Association between Physical Activity, Weight-adjusted Waist Index, and All-cause Mortality in Chinese Older Adults:A National Community-Based Cohort Study

Association between Physical Activity, Weight-adjusted Waist Index, and All-cause Mortality in Chinese Older Adults:A National Community-Based Cohort 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 between Physical Activity, Weight-adjusted Waist Index, and All-cause Mortality in Chinese Older Adults:A National Community-Based Cohort Study Kexin REN, Yuan TAO, Meihong WANG This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4903687/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This study aims to explore interactions between physical activity and weight-adjusted waist index (WWI), as well as their effects on elderly health. Data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) for 2011–2018 included 7,034 residents aged ≥ 60 years. We utilized Cox proportional hazard models to assess the relationships between physical activity, WWI, and all-cause mortality, supplemented by subgroup analyses and interaction tests. We conducted a mediation analysis to assess how much of the effect of physical activity on survival status was mediated through WWI. The results showed that active individuals and those transitioning from inactive to active lifestyles exhibited significantly lower all-cause mortality risks, with reductions of 26% (HR = 0.74, CI: 0.65–0.83) and 9% (HR = 0.91, CI: 0.83–0.99), respectively. A positive correlation was found between WWI and all-cause mortality, with a threshold of 11.38 cm/√kg indicating an increased risk. Although no interaction between physical activity and WWI was observed (P = 0.462), mediation analysis showed that 3.06% of the effect of physical activity on survival status was mediated through WWI. The findings provide scientific evidence for developing health promotion strategies aimed at the elderly population. Health sciences/Health care Health sciences/Health occupations Health sciences/Medical research All-cause mortality Physical activity WWI CLHLS Older adults Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction With the burgeoning aging population in China, the nation is grappling with the multifaceted challenges of an aging society. According to the National Bureau of Statistics of China, the proportion of individuals aged 60 and above is projected to reach over 35% by 2050 [ 1 ]. This demographic shift brings to the forefront the importance of understanding factors that contribute to healthy aging and the reduction of age-related morbidity and mortality. Physical activity is widely recognized for its salutary effects on health, particularly in older adults. Numerous epidemiological studies have underscored the role of regular exercise in mitigating the risk of all-cause mortality[ 2 ][ 3 ][ 4 ].This includes a reduction in premature death from all causes[ 5 ], a decreased risk of 26 different types of cancer[ 6 ], and a lower risk of heart disease, which is one of the leading causes of death globally[[ 7 ]. However, there are few natiomnal community-based cohort studies that address the effects of physical activity on all-cause mortality in Chinese older adults. A study by Yin R et al. based on CLHLS data demonstrated that maintaining regular physical activity or shifting from inactivity to activity was consistently associated with longer survival in the elderly population, but for a study population aged 80 years and older[ 8 ]. Concurrently, there is a growing interest in the relationship between adiposity measures and health outcomes in the elderly. The Weight-Adjusted Waist Index (WWI), a novel anthropometric indicator, has emerged as a promising tool for assessing obesity-related risks[ 9 ].The index, calculated by dividing waist circumference by the square root of weight, is posited to better reflect the distribution of abdominal fat, which is more closely associated with adverse health outcomes [ 10 ]. Recent studies, particularly in Chinese populations, have begun to unravel the association between WWI and health outcomes, such as hypertension incidence [ 11 ] and cardiovascular mortality [ 12 ]. Additionally, another study reported a nonlinear relationship between WWI and all-cause mortality, suggesting that both very high and very low WWI values may confer increased mortality risk [ 13 ]. Despite the individual associations of physical activity and WWI with health outcomes, there is a dearth of research examining their combined effects on all-cause mortality in the Chinese older adult population. Existing literature has yet to explore the interplay between these factors within a national, community-based cohort study framework. Such research is vital, as it can provide insights into the complex interactions between lifestyle factors and health in the context of a rapidly aging China. This study, based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS), aimed to investigate the independent and combined effects of physical activity and WWI on mortality risk.The findings of this research have the potential to inform public health strategies and clinical guidelines aimed at promoting healthy aging and reducing premature mortality among China's elderly population. 2. Methods 2.1 Data sources The data for this study come from the the Chinese Longitudinal Healthy Longevity Survey (CLHLS), the largest cohort study of the elderly population in China, organised by the Centre for Healthy Ageing and Development at Peking University and the National Institute for Development Research. The CLHLS covered 23 provinces, municipalities, and autonomous regions, with a cumulative total of 113,000 household interviews, and randomly selected about half of the cities and counties as research sites in the 22 research provinces (excluding Hainan Province). The survey was approved by the Institutional Review Board of Peking University(IRB00001052-13074). All participants or their legal representatives provided written informed consent. We employed a sample comprising individuals aged 60 and above from the 2011 follow-up study, and all participants underwent subsequent evaluations in 2014 and 2018, with continuous monitoring extending until their demise, loss of follow-up, or the culmination of the study. Participants lacking complete records or surviving ≤ 3 months were excluded from the analysis.The final sample size for analysis is 7,035 (see Fig. 1 ). 2.2 Variable Measurement 2.2.1 Exposure In the survey, participants were asked "Do you exercise frequently at present?" and "Did you exercise frequently in the past?" Based on their responses to these two questions, participants were categorised into four groups: 1) physically active if they exercised frequently both in the past and now, 2) physically inactive if they did not exercise frequently either in the past or present, 3) inactive-to-active if they did not exercise frequently in the past but do so now, and 4) active-to- inactive if they exercised frequently in the past but do not exercise currently[ 15 ]. WWI is obtained by dividing the waist circumference (cm) by the square root of the body weight (kg)[ 9 ]. Physical examinations were performed during face-to-face interviews. Trained staff measured baseline weight and waist circumference following a standardized protocol. Participants were weighed in light clothing, with measurements taken to the nearest 0.1 kg. Waist circumference was measured using a flexible tape at the midpoint between the lowest rib and the iliac crest, rounded to the nearest 1 cm. 2.2.2 Outcome The study's outcome was all-cause mortality. In the second and third surveys, data were gathered regarding the participants' survival status and date of death. If the exact day was unavailable, the 15th of the month was used as the assumed date of death. Participants who were still alive or lost to follow-up were censored at their last point of contact. 2.2.3 Covariates Based on previous studies of physical activity and mortality, as well as WWI and mortality, we included a variety of covariates that might influence the results: age, gender, birth place, educational background, marital status,smoking[ 16 ], drinking[ 17 ], sleep quality[ 18 ], waist circumference [ 19 ], Self-assessment of health[ 20 ], medical insurance[ 21 ],economic state[ 22 ]. 2.3 Statistical analysis Participant demographics were analyzed across subgroups of physical activity using chi-square tests and ANOVA. We employed Cox proportional hazards models to examine the relationship between physical activity, WWI, and all-cause mortality.The result was expressed as hazard ratios (HR) and 95% confidence intervals (CI).To account for potential confounders, we established three models: Model 1 was unadjusted; Model 2 was adjusted for age, sex, residence, educational background, and marital status; and Model 3 was further adjusted for age, sex, educational background, marital status, alcohol consumption, smoking status, Self-assessment of health, medical insurance, and socioeconomic status.The restricted cubic spline (RCS) curves were employed to analyse the non-linear relationship between physical activity and all-cause mortality, and similarly between WWI and all-cause mortality; and finally, mediating effect analysis was conducted to explore the mechanism of WWI's role in the relationship between physical activity and survival status. All statistical analyses were performed using Stata(version 17), R (version 4.3.2) or Zstats ( https://www.medsta.cn/ ). 