长期休闲时间体力活动强度与全因和死因特异性死亡率：一项美国成年人的前瞻性队列研究。
Long-Term Leisure-Time Physical Activity Intensity and All-Cause and Cause-Specific Mortality: A Prospective Cohort of US Adults.
机构信息
Departments of Nutrition (D.H.L., H.-K.J., N.K., E.B.R., F.K.T., E.L.G.), Harvard T.H. Chan School of Public Health, Boston, MA.
Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil (L.F.M.R.).
出版信息
Circulation. 2022 Aug 16;146(7):523-534. doi: 10.1161/CIRCULATIONAHA.121.058162. Epub 2022 Jul 25.
BACKGROUND
The 2018 physical activity guidelines for Americans recommend a minimum of 150 to 300 min/wk of moderate physical activity (MPA), 75 to 150 min/wk of vigorous physical activity (VPA), or an equivalent combination of both. However, it remains unclear whether higher levels of long-term VPA and MPA are, independently and jointly, associated with lower mortality.
METHODS
A total of 116 221 adults from 2 large prospective US cohorts (Nurses' Health Study and Health Professionals Follow-up Study, 1988-2018) were analyzed. Detailed self-reported leisure-time physical activity was assessed with a validated questionnaire, repeated up to 15 times during the follow-up. Cox regression was used to estimate the hazard ratio and 95% CI of the association between long-term leisure-time physical activity intensity and all-cause and cause-specific mortality.
RESULTS
During 30 years of follow-up, we identified 47 596 deaths. In analyses mutually adjusted for MPA and VPA, hazard ratios comparing individuals meeting the long-term leisure-time VPA guideline (75-149 min/wk) versus no VPA were 0.81 (95% CI, 0.76-0.87) for all-cause mortality, 0.69 (95% CI, 0.60-0.78) for cardiovascular disease (CVD) mortality, and 0.85 (95% CI, 0.79-0.92) for non-CVD mortality. Meeting the long-term leisure-time MPA guideline (150-299 min/wk) was similarly associated with lower mortality: 19% to 25% lower risk of all-cause, CVD, and non-CVD mortality. Compared with those meeting the long-term leisure-time physical activity guidelines, participants who reported 2 to 4 times above the recommended minimum of long-term leisure-time VPA (150-299 min/wk) or MPA (300-599 min/wk) showed 2% to 4% and 3% to 13% lower mortality, respectively. Higher levels of either long-term leisure-time VPA (≥300 min/wk) or MPA (≥600 min/wk) did not clearly show further lower all-cause, CVD, and non-CVD mortality or harm. In joint analyses, for individuals who reported <300 min/wk of long-term leisure-time MPA, additional leisure-time VPA was associated with lower mortality; however, among those who reported ≥300 min/wk of long-term leisure-time MPA, additional leisure-time VPA did not appear to be associated with lower mortality beyond MPA.
CONCLUSIONS
The nearly maximum association with lower mortality was achieved by performing ≈150 to 300 min/wk of long-term leisure-time VPA, 300 to 600 min/wk of long-term leisure-time MPA, or an equivalent combination of both.
背景
2018 年美国体育活动指南建议，每周至少进行 150 至 300 分钟中等强度的身体活动（MPA）、75 至 150 分钟剧烈强度的身体活动（VPA），或两者的等效组合。然而，目前尚不清楚长期进行较高水平的 VPA 和 MPA 是否会独立或联合与较低的死亡率相关。
方法
共有来自 2 个大型美国前瞻性队列（护士健康研究和健康专业人员随访研究，1988-2018 年）的 116221 名成年人参与了这项研究。详细的休闲时间体力活动通过经过验证的问卷进行评估，在随访期间最多重复 15 次。使用 Cox 回归估计长期休闲时间体力活动强度与全因和特定原因死亡率之间的关联的风险比和 95%置信区间。
结果
在 30 年的随访期间，我们共发现 47596 例死亡。在相互调整 MPA 和 VPA 的分析中，与没有 VPA 的个体相比，达到长期休闲时间 VPA 指南（75-149 分钟/周）的个体全因死亡率的风险比为 0.81（95%置信区间，0.76-0.87），心血管疾病（CVD）死亡率为 0.69（95%置信区间，0.60-0.78），非 CVD 死亡率为 0.85（95%置信区间，0.79-0.92）。达到长期休闲时间 MPA 指南（150-299 分钟/周）同样与较低的死亡率相关：全因、CVD 和非 CVD 死亡率降低 19%至 25%。与达到长期休闲时间体力活动指南的参与者相比，报告进行 2 至 4 次推荐最低长期休闲时间 VPA（150-299 分钟/周）或 MPA（300-599 分钟/周）的参与者，死亡率分别降低 2%至 4%和 3%至 13%。较高水平的长期休闲时间 VPA（≥300 分钟/周）或 MPA（≥600 分钟/周）并不明显显示出更低的全因、CVD 和非 CVD 死亡率或危害。在联合分析中，对于报告的长期休闲时间 MPA ＜300 分钟/周的个体，额外的休闲时间 VPA 与较低的死亡率相关；然而，对于报告的长期休闲时间 MPA ≥300 分钟/周的个体，额外的休闲时间 VPA 似乎不会与 MPA 之外的较低死亡率相关。
结论
通过进行 ≈150 至 300 分钟/周的长期休闲时间 VPA、300 至 600 分钟/周的长期休闲时间 MPA 或两者的等效组合，与较低死亡率的关联达到了几乎最大的程度。
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