Rey Lopez Juan Pablo, Sabag Angelo, Martinez Juan Maria, Rezende Leandro F M, Pastor-Valero Maria
Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, Australia.
i+HEALTH Research Group, Department of Health Sciences, Universidad Europea Miguel de Cervantes, Valladolid, Spain.
BMJ Open Sport Exerc Med. 2020 Oct 5;6(1):e000775. doi: 10.1136/bmjsem-2020-000775. eCollection 2020.
To examine whether vigorous-intensity physical activity confers additional reductions on all-cause and cause-specific mortality compared with moderate-intensity physical activity.
A systematic review (registered in PROSPERO CRD42019138995) and meta-analysis.
Three electronic databases up to April 14 2020.
Inclusion criteria were prospective studies that contained information about (1) moderate-intensity (3-5.9 metabolic equivalent tasks (METs)) and vigorous-intensity (≥6 METs) physical activities and (2) all-cause and/or cause-specific mortality. Exclusion criteria were prospective studies that (1) exclusively recruited diseased patients (eg, hypertensive patients and diabetics) or (2) did not account for total physical activity in their multivariable models (3) or did not adjust or exclude individuals with comorbidities at baseline or (4) used physically inactive participants as reference group.
Five studies (seven cohorts using sex-specific results) were pooled into a meta-analysis. For all-cause mortality and controlling by total physical activity, vigorous-intensity physical activity (vs moderate) was not associated with a larger reduction in mortality (HR 0.95, 95% CI 0.83 to 1.09). After the exclusion of one study judged with critical risk of bias (Risk Of Bias in Non randomized Studies, ROBINS tool) from meta-analysis, results remained similar (HR 0.98, 95% CI 0.85 to 1.12). Due to the limited number of studies, meta-analyses for cancer and cardiovascular mortality were not performed.
Prospective studies suggest that, for the same total physical activity, both vigorous-intensity and moderate-intensity physical activities reduce all-cause mortality to the same extent. However, absence of evidence must not be interpreted as evidence of absence due to the existing methodological flaws in the literature.
探讨与中等强度身体活动相比，剧烈强度身体活动是否能进一步降低全因死亡率和特定病因死亡率。
系统评价（已在PROSPERO注册，注册号CRD42019138995）和荟萃分析。
截至2020年4月14日的三个电子数据库。
前瞻性研究，包含以下信息：（1）中等强度（3 - 5.9代谢当量任务（METs））和剧烈强度（≥6 METs）身体活动；（2）全因死亡率和/或特定病因死亡率。排除标准：（1）仅招募患病患者（如高血压患者和糖尿病患者）的前瞻性研究；（2）在多变量模型中未考虑总身体活动量的前瞻性研究；（3）在基线时未调整或排除合并症个体的前瞻性研究；（4）以身体不活动的参与者作为参照组的前瞻性研究。
五项研究（七组使用按性别分层的结果）被纳入荟萃分析。对于全因死亡率并控制总身体活动量，剧烈强度身体活动（与中等强度相比）与死亡率降低幅度更大无关（风险比0.95，95%置信区间0.83至1.09）。在从荟萃分析中排除一项被判定存在严重偏倚风险的研究（非随机研究中的偏倚风险，ROBINS工具）后，结果仍然相似（风险比0.98，95%置信区间0.85至1.12）。由于研究数量有限，未对癌症和心血管疾病死亡率进行荟萃分析。
前瞻性研究表明，对于相同的总身体活动量，剧烈强度和中等强度身体活动在降低全因死亡率方面程度相同。然而，由于现有文献存在方法学缺陷，缺乏证据不能被解释为不存在证据。