3. Results 3.1 Baseline characteristics The socio-demographic characteristics, lifestyle habits, and socio-economic factors of the participants categorized by changes in physical activity are presented in Table 1 . Among the 7,034 participants, nearly half (N = 3,433, 48.8%) remained inactive, while fewer than 20% (N = 1,149, 16.3%) had always been active. Additionally, 22.8% (N = 1,603) transitioned from inactive-to- active, and 12.1% (N = 849) shifted from active-to-inactive. The mean age was significantly lower in both the active group and the inactive-to-active group compared to the other two groups (P < 0.001). Females dominated the inactive group (58.52%), while males were more prevalent in the active group (59.18%). Participants who either maintained or adopted exercise had higher self-assessed health scores compared to the two groups that remained inactive (P < 0.001). Furthermore, we categorized the WWI of the different exercise groups into quartiles, revealing a significant difference in the values among the groups (P < 0.001). Table 1 Baseline characteristics by changes in physical activity among older adults in CLHLS 2011–2018 Variables Total (n = 7034) inactive (n = 3433) active (n = 1149) Inactive-to-active (n = 1603) Active-to- inactive (n = 849) P Age, Mean ± SD 84.35 ± 10.88 85.14 ± 11.38 82.13 ± 10.08 82.66 ± 9.99 87.30 ± 10.40 < .001 Gender, n(%) < .001 Male 3268 (46.46) 1424 (41.48) 680 (59.18) 756 (47.16) 408 (48.06) Female 3766 (53.54) 2009 (58.52) 469 (40.82) 847 (52.84) 441 (51.94) Ethnic, n(%) 0.008 Non-Han 419 (5.96) 228 (6.64) 48 (4.18) 102 (6.36) 41 (4.83) Han 6615 (94.04) 3205 (93.36) 1101 (95.82) 1501 (93.64) 808 (95.17) Birth Place, n(%) < .001 Rural 6281 (89.29) 3227 (94.00) 871 (75.81) 1458 (90.95) 725 (85.39) Urban 753 (10.71) 206 (6.00) 278 (24.19) 145 (9.05) 124 (14.61) Marital, n(%) a < .001 Others 4273 (60.75) 2180 (63.50) 592 (51.52) 941 (58.70) 560 (65.96) Married 2761 (39.25) 1253 (36.50) 557 (48.48) 662 (41.30) 289 (34.04) Education, n(%) < .001 lliterate 3896 (55.39) 2222 (64.72) 371 (32.29) 858 (53.52) 445 (52.41) Primary 2270 (32.27) 968 (28.20) 444 (38.64) 565 (35.25) 293 (34.51) Secondary 739 (10.51) 219 (6.38) 268 (23.32) 163 (10.17) 89 (10.48) University and above 129 (1.83) 24 (0.70) 66 (5.74) 17 (1.06) 22 (2.59) Drink, n(%) 0.034 No 5711 (81.19) 2819 (82.11) 928 (80.77) 1264 (78.85) 700 (82.45) Yes 1323 (18.81) 614 (17.89) 221 (19.23) 339 (21.15) 149 (17.55) Econnomic State, n(%) < .001 Average and below 5780 (82.17) 2949 (85.90) 852 (74.15) 1273 (79.41) 706 (83.16) Affluent and above 1254 (17.83) 484 (14.10) 297 (25.85) 330 (20.59) 143 (16.84) Medical Insurance, n(%) < .001 No 1191 (16.93) 459 (13.37) 296 (25.76) 243 (15.16) 193 (22.73) Yes 5843 (83.07) 2974 (86.63) 853 (74.24) 1360 (84.84) 656 (77.27) WWI, n(%) b < .001 Q1 1768 (25.14) 880 (25.63) 282 (24.54) 404 (25.20) 202 (23.79) Q2 1765 (25.09) 853 (24.85) 321 (27.94) 388 (24.20) 203 (23.91) Q3 1749 (24.86) 791 (23.04) 337 (29.33) 410 (25.58) 211 (24.85) Q4 1752 (24.91) 909 (26.48) 209 (18.19) 401 (25.02) 233 (27.44) Waist,mean ± SD 81.72 ± 18.83 80.43 ± 18.73 84.21 ± 13.63 82.23 ± 12.33 82.61 ± 31.09 < .001 Sleep quality, Mean ± SD 2.32 ± 0.96 2.37 ± 0.94 2.16 ± 0.94 2.30 ± 0.98 2.36 ± 0.98 < .001 Health, Mean ± SD 2.40 ± 0.92 2.31 ± 0.90 2.63 ± 0.91 2.48 ± 0.91 2.30 ± 0.95 < .001 Mean ± SD for continuous variables: the P value was calculated by ANOVA; (%) for categorical variables: the P value was calculated by Chi-square test a Others include widowed, separated, divorced, or never married. b Q is for Quartile 3.2 Association between Physical Activity, WWI and All-cause Mortality We conducted a comprehensive analysis utilizing Cox proportional hazards regression to explore the relationship between diverse physical activity patterns and all-cause mortality, as detailed in Table 2 . Both the unadjusted and covariate-adjusted results robustly demonstrated a statistically significant decrease in the hazard ratio (HR) among individuals classified as active, as well as those transitioning from inactive-to-active statuses (p < 0.001). Specifically, in Model 3, our findings revealed that the HR for the active group stood at 0.74 (95% CI: 0.65–0.83), translating to a remarkable 26% reduction in the risk of mortality compared to their less active counterparts. Furthermore, for those who transitioned from an inactive to an active lifestyle, the HR was 0.91 (95% CI: 0.83–0.99), signifying a potential 9% reduction in the risk of death, emphasizing the positive impact of altering exercise habits. Moreover, we conducted a thorough examination of the correlation between WWI and overall mortality, with the outcomes presented in Table 2 . Prior to adjusting for confounding variables, a pronounced elevation in mortality risk was observed exclusively in the fourth quartile (Q4, the highest category) compared to the first quartile (Q1, the lowest category), reaching statistical significance (p < 0.001), with a hazard ratio (HR) of 1.24 (95% CI: 1.12 to 1.37). Subsequent to comprehensive adjustment for covariates, notable increases in mortality risk emerged for both the second (Q2) and third (Q3) quartiles (P < 0.05), while the risk in the fourth quartile (Q4) demonstrated an exceedingly significant surge (P < 0.001). In summary, a graded increase in mortality risk was observed with progressive elevation in WWI quartiles, with respective increments of 13% (Q2), 15% (Q3), and a substantial 43% (Q4), underscoring the heightened risk associated with higher WWI levels. Table 2 The associations between physical activity, WWI and survival among older adults in CLHLS 2011–2018. Variables Model1 Model2 Model3 HR (95%CI) P HR (95%CI) P HR (95%CI) P Physical Activity Inactive 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) Active 0.63 (0.56 ~ 0.71) < .001 0.72 (0.64 ~ 0.81) < .001 0.74 (0.65 ~ 0.83) < .001 Inactive-to-active 0.82 (0.75 ~ 0.90) < .001 0.90 (0.82 ~ 0.99) 0.025 0.91 (0.83 ~ 0.99) 0.049 Active-to-inactive 1.21 (1.09 ~ 1.34) < .001 1.10 (0.99 ~ 1.22) 0.085 1.11 (1.00 ~ 1.24) 0.053 WWI a Q1(< 10.58cm/√kg) 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) Q2(10.58 ~ 11.38cm/√kg) 0.99 (0.89 ~ 1.09) 0.775 1.00 (0.90 ~ 1.10) 0.924 1.13 (1.01 ~ 1.26) 0.033 Q3(11.38 ~ 12.30cm/√kg) 1.00 (0.90 ~ 1.11) 0.965 0.94 (0.85 ~ 1.04) 0.235 1.15 (1.02 ~ 1.29) 0.023 Q4(≥ 12.30cm/√kg) 1.24 (1.12 ~ 1.37) < .001 1.04 (0.94 ~ 1.15) 0.444 1.43 (1.25 ~ 1.63) < .001 HR: Hazard Ratio, CI: Confidence Interval, a Q is for Quartile Model1: Crude Model2: Adjust: age, gender, ethnic, birth place, education, marital Model3: Adjust: age, gender, ethnic, birth place, education, marital,econnomic state, medical insurance, waist, sleep quality, health In order to delve nonlinear associations among physical activity, WWI, and all-cause mortality, we crafted RCS curves(Fig. 2 ). Regarding the relationship between physical activity and all-cause mortality, our analysis revealed a pronounced statistical correlation (P < 0.001 for the overall analysis), both prior to and subsequent to adjusting for covariates. Notably, the P-values for non-linearity in Figures A and B, which depict this relationship, remained below 0.001, conclusively demonstrating a nonlinear association between physical activity levels and all-cause mortality. Elderly individuals who maintain an active lifestyle consistently exhibit the lowest all-cause mortality rates. Moreover, those transitioning from inactivity to an active lifestyle display a mortality rate slightly elevated compared to the consistently active group but significantly lower than those who remain inactive or move from active-to-inactive. Similarly, the link between WWI (Waist-to-Weight Index) and all-cause mortality manifested a statistically significant correlation (P < 0.001) before and after covariate adjustment. However, upon covariate adjustment, the strength of evidence for nonlinearity weakened, as evidenced by a notable increase in the P-value for non-linearity (from P < 0.001 to P < 0.044), suggesting that while the nonlinear relationship persists, its statistical significance diminishes.Figures C and D highlight a distinct inflection point corresponding to Q3 of WWI, revealing that when WWI surpasses 11.38 cm/√kg, there is a marked increase in all-cause mortality rates. 3.3 Subgroup Analyses for Association Between Physical Activity and All-Cause Mortality To assess whether the association between physical activity and all-cause mortality was consistent across populations, subgroup analyzes and interaction tests stratified by age, gender, marial, drink,medical insurance and WWI were performed. The physical activity group shown in Fig. 3 was derived from the active and inactive-to- active groups, and the control group was derived from the inactive and active-to- inactive groups. Subgroup analyses revealed significant interactions between physical activity and gender, marital status, drinking habits, and insurance status. Notably, females (HR = 0.62) and non-drinkers (HR = 0.67) exhibited a more pronounced reduction in risk. Age and WWI quartiles did not show significant interactions with physical activity, although a consistent reduction in risk was observed across all age groups and WWI categories. 