Department of Community Health Sciences, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada.
BMC Geriatr. 2024 Aug 20;24(1):695. doi: 10.1186/s12877-024-05208-6.
Physical inactivity is common among older adults and is associated with poor health outcomes. Medical fitness facilities provide a medically focused approach to physical fitness and can improve physical activity in their communities. This study aimed to assess the relationship between membership in the medical fitness model and all-cause mortality, health care utilization, and major adverse cardiac events in older adults.
A propensity weighted retrospective cohort study linked individuals that attended medical fitness facilities to provincial health administrative databases. Older adults who had at least 1 year of health coverage from their index date between January 1st, 2005 to December 31st 2015 were included. Controls were assigned a pseudo-index date at random based on the frequency distribution of index dates in members. Members were stratified into low frequency attenders (< 1 Weekly Visits) and regular frequency attenders (> 1 Weekly Visits). Time to event models estimated the hazard ratios (HRs) for risk of all-cause mortality and major adverse cardiac event. Negative binomial models estimated the risk ratios (RRs) for risk of hospitalizations, outpatient primary care visits and emergency department visits.
Among 3,029 older adult members and 91,734 controls, members had a 45% lower risk of all-cause mortality (HR: 0.55, 95% CI: 0.50 - 0.61), 20% lower risk of hospitalizations (RR: 0.80, 95% CI: 0.75 - 0.84), and a 27% (HR: 0.72, 95% CI: 0.66 - 0.77), lower risk of a major adverse cardiovascular event. A dose-response effect with larger risk reductions was associated with more frequent attendance as regular frequency attenders were 4% more likely to visit a general practitioner for a routine healthcare visit (RR: 1.04, 95% CI: 1.01 - 1.07), but 23% less likely to visit the emergency department (RR: 0.87, 95% CI: 0.82 - 0.92).
Membership at a medical fitness facility was associated with a decreased risk of mortality, health care utilization and cardiovascular events. The medical fitness model may be an alternative approach for public health strategies to promote positive health behaviors in older adult populations.
身体活动不足在老年人中很常见，并且与不良健康结果有关。医疗健身设施提供了一种以医学为重点的健身方法，可以改善其社区的身体活动水平。本研究旨在评估加入医疗健身模式与全因死亡率、医疗保健利用和老年人心血管不良事件之间的关系。
一项基于倾向评分的回顾性队列研究将参加医疗健身设施的个人与省级卫生行政数据库联系起来。纳入的参与者在 2005 年 1 月 1 日至 2015 年 12 月 31 日期间至少有 1 年的健康保险。根据成员的索引日期的频率分布，为对照组随机分配虚拟索引日期。成员分为低频率（每周就诊次数<1 次）和高频率（每周就诊次数>1 次）。时间事件模型估计全因死亡率和主要不良心脏事件风险的风险比（HR）。负二项式模型估计住院、门诊初级保健就诊和急诊就诊风险的风险比（RR）。
在 3029 名老年会员和 91734 名对照者中，会员全因死亡率风险降低 45%（HR：0.55，95%CI：0.50-0.61），住院风险降低 20%（RR：0.80，95%CI：0.75-0.84），主要不良心血管事件风险降低 27%（HR：0.72，95%CI：0.66-0.77）。更频繁的就诊与更大的风险降低相关，因为高频率就诊者看全科医生进行常规医疗就诊的可能性增加 4%（RR：1.04，95%CI：1.01-1.07），但去急诊的可能性降低 23%（RR：0.87，95%CI：0.82-0.92）。
参加医疗健身设施与死亡率、医疗保健利用和心血管事件风险降低相关。医疗健身模式可能是促进老年人群积极健康行为的公共卫生策略的一种替代方法。
