Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.
Charles Perkins Centre, The University of Sydney, Camperdown, Australia.
PLoS Med. 2024 May 2;21(5):e1004384. doi: 10.1371/journal.pmed.1004384. eCollection 2024 May.
There is little long-term causal evidence on the effect of physical activity on health-related quality of life. This study aimed to examine the associations between longitudinal patterns of physical activity over 15 years and health-related quality of life in both the physical and mental health domains, in a cohort of middle-aged Australian women.
We used data collected at 3-year intervals (1998 to 2019) from 11,336 participants in the Australian Longitudinal Study on Women's Health (ALSWH) (1946 to 1951 birth cohort). Primary outcomes were the physical (PCS) and mental health component summary (MCS) scores (range from 0 to 100; higher scores indicate higher perceived physical/mental health) from the SF-36 in 2019 (when women aged 68 to 73 years). Using target trial emulation to imitate a randomized controlled trial (RCT), we tested 2 interventions: (1) meeting the World Health Organization (WHO) physical activity guidelines consistently throughout the 15-year "exposure period" (2001 to 2016; when women aged 50-55 to 65-70 years; physical activity assessed every 3 years); and (2) not meeting the guidelines at the beginning of the exposure period but starting to first meet the guidelines at age 55, 60, or 65; against the control of not meeting the guidelines throughout the exposure period. Analysis controlled for confounding using marginal structural models which were adjusted for sociodemographic and health variables and conditions. Consistent adherence to guidelines during the exposure period (PCS: 46.93 [99.5% confidence interval [CI]: 46.32, 47.54]) and first starting to meet the guidelines at age 55 (PCS: 46.96 [99.5% CI: 45.53, 48.40]) were associated with three-point higher PCS (mean score difference: 3.0 [99.5% CI: 1.8, 4.1] and 3.0 [99.5% CI:1.2, 4.8]) than consistent non-adherence (PCS: 43.90 [99.5% CI: 42.79, 45.01]). We found a similar pattern for most SF-36 subscales but no significant effects of the interventions on MCS. The main limitations of the study were that it may not account for all underlying health conditions and/or other unmeasured or insufficiently measured confounders, the use of self-reported physical activity and that findings may not be generalizable to all mid-age women.
Results from the emulated RCT suggest women should be active throughout mid-age, ideally increasing activity levels to meet the guidelines by age 55, to gain the most benefits for physical health in later life.
关于体力活动对健康相关生活质量的影响，几乎没有长期的因果证据。本研究旨在考察 15 年内体力活动的纵向模式与中年澳大利亚女性身心健康领域的健康相关生活质量之间的关联。
我们使用澳大利亚妇女健康纵向研究（ALSWH）（1946 年至 1951 年出生队列）中 11336 名参与者在 3 年时间间隔（1998 年至 2019 年）收集的数据。主要结局指标是 2019 年 SF-36 的身体（PCS）和心理健康成分综合评分（范围为 0 到 100；分数越高表示感知到的身体/心理健康水平越高）。使用目标试验仿真模拟随机对照试验（RCT），我们测试了 2 种干预措施：（1）在 15 年的“暴露期”（2001 年至 2016 年；当女性年龄在 50-55 岁至 65-70 岁时；每 3 年评估一次体力活动）内始终符合世界卫生组织（WHO）体力活动指南；（2）在暴露期开始时不符合指南，但在 55 岁、60 岁或 65 岁时开始首次符合指南；与整个暴露期不符合指南的对照。使用边缘结构模型进行分析，该模型通过社会人口统计学和健康变量以及条件进行了混杂因素调整。在暴露期内始终遵守指南（PCS：46.93 [99.5%置信区间（CI）：46.32，47.54]）和首次在 55 岁开始符合指南（PCS：46.96 [99.5% CI：45.53，48.40]）与 PCS 高出三分相关（平均得分差异：3.0 [99.5% CI：1.8，4.1] 和 3.0 [99.5% CI：1.2，4.8]）与始终不遵守指南相比（PCS：43.90 [99.5% CI：42.79，45.01]）。我们发现 SF-36 大多数子量表都存在类似的模式，但干预措施对 MCS 没有显著影响。该研究的主要局限性是它可能无法解释所有潜在的健康状况和/或其他未测量或测量不足的混杂因素，使用自我报告的体力活动以及研究结果可能不适用于所有中年女性。
模拟 RCT 的结果表明，女性应在中年时保持活跃，理想情况下应在 55 岁之前提高活动水平以达到指南要求，从而在以后的生活中获得最大的身体健康益处。
