O'Keefe James H, O'Keefe Evan L, Lavie Carl J
Clockwise, James H. O'Keefe, MD, MSMA member since 2003, is at Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
Evan L. O'Keefe, MS, is in the Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana.
Mo Med. 2018 Mar-Apr;115(2):98-105.
are evolutionarily adapted to be very physically active throughout life, and thus habitual physical activity (PA) is essential for well-being and longevity. Never the less, middle-aged and older individuals engaging in excessive strenuous endurance exercise appear to be at increased risk for a variety of adverse cardiovascular (CV) effects including atrial fibrillation, myocardial fibrosis, and coronary atherosclerosis. An emerging body of evidence indicates U-shaped or reverse J-shaped curves whereby low doses and moderate doses of PA significantly reduce long-term risks for both total mortality and CV mortality, however, at very high doses of chronic strenuous exercise much of the protection against early mortality and CV disease is lost. The optimal dose, or what we term 'Goldilocks Zone,' of PA may be: at least 150 minutes per week of moderate-intensity aerobic exercise or 75 minutes per week of vigorous-intensity aerobic activity, but not more than four to five cumulative hours per week of vigorous (heart-pounding, sweatproducing) exercise, especially for those over 45 years of age. It is also important to take at least one day per week off from vigorous exercise. There appears to be no concerns about an upper threshold for safety for leisure-time low-to-moderate intensity activities such as walking at a comfortable pace, housework, gardening, etc. After every 30 consecutive minutes spent sitting, stand up and move, ideally walking briskly for about five minutes.
人类在进化过程中适应了一生中保持高度的身体活动，因此习惯性身体活动（PA）对于身心健康和长寿至关重要。然而，中老年人进行过度剧烈的耐力运动似乎会增加患各种心血管（CV）不良影响的风险，包括心房颤动、心肌纤维化和冠状动脉粥样硬化。越来越多的证据表明存在U形或倒J形曲线，即低剂量和中等剂量的PA可显著降低全因死亡率和心血管死亡率的长期风险，然而，在非常高剂量的慢性剧烈运动中，许多对早期死亡和心血管疾病的保护作用会丧失。PA的最佳剂量，即我们所说的“刚刚好的区间”，可能是：每周至少150分钟的中等强度有氧运动或每周75分钟的高强度有氧运动，但每周累计剧烈（心跳加速、出汗）运动不超过四到五个小时，尤其是对于45岁以上的人。每周至少有一天不进行剧烈运动也很重要。对于休闲时的低至中等强度活动，如以舒适的步伐行走、做家务、园艺等，似乎不存在安全上限的问题。每连续坐30分钟后，站起来活动一下，理想情况下轻快地走大约五分钟。
