Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC USA.
Department of Health Education and Promotion East Carolina University Greenville NC USA.
J Am Heart Assoc. 2023 Apr 4;12(7):e028180. doi: 10.1161/JAHA.122.028180. Epub 2023 Mar 28.
Background Few studies have investigated associations of acclerometer-based assessments of physical activity (PA) and sedentary behavior (SB) with incidence of cardiovascular disease (CVD) and its components. This prospective cohort study assessed the associations of accelerometer-measured PA and SB with total CVD, myocardial infarction, and ischemic stroke (IS). Methods and Results The authors included 16 031 women aged 62 years and older, free of CVD, with adherent accelerometer wear (≥10 hours/day for ≥4 days) from the Women's Health Study (mean age, 71.4 years [SD, 5.6 years]). Hip-worn ActiGraph GT3X+ accelerometers measured total volume of PA (total average daily vector magnitude), minutes per day of high-light PA and moderate to vigorous PA (MVPA), and SB. Women reported diagnoses of CVD, which were adjudicated using medical records and death certificates. Hazard ratios (HRs) were estimated for each exposure, and 95% CIs using Cox proportional hazards models were adjusted for accelerometer wear time, age, self-reported general health, postmenopausal hormone therapy, smoking status, and alcohol use. The hypothetical effect of replacing 10 minutes/day of SB or high-light PA with MVPA on CVD incidence was assessed using adjusted isotemporal substitution Cox models. Over a mean of 7.1 years (SD, 1.6 years) of follow-up, 482 total CVD cases, 107 myocardial infarction cases, and 181 IS cases were diagnosed. Compared with the lowest quartiles of total average daily vector magnitude and MVPA (≤60 minutes), women who were in the highest quartiles (>120 minutes of MVPA) had a 43% (95% CI, 24%-58%) and 38% (95% CI, 18%-54%) lower hazard of total CVD, respectively. Estimates were similar for total average daily vector magnitude and MVPA with IS, but PA was not associated with myocardial infarction overall. High-light PA was not associated with any CVD outcomes. Women who spent <7.4 hours sedentary per day had a 33% (95% CI, 11%-49%) lower hazard of total CVD compared with those who spent ≥9.5 hours sedentary. Replacing 10 minutes of SB with MVPA was associated with a 4% lower incidence of total CVD (HR, 0.96 [95% CI, 0.93-0.99]). Conclusions Accelerometer-assessed total PA and MVPA were inversely associated with total CVD and IS incidence, and SB was directly associated with total CVD; high-light PA was not related to CVD.
背景 很少有研究调查基于加速度计的身体活动 (PA) 和久坐行为 (SB) 评估与心血管疾病 (CVD) 及其成分的发病之间的关系。本前瞻性队列研究评估了加速度计测量的 PA 和 SB 与总 CVD、心肌梗死和缺血性中风 (IS) 的相关性。
方法和结果 作者纳入了 16031 名年龄在 62 岁及以上、无 CVD、加速度计佩戴时间超过 10 小时/天 (>4 天)（平均年龄 71.4 岁[标准差 5.6 岁]）的妇女，来自妇女健康研究。佩戴在臀部的 ActiGraph GT3X+ 加速度计测量了总 PA 量（总平均日常向量幅度）、每天高轻度 PA 和中等到剧烈 PA (MVPA) 的分钟数以及 SB。妇女报告了 CVD 的诊断，这些诊断使用病历和死亡证明进行了裁定。使用 Cox 比例风险模型估计了每种暴露的风险比 (HR)，95%置信区间 (CI) 通过 Cox 比例风险模型进行了调整，这些模型调整了加速度计佩戴时间、年龄、自我报告的一般健康状况、绝经后激素治疗、吸烟状况和饮酒情况。使用调整后的等时替代 Cox 模型评估了每天用 10 分钟 SB 或高轻度 PA 替代 MVPA 对 CVD 发病率的假设影响。在平均 7.1 年（标准差 1.6 年）的随访期间，诊断出 482 例总 CVD 病例、107 例心肌梗死病例和 181 例 IS 病例。与总平均日常向量幅度和 MVPA 的最低四分位数（≤60 分钟）相比，处于最高四分位数（>120 分钟 MVPA）的女性患总 CVD 的风险分别降低了 43%（95%CI，24%-58%）和 38%（95%CI，18%-54%）。总体 CVD 与总平均日常向量幅度和 MVPA 与 IS 的估计值相似，但 PA 与心肌梗死无关。高强度 PA 与任何 CVD 结局均无关。每天坐着的时间少于 7.4 小时的女性患总 CVD 的风险比每天坐着时间超过 9.5 小时的女性低 33%（95%CI，11%-49%）。用 MVPA 替代 10 分钟 SB 与总 CVD 发生率降低 4%相关（HR，0.96[95%CI，0.93-0.99]）。
结论 基于加速度计的总 PA 和 MVPA 与总 CVD 和 IS 的发病呈负相关，而 SB 与总 CVD 呈正相关；高强度 PA 与 CVD 无关。
