Department of Sports Science and Clinical Biomechanics, Centre for Active and Healthy Ageing, University of Southern Denmark, Odense, Denmark.
Faculty of Medicine and Health, Charles Perkin Centre, School of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia.
JAMA Intern Med. 2022 Nov 1;182(11):1139-1148. doi: 10.1001/jamainternmed.2022.4000.
Recommendations for the number of steps per day may be easier to enact for some people than the current time- and intensity-based physical activity guidelines, but the evidence to support steps-based goals is limited.
To describe the associations of step count and intensity with all-cause mortality and cancer and cardiovascular disease (CVD) incidence and mortality.
DESIGN, SETTING, AND PARTICIPANTS: This population-based prospective cohort study used data from the UK Biobank for 2013 to 2015 (median follow-up, 7 years) and included adults 40 to 79 years old in England, Scotland, and Wales. Participants were invited by email to partake in an accelerometer study. Registry-based morbidity and mortality were ascertained through October 2021. Data analyses were performed during March 2022.
Baseline wrist accelerometer-measured daily step count and established cadence-based step intensity measures (steps/min): incidental steps, (<40 steps/min), purposeful steps (≥40 steps/min); and peak-30 cadence (average steps/min for the 30 highest, but not necessarily consecutive, min/d).
All-cause mortality and primary and secondary CVD or cancer mortality and incidence diagnosis. For cancer, analyses were restricted to a composite cancer outcome of 13 sites that have a known association with reduced physical activity. Cox restricted cubic spline regression models were used to assess the dose-response associations. The linear mean rate of change (MRC) in the log-relative hazard ratio for each outcome per 2000 daily step increments were also estimated.
The study population of 78 500 individuals (mean [SD] age, 61 [8] years; 43 418 [55%] females; 75 874 [97%] White individuals) was followed for a median of 7 years during which 1325 participants died of cancer and 664 of CVD (total deaths 2179). There were 10 245 incident CVD events and 2813 cancer incident events during the observation period. More daily steps were associated with a lower risk of all-cause (MRC, -0.08; 95% CI, -0.11 to -0.06), CVD (MRC, -0.10; 95% CI, -0.15 to -0.06), and cancer mortality (MRC, 95% CI, -0.11; -0.15 to -0.06) for up to approximately 10 000 steps. Similarly, accruing more daily steps was associated with lower incident disease. Peak-30 cadence was consistently associated with lower risks across all outcomes, beyond the benefit of total daily steps.
The findings of this population-based prospective cohort study of 78 500 individuals suggest that up to 10 000 steps per day may be associated with a lower risk of mortality and cancer and CVD incidence. Steps performed at a higher cadence may be associated with additional risk reduction, particularly for incident disease.
与目前基于时间和强度的身体活动指南相比，每天推荐的步数可能更容易被一些人执行，但支持基于步数的目标的证据有限。
描述步数和强度与全因死亡率以及癌症和心血管疾病 (CVD) 发病率和死亡率的关系。
设计、设置和参与者：这项基于人群的前瞻性队列研究使用了英国生物银行 2013 年至 2015 年的数据（中位随访 7 年），纳入了英格兰、苏格兰和威尔士 40 至 79 岁的成年人。通过电子邮件邀请参与者参加加速度计研究。通过 2021 年 10 月确定基于登记的发病率和死亡率。数据分析于 2022 年 3 月进行。
基线腕部加速度计测量的日常步数和既定基于节奏的步幅强度测量（步/分钟）：偶然步幅（<40 步/分钟）、有目的步幅（≥40 步/分钟）；以及 30 次最高峰值节奏（每天最高但不一定连续的 30 分钟的平均步幅/分钟）。
全因死亡率以及原发性和继发性 CVD 或癌症死亡率和发病诊断。对于癌症，分析仅限于一个复合癌症结局，包括 13 个与体力活动减少有已知关联的部位。使用 Cox 受限立方样条回归模型评估剂量反应关联。还估计了对数相对危险比的线性平均变化率（MRC），每个结果每增加 2000 步/天。
这项涉及 78500 名个体的研究人群（平均[标准差]年龄 61[8]岁；43418[55%]女性；75874[97%]白种人）在中位随访 7 年期间被跟踪观察，在此期间有 1325 人死于癌症，664 人死于 CVD（总死亡 2179 人）。在此期间观察到 10245 例 CVD 事件和 2813 例癌症事件。每天增加更多的步数与全因（MRC，-0.08；95%CI，-0.11 至 -0.06）、CVD（MRC，-0.10；95%CI，-0.15 至 -0.06）和癌症死亡率（MRC，95%CI，-0.11；-0.15 至 -0.06）的风险降低相关，最多可达约 10000 步。同样，每天增加更多的步数与所有结局的较低发病风险相关，这超过了总步数的益处。峰值 30 节奏与所有结局的较低风险相关，超过了总步数的益处。
这项涉及 78500 名个体的基于人群的前瞻性队列研究的结果表明，每天增加 10000 步可能与降低死亡率、癌症和 CVD 发病率风险相关。以更高节奏完成的步骤可能与额外的风险降低相关，特别是对发病事件。
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