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The association between weekend warrior physical activity pattern and albuminuria in hypertensive patients

樱花视频 volume听24, Article听number:听3431 (2024) Cite this article

Abstract

Background

Albuminuria, a critical and sensitive indicator of vascular injury, has been linked to early kidney damage in patients with hypertension. High-quality physical activity (PA) may reduce urinary albumin excretion. Yet, the connection between PA patterns and albuminuria is still not well understood.

Methods

Albuminuria was identified as urinary albumin/creatinine ratio (ACR)鈥�>鈥�30 mg/g. PA was assessed by a series of self-report questionnaires and grouped into inactive PA, insufficient PA, weekend warriors (WWs), and regular PA. Logistic regression was conducted to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) to explore the relationship between PA pattern and albuminuria among hypertensive adults. Subgroup and sensitivity analyses were conducted to verify the robustness of the results.

Results

This research included 12,961 hypertensive adults (mean age: 54.31鈥壜扁��0.24 years), including 6,060 (46.76%) females and 6,901 (53.24%) males. Of them, 2,239 (17.27%) were identified with albuminuria, and 10,722 (82.73%) were without albuminuria. Logistic regression showed that WWs had a 47% lower risk of albuminuria (OR鈥�=鈥�0.53,95%CI:0.35鈥�0.80), and regular PA had a 32% decreased risk of albuminuria (OR鈥�=鈥�0.68,95%CI:0.56鈥�0.82). However, there were no differences between WWs and regular PA in reducing albuminuria among hypertensive adults. Subgroup analyses showed that these inverse associations of WWs and regular PA with albuminuria were found in hypertensive adults without diabetes.

Conclusions

Compared with inactive PA, both WWs and regular PA could confer the听equivalent benefits on reducing albuminuria among hypertensive adults.听These findings highlight the beneficial effect of PA on albuminuria and provide a proven method for those hypertensive adults with a busy lifestyle.

Peer Review reports

Introduction

Albuminuria in individuals with hypertension has been regarded as a sensitive indicator of hypertension target organ damage (TOD) [1]. Several pieces of clinical evidence have demonstrated that the hypertensive population has an increased occurrence of proteinuria [2]. Previous research has proven that urinary albumin symbolizes a valuable indicator of cardiovascular outcomes among patients with hypertension. Meanwhile, decreased urinary albumin excretion has been shown to be related to a lower risk of myocardial infarction and cerebrovascular accidents among patients with hypertension [3]. Therefore, effective early prevention, including the development of a healthy lifestyle and diet, is urgently needed to prevent albuminuria among hypertensive adults.

To date, physical activity (PA) has been known to have countless profound benefits in enhancing physical condition by regulating emotions and preventing diseases, such as cardiovascular disease (CVD), diabetes, renal dysfunction, and several cancers [4, 5]. In addition, PA is beneficial for CVD by improving vascular endothelial function and decreasing indicators of inflammation [6]. Moreover, the advantages of consistent PA in preventing hypertension and improving prognosis were well-established in previous investigations [7, 8]. A prior survey with 3,587 participants enrolled in the United States demonstrated that a higher level of PA reduced urinary albumin excretion [9]. Further, according to the PA guidelines, adults are recommended to engage in at least 150 min of moderate-intensity PA weekly or 75 min a week of vigorous-intensity PA or an equivalent combination [10]. Still, considering the busy lifestyle, PA on weekends or leisure time may be a more suitable option. As has been proven in prior literature, achieving the recommended quality of PA was equally crucial, regardless of the exercise times per week [11]. Subsequently, in a study of 63,591 subjects, O'Donovan, and colleagues found that a short-bout, irregular PA pattern could decrease the mortality risk for CVD [12]. Thus, some individuals may prefer to condense all aerobic activity into once or twice a week, called "weekend warriors" (WWs). Even though WWs exercise less frequently, the duration of each exercise can be extended, and the intensity can meet the International PA guidelines [13]. Despite this, little is known about the correlation between WWs activity and the risk of albuminuria in hypertensive patients.

Considering the importance of PA as a group of modifiable CVD risk factors, which can directly optimize life quality for the public, the primary aim of our research was to evaluate the connection between different PA patterns and albuminuria among hypertension adults from the US National Health and Nutrition Examination Survey (NHANES). Considering the impact of glucose metabolism on the risk of albuminuria, we defined two secondary objectives for this study: (1) to investigate whether diabetes affects the relationship between different PA patterns and albuminuria risk, and (2) to examine whether exercise can improve insulin resistance.

