The association between domain-specific physical activity in adults and Parkinson’s disease and all-cause mortality: a NHANES study from 2007 to 2018

This study aimed to examine the associations between physical activity (PA) of different domains and intensities with the risk of Parkinson’s disease (PD) and all-cause mortality among adults aged 40 years and older. A total of 13,960 participants from the National Health and Nutrition Examination Survey (NHANES) 2007–2018 were included. Multivariable logistic regression models were used to evaluate the associations between PA and PD prevalence. Kaplan–Meier survival curves with log-rank tests were applied to compare mortality across PA categories, and Cox proportional hazards models were employed to assess the joint effects of PA and PD on all-cause mortality. Sex-stratified subgroup analyses and multiple sensitivity analyses were also performed to confirm the robustness of the findings. After adjustment for potential confounders, vigorous occupational PA (OPA) (OR = 0.349, 95% CI: 0.181–0.674) and total vigorous PA (OR = 0.471, 95% CI: 0.260–0.853) were inversely associated with PD prevalence. Survival analyses demonstrated that higher levels of PA, regardless of domain or intensity, were significantly associated with lower mortality. Consistent results were observed in Cox regression models, where adherence to moderate or vigorous PA was associated with a 29.5% (HR = 0.705, 95% CI: 0.638–0.7781) and 29.0% (HR = 0.710, 95% CI: 0.610–0.826) reduction in mortality risk, respectively. Among participants with PD, those not engaging in vigorous OPA (HR = 1.483, 95% CI: 1.134–1.940) or total vigorous PA (HR = 1.504, 95% CI: 1.150–1.968) had significantly higher mortality than non-PD individuals, whereas those who were physically active exhibited mortality risks comparable to their non-PD counterparts. Sensitivity analyses yielded consistent results, supporting the robustness of these associations. Vigorous occupational and total vigorous physical activity were inversely associated with both PD prevalence and all-cause mortality among adults aged ≥ 40 years. Moreover, adherence to vigorous PA among individuals with PD may mitigate the excess mortality risk associated with the disease. Nevertheless, prospective cohort studies are warranted to confirm these findings and clarify the underlying mechanisms.