More Physical Activity Linked to Lower Odds of the ‘Three Highs’ in Older Chinese Adults

Among middle-aged and older Chinese adults, those who reported higher levels of physical activity were less likely to have hypertension, hyperglycaemia, hyperlipidaemia, or all three conditions at once, according to an open-access study published in BMC Public Health. The findings come from a cross-sectional analysis of a large national sample, and the authors caution that the design shows associations rather than proven cause and effect. Hypertension, hyperglycaemia and hyperlipidaemia are often described collectively as the "three highs" (3H), because each involves an elevated reading of blood pressure, blood glucose or blood lipids.

While physical activity has long been linked to cardiometabolic health, the study's authors note that its relationship with the individual conditions and, in particular, with their co-occurrence has remained incompletely understood. The research team, led by Xin Chen, Dexin Wang and Zihao Zhang, used multivariable logistic regression to estimate how a total physical activity score related to the prevalence of each condition and to having all three simultaneously. To test whether the relationship was linear, they applied restricted cubic spline analysis, a technique that allows the shape of an association to bend rather than forcing it into a straight line.

They also ran subgroup and interaction analyses to see whether the associations differed by age, sex, smoking status, drinking status, and a history of stroke, arthritis or rheumatism, or asthma. When participants were grouped into tertiles by their total physical activity score, the prevalence of the three-high conditions differed significantly between groups, with the lowest prevalence observed in the most active tertile. In models adjusted for multiple covariates, each unit increase in the total physical activity score was associated with lower odds of hypertension (odds ratio 0.907, 95% confidence interval 0.869–0.946), hyperlipidaemia (0.863, 0.822–0.906), hyperglycaemia (0.823, 0.772–0.878) and concurrent 3H conditions (0.778, 0.703–0.862), all statistically significant at p < 0.001.

The strongest relative association appeared for the co-occurrence of all three conditions, where the odds ratio of 0.778 implies roughly a 22% reduction in odds per unit of the activity score within the observed range. The spline analysis showed an overall negative association for each outcome, and the odds ratios generally fell below 1.0 once the total physical activity score exceeded 93.3, suggesting that the apparent benefit became more consistent at higher activity levels. As an additional layer of analysis, the researchers used exploratory structural equation models to examine statistical pathways between physical activity and the three conditions.

These mediation analyses suggested that physical activity may influence the three-high conditions partly by affecting hyperglycaemia, hyperlipidaemia and hypertension themselves, though the authors frame this as an exploratory statistical examination rather than a demonstration of biological mechanism. The subgroup and interaction analyses indicated that the associations between physical activity and the three-high conditions were examined across strata of age, sex, smoking and drinking status, and the presence of stroke, arthritis or rheumatism, or asthma. The published abstract reports that these analyses were performed to test whether the associations differed across these characteristics, without detailing every subgroup result.

Because the data are cross-sectional, the study cannot establish that higher activity causes lower prevalence; it is equally possible that people with hypertension, diabetes or dyslipidaemia exercise less because of their conditions, or that unmeasured factors influence both activity and cardiometabolic health. Nevertheless, the study adds to a growing body of evidence that physical activity is associated with better cardiometabolic profiles in ageing populations, and it is unusual in quantifying that association for the simultaneous presence of all three conditions rather than for each in isolation.

Subject of Research: Associations between physical activity and hypertension, hyperglycaemia and hyperlipidaemia among middle-aged and older Chinese adults

Article Title: Physical activity and the prevalence of hypertension, hyperglycaemia, hyperlipidaemia, and their co-occurrence among middle-aged and older Chinese adults

Article References: Chen, X., Wang, D., & Zhang, Z. (2026). Physical activity and the prevalence of hypertension, hyperglycaemia, hyperlipidaemia, and their co-occurrence among middle-aged and older Chinese adults. BMC Public Health. https://doi.org/10.1186/s12889-026-29685-z

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29685-z

Keywords: physical activity, hypertension, hyperglycaemia, hyperlipidaemia, three highs, cardiometabolic health, cross-sectional study, Chinese adults, BMC Public Health, logistic regression, mediation analysis, ageing