Methods

Study design and population

NHANES program is a biennial and nationally replicated cross-sectional plan conducted by the National Center for Health Statistics (NCHS) to investigate the risk factors of common diseases and detailed health status among Americans. The datasets from NHANES were collected by highly trained staff and contained face-to-face interviews, biochemical tests, and physical examinations. All NHANES examinees were eligible to have two interviews. The first interview was completed in their home, and the second was conducted in the mobile examination center (MEC) via a series of health examinations. Written informed consent was provided by all children and adults when they were enrolled, and then NCHS signed all informed consent. For this reason, there is no need to provide additional local ethical approval due to the data's openness and originality. The public data of the current analysis can be found at NHANES' online website: .

The current study extracted public data from six NHANES year-cycles (2007鈥�2008, 2009鈥�2010, 2011鈥�2012, 2013鈥�2014, 2015鈥�2016, 2017鈥�2018) to assess the relationship between PA pattern and albuminuria. Specifically, 59,842 participants from NHANES 2007鈥�2018 were evaluated. Among them, only 17,891 participants were defined as having hypertension. We further excluded participants with the missing value of the following conditions: urinary albumin/creatinine ratio (ACR) (n鈥�=鈥�431), PA (n鈥�=鈥�66), and covariates data (n鈥�=鈥�4433). Finally, we analyzed 12,961 eligible hypertensive participants in the current study (Fig.听1).

Fig.听1
figure 1

Flow chart of the study design

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Definition of albuminuria

Urine specimens of NHANES subjects were procured at standardized MEC. Urinary albumin and creatinine were assessed through solid-phase fluorescence immunoassay. The calculation methodology for ACR entailed dividing urine albumin concentration (mg) by urine creatinine concentration (g) and then we defined ACR鈥�>鈥�30 mg/g as albuminuria [14].

Definition of hypertension

The blood pressure (BP) measurement protocol employed adhered to the procedures established by the American Heart Association. BP was measured at rest three times, and the mean values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were computed. According to the previous guidelines, individuals with SBP鈥夆墺鈥�130 mmHg and/or DBP鈥夆墺鈥�80 mmHg were classified as hypertensive [15]. Additionally, participants who answered "yes" to the question "Has anyone ever told you that you have high blood pressure?" or who used any anti-hypertensive drugs currently were also categorized as hypertensive. Moreover, according to our definition, uncontrolled hypertension was defined if the SBP鈥夆墺鈥�130 mmHg, or DBP鈥夆墺鈥�80 mmHg regardless of the use of hypotensive drugs [16].

Assessment of PA pattern

A series of survey questions of PA were recorded by highly trained collectors, which was verified in previous publications. All activities were segmented into three categories: transportation-related PA (TPA), leisure-time PA (LTPA), and occupational-related PA (OPA). Furthermore, by NHANES analysis guidelines, 1 min of vigorous PA was equivalent to 2 min of moderate PA [17]. Of note, TPA was excluded from the present analysis. Therefore, we initially selected OPA and LTPA as primary variables to calculate total PA with the combination of duration and frequency [18]. Then, we classified all participants into 4 categories based on total PA: inactive PA (0 min/week), insufficient PA (0鈥�<鈥塼otal PA鈥�<鈥�150 min/week), WWs (total PA鈥夆墺鈥�150 min/week and frequency鈥夆墹鈥�2 sessions/week), and regular PA (total PA鈥夆墺鈥�150 min/week and frequency鈥�>鈥�2 sessions/week).

Covariates

Based on clinical experience and previous publications, we selected some continuous variables and categorical variables as the potential confounders. Continuous variables included age, body mass index (BMI), alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine, and uric acid. And categorical variables included gender, race, education level, marital status, poverty income ratio (PIR), smoking, alcohol status, CVD, diabetes, hyperlipidemia, and medication use. Race was categorized as Non-Hispanic Black, Non-Hispanic White, Mexican American, and other races [19]. Marital status was categorized as married, unmarried, and others [20]. PIR was divided into 3 groups:鈥夆墹鈥�1.30, 1.30鈥�3.50, and鈥�>鈥�3.50 [21]. Education level was stratified into 5 levels: less than 9th grade, 9th-11th grade, high school, some college, and college or above [22]. Smoking, alcohol status, and CVD were assessed through a self-reported questionnaire. Alcohol status was categorized as never (<鈥�12 drinks in a lifetime), former (鈮モ��12 drinks in 1 year and did not drink last year), mild drinker (鈮も��1 drink/day for women or鈥夆墹鈥�2 drinks/day for men), and heavy drinker (鈮モ��2 drinks/day for women or鈥夆墺鈥�3 drinks/day for men) [23]. Diabetes was defined as the diagnosis told by doctors or the current use of diabetes medications or insulin [24].