3.4 Mediating effects of WWI between physical activity and survival states Following stepwise regression, linear regression analyses were conducted with physical activity as the independent variable, survival status as the dependent variable, and WWI as the mediating variable. The results showed that physical activity had an effect on both WWI and survival status (i.e., c=-0.099, P < 0.001; a=-0.045, P < 0.001), and after the introduction of WWI, physical activity, WWI had an effect on survival status (i.e., c'=-0.096, P < 0.001; b = 0.067, P < 0.001). After establishing the mediation model, it showed that the total effect value of physical activity on survival status was − 0.099, and the direct effect value was − 0.096, and ab was the same sign as c', which suggests that there is a partially mediated effect of WWI between physical activity and survival status, as shown in Fig. 4 . a: effect value of physical activity on WWI, b: effect value of WWI on survival status, c: total effect value of physical activity on survival status, c': direct effect value of physical activity on survival status To robustly validate the mediating effects of WWI in the relationship between physical activity and survival status among older adults, we conducted hypothesis testing employing the nonparametric percentile Bootstrap method. Setting Bootstrap random sampling 5,000 times, the results show that none of the Bootstrap confidence intervals contain 0, indicating that the partial mediating effect of WWI on the impact of physical activity on the survival status of elderly people has statistical significance, although the proportion of mediating effect to the total effect is only 3.06%, see Table 3 . Table 3 Bootstrap mediated effect test of WWI between physical activity and survival status in the elderly Effect Coefficient Std. Err. 95% CI P Indirect Effect -0.003 0.001 -0.001 ~ -0.005 < 0.001 Direct Effect -0.096 0.011 -0.073 ~ -0.120 < 0.001 Total Effect -0.099 0 .012 -0.076 ~ -0.123 < 0.001 PM,% 3.06 PM,percent mediation 4. Disscusion Using data from the CLHLS, we examined the relationship between physical activity and all-cause mortality among Chinese older adults. Our findings indicate that maintaining exercise habits and transitioning from inactivity to an active lifestyle are associated with longer survival, regardless of covariate consideration.In exploring the nexus between physical activity and all-cause mortality, particularly in the elderly, many studies have provided consistent insights as presented in this article. For example, a longitudinal study of 85,545 elderly Australians found that a high-quality diet combined with high levels of moderate-to-vigorous physical activity (MVPA) significantly reduced risks of cardiovascular disease (CVD) and all-cause mortality [ 23 ]. The National Health and Nutrition Examination Survey (NHANES) 2011–2014 data emphasized that objective measures of physical activity, above age, are the strongest predictors of all-cause mortality [ 24 ].A retrospective cohort study utilizing Korean National Health and Nutrition Examination Survey (KNHANES)-mortality linked data underscored the joint influence of physical activity and socioeconomic status (SES) on mortality, revealing a notable decrease in mortality risk among older adults with low SES who engage in regular physical activity [ 25 ]. Similarly, among low-income older Americans, a cohort study showed that high sitting time is an independent risk factor for all-cause and CVD mortality, while leisure-time physical activity (LTPA) mitigated this risk [ 26 ].In the Indian context, the Longitudinal Aging Study evidence suggests that adequate physical activity significantly lowers the risk of CVD among the elderly, emphasizing the importance of regular exercise in reducing CVD burden [ 27 ].Collectively, these findings highlight the pivotal role of physical activity in promoting longevity and reducing all-cause mortality in the elderly, transcending geographical and socioeconomic barriers. The shift from a sedentary to an active lifestyle is associated with longer survival, a benefit consistent across varying covariates. This underscores the need for public health interventions that encourage and facilitate active lifestyles among the elderly, thereby enhancing their health and well-being. WWI has garnered attention as an emerging indicator for assessing obesity. Experimental findings indicate that a reduction in WWI significantly decreases the risk of multimorbidity in older adults [ 28 ] and is positively associated with all-cause mortality in this population [ 13 ].All these results strongly support the premise of this paper that higher WWI values are associated with an increased risk of death. Furthermore, we identified that a WWI threshold of ≥ 11.38 cm/√kg may indicate an elevated risk of death among Chinese older adults, as demonstrated by the RCS curve. This finding slightly differs from those of other studies.For example, according to the NHANES database, a study of a non-Asian population aged 18 to 80 years found that when WWI exceeded 10.46 cm/√kg, all-cause mortality increased by 20% for each unit increase in WWI [HR = 1.20, 95% CI: (1.08, 1.33)] [ 29 ]. Additionally, a cohort study conducted in rural China recruited 10,338 non-hypertensive participants aged 18 years and older in Henan Province. This study found a positive association between WWI and the prevalence of hypertension over a subsequent six-year follow-up, revealing a significantly higher odds ratio (OR) for developing hypertension, particularly when WWI was ≥ 10.91 cm/√kg [OR = 1.50, 95% CI: 1.24–1.82] [ 29 ]. The subtle differences in WWI thresholds may be attributed to the fact that the study population in this paper comprised individuals aged 60 years and older. Given that both physical activity as well as WWI have been shown to be strongly associated with all-cause mortality, a thought-provoking question is: Is there some potential correlation between the two? In order to explore this topic, subgroup analyses and interaction analyses were carefully designed with the aim of revealing possible subtle links between them.The results of the study showed significant interaction effects between physical activity and a range of socio-demographic factors and lifestyle habits, including gender, marital status, alcohol consumption, and health insurance status, when all-cause mortality was taken into account. These findings not only enrich our knowledge of health risk factors, but also highlight the importance of individual differences in influencing health outcomes.However, it is worth noting that when exploring whether there was an interaction between physical activity and WWI, our analyses did not find a statistically significant association between the two (P for interacton = 0.462).It is important to note that the assessment of physical activity in our study was based on self-reported data, which could introduce potential bias [ 30 ]. Further, we analysed in depth the mediating effect of WWI between physical activity level and survival status. By constructing a mediating effect model, we found that WWI partially mediated this relationship. Although the proportion of the mediating effect was relatively low, at 3.06%, this finding is still clinically significant. Physical activity may have an indirect positive impact on all-cause mortality by reducing WWI values, which in turn may contribute to lowering all-cause mortality.Furthermore, despite the low proportion of the mediating effect, it serves as a reminder that other potential mediating variables or pathways should not be overlooked when exploring the relationship between physical activity and health outcomes. Future research could further explore how physical activity affects all-cause mortality through other mechanisms, such as improving cardiovascular health[ 31 ], reducing the inflammatory response[ 32 ], strengthening the immune system[ 33 ], promoting mental health[ 34 ], and improving metabolic function[ 35 ], and how these mechanisms interact with WWI. 5. Concusion In conclusion, our study of older adults in China shows that maintaining physical activity or shifting from a sedentary lifestyle to an active one can reduce all-cause mortality. Conversely, a higher Weight-Adjusted Waist Index (WWI) is linked to an increased risk of all-cause mortality.The WWI seems to have a partial mediating effect between physical activity and death, shedding light on why physical activity reduces the risk of death. Further research is necessary to investigate additional mechanisms through which physical activity may lower the risk of death. The findings provide scientific evidence for developing health promotion strategies aimed at the elderly population, highlighting the importance of regular physical activity and maintaining a healthy weight to prevent premature death. Declarations The authors declare that they have no confict of interest regarding the publication of this article. Funding This study was funded and organized by the Scientific Research Program of Jilin Provincial Department of Education (JJKH20240541SK), the Research Projects on Teaching Reform of Vocational and Adult Education in Jilin Province (2023ZCY302), and the Sports Science Research Projects of Jilin Provincial Sports Bureau (202324). Author Contribution Kexin Ren proposed the main research objectives and was responsible for the conception, design and implementation of the study; Yuan Tao carried out the collection and organization of data, statistical processing, and manuscript writing; Meihong Wang was responsible for the drawing and presentation of figures and tables.All authors reviewed the manuscript. Acknowledgement We express our gratitude to the CLHLS team for providing us with the data, and we extend our appreciation to every respondent in the study for their valuable contributions. Data Availability Raw data for this article is available from the CLHLS website (https://opendata.pku.edu.cn). The datasets used and/or analyzed during the current study are available from the first author on reasonable request (First author: Kexin REN, E-mail: [email protected] ). References National Bureau of Statistics of China. 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Med. 28 (10), 2045–2055. 10.1038/s41591-022-01978-x (2022). Im, P. K. et al. China Kadoorie Biobank Collaborative Group. Alcohol consumption and risks of more than 200 diseases in Chinese men. Nat. Med. 29 (6), 1476–1486. 10.1038/s41591-023-02383-8 (2023). Windred, D. P. et al. Sleep regularity is a stronger predictor of mortality risk than sleep duration: A prospective cohort study. Sleep . 47 (1), zsad253. 10.1093/sleep/zsad253 (2024). Darsini, D., Hamidah, H., Notobroto, H. B. & Cahyono, E. A. Health risks associated with high waist circumference: A systematic review. J. Public. Health Res. 9 (2), 1811. 10.4081/jphr.2020.1811 (2020). Hu, C. et al. Change in Healthy Lifestyle and Subsequent Risk of Cognitive Impairment Among Chinese Older Adults: A National Community-Based Cohort Study. J. Gerontol. Biol. Sci. Med. Sci. 79 (8), glae148. 10.1093/gerona/glae148 (2024). Si-Yuan, Y. et al. Impact of urban and rural residents medical insurance on self-rated health of residents in China: a panel study from the China family panel studies national baseline survey. Front. Public. Health . 12 , 1349416. 10.3389/fpubh.2024.1349416 (2024). Barakat, C. & Konstantinidis, T. A Review of the Relationship between Socioeconomic Status Change and Health. Int. J. Environ. Res. Public. Health . 