School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China.
Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
J Phys Act Health. 2024 Apr 29;21(8):756-764. doi: 10.1123/jpah.2023-0576. Print 2024 Aug 1.
To assess the associations of replacing sedentary behavior with different types of physical activity with mortality among the US adults of varying diabetes statuses.
This prospective cohort study included 21,637 participants (mean age, 48.5 y) from the National Health and Nutrition Examination Survey 2007-2018. Physical activity including leisure-time moderate-vigorous-intensity activity (MVPA), walking/bicycling, worktime MVPA, and sedentary behavior. We conducted an isotemporal substitution analysis using Cox regression to estimate the associations between replacements and mortality risks.
We found significant protective associations between replacing 30 minutes per day sedentary behavior with 3 types of physical activity and all-cause, cardiovascular disease (CVD) mortality risk (except worktime MVPA for CVD mortality) among total participants, with hazard ratio (HR; 95% confidence interval [CI]) ranging from 0.86 (0.77-0.95) to 0.96 (0.94-0.98). Among participants with diagnosed diabetes, replacing sedentary behavior with leisure-time MVPA was associated with a lower all-cause mortality risk (HR 0.81, 95% CI, 0.70-0.94), which was also observed in other subgroups, with HRs (95% CI) ranging from 0.87 (0.80-0.94) to 0.89 (0.81-0.99). Among those with prediabetes/undiagnosed diabetes, replacing sedentary behavior with walking/bicycling was associated with lower CVD mortality risk, and replacement to work-time MVPA was associated with lower all-cause and CVD mortality risk, with HRs (95% CI) ranging from 0.72 (0.63-0.83) to 0.96 (0.92-0.99).
Replacing sedentary behaviors with 30 minutes per day leisure-time MVPA was associated with lower all-cause mortality, regardless of diabetes statuses. Among people with prediabetes/undiagnosed diabetes, walking/bicycling was additionally associated with lower CVD mortality, and worktime MVPA was associated with lower all-cause and CVD mortality.
评估用不同类型的身体活动替代久坐行为与美国不同糖尿病状态成年人的死亡率之间的关联。
这项前瞻性队列研究纳入了 2007 年至 2018 年期间来自国家健康和营养检查调查的 21637 名参与者（平均年龄 48.5 岁）。身体活动包括休闲时间中高强度活动（MVPA）、步行/骑自行车、工作时间 MVPA 和久坐行为。我们使用 Cox 回归进行等时替代分析，以估计替代与死亡率风险之间的关联。
我们发现，在总参与者中，用 3 种身体活动替代每天 30 分钟的久坐行为与全因和心血管疾病（CVD）死亡率风险显著相关（除了工作时间 MVPA 与 CVD 死亡率无关），危险比（HR；95%置信区间[CI]）范围从 0.86（0.77-0.95）到 0.96（0.94-0.98）。在诊断患有糖尿病的参与者中，用休闲时间 MVPA 替代久坐行为与全因死亡率风险降低相关（HR 0.81，95%CI，0.70-0.94），这在其他亚组中也观察到，HR（95%CI）范围从 0.87（0.80-0.94）到 0.89（0.81-0.99）。在患有前驱糖尿病/未确诊糖尿病的参与者中，用步行/骑自行车替代久坐行为与 CVD 死亡率降低相关，而用工作时间 MVPA 替代与全因和 CVD 死亡率降低相关，HR（95%CI）范围从 0.72（0.63-0.83）到 0.96（0.92-0.99）。
用每天 30 分钟的休闲时间 MVPA 替代久坐行为与全因死亡率降低相关，无论糖尿病状态如何。在患有前驱糖尿病/未确诊糖尿病的人群中，步行/骑自行车与 CVD 死亡率降低相关，而工作时间 MVPA 与全因和 CVD 死亡率降低相关。