Statistical analysis

According to the NHANES analysis tutorial, a complex survey design was fully considered, and appropriate sample weight was applied in the current study [25]. The significance level was defined as 伪鈥�=鈥�0.05, and all statistical tests were bilateral. R software (version 4.1.3) was conducted for all statistical analyses.

Differences in baseline between four PA patterns were compared using one-way ANOVA tests for continuous variables and chi-square tests for categorical variables. Continuous variables are displayed as mean鈥壜扁�塻tandard error (SE), and categories variables are indicated as the frequency with percentage. Weighted logistic regression was conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs) to analyze the relationship between each PA pattern and albuminuria among hypertensive adults. Model听1听was听adjusted听for听no听covariates. Model 2 was adjusted for age, gender, and race. Model 3 was further adjusted for model 2, plus marital status, PIR, education level, BMI, smoking, alcohol status, CVD, diabetes, serum creatinine, uric acid, ALT, AST, hyperlipidemia, and medication use. Due to the skewed distribution of ACR, we perform a logarithmic transformation on its values to meet the linear assumption. Furthermore, given that poor BP control may aggravate proteinuria, we explored the connection between different PA patterns and albuminuria risk among uncontrolled and controlled hypertension participants. In addition, we investigated the stability of interrelations between subgroups through stratified analysis and interaction effects.

Additionally, we utilized lipid markers, fasting blood glucose, Homeostatic Model Assessment-insulin resistance (HOMA-IR), and systemic immune-inflammation index (SII, platelets count鈥壝椻�塶eutrophil/lymphocyte ratio) to assess the impact of each PA pattern on lipid metabolism, glucose metabolism, and inflammation.

To test the robustness of our results, several sensitivity analyses were performed. First, we selected 140/90 mmHg as a new hypertensive cut-off value to verify our results in the fully-adjusted model. Second, to avoid possible reverse causation in the hypertension assessment, participants with SBP鈥�<鈥�90/DBP鈥�<鈥�60mmHg were excluded from the final analyses (n鈥�=鈥�1837). Third, three hypertension diagnosis criteria were separately used to verify the correlation of PA pattern and albuminuria risk among hypertension adults.

Results

Baseline characteristics of included participants

As illustrated in Table听1, the sample size for 6-year NHANES cycles was 12,961, including 4,699 (36.25%) inactive PA participants, 1,732 (13.36%) insufficient PA participants, 387 (2.99%) WWs and 6,143 (47.40%) regular PA participants. Of them, 6,060 (46.76%) were females and 6,901 (53.24%) were males, with an average age of 54.31鈥壜扁��0.24 years. Specifically, variables of age, BMI, gender, race, education, marital status, PIR, ALT, serum uric acid, diabetes, hyperlipidemia, CVD, alcohol status, ACR, and medication use were all associated with PA pattern (all P鈥�<鈥�0.05). No significant differences among the four PA patterns were found in AST, serum creatinine, and smoke.

Table 1 The baseline characteristics of study participants according to PA pattern
Full size table

The demographic and clinical features of hypertensive adults with and without albuminuria are shown in Table S1. Briefly, 10,722 (82.73%) hypertensive adults were identified to be without albuminuria, while 2,239 (17.27%) were with albuminuria. Hypertensive adults with albuminuria were more likely to be older, Non-Hispanic White, college-educated, married, and current non-drinkers, had a lower level of PIR and had a higher level of BMI, AST, serum creatinine, and serum uric acid compared to those without albuminuria adults (all P鈥�<鈥�0.05). Besides, adults with albuminuria tended to use antidiabetic drugs and had a higher prevalence of diabetes, hyperlipidemia, and CVD (all P鈥�<鈥�0.05). No significant differences were found between the two groups regarding gender, ALT, smoking, and the use of anti-hypertensive drugs.

