Program in Physical Therapy, Washington University School of Medicine, St Louis, Missouri.
Center for Human Nutrition, Washington University School of Medicine, St Louis, Missouri.
JAMA Oncol. 2022 Mar 1;8(3):395-403. doi: 10.1001/jamaoncol.2021.6590.
Sedentary behaviors, particularly prolonged sitting and lack of physical activity, may influence survival after cancer.
To examine the independent and joint associations of daily sitting time and leisure-time physical activity with mortality outcomes among cancer survivors.
DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort of a nationally representative sample of cancer survivors, age 40 years or older (n = 1535; weighted population, 14 002 666), from the US National Health and Nutrition Examination Survey from 2007 to 2014. Participants were linked to mortality data from their interview and physical examination date through December 31, 2015. Daily sitting time and leisure-time physical activity (LTPA) were self-reported using the Global Physical Activity Questionnaire. Data analyses were performed from January 1 to May 1, 2021.
All-cause, cancer-specific, and noncancer mortality.
Among 1535 cancer survivors (mean [SE] age, 65.1 [0.4] years; 828 [60.1%] females; 945 [83.1%] non-Hispanic White individuals), 950 (56.8%) reported LTPA of 0 minutes per week (min/wk) during the previous week (inactive); 226 (15.6%) reported LTPA of less than 150 min/wk (insufficiently active); 359 (27.6%) reported LTPA of 150 min/wk or more (active); 553 (35.4%) reported sitting for 6 to 8 hours per day (h/d); and 328 (24.9%) reported sitting for more than 8 h/d. Of note, 574 (35.8%) cancer survivors reported no LTPA with concurrent sitting of more than 6 h/d. During the follow-up period of up to 9 years (median, 4.5 years; 6980 person-years), there were 293 deaths (cancer, 114; heart diseases, 41; other causes, 138). Multivariable models showed that being physically active was associated with lower risks of all-cause (hazard ratio [HR], 0.34; 95% CI, 0.20-0.60) and cancer-specific (HR, 0.32; 95% CI, 0.15-0.70) mortality compared with inactivity. Sitting more than 8 h/d was associated with higher risks of all-cause (HR, 1.81; 95% CI, 1.05-3.14) and cancer-specific (HR, 2.27; 95% CI, 1.08-4.79) mortality compared with those sitting less than 4 h/d. In the joint analyses, prolonged sitting was associated with an increased risk of death among cancer survivors who were not sufficiently active. Specifically, inactive and insufficiently active survivors reported sitting more than 8 h/d had the highest overall (HR, 5.38; 95% CI, 2.99-9.67) and cancer-specific (HR, 4.71; 95% CI, 1.60-13.9) mortality risks.
In this cohort study of a nationally representative sample of US cancer survivors, the combination of prolonged sitting with lack of physical activity was highly prevalent and was associated with the highest risks of death from all causes and cancer.
久坐行为，尤其是长时间坐着和缺乏身体活动，可能会影响癌症患者的生存。
研究癌症幸存者的日常久坐时间和休闲时间体力活动与死亡率结果的独立和联合关联。
设计、地点和参与者：这是一项来自美国全国健康和营养检查调查的全国代表性癌症幸存者队列研究，年龄在 40 岁或以上（n=1535；加权人口 14002666），研究时间为 2007 年至 2014 年。参与者通过他们的访谈和体检日期与死亡率数据相关联，截止日期为 2015 年 12 月 31 日。日常久坐时间和休闲时间体力活动（LTPA）使用全球体力活动问卷进行自我报告。数据分析于 2021 年 1 月 1 日至 5 月 1 日进行。
全因、癌症特异性和非癌症死亡率。
在 1535 名癌症幸存者中（平均[SE]年龄，65.1[0.4]岁；828[60.1%]名女性；945[83.1%]名非西班牙裔白人个体），950 名（56.8%）报告上周每周零分钟的 LTPA（不活跃）；226 名（15.6%）报告的 LTPA 少于 150 分钟/周（不活跃）；359 名（27.6%）报告的 LTPA 为 150 分钟/周或更多（活跃）；553 名（35.4%）报告每天坐 6 到 8 小时；328 名（24.9%）报告每天坐超过 8 小时。值得注意的是，574 名（35.8%）癌症幸存者报告没有 LTPA，同时每天坐着超过 6 小时。在最长 9 年的随访期间（中位数，4.5 年；6980 人年），有 293 人死亡（癌症 114 人；心脏病 41 人；其他原因 138 人）。多变量模型显示，与不活动相比，积极活动与全因（危险比[HR]，0.34；95%置信区间，0.20-0.60）和癌症特异性（HR，0.32；95%置信区间，0.15-0.70）死亡率降低相关。每天坐超过 8 小时与全因（HR，1.81；95%置信区间，1.05-3.14）和癌症特异性（HR，2.27；95%置信区间，1.08-4.79）死亡率升高相关，与每天坐少于 4 小时的人相比。在联合分析中，长时间坐着与未充分活跃的癌症幸存者的死亡风险增加相关。具体来说，不活跃和不活跃的幸存者报告每天坐超过 8 小时，总体（HR，5.38；95%置信区间，2.99-9.67）和癌症特异性（HR，4.71；95%置信区间，1.60-13.9）死亡率风险最高。
在这项针对美国全国代表性癌症幸存者样本的队列研究中，长时间坐着与缺乏体力活动相结合的情况非常普遍，与所有原因和癌症导致的死亡风险最高有关。