20 (13), 6249. 10.3390/ijerph20136249 (2023). Ding, D. et al. The association of diet quality and physical activity with cardiovascular disease and mortality in 85,545 older Australians: A longitudinal study. J Sport Health Sci. May 28:S2095-2546(24)00082 – 6. doi: (2024). 10.1016/j.jshs.2024.05.011 Leroux, A. et al. NHANES 2011–2014: Objective Physical Activity is the Strongest Predictor of All-Cause Mortality. Med. Sci. Sports Exerc. 1 10.1249/MSS.0000000000003497 (2024 Jul). Lee, S., Ma, X., Choi, Y. & Kim, Y. S. Association of physical activity and socio-economic status on mortality in older adults: a retrospective cohort study of KNHANES-mortality linked data. Sci. Rep. 14 (1), 14447. 10.1038/s41598-024-62216-7 (2024). Liu, L. et al. Sitting time, physical activity and mortality: a cohort study in low-income older Americans. Am J Prev Med. 2024 Jul 30:S0749-3797(24)00260-5. 10.1016/j.amepre.2024.07.018 Singh, D. M., Singh, D. S., Pandey, D. M. K. & Singh, S. Exploring the Link Between Physical Activity and Cardiovascular Disease in India's Elderly: Evidence from the Longitudinal Aging Study. Curr. Probl. Cardiol. 30 , 102778. 10.1016/j.cpcardiol.2024.102778 (2024 Jul). Chen, Z. T. et al. Association of changes in waist circumference, waist-to-height ratio and weight-adjusted-waist index with multimorbidity among older Chinese adults: results from the Chinese longitudinal healthy longevity survey (CLHLS). BMC Public. Health . 24 (1), 318. 10.1186/s12889-024-17846-x (2024). Cao, T. et al. Association of weight-adjusted waist index with all-cause mortality among non-Asian individuals: a national population-based cohort study. Nutr. J. 23 (1), 62. 10.1186/s12937-024-00947-z (2024). Zeng, Y., Feng, Q., Hesketh, T., Christensen, K. & Vaupel, J. W. Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest-old in China: a cohort study. Lancet . 389 , 1619–1629. https://doi.org/10.1016/s0140-6736(17)30548-2 (2017). Kodama, S. et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA . 301 (19), 2024–2035. 10.1001/jama.2009.681 (2009). Petersen, A. M. & Pedersen, B. K. The role of IL-6 in mediating the anti-inflammatory effects of exercise. J. Physiol. Pharmacol. 57 (Suppl 10), 43–51 (2006). Chastin, S. F. M. et al. Effects of Regular Physical Activity on the Immune System, Vaccination and Risk of Community-Acquired Infectious Disease in the General Population: Systematic Review and Meta-Analysis. Sports Med. 51 (8), 1673–1686. 10.1007/s40279-021-01466-1 (2021). Ströhle, A. Physical activity, exercise, depression and anxiety disorders. J. Neural Transm (Vienna) . 116 (6), 777–784. 10.1007/s00702-008-0092-x (2009). Serra, M. C. et al. Effects of Weight Loss with and without Exercise on Regional Body Fat Distribution in Postmenopausal Women. Ann. Nutr. Metab. 70 (4), 312–320. 10.1159/000475766 (2017). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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-4903687","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":355879422,"identity":"d46473ed-c7da-4ba6-8b84-870e89db881f","order_by":0,"name":"Kexin REN","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtElEQVRIiWNgGAWjYBACxnYGBgmGAwxybOztB4jU0gzRYszHcyaBSGuYIVoS50k4GBCpo5n94e2KM4fT2yQYEhh+VGwjxmE8xpZnbqTltkk3HmDsOXObKC1skg0fbHLbZA4kMDO2EaWF/RlQi0Q6m0SCAbFaGMwkG27YJJCiBeiXhjNphm3AQD5IlF8M29sf3mw4dlhevr394IMfFcRoaUDiHCCsHgjkiVI1CkbBKBgFIxsAAFVwOx7rqByBAAAAAElFTkSuQmCC","orcid":"","institution":"Jilin Normal University","correspondingAuthor":true,"prefix":"","firstName":"Kexin","middleName":"","lastName":"REN","suffix":""},{"id":355879424,"identity":"b2deb0fe-38b5-4e7c-a586-24065c220d25","order_by":1,"name":"Yuan TAO","email":"","orcid":"","institution":"Jilin Normal University","correspondingAuthor":false,"prefix":"","firstName":"Yuan","middleName":"","lastName":"TAO","suffix":""},{"id":355879425,"identity":"5d1facae-3e94-45c2-8a35-c2cdac2da01e","order_by":2,"name":"Meihong WANG","email":"","orcid":"","institution":"Jilin Normal University","correspondingAuthor":false,"prefix":"","firstName":"Meihong","middleName":"","lastName":"WANG","suffix":""}],"badges":[],"createdAt":"2024-08-13 03:12:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4903687/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4903687/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":64930153,"identity":"545d2e96-5239-43ec-9e13-a5900d0abb79","added_by":"auto","created_at":"2024-09-20 13:48:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":92222,"visible":true,"origin":"","legend":"Flow chart of this analysis based on CLHLS 2011\u0026ndash;2018","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4903687/v1/22ef66b1effe64e84adf53bb.png"},{"id":64930948,"identity":"b1dc4ae8-ae87-428f-9683-ebc3bb27fed3","added_by":"auto","created_at":"2024-09-20 13:56:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":131851,"visible":true,"origin":"","legend":"The nonlinear associations between physical activity,WWI and all-cause mortality. A and C denote outcomes with no adjustment for covariates, and B and D denote outcomes with adjustment for covariates.","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4903687/v1/3dad66c5c1c51b8d26b229ab.png"},{"id":64930152,"identity":"cd46cb5a-20ae-47f9-a44c-3b5970ad0d5d","added_by":"auto","created_at":"2024-09-20 13:48:07","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":267014,"visible":true,"origin":"","legend":"\u003cp\u003eSubgroup analysis of the association between physical activity and all-cause mortality\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4903687/v1/78af6527d581af7262469ea4.png"},{"id":64930155,"identity":"ae4ee5d0-3699-4d9b-a908-98c58836fa6b","added_by":"auto","created_at":"2024-09-20 13:48:07","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":47766,"visible":true,"origin":"","legend":"\u003cp\u003eMediation model of WWI in the relationship between physical activity and survival status\u003c/p\u003e","description":"","filename":"floatimage420.png","url":"https://assets-eu.researchsquare.com/files/rs-4903687/v1/173bd0e857c42fe145d08238.png"},{"id":73133133,"identity":"0a962764-a68c-4a08-94d5-0d27c54135f9","added_by":"auto","created_at":"2025-01-07 05:26:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1286099,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4903687/v1/c9eae67e-64ce-4e7a-bcf5-79d8dbef2ea7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association between Physical Activity, Weight-adjusted Waist Index, and All-cause Mortality in Chinese Older Adults:A National Community-Based Cohort Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eWith the burgeoning aging population in China, the nation is grappling with the multifaceted challenges of an aging society. According to the National Bureau of Statistics of China, the proportion of individuals aged 60 and above is projected to reach over 35% by 2050 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This demographic shift brings to the forefront the importance of understanding factors that contribute to healthy aging and the reduction of age-related morbidity and mortality.\u003c/p\u003e \u003cp\u003ePhysical activity is widely recognized for its salutary effects on health, particularly in older adults. Numerous epidemiological studies have underscored the role of regular exercise in mitigating the risk of all-cause mortality[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e][\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e][\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].This includes a reduction in premature death from all causes[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], a decreased risk of 26 different types of cancer[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], and a lower risk of heart disease, which is one of the leading causes of death globally[[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, there are few natiomnal community-based cohort studies that address the effects of physical activity on all-cause mortality in Chinese older adults. A study by Yin R et al. based on CLHLS data demonstrated that maintaining regular physical activity or shifting from inactivity to activity was consistently associated with longer survival in the elderly population, but for a study population aged 80 years and older[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConcurrently, there is a growing interest in the relationship between adiposity measures and health outcomes in the elderly. The Weight-Adjusted Waist Index (WWI), a novel anthropometric indicator, has emerged as a promising tool for assessing obesity-related risks[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].The index, calculated by dividing waist circumference by the square root of weight, is posited to better reflect the distribution of abdominal fat, which is more closely associated with adverse health outcomes [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Recent studies, particularly in Chinese populations, have begun to unravel the association between WWI and health outcomes, such as hypertension incidence [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and cardiovascular mortality [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, another study reported a nonlinear relationship between WWI and all-cause mortality, suggesting that both very high and very low WWI values may confer increased mortality risk [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the individual associations of physical activity and WWI with health outcomes, there is a dearth of research examining their combined effects on all-cause mortality in the Chinese older adult population. Existing literature has yet to explore the interplay between these factors within a national, community-based cohort study framework. Such research is vital, as it can provide insights into the complex interactions between lifestyle factors and health in the context of a rapidly aging China.