Association between PA pattern and albuminuria

Results using multivariate linear regression and logistic regression to analyze the association between PA pattern and albuminuria/lnACR are presented in Table听2, Fig.听2, and Figure S1. When we treated the independent variable as a categorical听variable and controlled all covariates, WWs had a 47% lower risk of albuminuria (OR鈥�=鈥�0.53, 95%CI:0.35鈥�0.80), and regular PA had a 32% lower risk of albuminuria (OR鈥�=鈥�0.68, 95%CI:0.56鈥�0.82) comparing with inactive PA. No significant effect was found for the relationship between insufficient PA and albuminuria. Similar results were observed when we performed lnACR as a continuous variable in the same model. WWs and regular PA were both related to decreased lnACR in hypertensive adults, with corresponding regression coefficients (95%CI) being -0.09 (-0.14, -0.03) and -0.07 (-0.10, -0.04), respectively. Importantly, there were no differences between WWs and regular PA, indicating WWs and regular PA had the same efficacy in reducing albuminuria among hypertensive adults.

Table 2 Association between PA pattern and albuminuria among hypertension adults
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Fig.听2
figure 2

The forest plot of physical activity pattern and albuminuria in hypertension

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As illustrated in Table听3, we further explored PA pattern and albuminuria associations among patients with controlled and uncontrolled hypertension. In the controlled hypertension group, WWs had a 68% lower risk of albuminuria (OR鈥�=鈥�0.32,95%CI:0.11鈥�0.93), and regular PA had a 38% lower risk of albuminuria (OR鈥�=鈥�0.62, 95%CI:0.43鈥�0.90) comparing with inactive PA in the fully adjusted model. Similar results were observed among patients with uncontrolled hypertension. WWs and regular PA were both inversely associated with the odds of albuminuria after adjusting for all confounding factors. The OR (95%CI) was 0.56 (0.35鈥�0.89) for WWs and 0.68 (0.56鈥�0.82) for regular PA. No significant differences between WWs and regular PA were found in decreasing albuminuria regardless of blood pressure control.

Table 3 Associations of PA pattern and albuminuria in controlled hypertension and uncontrolled hypertension
Full size table

Finally, we investigated the relationship between each PA pattern and glucose metabolism, lipid metabolism, and inflammation. Compared with those who were inactive PA, WWs had lower fast glucose, HOMA-IR, and SII. However, no significant differences were found in lipid metabolism for WWs (Table S2).

Subgroup and sensitivity analysis

Subgroup analyses of the associations between PA pattern and albuminuria are shown in Table听4. WWs were related to decreased albuminuria among those hypertensive participants who were male, old adults (aged鈥夆墺鈥�60 years), Non-Hispanic White, non-smokers, without diabetes and obesity, and had PIR鈥夆墹鈥�3.50. Importantly, a significant interaction between diabetes and PA pattern with albuminuria was found (P for interaction鈥�=鈥�0.016).

Table 4 Subgroup analysis for the relationship between PA pattern and albuminuria among hypertension adultsa
Full size table

In the sensitivity analyses, we initially selected 140/90mmHg as the hypertensive cut-off value to explore the correlation of WWs and regular PA with albuminuria. As expected, we found the results were robust by using logistic and linear regression (Table S3). Furthermore, after excluding hypotension participants, we observed that WWs and regular PA had equivalent benefits in reducing albuminuria among hypertensive adults (Table S4). Additionally, our results showed that WWs and regular PA associations with hypertensive albuminuria consistently used three different hypertension diagnosis criteria (Table S5). Finally, no difference between WWs, sufficiently active PA, and highly active PA was observed on reducing the risk of albuminuria (Table S6).

Discussion

The current survey data from NHANES demonstrated that WWs pattern was related to decreased risk of albuminuria among hypertension adults compared with inactive PA. More importantly, WWs and regular PA could confer the equivalent benefits of reducing albuminuria among hypertension adults. Additionally, subgroup analysis revealed that these inverse associations of WWs and regular PA with albuminuria were found in hypertension adults without diabetes. These findings highlighted the beneficial effect of PA on albuminuria and provided a novel and effective movement pattern for those hypertension adults with a busy lifestyle.

