Liew Seaw Jia, Petrunoff Nicholas A, Neelakantan Nithya, van Dam Rob M, Müller-Riemenschneider Falk
Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore.
AJPM Focus. 2022 Dec 10;2(1):100054. doi: 10.1016/j.focus.2022.100054. eCollection 2023 Mar.
This review synthesized evidence from prospective cohort studies on the association of device-measured physical activity and sedentary behavior with cardiovascular disease and all-cause mortality among adults.
Five databases were searched from 2000 through April 29, 2020. Study quality was appraised using the NIH Quality Assessment Tool. Pooled hazard ratio and 95% CI were obtained from random-effects meta-analyses. Subgroup analyses by age and sex were conducted for studies on all-cause mortality.
Of 29 articles included in the systematic review, 5 studies on cardiovascular disease mortality and 15 studies on all-cause mortality were included in meta-analyses. Comparing the highest with the lowest exposure categories, the pooled hazard ratios (95% CIs) for cardiovascular disease mortality were 0.29 (CI=0.18, 0.47) for total physical activity, 0.37 (CI=0.25, 0.55) for moderate-to-vigorous physical activity, 0.62 (0.41-0.93) for light physical activity, and 1.89 (CI=1.09, 3.29) for sedentary behavior. The pooled hazard ratios (95% CIs) for all-cause mortality were 0.42 (CI=0.34, 0.53) for total physical activity, 0.43 (CI=0.35, 0.53) for moderate-to-vigorous physical activity, 0.58 (CI=0.43, 0.80) for light physical activity, and 1.58 (CI=1.19, 2.09) for sedentary behavior. The pooled hazard ratio (95% CI) for all-cause mortality was 0.35 (CI=0.29, 0.42) for steps per day, but the studies available for analysis were conducted in older adults. The results of subgroup analyses were consistent with the main results.
Rapidly accumulating evidence suggests that more physical activity and less sedentary behavior are associated with a lower risk of cardiovascular disease and all-cause mortality. Similar beneficial relationships were found for step counts and all-cause mortality among older adults. Future studies employing standardized research methodologies and up-to-date data processing approaches are warranted to recommend specific amounts of physical activity and limits to sedentary behavior.
本综述综合了前瞻性队列研究的证据，以探讨通过设备测量的身体活动和久坐行为与成年人心血管疾病及全因死亡率之间的关联。
检索了2000年至2020年4月29日期间的五个数据库。使用美国国立卫生研究院质量评估工具对研究质量进行评估。通过随机效应荟萃分析获得合并风险比和95%置信区间。对全因死亡率研究按年龄和性别进行亚组分析。
在纳入系统评价的29篇文章中，有5项关于心血管疾病死亡率的研究和15项关于全因死亡率的研究纳入了荟萃分析。将最高暴露类别与最低暴露类别进行比较，心血管疾病死亡率的合并风险比（95%置信区间）分别为：总身体活动为0.29（置信区间=0.18，0.47），中度至剧烈身体活动为0.37（置信区间=0.25，0.55），轻度身体活动为0.62（0.41 - 0.93），久坐行为为1.89（置信区间=1.09，3.29）。全因死亡率的合并风险比（95%置信区间）分别为：总身体活动为0.42（置信区间=0.34，0.53），中度至剧烈身体活动为0.43（置信区间=0.35，0.53），轻度身体活动为0.58（置信区间=0.43, 0.80），久坐行为为1.58（置信区间=1.19，2.09）。每天步数的全因死亡率合并风险比（95%置信区间）为0.35（置信区间=0.29，0.42），但可用于分析的研究是在老年人中进行的。亚组分析结果与主要结果一致。
迅速积累的证据表明，更多的身体活动和更少的久坐行为与较低的心血管疾病风险和全因死亡率相关。在老年人中，步数与全因死亡率之间也发现了类似的有益关系。有必要开展采用标准化研究方法和最新数据处理方法的未来研究，以推荐具体的身体活动量和久坐行为限制。
