Accelerometer-derived 24-hour movement profiles and risk of cardiovascular disease and mortality: a prospective study of 76,778 UK Biobank participants
Y Zhao, J Li, R Guo, Y Miao, Y Luo, H Wang, F Yang, Y WuAbstract
Background
Daily movement behaviors form an interdependent 24-hour system, yet cardiovascular prevention strategies focus primarily on isolated activity metrics. Whether device-derived behavioral phenotypes better capture cardiovascular risk remains unclear.
Methods
This prospective cohort study included adult UK Biobank participants free of baseline cardiovascular disease. Valid 7-day wrist accelerometer data were processed using a validated machine learning framework to classify sleep, sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Latent profile analysis derived distinct 24-hour movement phenotypes based on time-use composition. Multivariable Cox proportional hazards models, adjusted for sociodemographic, lifestyle, and clinical covariates, alongside compositional data analysis, were utilized to assess associations with incident CVD, mortality, and theoretical time reallocations.
Results
The final analysis comprised 76,778 participants. Over a median follow-up of 9.9 years, 5,504 incident CVD events and 541 cardiovascular deaths were documented. Five distinct movement phenotypes were identified. Compared with the "High Sedentary" referent group, the "High LPA Movers" exhibited a significantly lower risk of incident CVD (HR 0.89; 95% CI 0.81–0.99) despite engaging in minimal vigorous exertion. Furthermore, the "High MVPA Warriors" demonstrated further risk reductions for incident CVD (HR 0.81; 95% CI 0.71–0.93) and conferred the greatest survival advantage for cardiovascular mortality (HR 0.47; 95% CI 0.29–0.77). Compositional isotemporal substitution confirmed that replacing 30 minutes/day of SB with LPA was associated with reduced risks of incident CVD (HR 0.98; 95% CI 0.97–0.99) and cardiovascular mortality (HR 0.94; 95% CI 0.92–0.96).
Conclusion
Device-derived 24-hour movement phenotypes reveal profound heterogeneity in cardiovascular risk that is not captured by isolated activity metrics. While moderate-to-vigorous activity remains the most potent driver of cardiovascular survival, achieving high volumes of light-intensity activity or simply reallocating 30 minutes of sedentary time offers clinically meaningful protection. These findings advocate for a shift in preventive cardiology towards personalized, whole-day movement strategies.Figure 1Figure 2