Our conclusions demonstrated a similar effect of WWs and regular PA pattern on proteinuria in hypertensive patients, which was partly consistent with previous studies. For example, a recently published meta-analysis concluded that both the WWs pattern and regular PA pattern had similar cardiovascular disease (CVD) benefits compared to inactive PA [4]. Similarly, a cross-sectional study found that WWs and regular PA helped reduce the Visceral Adiposity Index compared to inactive PA. Furthermore, no significant distinction was found between WWs and regular PA pattern, emphasizing the importance of PA duration rather than frequency [18].Considering the benefits of the WWs pattern, the WWs pattern may be incorporated into future PA guidelines and treatments in clinical practice, especially for those people with a busy lifestyle.

Interestingly, our results showed that active PA could be a potential protective factor for hypertensive patients with albuminuria [26]. Hypertension features sympathetic hyperexcitability, contributing to glomerular foot cell damage, atherosclerosis, and endothelial dysfunction, ultimately resulting in proteinuria [9, 26]. Indeed, regular moderate PA has been proven to promote an antioxidant state, increase nitric oxide (NO) production, and improve vascular endothelial function [27]. Besides, adherence to active PA can alleviate sympathetic overdrive and improve sympathovagal balance, thereby reducing urinary albumin excretion [28]. Based on our sensitivity analysis, the WWs pattern was adversely related to proteinuria in both听controlled听and听uncontrolled hypertension听groups, reflecting that the WWs pattern was proven to benefit the reduction of proteinuria, regardless of blood pressure control. It has been suggested that hypertension and impaired microvascular endothelial function are considered to be malignant circles [29]. We speculated that active physical exercise could interrupt this bi-directional association by enhancing microvascular endothelial function.

A novel finding in our analysis was that a frequency of once or twice weekly of medium- or high-intensity PA pattern was inversely related to SII, fast glucose, and HOMA-IR. This observation was supported by prior research that emphasized WWs exercise pattern was sufficiently beneficial in reducing blood glucose and improving insulin secretion, oxidative stress, and inflammation [30]. Elevated fasting plasma glucose was recognized as a significant and independent risk factor for albuminuria events [31]. Insulin resistance can affect renal hemodynamics, and cause glomerular dysfunction and glomerulosclerosis, ultimately leading to albuminuria [32, 33]. Meanwhile, excessive inflammatory cell factors can directly impair renal glomerular function and correlate with an increased urinary protein excretion rate [34]. Thus, we speculated that adherence to exercise could decrease the urinary protein excretion rate by counteracting the harmful effects of hyperglycemia, insulin resistance, and inflammation on renal function. Nevertheless, the WWs pattern could not improve lipid metabolism, which was partly consistent with research by Lee et al. Their study pointed out that men with high-risk factors like hyperlipidemia may not benefit from sporadic PA as the WWs. Owing to some positive impacts on PA that were short-lived [13]. Therefore, WWs might fail to enjoy the full benefits of PA.

Our results revealed that the inverse relationship of WWs and regular PA with albuminuria was found in hypertension adults without diabetes. As we all know, chronic inflammation, prolonged hyperglycemic state, and intractable hyperinsulinemia are often accompanied by diabetic patients [35]. Meanwhile, diabetes can cause severe vascular endothelial damage and aggravate glomerular podocyte injury, which in turn causes complicated clinical complications [36]. It may not be possible to reduce albuminuria through physical exercise because those patients with hypertension and diabetes have severe endothelial function impairment and high-grade systemic inflammation. Further prospective studies are needed to confirm our conjecture.

Our research has several strengths. First, the current research data is established on the NHANES database, which provides a large-scale and nationally representative database, making our study findings reliable. Second, the ACR is an accurate and sensitive index with fewer influencing factors, relatively stable in individuals, enabling a better assessment of early renal damage in hypertension. Third, the sensitivity analyses performed by several methods were incredibly stable and strongly provided robustness to our conclusions.

Of note, several limitations should be pointed out in our research. First, given the limitations of the cross-sectional design, causality cannot be definitively established. Second, our study relied on self-reported questionnaires, which could be affected by recall bias. Finally, the current study primarily explored different PA patterns, without delving further into the correlation between PA intensity, exercise/sedentary ratio, and proteinuria.

Conclusion

Compared with inactive PA, WWs and regular PA could confer the equivalent benefits on reducing albuminuria among hypertensive adults. These findings highlighted the beneficial effect of PA on albuminuria and provided a novel and effective movement pattern for those hypertensive adults with a busy lifestyle.

Data availability

Data described in the manuscript are publicly and freely available without restriction at https://www.cdc.gov/nchs/nhanes/index.htm.

