Real-World Associations Between Physical Activity, LDL Cholesterol, and Functional Performance in Primary Care: A Cross-Sectional Study

Background: Physical activity (PA) is associated with cardiometabolic health and functional performance, but evidence from real-world primary care populations simultaneously examining PA, low-density lipoprotein cholesterol (LDL-C), and functional performance remains limited. Objective: This study evaluated associations between PA, LDL-C, and functional performance in a real-world primary care cohort. Methods: This cross-sectional observational study included 863 adult primary care patients evaluated between February 2021 and March 2026. The overall cohort had a mean age of 52.4 ± 14.8 years, and 53.3% of participants were female. PA was assessed using self-reported activity categories (low, moderate, or high) obtained during a routine clinical evaluation. LDL-C concentrations were analyzed in the full cohort, while Timed Up and Go (TUG) functional performance assessment was available in an exploratory subgroup (n = 214). Multivariable regression analyses were adjusted for age, sex, body mass index (BMI), diabetes mellitus, and arterial hypertension in the TUG analysis. Results: Higher PA categories were associated with lower LDL-C concentrations across groups (p < 0.001). Mean LDL-C concentrations were 3.68 ± 1.05 mmol/L in the low PA group, 3.39 ± 0.97 mmol/L in the moderate PA group, and 3.12 ± 0.89 mmol/L in the high PA group. In the exploratory TUG subgroup, higher PA categories were also associated with better functional performance (p < 0.001). These associations remained significant after multivariable adjustment. Conclusions: Higher self-reported PA levels were associated with lower LDL-C concentrations in the full cohort and with better functional performance in the subgroup with available TUG data. Because of the cross-sectional observational design, these findings should be interpreted as associations and do not establish causality or directionality. Residual confounding, particularly from unavailable data on lipid-lowering medication use, smoking status, diet, socioeconomic status, and other cardiovascular risk factors, cannot be excluded. Future longitudinal studies using objective PA assessment, a more complete confounder assessment, and direct measurement of regulatory processes are warranted.