Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland.
JAMA Netw Open. 2019 Mar 1;2(3):e190355. doi: 10.1001/jamanetworkopen.2019.0355.
Although the benefits of leisure-time physical activity (LTPA) in middle age are established, the health effects of long-term participation and changes in LTPA between adolescence and middle age have not been documented.
To determine whether an association exists between LTPA life course patterns and mortality.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used data from the National Institutes of Health-AARP (formerly American Association of Retired Persons) Diet and Health Study established in 1995 to 1996. Data analysis was conducted from March 2017 through February 2018. Data were analyzed for 315 059 adult AARP members living in 6 states, namely, California, Florida, Louisiana, New Jersey, North Carolina, or Pennsylvania, or 2 metropolitan areas, Atlanta, Georgia, or Detroit, Michigan.
Self-reported LTPA (hours per week) at the baseline interview for ages grouped as 15 to 18, 19 to 29, 35 to 39, and 40 to 61 years.
All-cause, cardiovascular disease (CVD)-related, and cancer-related mortality records available through December 31, 2011.
Of 315 059 participants, 183 451 (58.2%) were men, and the participants were 50 to 71 years of age at enrollment. Ten LTPA trajectories (categorized as maintaining, increasing, and decreasing LTPA across time) were identified, and 71 377 deaths due to all causes, 22 219 deaths due to CVD, and 16 388 deaths due to cancer occurred. Compared with participants who were consistently inactive throughout adulthood, participants who maintained the highest amount of LTPA in each age period were at lower risks for all-cause, CVD-related, and cancer-related mortality. For example, compared with participants who were consistently inactive, maintaining higher amounts of LTPA was associated with lower all-cause (hazard ratio [HR], 0.64; 95% CI, 0.60-0.68), CVD-related (HR, 0.58; 95% CI, 0.53-0.64), and cancer-related (HR, 0.86; 95% CI, 0.77-0.97) mortality. Adults who were less active throughout most of the adult life course but increased LTPA in later adulthood (40-61 years of age) also had lower risk for all-cause (HR, 0.65; 95% CI, 0.62-0.68), CVD-related (HR, 0.57; 95% CI, 0.53-0.61), and cancer-related (HR, 0.84; 95% CI, 0.77-0.92) mortality.
Maintaining higher LTPA levels and increasing LTPA in later adulthood were associated with comparable low risk of mortality, suggesting that midlife is not too late to start physical activity. Inactive adults may be encouraged to be more active, whereas young adults who are already active may strive to maintain their activity level as they get older.
虽然已经确定了中年时期休闲时间体力活动（LTPA）的益处，但长期参与和青春期与中年时期 LTPA 变化的健康影响尚未记录。
确定 LTPA 生命历程模式与死亡率之间是否存在关联。
设计、设置和参与者：这项前瞻性队列研究使用了 1995 年至 1996 年期间美国国立卫生研究院-美国退休人员协会（前身为美国退休人员协会）饮食与健康研究的数据。数据分析于 2017 年 3 月至 2018 年 2 月进行。分析了居住在加利福尼亚州、佛罗里达州、路易斯安那州、新泽西州、北卡罗来纳州或宾夕法尼亚州或佐治亚州亚特兰大或密歇根州底特律的 6 个州或 2 个大都市区的 315059 名 AARP 成年会员的数据。
在基线访谈中报告的 LTPA（每周几小时），年龄组为 15 至 18 岁、19 至 29 岁、35 至 39 岁和 40 至 61 岁。
截至 2011 年 12 月 31 日，所有原因、心血管疾病（CVD）相关和癌症相关死亡率记录均可获得。
在 315059 名参与者中，183451 名（58.2%）为男性，参与者在入组时年龄为 50 至 71 岁。确定了 10 种 LTPA 轨迹（分为随时间保持、增加和减少 LTPA），发生了 71377 例因各种原因导致的死亡、22219 例因 CVD 导致的死亡和 16388 例因癌症导致的死亡。与整个成年期一直不活跃的参与者相比，在每个年龄段保持最高 LTPA 量的参与者因各种原因、CVD 相关和癌症相关的死亡风险较低。例如，与一直不活跃的参与者相比，保持较高的 LTPA 量与较低的全因死亡率（风险比 [HR]，0.64；95%CI，0.60-0.68）、CVD 相关死亡率（HR，0.58；95%CI，0.53-0.64）和癌症相关死亡率（HR，0.86；95%CI，0.77-0.97）相关。在大多数成年生活中活动较少但在成年后期（40-61 岁）增加 LTPA 的成年人也具有较低的全因（HR，0.65；95%CI，0.62-0.68）、CVD 相关（HR，0.57；95%CI，0.53-0.61）和癌症相关（HR，0.84；95%CI，0.77-0.92）死亡率。
保持较高的 LTPA 水平和增加成年后期的 LTPA 与死亡率的低风险相当，这表明中年并不是开始体力活动的太晚的时间。不活跃的成年人可能会被鼓励更加活跃，而已经活跃的年轻人随着年龄的增长可能会努力保持他们的活动水平。