\u003c/p\u003e \u003cp\u003e This study, based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS), aimed to investigate the independent and combined effects of physical activity and WWI on mortality risk.The findings of this research have the potential to inform public health strategies and clinical guidelines aimed at promoting healthy aging and reducing premature mortality among China's elderly population.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Data sources\u003c/h2\u003e \u003cp\u003eThe data for this study come from the the Chinese Longitudinal Healthy Longevity Survey (CLHLS), the largest cohort study of the elderly population in China, organised by the Centre for Healthy Ageing and Development at Peking University and the National Institute for Development Research. The CLHLS covered 23 provinces, municipalities, and autonomous regions, with a cumulative total of 113,000 household interviews, and randomly selected about half of the cities and counties as research sites in the 22 research provinces (excluding Hainan Province). The survey was approved by the Institutional Review Board of Peking University(IRB00001052-13074). All participants or their legal representatives provided written informed consent.\u003c/p\u003e \u003cp\u003eWe employed a sample comprising individuals aged 60 and above from the 2011 follow-up study, and all participants underwent subsequent evaluations in 2014 and 2018, with continuous monitoring extending until their demise, loss of follow-up, or the culmination of the study. Participants lacking complete records or surviving\u0026thinsp;\u0026le;\u0026thinsp;3 months were excluded from the analysis.The final sample size for analysis is 7,035 (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Variable Measurement\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Exposure\u003c/h2\u003e \u003cp\u003eIn the survey, participants were asked \"Do you exercise frequently at present?\" and \"Did you exercise frequently in the past?\" Based on their responses to these two questions, participants were categorised into four groups: 1) physically active if they exercised frequently both in the past and now, 2) physically inactive if they did not exercise frequently either in the past or present, 3) inactive-to-active if they did not exercise frequently in the past but do so now, and 4) active-to- inactive if they exercised frequently in the past but do not exercise currently[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWWI is obtained by dividing the waist circumference (cm) by the square root of the body weight (kg)[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Physical examinations were performed during face-to-face interviews. Trained staff measured baseline weight and waist circumference following a standardized protocol. Participants were weighed in light clothing, with measurements taken to the nearest 0.1 kg. Waist circumference was measured using a flexible tape at the midpoint between the lowest rib and the iliac crest, rounded to the nearest 1 cm.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Outcome\u003c/h2\u003e \u003cp\u003eThe study's outcome was all-cause mortality. In the second and third surveys, data were gathered regarding the participants' survival status and date of death. If the exact day was unavailable, the 15th of the month was used as the assumed date of death. Participants who were still alive or lost to follow-up were censored at their last point of contact.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3 Covariates\u003c/h2\u003e \u003cp\u003eBased on previous studies of physical activity and mortality, as well as WWI and mortality, we included a variety of covariates that might influence the results: age, gender, birth place, educational background, marital status,smoking[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], drinking[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], sleep quality[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], waist circumference [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], Self-assessment of health[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], medical insurance[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e],economic state[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Statistical analysis\u003c/h2\u003e \u003cp\u003eParticipant demographics were analyzed across subgroups of physical activity using chi-square tests and ANOVA. We employed Cox proportional hazards models to examine the relationship between physical activity, WWI, and all-cause mortality.The result was expressed as hazard ratios (HR) and 95% confidence intervals (CI).To account for potential confounders, we established three models: Model 1 was unadjusted; Model 2 was adjusted for age, sex, residence, educational background, and marital status; and Model 3 was further adjusted for age, sex, educational background, marital status, alcohol consumption, smoking status, Self-assessment of health, medical insurance, and socioeconomic status.The restricted cubic spline (RCS) curves were employed to analyse the non-linear relationship between physical activity and all-cause mortality, and similarly between WWI and all-cause mortality; and finally, mediating effect analysis was conducted to explore the mechanism of WWI's role in the relationship between physical activity and survival status. All statistical analyses were performed using Stata(version 17), R (version 4.3.2) or Zstats (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.medsta.cn/\u003c/span\u003e\u003cspan address=\"https://www.medsta.cn/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Baseline characteristics\u003c/h2\u003e \u003cp\u003eThe socio-demographic characteristics, lifestyle habits, and socio-economic factors of the participants categorized by changes in physical activity are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Among the 7,034 participants, nearly half (N\u0026thinsp;=\u0026thinsp;3,433, 48.8%) remained inactive, while fewer than 20% (N\u0026thinsp;=\u0026thinsp;1,149, 16.3%) had always been active. Additionally, 22.8% (N\u0026thinsp;=\u0026thinsp;1,603) transitioned from inactive-to- active, and 12.1% (N\u0026thinsp;=\u0026thinsp;849) shifted from active-to-inactive. The mean age was significantly lower in both the active group and the inactive-to-active group compared to the other two groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Females dominated the inactive group (58.52%), while males were more prevalent in the active group (59.18%). Participants who either maintained or adopted exercise had higher self-assessed health scores compared to the two groups that remained inactive (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, we categorized the WWI of the different exercise groups into quartiles, revealing a significant difference in the values among the groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics by changes in physical activity among older adults in CLHLS 2011\u0026ndash;2018\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;7034)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003einactive\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;3433)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eactive\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1149)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eInactive-to-active\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1603)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eActive-to- inactive\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;849)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84.35\u0026thinsp;\u0026plusmn;\u0026thinsp;10.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.14\u0026thinsp;\u0026plusmn;\u0026thinsp;11.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.13\u0026thinsp;\u0026plusmn;\u0026thinsp;10.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82.66\u0026thinsp;\u0026plusmn;\u0026thinsp;9.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e87.30\u0026thinsp;\u0026plusmn;\u0026thinsp;10.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3268 (46.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1424 (41.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e680 (59.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e756 (47.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e408 (48.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3766 (53.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2009 (58.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e469 (40.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e847 (52.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e441 (51.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnic, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Han\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e419 (5.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e228 (6.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 (4.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e102 (6.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41 (4.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6615 (94.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3205 (93.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1101 (95.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1501 (93.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e808 (95.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBirth Place, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6281 (89.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3227 (94.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e871 (75.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1458 (90.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e725 (85.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e753 (10.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e206 (6.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e278 (24.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e145 (9.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e124 (14.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital, n(%)\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4273 (60.