Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China.
Department of Sociology and Institute for Empirical Social Science Research, School of Humanities and Social Sciences, Xi'an Jiaotong University, Xi'an, China.
JAMA Intern Med. 2021 Feb 1;181(2):203-211. doi: 10.1001/jamainternmed.2020.6331.
IMPORTANCE: It is unclear whether, for the same amount of total physical activity, a higher proportion of vigorous physical activity (VPA) to total physical activity is associated with a greater reduction in mortality. OBJECTIVE: To examine the association of the proportion of VPA to total physical activity (defined as moderate to vigorous physical activity [MVPA]) with all-cause mortality, cardiovascular disease mortality, and cancer mortality. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included 403 681 adults from the National Health Interview Survey 1997-2013 who provided data on self-reported physical activity and were linked to the National Death Index records through December 31, 2015. Statistical analysis was performed from May 15, 2018, to August 15, 2020. EXPOSURES: Proportion of VPA to total physical activity among participants performing any MVPA. MAIN OUTCOMES AND MEASURES: All-cause mortality, cardiovascular disease mortality, and cancer mortality. Cox proportional hazards regression models were performed to estimate hazard ratios (HRs) and 95% CIs, adjusted for sociodemographic characteristics, lifestyle risk factors, and total physical activity. RESULT: Among the 403 681 individuals (225 569 women [51.7%]; mean [SD] age, 42.8 [16.3] years) in the study, during a median 10.1 years (interquartile range, 5.4-14.6 years) of follow-up (407.3 million person-years), 36 861 deaths occurred. Mutually adjusted models considering the recommendations of moderate physical activity (MPA; 150-299 vs 0 minutes per week) and VPA (≥75-149 vs 0 minutes per week) showed similar associations for all-cause mortality (MPA: HR, 0.83; 95% CI, 0.80-0.87; and VPA: HR, 0.80; 95% CI, 0.76-0.84) and cardiovascular disease mortality (MPA: HR, 0.75; 95% CI, 0.68-0.83; and VPA: HR, 0.79; 95% CI, 0.70-0.91). For the same contrasts, VPA (HR, 0.89; 95% CI, 0.80-0.99) showed a stronger inverse association with cancer mortality compared with MPA (HR, 0.94; 95% CI, 0.86-1.02). Among participants performing any MVPA, a higher proportion of VPA to total physical activity was associated with lower all-cause mortality but not with cardiovascular disease and cancer mortality. For instance, compared with participants with 0% of VPA (no vigorous activity), participants performing greater than 50% to 75% of VPA to total physical activity had a 17% lower all-cause mortality (hazard ratio, 0.83; 95% CI, 0.78-0.88), independent of total MVPA. The inverse association between proportion of VPA to total physical activity and all-cause mortality was consistent across sociodemographic characteristics, lifestyle risk factors, and chronic conditions at baseline. CONCLUSIONS AND RELEVANCE: This study suggests that, for the same volume of MVPA, a higher proportion of VPA to total physical activity was associated with lower all-cause mortality. Clinicians and public health interventions should recommend 150 minutes or more per week of MVPA but also advise on the potential benefits associated with VPA to maximize population health.
重要性：目前尚不清楚，对于相同总量的身体活动，更高比例的剧烈身体活动（VPA）与总身体活动之间是否存在关联，与降低死亡率的程度更大。 目的：研究 VPA 与总身体活动（定义为中等到剧烈身体活动[MVPA]）的比例与全因死亡率、心血管疾病死亡率和癌症死亡率之间的关联。 设计、地点和参与者：这项队列研究纳入了 1997 年至 2013 年参加全国健康访谈调查的 403681 名成年人，他们提供了关于自我报告身体活动的数据，并通过国家死亡指数记录与 2015 年 12 月 31 日进行了链接。统计分析于 2018 年 5 月 15 日至 2020 年 8 月 15 日进行。 暴露情况：进行任何 MVPA 的参与者中 VPA 占总身体活动的比例。 主要结果和测量指标：全因死亡率、心血管疾病死亡率和癌症死亡率。使用 Cox 比例风险回归模型来估计风险比（HR）和 95%置信区间，调整了社会人口统计学特征、生活方式风险因素和总身体活动。 结果：在研究中的 403681 名个体（225569 名女性[51.7%]；平均[标准差]年龄，42.8[16.3]岁）中，在中位 10.1 年（四分位间距，5.4-14.6 年）的随访期间（407.3 百万人年），发生了 36861 例死亡。在考虑到中等体力活动（MPA；150-299 分钟/周与 0 分钟/周）和 VPA（≥75-149 分钟/周与 0 分钟/周）建议的相互调整模型中，所有原因死亡率（MPA：HR，0.83；95%CI，0.80-0.87；和 VPA：HR，0.80；95%CI，0.76-0.84）和心血管疾病死亡率（MPA：HR，0.75；95%CI，0.68-0.83；和 VPA：HR，0.79；95%CI，0.70-0.91）显示出类似的关联。对于相同的对比，VPA（HR，0.89；95%CI，0.80-0.99）与 MPA（HR，0.94；95%CI，0.86-1.02）相比，与癌症死亡率的负相关更强。在进行任何 MVPA 的参与者中，VPA 占总身体活动的比例越高，全因死亡率越低，但与心血管疾病和癌症死亡率无关。例如，与 VPA 比例为 0%（无剧烈活动）的参与者相比，VPA 比例大于 50%至 75%的参与者的全因死亡率降低了 17%（HR，0.83；95%CI，0.78-0.88），这与总 MVPA 无关。VPA 占总身体活动比例与全因死亡率之间的负相关关系在基线时的社会人口统计学特征、生活方式风险因素和慢性疾病中是一致的。 结论和相关性：这项研究表明，对于相同的 MVPA 量，VPA 占总身体活动的比例越高，与全因死亡率的降低程度越大。临床医生和公共卫生干预措施应该建议每周进行 150 分钟或更多的 MVPA，但也应该建议与 VPA 相关的潜在益处，以最大限度地提高人群健康水平。
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