levels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable \u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e Characteristics of study population.\u003c/p\u003e\n\u003ctable width=\"576\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003e\u003cstrong\u003eNocturia\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u003cstrong\u003eAll\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e\u003cstrong\u003eP-vaule\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e3923 (71.12%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e1593(28.88)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e5516(100%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge(years)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e44.04\u0026plusmn;0.29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e53.85\u0026plusmn;0.49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e46.26\u0026plusmn;0.60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003e\u003cstrong\u003eOPA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e696.77\u0026plusmn;28.82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e576.82\u0026plusmn;45.48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e669.57\u0026plusmn;24.56\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003e\u003cstrong\u003eTPA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e91.01\u0026plusmn;5.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e80.32\u0026plusmn;8.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e88.59\u0026plusmn;4.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e0.176\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003e\u003cstrong\u003eLTPA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e236.77\u0026plusmn;8.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e151.08\u0026plusmn;13.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e217.33\u0026plusmn;6.93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003e\u003cstrong\u003ePA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e1024.55\u0026plusmn;31.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e808.22\u0026plusmn;48.95\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e975.49\u0026plusmn;26.62\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"344\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge, n (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003e20-50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e2370 (60.41%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;544 (34.15%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;2914 (52.83%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003e\u0026ge;50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e1553 (39.59%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;1049 (65.85%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;2602 (47.17%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"344\"\u003e\n\u003cp\u003e\u003cstrong\u003eGender, n (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e2120 (54.04%),\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e740 (46.45%),\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e2860 (51.85%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e1803 (45.96%),\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e853 (53.55%),\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e2656 (48.15%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"344\"\u003e\n\u003cp\u003e\u003cstrong\u003eRace, n (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eMexican American\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e633 (16.14%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;299 (18.77%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;932 (16.90%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eOther Hispanic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e395 (10.07%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;195 (12.24%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;590 (10.70%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eNon-Hispanic White\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e1928 (49.15%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;644 (40.43%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;2572 (46.63%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eNon-Hispanic Black\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e621 (15.83%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;370 (23.23%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;991 (17.97%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eOther Race - Including Multi-Racial\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e346 (8.82%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;85 (5.34%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;431 (7.81%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"344\"\u003e\n\u003cp\u003e\u003cstrong\u003eEducation, n (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eLess than high school\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e885 (22.56%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;616 (38.67%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;1501 (27.21%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eHigh school\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e862 (21.97%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;374 (23.48%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;1236 (22.41%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eMore than high school\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e2176 (55.47%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;603 (37.85%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;2779 (50.38%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"344\"\u003e\n\u003cp\u003e\u003cstrong\u003eMarital status, n (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eWidowed/Divorced/Separated/Never