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2180 (63.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e592 (51.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e941 (58.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e560 (65.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2761 (39.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1253 (36.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e557 (48.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e662 (41.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e289 (34.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3896 (55.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2222 (64.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e371 (32.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e858 (53.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e445 (52.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2270 (32.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e968 (28.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e444 (38.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e565 (35.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e293 (34.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e739 (10.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e219 (6.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e268 (23.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e163 (10.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e89 (10.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129 (1.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (0.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (5.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (2.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrink, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.034\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5711 (81.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2819 (82.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e928 (80.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1264 (78.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e700 (82.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1323 (18.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e614 (17.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e221 (19.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e339 (21.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e149 (17.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEconnomic State, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5780 (82.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2949 (85.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e852 (74.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1273 (79.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e706 (83.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAffluent and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1254 (17.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e484 (14.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e297 (25.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e330 (20.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e143 (16.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical Insurance, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1191 (16.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e459 (13.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e296 (25.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e243 (15.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e193 (22.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5843 (83.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2974 (86.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e853 (74.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1360 (84.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e656 (77.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWWI, n(%)\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1768 (25.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e880 (25.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e282 (24.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e404 (25.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e202 (23.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1765 (25.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e853 (24.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e321 (27.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e388 (24.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e203 (23.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1749 (24.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e791 (23.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e337 (29.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e410 (25.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e211 (24.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1752 (24.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e909 (26.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e209 (18.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e401 (25.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e233 (27.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWaist,mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.72\u0026thinsp;\u0026plusmn;\u0026thinsp;18.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.43\u0026thinsp;\u0026plusmn;\u0026thinsp;18.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.21\u0026thinsp;\u0026plusmn;\u0026thinsp;13.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82.23\u0026thinsp;\u0026plusmn;\u0026thinsp;12.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82.61\u0026thinsp;\u0026plusmn;\u0026thinsp;31.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSleep quality, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD for continuous variables: the P value was calculated by ANOVA; (%) for categorical variables: the P value was calculated by Chi-square test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003eOthers include widowed, separated, divorced, or never married.\u003c/p\u003e \u003cp\u003e \u003csup\u003eb\u003c/sup\u003e Q is for Quartile\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Association between Physical Activity, WWI and All-cause Mortality\u003c/h2\u003e \u003cp\u003eWe conducted a comprehensive analysis utilizing Cox proportional hazards regression to explore the relationship between diverse physical activity patterns and all-cause mortality, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Both the unadjusted and covariate-adjusted results robustly demonstrated a statistically significant decrease in the hazard ratio (HR) among individuals classified as active, as well as those transitioning from inactive-to-active statuses (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Specifically, in Model 3, our findings revealed that the HR for the active group stood at 0.74 (95% CI: 0.65\u0026ndash;0.83), translating to a remarkable 26% reduction in the risk of mortality compared to their less active counterparts. Furthermore, for those who transitioned from an inactive to an active lifestyle, the HR was 0.91 (95% CI: 0.83\u0026ndash;0.99), signifying a potential 9% reduction in the risk of death, emphasizing the positive impact of altering exercise habits.\u003c/p\u003e \u003cp\u003eMoreover, we conducted a thorough examination of the correlation between WWI and overall mortality, with the outcomes presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Prior to adjusting for confounding variables, a pronounced elevation in mortality risk was observed exclusively in the fourth quartile (Q4, the highest category) compared to the first quartile (Q1, the lowest category), reaching statistical significance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with a hazard ratio (HR) of 1.24 (95% CI: 1.12 to 1.37). Subsequent to comprehensive adjustment for covariates, notable increases in mortality risk emerged for both the second (Q2) and third (Q3) quartiles (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while the risk in the fourth quartile (Q4) demonstrated an exceedingly significant surge (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In summary, a graded increase in mortality risk was observed with progressive elevation in WWI quartiles, with respective increments of 13% (Q2), 15% (Q3), and a substantial 43% (Q4), underscoring the heightened risk associated with higher WWI levels.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe associations between physical activity, WWI and survival among older adults in CLHLS 2011\u0026ndash;2018.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eModel1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eModel2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eModel3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical Activity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00 (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00 (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00 (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.63 (0.56\u0026thinsp;~\u0026thinsp;0.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.72 (0.64\u0026thinsp;~\u0026thinsp;0.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.74 (0.65\u0026thinsp;~\u0026thinsp;0.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInactive-to-active\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.82 (0.75\u0026thinsp;~\u0026thinsp;0.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.90 (0.82\u0026thinsp;~\u0026thinsp;0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.025\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.91 (0.83\u0026thinsp;~\u0026thinsp;0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.049\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive-to-inactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.21 (1.09\u0026thinsp;~\u0026thinsp;1.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.10 (0.99\u0026thinsp;~\u0026thinsp;1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.11 (1.00\u0026thinsp;~\u0026thinsp;1.