Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
PLoS One. 2023 Jan 26;18(1):e0280878. doi: 10.1371/journal.pone.0280878. eCollection 2023.
A physically active lifestyle is recognized as a precondition of healthy aging. However, the majority of studies exploring its association with mortality in cohorts of adults used single-time physical activity (PA) estimate, which do not consider its dynamic nature with changes that occur with aging. The aim of the present study is to explore the presence of different PA trajectories in a population-based cohort and their association with mortality.
We used data of the population-based cohort study CARLA and included 1041 older adults (45-83 years at baseline) with self-reported physical activity at baseline (2002-2006), first follow-up (2007-2010) and second follow-up (2013). Trajectories were identified using growth mixture modelling. Cox proportional hazard models were used to assess the association between trajectories of PA and all-cause mortality during ~6 years since the second follow-up after adjusting for age, sex, lifestyle factors and comorbidities and after correction for classification error. In a sensitivity analysis we weighted the models to account for selection bias during follow-up. As a further sensitivity analysis, we excluded the first year of follow-up to account for reverse causation.
Three PA trajectories (categorized as consistently low, consistently moderate, and high at baseline but strongly decreasing PA across time) were identified, and 121 deaths due to all causes occurred. Compared with participants who had consistently low PA-levels throughout the follow-up period, participants who maintained moderate PA-levels were at a lower risk of all-cause mortality (hazard ratio [HR], 0.49; 95%CI, 0.30-0.70). Participants with high PA-levels at baseline but strongly decreasing PA across time, had similar mortality risk compared to the participants with consistently low PA-levels (hazard ratio [HR], 0.97; 95%CI, 0.50-1.80). The effects were strengthened in the analysis weighted for selection bias.
Our results suggest that, compared to those who had consistently low PA levels, those who maintained a moderate level of PA showed a protective effect in terms of their mortality risk but not those who displayed a decline from high PA levels.
积极的生活方式被认为是健康老龄化的前提。然而，大多数研究在探索成年人队列中与死亡率相关的生活方式时，使用的是单次的身体活动（PA）估计，而没有考虑其随年龄变化的动态特性。本研究旨在探讨基于人群的队列中不同 PA 轨迹的存在及其与死亡率的关系。
我们使用基于人群的 CARLA 队列研究的数据，纳入了基线时有自我报告的身体活动（2002-2006 年）、第一次随访（2007-2010 年）和第二次随访（2013 年）的 1041 名老年人（基线时 45-83 岁）。使用增长混合建模识别轨迹。使用 Cox 比例风险模型评估 PA 轨迹与第二次随访后约 6 年内全因死亡率之间的关联，调整年龄、性别、生活方式因素和合并症，并在分类错误校正后进行调整。在敏感性分析中，我们对模型进行加权以考虑随访期间的选择偏差。作为进一步的敏感性分析，我们排除了随访的第一年，以考虑反向因果关系。
确定了三种 PA 轨迹（基线时归类为持续低、持续中、高，但随时间强烈下降），有 121 例全因死亡。与整个随访期间一直保持低 PA 水平的参与者相比，保持中等 PA 水平的参与者全因死亡率较低（风险比 [HR]，0.49；95%CI，0.30-0.70）。基线时 PA 水平较高但随时间强烈下降的参与者，与持续低 PA 水平的参与者相比，死亡率风险相似（HR，0.97；95%CI，0.50-1.80）。在对选择偏差进行加权的分析中，这些影响得到了加强。
我们的研究结果表明，与一直保持低 PA 水平的参与者相比，保持中等 PA 水平的参与者的死亡率风险具有保护作用，但从高 PA 水平下降的参与者则没有。