married\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e1561 (39.79%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;709 (44.51%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;2270 (41.15%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eMarried/Living with partner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e2362 (60.21%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;884 (55.49%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;3246 (58.85%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003e\u003cstrong\u003ePIR, n (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003e\u0026lt;1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e799 (20.37%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;465 (29.19%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;1264 (22.92%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003e1-4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e2047 (52.18%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;843 (52.92%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;2890 (52.39%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003e\u0026gt;4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e1077 (27.45%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;285 (17.89%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;1362 (24.69%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"344\"\u003e\n\u003cp\u003e\u003cstrong\u003eCotinine(ng/mL), n (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e0.225\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003e\u0026lt;0.015\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e885 (22.56%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;357 (22.41%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;1242 (22.52%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003e0.015-3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e1906 (48.59%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;810 (50.85%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;2716 (49.24%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003e\u0026gt;3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e1132 (28.86%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;426 (26.74%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;1558 (28.25%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"432\"\u003e\n\u003cp\u003e\u003cstrong\u003eDrink at least 12 drinks/year, n (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e923 (23.53%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;496 (31.14%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;1419 (25.73%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e3000 (76.47%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;1097 (68.86%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;4097 (74.27%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"344\"\u003e\n\u003cp\u003e\u003cstrong\u003eDiabetes history, n (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e3221 (82.11%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;1049 (65.85%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;4270 (77.41%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e702 (17.89%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;544 (34.15%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;1246 (22.59%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"344\"\u003e\n\u003cp\u003e\u003cstrong\u003eHypertension history, n (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e2050 (52.26%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;529 (33.21%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;2579 (46.75%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e1873 (47.74%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;1064 (66.79%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;2937 (53.25%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"344\"\u003e\n\u003cp\u003e\u003cstrong\u003eHyperlipidemia history, n (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e1246 (31.76%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;434 (27.24%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;1680 (30.46%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"235\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e2677 (68.24%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;1159 (72.76%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;3836 (69.54%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e \u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Linear association between physical activity and nocturia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe utilized a survey-weighted logistic regression model to assess the associations between different domains of physical activity and the risk of nocturia. As shown in Table 2, total PA (OR: 0.5176, 95% CI: 0.4418-0.6064, P \u0026lt; 0.0001), OPA (OR: 0.8056, 95% CI: 0.6832-0.9500, P = 0.01), and LTPA (OR: 0.5227, 95% CI: 0.4382-0.6235, P \u0026lt; 0.0001) were negatively associated with nocturia risk. After adjusting for all confounders, the association between OPA and nocturia was no longer significant, while total PA (OR: 0.7523, 95% CI: 0.6307-0.8974, P = 0.002) and LTPA (OR: 0.7664, 95% CI: 0.6314-0.9304, P = 0.007) remained negatively associated with nocturia risk. We further examined the dose-response relationship between PA and nocturia by categorizing PA into four groups (0 min/week, 1-149 min/week, 150-299 min/week, and \u0026ge;300 min/week). (Figure 3) Even in fully adjusted models, total PA in the 150-299 min/week (OR: 0.7121, 95% CI: 0.5296-0.9575, P = 0.025) and \u0026ge;300 min/week (OR: 0.7279, 95% CI: 0.5937-0.8925, P = 0.002) groups showed a significant negative association with nocturia risk. LTPA \u0026ge;300 min/week (OR: 0.7368, 95% CI: 0.5796-0.9365, P = 0.013) also demonstrated a significant negative correlation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable \u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e Multivariable OR for nocturia based on the meeting PA guideline.