Abbreviations

ACR:

Albumin/creatinine ratio

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

BMI:

Body mass index

CI:

Confidence interval

CVD:

Cardiovascular disease

DBP:

Diastolic blood pressure

HOMA-IR:

Homeostatic Model Assessment-insulin resistance

LTPA:

Leisure-time physical activity

MEC:

Mobile examination center

NCHS:

National Center for Health Statistics

NHANES:

National Health and Nutrition Examination Survey

NO:

Nitric oxide

OPA:

Occupation-related physical activity

OR:

Odds ratio

PA:

Physical activity

PIR:

Poverty income ratio

SBP:

Systolic blood pressure

SE:

Standard error

SII:

Systemic immune-inflammation index

TOD:

Target organ damage

TPA:

Transportation-related physical activity

WWs:

Weekend warriors

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Acknowledgements

We thank Mr. Jing Zhang for his excellent contribution to the NHANES database so that we can easily extract these data.

Funding

This work was supported by the Key Project of Technology Innovation and Application Development in Chongqing (CSTB2023TIAD-KPX0048), the Construction of graduate tutor team in Chongqing Medical University (cqmudstd202205), the postdoctoral project of Chongqing Natural Science Foundation (CSTB2022NSCQ-BHX0626), Natural Science Foundation of Chongqing鈥係cience鈥俛nd鈥俆echnology鈥侰ommission (CSTB2023NSCQ-BHX0020), Postdoctoral Project of Chongqing Natural Science Foundation (CSTB2022NSCQ-MSX1657), and China Postdoctoral Science Foundation (2023MD744155).

Author information

Author notes

  1. Bingquan Xiong, Wenlong Yu and Xinyi Guan contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Road, Yuzhong District, Chongqing, 400010, China

    Bingquan Xiong,听Wenlong Yu,听Huiping Yang,听Yingrui Li,听Bin Liu,听Yufan Wang听&听Qiang She

  2. Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Road, Chongqing, 400010, China

    Xinyi Guan

  3. Department of VIP, Chongqing General Hospital, Chongqing University, Chongqing, China

    Zhuo Tian

  4. Department of Geriatrics, The First People鈥檚 Hospital of Neijiang, No. 31 Tuozhong Lane, Jiaotong Road, Neijiang, Sichuan Province, 641000, China

    Min Zhu

  5. Department of Endocrinology and Metabolism, The First Affiliated Hospital of Jinan University, No. 613, Huang Pu Avenue West, Guangzhou, Guangdong, China

    Jiaxin Wang

Authors
  1. Bingquan Xiong

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  2. Wenlong Yu

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  10. Yufan Wang

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Contributions

XB, YW and XG had the main responsibility for data analysis and writing the manuscript. YW, MZ, and HY contributed to the conception and design of the study, analysis, and interpretation of the data, and drafting of the manuscript. JW, YL, and BL contributed to the acquisition of data. XB, WY and ZT revised the manuscript. WY and QS are the guarantors. All authors contributed to the writing and final approval of the manuscript.

Corresponding authors

Correspondence to Yufan Wang or Qiang She.

Ethics declarations

Ethics approval and consent to participate

NHANES is conducted by the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics (NCHS). The NCHS Research Ethics Review Committee reviewed and approved the NHANES study protocol. All participants signed written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Supplementary Information

Additional file 1:听Table S1. The baseline characteristics of study participants according to albuminuria status. Table S2. The relationship of PA pattern and glucose metabolism, lipid metabolism, and inflammation*. Table S3. Association between PA pattern and albuminuria using a hypertensive cut-off value of 140/90 mmHg (n=10376). Table S4. Association between PA pattern and albuminuria after exclusion of hypotension patients (n=11124). Table S5. Association between PA pattern and albuminuria in three diagnosis criteria. Table S6. Relationship of WW, sufficiently active, and highly active of albuminuria among hypertensive adults. Figure S1. The forest plot of physical activity pattern and albuminuria in hypertension.

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Xiong, B., Yu, W., Guan, X. et al. The association between weekend warrior physical activity pattern and albuminuria in hypertensive patients. 樱花视频 24, 3431 (2024). https://doi.org/10.1186/s12889-024-20899-7

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  • DOI: https://doi.org/10.1186/s12889-024-20899-7

Keywords

樱花视频

ISSN: 1471-2458

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