社区居住的老年人中活跃回合水平与跌倒发生率之间的 U 型关系：一项前瞻性队列研究。
The U-Shaped Relationship Between Levels of Bouted Activity and Fall Incidence in Community-Dwelling Older Adults: A Prospective Cohort Study.
机构信息
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China.
Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, China.
出版信息
J Gerontol A Biol Sci Med Sci. 2020 Sep 25;75(10):e145-e151. doi: 10.1093/gerona/glaa058.
BACKGROUND
It remains uncertain whether the association between physical activity (PA) and falls is U-shaped, and few studies have explored the potential mediation of PA accumulation pattern.
METHODS
We measured PA in 671 community-dwelling older adults (82.7 ± 3.8 years) using wrist-worn accelerometer for 7 days. PA was further classified to bouted PA (≥10 minutes bout length) and sporadic PA (<10 minutes bout length) for subanalysis. Fall incidence in the following 12-month was recorded through tri-monthly telephone interviews. Classification and Regression Tree analysis was used to identify two optimal cutoff values of each PA measurement to predict falls. Participants were then divided into "inactive," "moderately active," and "highly active" groups accordingly. Negative binomial regression models were used to estimate the association between the PA measures and fall incidence.
RESULTS
Six hundred and thirty-nine participants completed 12-month follow-up. Ninety-three (14.6%) experienced a total of 118 falls. Inactive and highly active older adults had higher falls per person month relative to the moderately active group (inactive: incidence rate ratios [IRR] = 2.372, 95% confidence interval [CI] = 1.317-4.271; highly active: IRR = 2.731, 95% CI = 1.196-6.232). Subanalyses found similar significant finding with bouted PA (p < .001) but not sporadic PA (p ≥ .221). The association between bouted PA and falls remained significant even after adjusting fall incidence for bouted activity time (inactive: IRR = 3.636, 95% CI = 2.238-5.907; highly active: IRR = 1.823, 95% CI = 1.072-3.1). Further adjustments for fall-related risk factors did not meaningfully change the results.
CONCLUSION
A U-shaped relationship was identified between bouted but not sporadic PA and fall incidence. There is an approximately twofold increase in fall rate in highly active older adults even after adjusting for activity time.
背景
目前尚不确定体力活动（PA）与跌倒之间的关系是否呈 U 型，并且很少有研究探讨 PA 积累模式的潜在中介作用。
方法
我们使用腕戴式加速度计测量了 671 名社区居住的老年人（82.7±3.8 岁）的 PA，连续测量 7 天。对于亚分析，PA 进一步分为爆发性 PA（≥10 分钟的运动长度）和非爆发性 PA（＜10 分钟的运动长度）。通过每三个月一次的电话访谈记录 12 个月内的跌倒发生率。使用分类和回归树分析确定每个 PA 测量的两个最佳截断值以预测跌倒。然后，参与者相应地分为“不活动”、“适度活跃”和“高度活跃”组。使用负二项回归模型估计 PA 测量值与跌倒发生率之间的关联。
结果
639 名参与者完成了 12 个月的随访。93 名（14.6%）共发生 118 次跌倒。与中度活跃组相比，不活跃和高度活跃的老年人的人均跌倒次数更高（不活跃：发病率比 [IRR] = 2.372，95%置信区间 [CI] = 1.317-4.271；高度活跃：IRR = 2.731，95% CI = 1.196-6.232）。亚分析发现，爆发性 PA（p<0.001）而非非爆发性 PA（p≥0.221）存在类似的显著发现。即使在校正爆发性活动时间后，爆发性 PA 与跌倒之间的关联仍然显著（不活跃：IRR = 3.636，95% CI = 2.238-5.907；高度活跃：IRR = 1.823，95% CI = 1.072-3.1）。进一步调整与跌倒相关的风险因素并没有显著改变结果。
结论
发现爆发性 PA 与跌倒发生率之间存在 U 型关系，但非爆发性 PA 与跌倒发生率之间没有这种关系。即使在校正活动时间后，高度活跃的老年人跌倒率也会增加近两倍。
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