\u003c/p\u003e\n\u003ctable width=\"573\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003e \u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e\u003cstrong\u003eModel 1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e\u003cstrong\u003eModel 2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e\u003cstrong\u003eModel 3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e \u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.5176 (0.4418, 0.6064)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.6441 (0.5448, 0.7615)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.7523 (0.6307, 0.8974)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"191\"\u003e\n\u003cp\u003e\u003cstrong\u003eOccupation-related PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"191\"\u003e\n\u003cp\u003e\u003cstrong\u003eOccupation-related PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"191\"\u003e\n\u003cp\u003e\u003cstrong\u003eOccupation-related PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.8056 (0.6832, 0.9500)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.9365 (0.7858, 1.1162)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e0.464\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.9416 (0.7863, 1.1276)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e0.513\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"191\"\u003e\n\u003cp\u003e\u003cstrong\u003eTransportation-related PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"191\"\u003e\n\u003cp\u003e\u003cstrong\u003eTransportation-related PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"191\"\u003e\n\u003cp\u003e\u003cstrong\u003eTransportation-related PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.8409 (0.6719, 1.0524)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.9181 (0.7255, 1.1617)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e0.477\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.9437 (0.7387, 1.2058)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e0.643\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"120\"\u003e\n\u003cp\u003e\u003cstrong\u003eLeisure-time PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"120\"\u003e\n\u003cp\u003e\u003cstrong\u003eLeisure-time PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"120\"\u003e\n\u003cp\u003e\u003cstrong\u003eLeisure-time PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.5227 (0.4382, 0.6235)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.6131 (0.5099, 0.7372)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.7664 (0.6314, 0.9304)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"191\"\u003e\n\u003cp\u003eModel 1 adjusts for none.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" width=\"311\"\u003e\n\u003cp\u003eModel 2 adjusts for age, ethnicity, and gender.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"9\" width=\"573\"\u003e\n\u003cp\u003eModel 3 adjusts for age, gender, ethnicity, education, marital status, PIR status, serum cotinine, alcohol status, hypertension history, diabetes history and hyperlipemia history\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eFigure \u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e Odds ratios for the nocturia based on the amount of PA in model 1 (A), model 2 (B) and model 3 (C).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Non-Linear relationship between physical activity and nocturia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe employed the RCS curve to describe the non-linear relationships between various physical activity domains and nocturia. (Figure 4) In the RCS model, total PA (P for non-linear \u0026lt; 0.0001) and LTPA (P for non-linear = 0.0486) exhibited significant non-linear relationships with nocturia. Total PA initially decreased to a nadir at 7.143 h/week, then slightly increased and peaked at 47.619 h/week before gradually decreasing again. LTPA decreased to a low point at 5.364 h/week, followed by a slight rise and stabilization. No significant non-linear relationship was identified between TPA, OPA, and nocturia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure \u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e Non-linear association between PA (A), OPA (B), TPA (C), LTPA (D) and nocturia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5 Propensity score matching and subgroup analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo further assess the robustness of the association between PA and nocturia, we performed sensitivity analyses using PSM. The characteristics of the study population regarding PSM analysis were displayed in Table S1. After applying the same survey-weighted logistic regression model, the results still indicated a negative association between total PA (OR: 0.8393, 95% CI: 0.6901-1.020, P = 0.039) and nocturia. (Table 3) Furthermore, we conducted subgroup analyses stratified by all confounders, revealing that PA was significantly associated with nocturia across most strata, including age \u0026ge;50, female, Non-Hispanic White, education level (more than high school), marital status (married/living with partner), PIR between 1 and 4, cotinine concentration between 0.015ng/mL and 3ng/mL, alcohol consumption, hypertension, diabetes, and hyperlipidemia. (Figure 5) However, no significant interaction effects were observed. In the subgroup analysis of the association between total PA and nocturia frequency, we identified a significant interaction effect in the hyperlipidemia (P = 0.006). (Figure S1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable \u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e Multivariable OR for nocturia based on the meeting PA guideline in the propensity score matching.