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWWI\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ1(\u0026lt;\u0026thinsp;10.58cm/\u0026radic;kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00 (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00 (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00 (Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ2(10.58\u0026thinsp;~\u0026thinsp;11.38cm/\u0026radic;kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.99 (0.89\u0026thinsp;~\u0026thinsp;1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.775\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00 (0.90\u0026thinsp;~\u0026thinsp;1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.924\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.13 (1.01\u0026thinsp;~\u0026thinsp;1.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.033\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ3(11.38\u0026thinsp;~\u0026thinsp;12.30cm/\u0026radic;kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00 (0.90\u0026thinsp;~\u0026thinsp;1.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.965\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94 (0.85\u0026thinsp;~\u0026thinsp;1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.15 (1.02\u0026thinsp;~\u0026thinsp;1.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.023\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ4(\u0026ge;\u0026thinsp;12.30cm/\u0026radic;kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.24 (1.12\u0026thinsp;~\u0026thinsp;1.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.04 (0.94\u0026thinsp;~\u0026thinsp;1.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.43 (1.25\u0026thinsp;~\u0026thinsp;1.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eHR: Hazard Ratio, CI: Confidence Interval, \u003csup\u003ea\u003c/sup\u003eQ is for Quartile\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eModel1: Crude\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eModel2: Adjust: age, gender, ethnic, birth place, education, marital\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eModel3: Adjust: age, gender, ethnic, birth place, education, marital,econnomic state, medical insurance, waist, sleep quality, health\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn order to delve nonlinear associations among physical activity, WWI, and all-cause mortality, we crafted RCS curves(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Regarding the relationship between physical activity and all-cause mortality, our analysis revealed a pronounced statistical correlation (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for the overall analysis), both prior to and subsequent to adjusting for covariates. Notably, the P-values for non-linearity in Figures A and B, which depict this relationship, remained below 0.001, conclusively demonstrating a nonlinear association between physical activity levels and all-cause mortality. Elderly individuals who maintain an active lifestyle consistently exhibit the lowest all-cause mortality rates. Moreover, those transitioning from inactivity to an active lifestyle display a mortality rate slightly elevated compared to the consistently active group but significantly lower than those who remain inactive or move from active-to-inactive.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSimilarly, the link between WWI (Waist-to-Weight Index) and all-cause mortality manifested a statistically significant correlation (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) before and after covariate adjustment. However, upon covariate adjustment, the strength of evidence for nonlinearity weakened, as evidenced by a notable increase in the P-value for non-linearity (from P\u0026thinsp;\u0026lt;\u0026thinsp;0.001 to P\u0026thinsp;\u0026lt;\u0026thinsp;0.044), suggesting that while the nonlinear relationship persists, its statistical significance diminishes.Figures C and D highlight a distinct inflection point corresponding to Q3 of WWI, revealing that when WWI surpasses 11.38 cm/\u0026radic;kg, there is a marked increase in all-cause mortality rates.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Subgroup Analyses for Association Between Physical Activity and All-Cause Mortality\u003c/h2\u003e \u003cp\u003eTo assess whether the association between physical activity and all-cause mortality was consistent across populations, subgroup analyzes and interaction tests stratified by age, gender, marial, drink,medical insurance and WWI were performed. The physical activity group shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e was derived from the active and inactive-to- active groups, and the control group was derived from the inactive and active-to- inactive groups. Subgroup analyses revealed significant interactions between physical activity and gender, marital status, drinking habits, and insurance status. Notably, females (HR\u0026thinsp;=\u0026thinsp;0.62) and non-drinkers (HR\u0026thinsp;=\u0026thinsp;0.67) exhibited a more pronounced reduction in risk. Age and WWI quartiles did not show significant interactions with physical activity, although a consistent reduction in risk was observed across all age groups and WWI categories.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Mediating effects of WWI between physical activity and survival states\u003c/h2\u003e \u003cp\u003eFollowing stepwise regression, linear regression analyses were conducted with physical activity as the independent variable, survival status as the dependent variable, and WWI as the mediating variable. The results showed that physical activity had an effect on both WWI and survival status (i.e., c=-0.099, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; a=-0.045, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and after the introduction of WWI, physical activity, WWI had an effect on survival status (i.e., c'=-0.096, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; b\u0026thinsp;=\u0026thinsp;0.067, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). After establishing the mediation model, it showed that the total effect value of physical activity on survival status was \u0026minus;\u0026thinsp;0.099, and the direct effect value was \u0026minus;\u0026thinsp;0.096, and ab was the same sign as c', which suggests that there is a partially mediated effect of WWI between physical activity and survival status, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ea: effect value of physical activity on WWI, b: effect value of WWI on survival status, c: total effect value of physical activity on survival status, c': direct effect value of physical activity on survival status\u003c/p\u003e \u003cp\u003eTo robustly validate the mediating effects of WWI in the relationship between physical activity and survival status among older adults, we conducted hypothesis testing employing the nonparametric percentile Bootstrap method. Setting Bootstrap random sampling 5,000 times, the results show that none of the Bootstrap confidence intervals contain 0, indicating that the partial mediating effect of WWI on the impact of physical activity on the survival status of elderly people has statistical significance, although the proportion of mediating effect to the total effect is only 3.06%, see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBootstrap mediated effect test of WWI between physical activity and survival status in the elderly\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEffect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStd. Err.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndirect Effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.001 \u003cb\u003e~\u003c/b\u003e -0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect Effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.073 \u003cb\u003e~\u003c/b\u003e -0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 .012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.076 \u003cb\u003e~\u003c/b\u003e -0.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePM,%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e3.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003ePM,percent mediation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Disscusion","content":"\u003cp\u003eUsing data from the CLHLS, we examined the relationship between physical activity and all-cause mortality among Chinese older adults. Our findings indicate that maintaining exercise habits and transitioning from inactivity to an active lifestyle are associated with longer survival, regardless of covariate consideration.In exploring the nexus between physical activity and all-cause mortality, particularly in the elderly, many studies have provided consistent insights as presented in this article. For example, a longitudinal study of 85,545 elderly Australians found that a high-quality diet combined with high levels of moderate-to-vigorous physical activity (MVPA) significantly reduced risks of cardiovascular disease (CVD) and all-cause mortality [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The National Health and Nutrition Examination Survey (NHANES) 2011\u0026ndash;2014 data emphasized that objective measures of physical activity, above age, are the strongest predictors of all-cause mortality [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].A retrospective cohort study utilizing Korean National Health and Nutrition Examination Survey (KNHANES)-mortality linked data underscored the joint influence of physical activity and socioeconomic status (SES) on mortality, revealing a notable decrease in mortality risk among older adults with low SES who engage in regular physical activity [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Similarly, among low-income older Americans, a cohort study showed that high sitting time is an independent risk factor for all-cause and CVD mortality, while leisure-time physical activity (LTPA) mitigated this risk [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].In the Indian context, the Longitudinal Aging Study evidence suggests that adequate physical activity significantly lowers the risk of CVD among the elderly, emphasizing the importance of regular exercise in reducing CVD burden [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].Collectively, these findings highlight the pivotal role of physical activity in promoting longevity and reducing all-cause mortality in the elderly, transcending geographical and socioeconomic barriers. The shift from a sedentary to an active lifestyle is associated with longer survival, a benefit consistent across varying covariates. This underscores the need for public health interventions that encourage and facilitate active lifestyles among the elderly, thereby enhancing their health and well-being.