Exercise is associated with lower all-cause mortality among older adults: a national cohort survival analysis with county-level industrial air pollution indicators.
Wang W, Xu J, et al. • Frontiers in public health • 2026
Self-reported current exercise habits were consistently associated with lower all-cause mortality among Chinese older adults (fully adjusted HR = 0.835), and this protective association was not significantly modified by county-level industrial air pollution indicators.
Key Findings
Results
Self-reported current exercise habits were significantly associated with lower all-cause mortality risk among older adults after multivariate adjustment.
Fully adjusted hazard ratio (HR) = 0.835, 95% CI: 0.773–0.902, p < 0.001
The association was robust to sequential adjustment for covariates including sex, health status, baseline age, smoking status, residence, BMI, functional status, and comorbidity count
Analysis included 16,954 participants aged ≥65 years from the Chinese Longitudinal Healthy Longevity Survey (2008–2014)
Three follow-up waves spanning 6 years were used with time-varying covariates updated at each wave
Results
SO2 emissions showed only a weak, non-significant association with survival risk in univariate analysis that was further attenuated after multivariate adjustment.
Univariate HR for SO2 emissions = 1.023, 95% CI: 0.942–1.111, p = 0.585
Fully adjusted HR for SO2 emissions = 1.001, 95% CI: 0.874–1.146, p = 0.992
All pollution indicators were standardized prior to analysis
County-level industrial air pollution indicators (annual soot and SO2 emissions and removals) were matched to individuals according to their residence
Results
Soot-related industrial air pollution indicators showed no significant associations with all-cause mortality.
Neither soot emissions nor soot removals were significantly associated with mortality outcomes
Four pollution indicators total were examined: SO2 emissions, SO2 removals, soot emissions, and soot removals
All pollution indicators were derived from county-level industrial data matched to participants by residence
Analyses were conducted using Cox proportional hazards models constructed sequentially from univariate to fully adjusted multivariate models
Results
No statistically significant multiplicative interaction was detected between exercise habits and any of the four county-level industrial air pollution indicators.
All interaction p-values were >0.05 for exercise habits crossed with each of the four pollution indicators
Two-way interaction models were constructed for each pollution indicator with exercise habits before multivariate adjustment
This finding indicates that industrial air pollution did not significantly modify the protective association between exercise and mortality
The study used multistage stratified sampling across 23 Chinese provinces
Methods
The study used a longitudinal cohort design with time-varying covariates updated across three follow-up waves over 6 years.
Data source was the Chinese Longitudinal Healthy Longevity Survey (CLHLS), 2008–2014
Multistage stratified sampling was conducted across 23 provinces
Sample included 16,954 participants aged ≥65 years
Self-reported current exercise habits and survival outcomes were the primary exposure and outcome variables, respectively
Covariates included sex, smoking status, baseline age, residence, BMI, functional status, and comorbidity count
What This Means
This research suggests that older adults who regularly exercise have a meaningfully lower risk of dying from any cause compared to those who do not exercise. Using data from nearly 17,000 Chinese adults aged 65 and older, followed over six years, researchers found that exercisers had about a 16.5% lower risk of death even after accounting for many other health factors like age, smoking, body weight, and existing health conditions. This finding held up consistently across different statistical models, suggesting the relationship is robust.
The study also examined whether living in areas with high levels of industrial air pollution—specifically soot and sulfur dioxide (SO2) emissions—weakened the protective effect of exercise. Researchers matched each participant to county-level data on industrial pollution where they lived. Contrary to what some might expect, industrial air pollution indicators were not significantly associated with mortality on their own, and they did not meaningfully change the benefit of exercise. In other words, the protective effect of exercise appeared to persist regardless of the level of local industrial pollution.
This research suggests that encouraging regular physical activity among older adults could be a valuable public health strategy even in industrially polluted areas, though the authors note that continued efforts to control industrial emissions remain important. Because the study relied on self-reported exercise habits and county-level rather than individual-level pollution measurements, future research with more precise exposure data would help confirm these findings.
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Wang W, Xu J, Wang C, Zhao Y, Ren H. (2026). Exercise is associated with lower all-cause mortality among older adults: a national cohort survival analysis with county-level industrial air pollution indicators.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1894835