\u003c/p\u003e\n\u003ctable width=\"573\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003e \u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e\u003cstrong\u003eModel 1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e\u003cstrong\u003eModel 2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e\u003cstrong\u003eModel 3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e \u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.5226 (0.4326, 0.6313)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.7476 (0.6080, 0.9191)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.8393 (0.6901, 1.0208)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.039\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"191\"\u003e\n\u003cp\u003e\u003cstrong\u003eOccupation-related PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"191\"\u003e\n\u003cp\u003e\u003cstrong\u003eOccupation-related PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"191\"\u003e\n\u003cp\u003e\u003cstrong\u003eOccupation-related PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.7897 (0.6517, 0.9569)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.016\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e1.0393 (0.8420, 1.2829)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e0.719\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.9536 (0.7763, 1.1714)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e0.651\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"191\"\u003e\n\u003cp\u003e\u003cstrong\u003eTransportation-related PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"191\"\u003e\n\u003cp\u003e\u003cstrong\u003eTransportation-related PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"191\"\u003e\n\u003cp\u003e\u003cstrong\u003eTransportation-related PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.8880 (0.6833, 1.1540)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e0.374\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e1.0653 (0.8022, 1.4148)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e0.662\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.9168 (0.6947, 1.2100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e0.54\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"120\"\u003e\n\u003cp\u003e\u003cstrong\u003eLeisure-time PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"120\"\u003e\n\u003cp\u003e\u003cstrong\u003eLeisure-time PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"120\"\u003e\n\u003cp\u003e\u003cstrong\u003eLeisure-time PA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.5504 (0.4495, 0.6738)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.7089 (0.5712, 0.8798)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.8412 (0.6731, 1.0514)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e0.129\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"191\"\u003e\n\u003cp\u003eModel 1 adjusts for none.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" width=\"311\"\u003e\n\u003cp\u003eModel 2 adjusts for age, ethnicity, and gender.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"45\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"9\" width=\"573\"\u003e\n\u003cp\u003eModel 3 adjusts for age, gender, ethnicity, education, marital status, PIR status, serum cotinine, alcohol status, hypertension history, diabetes history and hyperlipemia history\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eFigure \u003c/strong\u003e\u003cstrong\u003e5\u003c/strong\u003e Subgroup analysis of the association between physical activity and nocturia.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAlthough some studies have explored the association between physical activity and LUTS, nocturia\u0026mdash;recognized as the most prevalent and bothersome LUTS in men\u0026mdash;has received limited attention\u003csup\u003e1\u003c/sup\u003e. In this nationally representative cross-sectional study, we refined the classification of PA domains and found that total PA and LTPA were associated with a reduced risk of nocturia. These findings align with PA guidelines, which recommend that adults engage in 150-300 minutes of moderate-intensity PA or 75-150 minutes of vigorous-intensity PA per week, or a combination of both. However, no significant associations were observed for OPA or TPA.\u003c/p\u003e\n\u003cp\u003ePrevious limited studies have suggested a relationship between PA and nocturia. This study further investigated the association between different PA domains and nocturia. After adjusting for age, gender, and race, we observed a negative correlation between LTPA and total PA with nocturia. This negative correlation remained significant after adjusting for all covariates. Additionally, the RCS curve also suggests a non-linear negative correlation between PA, LTPA, and nocturia over a certain duration. Furthermore, sensitivity analyses validated the stability of this association. In summary, this study elucidated the correlation between PA across various domains and the risk of nocturia, highlighting that managing appropriate durations of PA may help mitigate the risk of nocturia.\u003c/p\u003e\n\u003cp\u003eThere is increasing recognition that nocturia is a common chronic condition closely associated to a significant decline in quality of life\u003csup\u003e29,30\u003c/sup\u003e. Previous studies have identified several factors associated with nocturia, including reduced bladder capacity, bladder storage issues, and excessive urine production. As research on nocturia advances, some studies have focused on the impact of PA and demonstrated that appropriate PA serves as a protective factor in preventing nocturia\u003csup\u003e13,20,21\u003c/sup\u003e. However, few studies have investigated whether all PA domains (such as OPA, TPA, and LTPA) affect nocturia equally. For this reason, we conducted a study using the NHANES database to explore the relationship between PA, its various domains, and nocturia. Our findings were consistent with previous reports, suggesting that