Sufficient leisure-time physical activity was associated with lower prevalence odds of chronic obstructive pulmonary disease among U.S. adults, according to a cross-sectional analysis of national survey data spanning 2007 to 2018, during which standardized COPD prevalence showed an overall upward pattern.
Researchers analyzed six repeated cross-sectional cycles of the National Health and Nutrition Examination Survey (NHANES), covering adults aged 20 years and older. The certified source roster contained 34,556 participants, and the formal primary model cohort comprised 31,722 participants, of whom 2,400 reported having COPD. Leisure-time physical activity was classified as inactive, insufficient, or sufficient, and daily sitting time was grouped as less than 4 hours, 4 to under 8 hours, or 8 or more hours.
The team used complex-survey methods, direct standardization to the projected year 2000 U.S. population across five adult age strata, and survey-weighted logistic regression. Only the continuous poverty-to-income ratio was multiply imputed by predictive mean matching with ten imputations, with coefficients and variances combined using Rubin’s rules.
After five-age-group standardization, COPD prevalence stood at 7.3% in 2007–2008, dipped to 5.5% in 2009–2010, and rose to 8.5% in 2017–2018. The global categorical P value was 0.0489, the linear trend P value was 0.0369, and the quadratic-component P value was 0.2782, indicating an overall upward pattern across the twelve-year window.
In the fully adjusted primary model, sufficient leisure-time physical activity was associated with lower prevalence odds of COPD compared with inactivity, with a prevalence odds ratio of 0.726 (95% CI, 0.618–0.852). By contrast, sitting time showed no statistically clear association: compared with sitting less than 4 hours per day, the prevalence odds ratios were 1.052 (95% CI, 0.910–1.217) for 4 to under 8 hours per day and 1.131 (95% CI, 0.954–1.339) for 8 or more hours per day.
The researchers also ran a model-prediction exercise for the 2017–2018 cycle. Setting leisure-time physical activity to the sufficient category for all model records yielded a predicted COPD prevalence of 7.64%, versus 9.03% under observed exposures. That absolute difference was 1.392 percentage points (95% CI, 0.581–2.203), a relative difference of 15.42% (95% CI, 7.09%–23.75%). A low-sitting scenario produced an absolute difference of 0.355 percentage points (95% CI, −0.387–1.098), an interval that includes zero.
The authors are explicit that these scenario contrasts are not estimates of preventable COPD. They describe them as descriptive, model-based contrasts rather than intervention effects, and the study’s conclusions emphasize that the hypothetical exposure scenarios do not establish what would happen under real-world changes in activity levels.
The repeated cross-sectional design cannot establish temporal or causal direction, and reverse causation remains plausible—meaning that people with COPD may exercise less because of their disease, rather than inactivity causing the disease. The self-reported nature of the COPD outcome and the cross-sectional measurement of both exposures and outcome further limit interpretation.
Subject of Research: Associations of leisure-time physical activity and sitting time with COPD prevalence among U.S. adults
Article Title: Trends in chronic obstructive pulmonary disease and their associations with leisure-time physical activity and sitting time in U.S. adults, 2007–2018
Article References: Yuan, L., Zhao, P., Wang, Q., & Yang, Z. (2026). Trends in chronic obstructive pulmonary disease and their associations with leisure-time physical activity and sitting time in U.S. adults, 2007–2018. BMC Pulmonary Medicine. https://doi.org/10.1186/s12890-026-04888-7
Image Credits: AI Generated
DOI: 10.1186/s12890-026-04888-7
Keywords: COPD, NHANES, physical activity, sitting time, sedentary behavior, prevalence, cross-sectional study, public health, pulmonary medicine, U.S. adults, epidemiology, Trends
News Source: Barbara Leach. (October 28, 2026). More Leisure-Time Physical Activity Tied to Lower COPD Prevalence in U.S. Adults. Scienmag.
