Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
New York University School of Medicine, New York.
JAMA Cardiol. 2016 Aug 1;1(5):568-74. doi: 10.1001/jamacardio.2016.1324.
Whether sustained physical activity prevents cardiovascular disease (CVD) events in older adults is uncertain.
To test the hypothesis that cardiovascular morbidity and mortality would be reduced in participants in a long-term physical activity program.
DESIGN, SETTING, AND PARTICIPANTS: The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, randomized trial. Participants were recruited at 8 centers in the United States. We randomized 1635 sedentary men and women aged 70 to 89 years with a Short Physical Performance Battery (SPPB) score of 9 or less but able to walk 400 m.
The physcial activity (PA) intervention was a structured moderate-intensity program, predominantly walking 2 times per week on site for 2.6 years on average. The successful aging intervention consisted of weekly health education sessions for 6 months, then monthly.
Total CVD events, including fatal and nonfatal myocardial infarction, angina, stroke, transient ischemic attack, and peripheral artery disease, were adjudicated by committee, and silent myocardial infarction was assessed by serial electrocardiograms. A limited outcome of myocardial infarction, stroke, and CVD death was also studied. Outcome assessors and adjudicators were blinded to intervention assignment.
The 1635 LIFE study participants were predominantly women (67%), with a mean (SD) age of 78.7 (5.2) years; 20% were African-American, 6% were Hispanic or other race or ethnic group, and 74% were non-Latino white. New CVD events occurred in 121 of 818 PA participants (14.8%) and 113 of 817 successful aging participants (13.8%) (HR, 1.10; 95% CI, 0.85-1.42). For the more focused combined outcome of myocardial infarction, stroke, or cardiovascular death, rates were 4.6% in PA and 4.5% in the successful aging group (HR, 1.05; 95% CI, 0.67-1.66). Among frailer participants with an SPPB score less than 8, total CVD rates were 14.2% in PA vs 17.7% in successful aging (HR, 0.76; 95% CI, 0.52-1.10), compared with 15.3% vs 10.5% among those with an SPPB score of 8 or 9 (HR, 1.59; 95% CI, 1.09-2.30) (P for interaction = .006). With the limited end point, the interaction was not significant (P = .59), with an HR of 0.94 (95% CI, 0.50-1.75) for an SPPB score less than 8 and an HR of 1.20 (95% CI, 0.62-2.34) for an SBBP score of 8 or 9.
Among participants in the LIFE Study, an aerobically based, moderately intensive PA program was not associated with reduced cardiovascular events in spite of the intervention's previously documented ability to prevent mobility disability.
clinicaltrials.gov Identifier: NCT00116194.
长期进行身体活动是否可以预防老年人的心血管疾病（CVD）事件仍不确定。
检验假设，即长期身体活动计划的参与者心血管发病率和死亡率会降低。
设计、地点和参与者：生活方式干预和老年人独立（LIFE）研究是一项多中心、随机试验。参与者是在美国 8 个中心招募的。我们随机招募了 1635 名年龄在 70 至 89 岁之间、短程体能表现电池（SPPB）评分为 9 或以下但能够行走 400 米的久坐男性和女性。
身体活动（PA）干预是一项结构化的中等强度方案，主要是每周两次在现场进行，平均持续 2.6 年。成功老龄化干预包括 6 个月的每周健康教育课程，然后是每月一次。
总心血管事件，包括致命和非致命性心肌梗死、心绞痛、中风、短暂性脑缺血发作和外周动脉疾病，由委员会进行裁决，静息性心肌梗死通过连续心电图进行评估。还研究了心肌梗死、中风和 CVD 死亡的有限结果。结果评估者和裁决者对干预分配情况不知情。
LIFE 研究的 1635 名参与者主要是女性（67%），平均年龄（标准差）为 78.7（5.2）岁；20%为非裔美国人，6%为西班牙裔或其他种族或族裔群体，74%为非拉丁裔白人。新发生的 CVD 事件发生在 818 名 PA 参与者中的 121 名（14.8%）和 817 名成功老龄化参与者中的 113 名（13.8%）（HR，1.10；95%CI，0.85-1.42）。对于心肌梗死、中风或心血管死亡的更集中的联合结果，PA 组的发生率为 4.6%，成功老龄化组的发生率为 4.5%（HR，1.05；95%CI，0.67-1.66）。在 SPPB 评分低于 8 的更脆弱参与者中，PA 组的总 CVD 发生率为 14.2%，成功老龄化组为 17.7%（HR，0.76；95%CI，0.52-1.10），而 SPPB 评分为 8 或 9 的参与者发生率为 15.3%（10.5%）（交互作用 P=0.006）。对于有限的终点，交互作用不显著（P=0.59），SPPB 评分低于 8 的 HR 为 0.94（95%CI，0.50-1.75），SPPB 评分为 8 或 9 的 HR 为 1.20（95%CI，0.62-2.34）。
在 LIFE 研究的参与者中，尽管该干预措施先前已被证明能够预防运动障碍，但基于有氧运动的适度强化 PA 方案与降低心血管事件无关。
clinicaltrials.gov 标识符：NCT00116194。
