基于英国生物库的加速度计测量体力活动、步数与癌症风险的剂量-反应关系：一项前瞻性队列分析。

Dose-response of accelerometer-measured physical activity, step count, and cancer risk in the UK Biobank: a prospective cohort analysis.

机构信息

Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.

出版信息

Lancet. 2023 Nov;402 Suppl 1:S83. doi: 10.1016/S0140-6736(23)02147-5.

DOI:10.1016/S0140-6736(23)02147-5

PMID:37997129

Abstract

BACKGROUND

Cancer is an age-related condition, but changes to modifiable lifestyle-related behaviours, including physical activity, could impact risk. While step count is an accessible metric of activity for older adults, its association with cancer risk remains poorly understood. We investigated the association between accelerometer-measured total activity, step count, and cancer risk.

METHODS

We analysed data from a prospective UK Biobank cohort of consenting participants who wore wrist-based Axivity AX3 accelerometer devices for 7 days between June 1, 2013 and Dec 23, 2015, had valid accelerometer data, and no previous cancer diagnosis at baseline. Machine learning models estimated total physical activity (vector magnitude) and step count. The primary outcome, a composite of 13 cancers previously associated with physical activity, was obtained from national registries. Hazard ratios (HR) and were calculated using Cox proportional hazard models, with attained age as the underlying timescale and adjustment for sex, ethnicity, smoking status, alcohol consumption, education, and Townsend Deprivation Index. The impact of reallocating time between behaviours was evaluated using compositional data analyses. Dose-response associations were assessed with restricted cubic splines.

FINDINGS

We analysed data from 86 556 participants, who were followed up during an average of 6·1 years (age range 43-78; 48 478 [56%] female and 38 078 [44%] male; 83 830 [97%] white). 5577 incident malignant cancers occurred among these 86 556 participants. Greater total physical activity was associated with a lower risk of physical-activity-related cancer (HR per 1 SD [+8·33 milligravity per day] 0·85, 95% CI 0·81-0·89). Reallocating 30 min/day from other activities to moderate-to-vigorous physical activity behaviour was associated with lower cancer risk (HR 0·96, 0·94-0·98), as was reallocating 1 h/day to light intensity activity (HR 0·94, 0·92-0·96), compared with the mean behaviour composition among included participants. Compared with taking 5000 steps per day, taking 10 000 daily steps was associated with a significantly lower risk of physical-activity-related cancer (HR 0·81, 0·73-0·90).

INTERPRETATION

In this sample from the UK Biobank, higher total physical activity and daily step count were associated with lower risk of physical-activity-related cancers. Findings suggest additional physical activity time, irrespective of intensity, may be beneficial. Increasing low intensity activity time and increasing daily step counts could be practical public health interventions to lower cancer risk, especially for aging adults.

FUNDING

National Institute of Health Oxford Cambridge Scholars Program, Wellcome Trust, Swiss Re, Health Data Research UK, and Cancer Research UK.

摘要

背景

癌症是一种与年龄相关的疾病，但可改变的与生活方式相关的行为的改变，包括身体活动，可能会影响风险。虽然计步是老年人活动的一种可衡量指标，但它与癌症风险的关系仍知之甚少。我们研究了加速度计测量的总活动、计步与癌症风险之间的关系。

方法

我们分析了英国生物库前瞻性队列中同意佩戴腕部 Axivity AX3 加速度计的参与者的数据，这些参与者在 2013 年 6 月 1 日至 2015 年 12 月 23 日期间佩戴了 7 天设备，有有效的加速度计数据，且基线时无癌症诊断。机器学习模型估计了总体力活动（矢量幅度）和计步。主要结局是从国家登记处获得的先前与体力活动相关的 13 种癌症的综合指标。使用 Cox 比例风险模型计算风险比（HR），并根据年龄、性别、种族、吸烟状况、饮酒量、教育程度和汤森贫困指数进行调整。使用成分数据分析评估了在行为之间重新分配时间的影响。使用受限立方样条评估剂量反应关系。

结果

我们分析了 86556 名参与者的数据，这些参与者的平均随访时间为 6.1 年（年龄范围为 43-78 岁；48478 名[56%]女性和 38078 名[44%]男性；97%为白人）。这些 86556 名参与者中发生了 5577 例恶性癌症。总体力活动与与体力活动相关的癌症风险降低相关（每增加 1 SD[+8.33 毫重力/天]，HR 为 0.85，95%CI 为 0.81-0.89）。与参与者的平均行为组成相比，每天从其他活动中重新分配 30 分钟至中高强度体力活动行为与较低的癌症风险相关（HR 为 0.96，0.94-0.98），每天重新分配 1 小时至低强度活动与较低的癌症风险相关（HR 为 0.94，0.92-0.96）。与每天走 5000 步相比，每天走 10000 步与与体力活动相关的癌症风险显著降低相关（HR 为 0.81，0.73-0.90）。