Erikssen G, Liestøl K, Bjørnholt J, Thaulow E, Sandvik L, Erikssen J
Medical Department, Central Hospital of Akershus, Nordbyhagen, Norway.
Lancet. 1998 Sep 5;352(9130):759-62. doi: 10.1016/S0140-6736(98)02268-5.
Point estimates of physical fitness give important information on the risk of death in healthy people, but there is little information available on effects of sequential changes in physical fitness on mortality. We studied this latter aspect in healthy middle-aged men over a total follow-up period of 22 years.
2014 healthy men aged 40-60 years had a bicycle exercise test and clinical examination, and completed a questionnaire in 1972-75 (survey 1). This was repeated for 1756 (91%) of 1932 men still alive by Dec 31, 1982 (survey 2). The exercise scores were adjusted for age. The change in exercise scores between surveys was divided into quartiles (Q1=least fit, Q4=fittest). An adjusted Cox's proportional hazards model was used to study the association between changes in physical fitness and mortality, with the Q1 men used as controls.
By Dec 31, 1994, 238 (17%) of the 1428 men had died, 120 from cardiovascular causes. There were 37 deaths in the Q4 group (19 cardiovascular); their relative risks of death were 0.45 (95% CI 0.29-0.69) for any cause and 0.47 (0.26-0.86) for cardiovascular causes. There was a graded, inverse relation between changes in physical fitness and mortality irrespective of physical fitness status at survey 1.
Change in physical fitness in healthy middle-aged men is a strong predictor of mortality. Even small improvements in physical fitness are associated with a significantly lowered risk of death. If confirmed, these findings should be used to influence public health policy.
身体健康状况的点估计为健康人群的死亡风险提供了重要信息，但关于身体健康状况的连续变化对死亡率的影响，目前几乎没有相关信息。我们在健康的中年男性中进行了一项为期22年的随访研究，以探讨这一问题。
1972 - 1975年，2014名年龄在40 - 60岁的健康男性接受了自行车运动测试和临床检查，并完成了一份问卷（调查1）。到1982年12月31日，对1932名仍在世的男性中的1756名（91%）进行了重复测试（调查2）。运动得分根据年龄进行了调整。两次调查之间运动得分的变化被分为四分位数（Q1 = 身体状况最差，Q4 = 身体状况最佳）。使用调整后的Cox比例风险模型研究身体健康状况变化与死亡率之间的关联，以Q1组男性作为对照。
到1994年12月31日，1428名男性中有238人（17%）死亡，其中120人死于心血管疾病。Q4组有37人死亡（19人死于心血管疾病）；他们因任何原因死亡的相对风险为0.45（95%可信区间0.29 - 0.69），因心血管疾病死亡的相对风险为0.47（0.26 - 0.86）。无论在调查1时的身体健康状况如何，身体健康状况的变化与死亡率之间都存在分级的负相关关系。
健康中年男性身体健康状况的变化是死亡率的有力预测指标。即使身体健康状况有微小改善，也会显著降低死亡风险。如果这些发现得到证实，应用于影响公共卫生政策。