PA may be an effective strategy for preventing nocturia. A study from the PLCO screening trial cohort indicated a significant negative correlation between PA and severe nocturia in men, with this correlation being more pronounced in individuals with nocturia\u003csup\u003e15\u003c/sup\u003e. Additionally, Sugaya et al. conducted an 8-week walking exercise program involving 30 older men, significantly reducing both nighttime and daytime urination compared to pre-exercise levels\u003csup\u003e22\u003c/sup\u003e. Furthermore, two studies investigated the potential of PA interventions to reduce nocturia in older women found similar results. Yuko et al. recruited 35 older women for a 52-week exercise program, observing significant improvements in overactive bladder symptoms, particularly in frequency and nocturia\u003csup\u003e15\u003c/sup\u003e. Surveys from community-dwelling older women also indicated that lower levels of PA were associated with more frequent nocturia episodes and more severe urinary incontinence symptoms\u003csup\u003e20\u003c/sup\u003e. Meanwhile, our study identified a correlation between the duration of PA and LTPA with nocturia, and the RCS analysis provided an optimal weekly PA duration. Based on our results and previous studies, we hypothesize that PA may influence nocturia and guide clinical treatment.\u003c/p\u003e\n\u003cp\u003eTo further explore how appropriate PA prevents nocturia, we reviewed the existing literature to examine its potential mechanisms. One study hypothesized that sustained physical fitness reduces systemic sympathetic nervous system activity at rest and decreases prostatic smooth muscle tension, thereby alleviating lower urinary tract symptoms\u003csup\u003e31\u003c/sup\u003e. Interestingly, studies have found that patients with nocturia significantly reduce nighttime urination frequency and daytime serum catecholamine levels after exercise\u003csup\u003e22\u003c/sup\u003e. The findings further supported previous hypotheses. Additionally, other studies have indicated that elderly individuals with nocturia have significantly lower serum melatonin levels compared to those without nocturia\u003csup\u003e32\u003c/sup\u003e. Melatonin, one of the most potent natural antioxidants, has been reported to treat nocturia effectively when administered before sleep\u003csup\u003e33\u003c/sup\u003e. It has also been found that adjusting PA can enhance melatonin secretion\u003csup\u003e34\u003c/sup\u003e.\u0026nbsp;Based on these findings, we hypothesized that PA might regulate nocturia by promoting melatonin secretion. Furthermore, PA and exercise were well-established for their roles in weight loss, reducing body fat, preventing type 2 diabetes, and maintaining reduced body weight after weight loss\u003csup\u003e35\u003c/sup\u003e.\u0026nbsp;Previous studies have\u0026nbsp;shown that obesity influences the development of nocturia through various mechanisms, such as obesity-induced atherosclerosis in the pelvic arteries, which may result in ischemia-driven collagen deposition and bladder fibrosis.\u003csup\u003e36,37\u003c/sup\u003e. Obesity can also increase intra-abdominal pressure and promote prostate enlargement\u003csup\u003e38\u003c/sup\u003e. Moreover, obesity-related insulin resistance and hyperinsulinemia may activate hypothalamic centers that regulate sympathetic activity, leading to elevated catecholamine levels and promoting prostate enlargement.\u0026nbsp;\u003csup\u003e39,40\u003c/sup\u003e. Therefore, we hypothesized that PA might alleviate nocturia by reducing obesity and regulating it through the abovementioned mechanisms. Based on these findings, the influence of PA on the risk of nocturia is plausible and may serve as a potential indicator for assessing nocturia risk. PA interventions may also help prevent or slow the progression of nocturia. However, the specific mechanisms by which PA influences nocturia warrant further exploration.\u003c/p\u003e\n\u003cp\u003eOur study had several strengths. First, since it was unclear whether all PA domains were equally beneficial for nocturia, we evaluated the associations of total PA, OPA, TPA, and LTPA with nocturia, addressing a gap in the research. Second, NHANES was a nationally representative cross-sectional survey targeting the civilian, noninstitutionalized population residing in the United States. Our results may have had practical implications for guiding nocturia patients with various occupational backgrounds to engage in appropriate PA. Lastly, this was the first attempt to explore the relationship between nocturia and PA using the NHANES database.\u003c/p\u003e\n\u003cp\u003eHowever, our study had several limitations. First, because NHANES data were cross-sectional, our study only explored associations and could not infer causality. Second, the exact mechanisms by which PA affected nocturia remained unclear. More prospective and experimental studies were needed to evaluate the potential effects of PA on nocturia, verify our hypotheses, and further investigate the underlying mechanisms. Additionally, the domains of physical activity and nocturia were assessed through self-reported questionnaires rather than objective measurements. PA data were limited to one week, making it challenging to capture PA\u0026apos;s long-term stability or trends. Finally, despite incorporating various potential confounding factors and applying exclusion criteria, there may have still been unaddressed confounders that could have impacted the precision of our findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study established a direct association between physical activity and the risk of nocturia, suggesting that total PA and LTPA\u0026mdash;but not OPA or TPA\u0026mdash;were linked to a reduced risk of nocturia. These findings may guide preventive strategies for nocturia; however, the underlying mechanisms require further exploration. Future studies should expand the study population and further differentiate physical activity by intensity (vigorous, moderate, or combined) and domain (LTPA, TPA, and OPA) to provide clinical insights for nocturia patients across different age groups and severity levels. Additionally, more longitudinal studies and objective measurement data are essential to confirm our hypotheses.