What This Means
This research suggests that where people live—specifically whether their county has good access to gyms, parks, and other exercise facilities—is linked to how many people die from a cluster of related conditions including heart disease, kidney failure, and diabetes (collectively called cardiovascular-kidney-metabolic or CKM syndrome). Analyzing data from US counties between 2014 and 2019, the study found that counties with better exercise access had about 11% lower total CKM death rates compared to counties with the worst access, and counties where more residents were physically inactive had about 23% higher CKM death rates. Southern US counties stood out as having the worst combination of limited exercise access, high inactivity, and high CKM mortality.
However, the picture was more complicated than expected when looking at the three components of CKM separately. The benefits of exercise access were clearest for heart disease deaths, but surprisingly, counties with better exercise access actually had higher rates of diabetes and kidney failure deaths. Similarly, while high inactivity was strongly linked to more cardiovascular deaths, kidney failure deaths were unexpectedly lower in the most inactive counties. These unexpected patterns likely reflect the complexity of ecological studies—county-level data cannot prove that individuals who are inactive are the ones dying, and many other community-level factors could be influencing these results.
This research suggests that improving access to exercise in underserved communities—particularly in the South—and reducing population-level physical inactivity could be important strategies for reducing the combined burden of heart, kidney, and metabolic disease deaths. However, the inconsistent findings for kidney and diabetes mortality highlight that the relationship between physical environment and these specific conditions is complex and warrants further investigation before drawing firm policy conclusions.