NHANES 2011-2014: Objective Physical Activity is the Strongest Predictor of All-Cause Mortality.

Objectively measured physical activity (PA) is a modifiable risk factor for mortality. Understanding the predictive performance of PA is essential to establish potential targets for early intervention to reduce mortality among older adults. The study used a subset of the National Health and Nutrition Examination Survey (NHANES) 2011-2014 data consisting of participants aged 50 to 80 years old (n = 3653, 24297.5 person-years of follow-up, 416 deaths). Eight accelerometry derived features and 14 traditional predictors of all-cause mortality were compared and ranked in terms of their individual and combined predictive performance using the 10-fold cross-validated Concordance (C) from Cox regression. The top three predictors of mortality in univariate analysis were PA related: average MIMS in the 10 most active hours (C = 0.697), total MIMS per day (C = 0.686), and average log transformed MIMS in the most 10 active hours of the day (C = 0.684), outperforming age (C = 0.676) and other traditional predictors of mortality. In multivariate regression, adding objectively measured PA to the top performing model without PA variables increased concordance from C = 0.776 to C = 0.790 (p < 0.001). These findings highlight the importance of PA as a risk marker of mortality and are consistent with prior studies, confirming the importance of accelerometer-derived activity measures beyond total volume.

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Conflict of Interest and Funding Source: This work was supported by the National Institute of Health under Award Number R01 NS060910 and R01 AG075883. Dr. Crainiceanu is consulting with Bayer, Johnson and Johnson, and Cytel on methods development for wearable devices in clinical trials.