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJY: Data analysis; writing \u0026ndash; original draft, writing \u0026ndash; review and editing. SR: supervision or mentorship. DX and YF: Data analysis; validation. LM: Research idea; funding acquisition. ZL: Study design; writing \u0026ndash; review and editing. All authors made contributions to the manuscript and have given their approval for the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe financial support received for this article was provided by the Natural Science Foundation of Ningbo Municipality (2021J281), the Key Cultivating Discipline of LihHuiLi Hospital (2022-P09), and the Ningbo Key Clinical Specialty Construction Project (2023-BZZ).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll original data can be accessed publicly through the NHANES database at the following link: https://www.cdc.gov/nchs/nhanes/index.htm.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data in this study were derived from the National Health and Nutrition Examination Survey, the survey was approved by the Research Ethics Review Board of the National Center for Health Statistics (NCHS), and all participants provided written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003eWolin, K. 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Circulation\u003cem\u003e.\u003c/em\u003e 106, 2533-2536. \u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"NHANES, nocturia, physical activity, U.S. adults, Cross-sectional analysis","lastPublishedDoi":"10.21203/rs.3.rs-5275372/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5275372/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNocturia is the most prevalent lower urinary tract symptom (LUTS) and is closely associated with various diseases and social burdens. This study aimed to investigate the relationship between different domains of physical activity (e.g., occupation-related physical activity [OPA], transportation-related physical activity [TPA], and leisure-time physical activity [LTPA]) and nocturia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study included 5516 participants from the cross-sectional National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2012. We employed survey-weighted logistic regression, restricted cubic splines (RCS), subgroup analysis, and sensitivity analysis to assess the relationship between different domains of physical activity and nocturia.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMultivariable logistic regression analysis revealed a significant negative correlation between PA, LTPA, and nocturia. Specifically, PA (OR: 0.7523, 95% CI: 0.6307\u0026ndash;0.8974, P\u0026thinsp;=\u0026thinsp;0.002) and LTPA (OR: 0.7664, 95% CI: 0.6314\u0026ndash;0.9304, P\u0026thinsp;=\u0026thinsp;0.007) were negatively associated with nocturia. The RCS curve demonstrated non-linear relationships between PA, LTPA, and nocturia. Additionally, subgroup analyses and sensitivity analyses further validated this association.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eBased on this cross-sectional study, we hypothesize that PA and LTPA are associated with a reduced risk of nocturia in adults aged 20 years and older in the United States. This underscoring the importance of physical activity in preventing and managing nocturia may provide valuable guidance for clinical practice.\u003c/p\u003e","manuscriptTitle":"Association of domain-specific physical activity with nocturia: a population- based study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-20 10:44:55","doi":"10.21203/rs.3.rs-5275372/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-23T05:35:23+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-20T14:00:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"166365675390725714303762782690534076678","date":"2024-12-20T12:51:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-02T15:36:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336303811359605912777717897322966839449","date":"2024-10-30T12:51:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-30T09:51:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-30T09:48:20+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-10-30T09:17:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-29T12:07:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-10-16T11:14:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1ecb2590-6834-4d82-a67a-e2ea559115c8","owner":[],"postedDate":"November 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":39780776,"name":"Health sciences/Urology/Bladder"},{"id":39780777,"name":"Health sciences/Urology/Urethra"},{"id":39780778,"name":"Health sciences/Urology/Urological manifestations"},{"id":39780779,"name":"Health sciences/Health care/Disease prevention"},{"id":39780780,"name":"Health sciences/Health care/Geriatrics"},{"id":39780781,"name":"Health sciences/Health care/Public health"},{"id":39780782,"name":"Health sciences/Health care/Quality of life"}],"tags":[],"updatedAt":"2025-01-27T16:06:17+00:00","versionOfRecord":{"articleIdentity":"rs-5275372","link":"https://doi.org/10.1038/s41598-025-86182-w","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-01-22 15:57:34","publishedOnDateReadable":"January 22nd, 2025"},"versionCreatedAt":"2024-11-20 10:44:55","video":"","vorDoi":"10.1038/s41598-025-86182-w","vorDoiUrl":"https://doi.org/10.1038/s41598-025-86182-w","workflowStages":[]},"version":"v1","identity":"rs-5275372","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5275372","identity":"rs-5275372","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}