School of Health Sciences, Western Sydney University, Campbelltown, NSW,Australia.
Translational Health Research Institute, Western Sydney University, Campbelltown, NSW,Australia.
J Phys Act Health. 2023 Jul 18;20(10):971-979. doi: 10.1123/jpah.2022-0624. Print 2023 Oct 1.
To investigate cardiovascular disease mortality associated with longitudinal changes in body weight, and recreational and nonrecreational physical activity during the obesogenic transition in the United States since the 1970s.
Data were analyzed from 4921 individuals aged 25-74 years who participated in the National Health and Nutrition Examination Survey between 1971 and 1979 and follow-up studies to 1992. Mortality was confirmed by searching the National Death Index or proxy interview; clinical data were collected in person. Changes in self-reported recreational and nonrecreational physical activity categories over time were coded as stable, increase, or decrease. Competing risks regression was used to determine hazard ratios adjusted for covariates. A logit model in a generalization method was used to explore mediation effects of change in body weight.
Compared with the "moderate-vigorous stable" group (reference), individuals who remained inactive ("inactive stable") or reduced their participation in physical activity ("active to inactive") experienced the highest mortality, with a 50% to 176% and 22% to 222% relative increased hazard ratios for nonrecreational and recreational physical activity, respectively, across all models adjusted for covariates. This corresponded to significant loss of life (up to 3 y; all P < .05). Individuals who became active ("inactive to active") were not at increased risk. We found weak (but nonstatistically significant) evidence of mediation effects of body weight change on mortality.
Longitudinal changes in moderate-vigorous recreational and nonrecreational physical activity were important predictors of cardiovascular disease mortality during the obesogenic transition period in the United States and were mostly unexplained by changes in body weight.
本研究旨在调查自 20 世纪 70 年代以来，在美国肥胖形成期间，体重的纵向变化以及休闲和非休闲体力活动与心血管疾病死亡率之间的关系。
本研究对 4921 名年龄在 25-74 岁之间的个体进行了数据分析，这些个体参加了 1971 年至 1979 年期间的国家健康和营养调查（National Health and Nutrition Examination Survey）以及 1992 年的后续研究。通过搜索国家死亡索引或代理访谈来确认死亡率；临床数据通过个人访谈收集。随着时间的推移，将自我报告的休闲和非休闲体力活动类别的变化编码为稳定、增加或减少。使用竞争风险回归来确定调整协变量后的风险比。使用广义方法中的逻辑模型来探索体重变化的中介效应。
与“适度剧烈稳定”组（参考组）相比，保持不活动（“不活动稳定”）或减少体力活动参与（“活跃转为不活跃”）的个体死亡率最高，非休闲和休闲体力活动的相对风险比分别为 50%至 176%和 22%至 222%，所有模型均调整了协变量。这相当于显著的生命损失（长达 3 年；所有 P <.05）。变得活跃的个体（“不活跃转为活跃”）没有增加风险。我们发现体重变化对死亡率的中介效应存在微弱（但无统计学意义）的证据。
在肥胖形成期间，休闲和非休闲中度剧烈体力活动的纵向变化是心血管疾病死亡率的重要预测指标，并且大部分无法用体重变化来解释。