\u003c/p\u003e \u003cp\u003eWWI has garnered attention as an emerging indicator for assessing obesity. Experimental findings indicate that a reduction in WWI significantly decreases the risk of multimorbidity in older adults [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and is positively associated with all-cause mortality in this population [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].All these results strongly support the premise of this paper that higher WWI values are associated with an increased risk of death. Furthermore, we identified that a WWI threshold of \u0026ge;\u0026thinsp;11.38 cm/\u0026radic;kg may indicate an elevated risk of death among Chinese older adults, as demonstrated by the RCS curve. This finding slightly differs from those of other studies.For example, according to the NHANES database, a study of a non-Asian population aged 18 to 80 years found that when WWI exceeded 10.46 cm/\u0026radic;kg, all-cause mortality increased by 20% for each unit increase in WWI [HR\u0026thinsp;=\u0026thinsp;1.20, 95% CI: (1.08, 1.33)] [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Additionally, a cohort study conducted in rural China recruited 10,338 non-hypertensive participants aged 18 years and older in Henan Province. This study found a positive association between WWI and the prevalence of hypertension over a subsequent six-year follow-up, revealing a significantly higher odds ratio (OR) for developing hypertension, particularly when WWI was \u0026ge;\u0026thinsp;10.91 cm/\u0026radic;kg [OR\u0026thinsp;=\u0026thinsp;1.50, 95% CI: 1.24\u0026ndash;1.82] [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The subtle differences in WWI thresholds may be attributed to the fact that the study population in this paper comprised individuals aged 60 years and older.\u003c/p\u003e \u003cp\u003eGiven that both physical activity as well as WWI have been shown to be strongly associated with all-cause mortality, a thought-provoking question is: Is there some potential correlation between the two? In order to explore this topic, subgroup analyses and interaction analyses were carefully designed with the aim of revealing possible subtle links between them.The results of the study showed significant interaction effects between physical activity and a range of socio-demographic factors and lifestyle habits, including gender, marital status, alcohol consumption, and health insurance status, when all-cause mortality was taken into account. These findings not only enrich our knowledge of health risk factors, but also highlight the importance of individual differences in influencing health outcomes.However, it is worth noting that when exploring whether there was an interaction between physical activity and WWI, our analyses did not find a statistically significant association between the two (P for interacton\u0026thinsp;=\u0026thinsp;0.462).It is important to note that the assessment of physical activity in our study was based on self-reported data, which could introduce potential bias [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurther, we analysed in depth the mediating effect of WWI between physical activity level and survival status. By constructing a mediating effect model, we found that WWI partially mediated this relationship. Although the proportion of the mediating effect was relatively low, at 3.06%, this finding is still clinically significant. Physical activity may have an indirect positive impact on all-cause mortality by reducing WWI values, which in turn may contribute to lowering all-cause mortality.Furthermore, despite the low proportion of the mediating effect, it serves as a reminder that other potential mediating variables or pathways should not be overlooked when exploring the relationship between physical activity and health outcomes. Future research could further explore how physical activity affects all-cause mortality through other mechanisms, such as improving cardiovascular health[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], reducing the inflammatory response[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], strengthening the immune system[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], promoting mental health[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and improving metabolic function[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], and how these mechanisms interact with WWI.\u003c/p\u003e"},{"header":"5. Concusion","content":"\u003cp\u003eIn conclusion, our study of older adults in China shows that maintaining physical activity or shifting from a sedentary lifestyle to an active one can reduce all-cause mortality. Conversely, a higher Weight-Adjusted Waist Index (WWI) is linked to an increased risk of all-cause mortality.The WWI seems to have a partial mediating effect between physical activity and death, shedding light on why physical activity reduces the risk of death. Further research is necessary to investigate additional mechanisms through which physical activity may lower the risk of death. The findings provide scientific evidence for developing health promotion strategies aimed at the elderly population, highlighting the importance of regular physical activity and maintaining a healthy weight to prevent premature death.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe authors declare that they have no confict of interest regarding the publication of this article.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was funded and organized by the Scientific Research Program of Jilin Provincial Department of Education (JJKH20240541SK), the Research Projects on Teaching Reform of Vocational and Adult Education in Jilin Province (2023ZCY302), and the Sports Science Research Projects of Jilin Provincial Sports Bureau (202324).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eKexin Ren proposed the main research objectives and was responsible for the conception, design and implementation of the study; Yuan Tao carried out the collection and organization of data, statistical processing, and manuscript writing; Meihong Wang was responsible for the drawing and presentation of figures and tables.All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe express our gratitude to the CLHLS team for providing us with the data, and we extend our appreciation to every respondent in the study for their valuable contributions.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eRaw data for this article is available from the CLHLS website (https://opendata.pku.edu.cn). The datasets used and/or analyzed during the current study are available from the first author on reasonable request (First author: Kexin REN, E-mail: [email protected]).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNational Bureau of Statistics of China. \u003cem\u003eStatistical Communique on Major Figures of the Seventh National Population Census\u003c/em\u003e (NBS Bulletin, 2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoolhaas, C. M. et al. Physical activity and cause-specific mortality: the Rotterdam Study. \u003cem\u003eInt. J. 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Data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) for 2011\u0026ndash;2018 included 7,034 residents aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years. We utilized Cox proportional hazard models to assess the relationships between physical activity, WWI, and all-cause mortality, supplemented by subgroup analyses and interaction tests. We conducted a mediation analysis to assess how much of the effect of physical activity on survival status was mediated through WWI. The results showed that active individuals and those transitioning from inactive to active lifestyles exhibited significantly lower all-cause mortality risks, with reductions of 26% (HR\u0026thinsp;=\u0026thinsp;0.74, CI: 0.65\u0026ndash;0.83) and 9% (HR\u0026thinsp;=\u0026thinsp;0.91, CI: 0.83\u0026ndash;0.99), respectively. A positive correlation was found between WWI and all-cause mortality, with a threshold of 11.38 cm/\u0026radic;kg indicating an increased risk. Although no interaction between physical activity and WWI was observed (P\u0026thinsp;=\u0026thinsp;0.462), mediation analysis showed that 3.06% of the effect of physical activity on survival status was mediated through WWI. The findings provide scientific evidence for developing health promotion strategies aimed at the elderly population.\u003c/p\u003e","manuscriptTitle":"Association between Physical Activity, Weight-adjusted Waist Index, and All-cause Mortality in Chinese Older Adults:A National Community-Based Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-20 13:48:02","doi":"10.21203/rs.3.rs-4903687/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d9a581ea-f08c-4aad-9cb0-5c1daf5e24c1","owner":[],"postedDate":"September 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":37837347,"name":"Health sciences/Health care"},{"id":37837348,"name":"Health sciences/Health occupations"},{"id":37837349,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-01-07T05:24:14+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-20 13:48:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4903687","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4903687","identity":"rs-4903687","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}