中国中老年人体力活动与全因死亡风险的关系：前瞻性队列研究

BackgroundInsufficient physical activity is one of the most important public health problems in the 21st century and studies have found an association between physical activity and mortality. The effect of physical activity on mortality risk has attracted much attention in recent yearsbut few studies have reported the relationship between physical activity and?all-cause mortality risk in different populations. ObjectiveTo explore the relationship between physical activity and all-cause mortality risk in middle-aged and older adults45 years old and abovein China. MethodsBased on the data of China Health and Retirement Tracking SurveyCHARLSfrom 2011 to 2018a total of 2 799 middle-aged and older adults from the 2011 baseline population of the CHARLS were selected as the research subjects on September 102022their baseline data such as demographic variableslifestyle variablesand number of chronic diseases were collected, and physical activity level was evaluated based on the International Physical Activity QuestionnaireIPAQas low level physical activity600 metabolic equivalentMETs/weekmoderate level of physical activity600-3 000 METs/weekhigh level of physical activity 3 000 METs/ week. The follow-up period was from 2011 to 2018and data from 20132015 and 2018 were selected for follow-up, with all-cause death as the endpoint eventand the subjects were divided into the survival groupn=2 424and allcause death groupn=375according to their survival status. Cox proportional hazard regression model was used to analyze the relationship between physical activity level and all-cause mortality risk in middle-aged and older adultssensitivity analysis and stratification analysis were also performed. ResultsDuring the 7-year follow-up375 cases of all-cause death occurred among 2 799 middle-aged and older adults with the incidence of all-cause death of 13.40%. There were statistically significant differences in physical activity levelgenderagemarital statuseducation levelADL limitationBMIsmokingalcohol consumption and the number of chronic diseases between the survival group and all-cause death groupP<0.05. After adjusting for confounding factorsmultivariate Cox proportional hazard regression analysis showed that the risk of all-cause death was reduced by 43%HR=0.5795%CI0.440.75P<0.001and 64%HR=0.3695%CI0.270.48P<0.001in the middle-aged and older adults with low level of physical activity and high level of physical activity, respectively. The results of both sensitivity analyses showed a reduced risk of all-cause mortality in the middle-aged and older adults with moderate and high levels of physical activity compared with those with low level of physical activityP<0.001indicating that the results are robust. Stratified analysis showed that moderate level of physical activity could reduce the risk of all-cause death by 50% HR=0.5095%CI0.330.26P<0.001in people aged 60-74 years and 51%HR=0.4995%CI0.330.73 P<0.001in people with normal BMI. High levels of physical activity were associated with a 74%HR=0.2695%CI0.140.47 P<0.001 and 65%HR=0.3595%CI0.240.51P<0.001lower risk of all-cause death in people aged 45 to 59 and 60 to 74 yearsrespectivelyand a 71%HR=0.2995%CI0.200.43P<0.001and 64%HR=0.3695%CI0.220.59 P<0.001lower risk of all-cause death in people with normal BMIoverweight or obesity. ConclusionBoth moderate and high levels of physical activity can reduce the risk of all-cause death in middle-aged and older adultsand the effect of high level of physical activity is more obvious. From the perspective of reducing the risk of all-cause deathit is suitable for people aged 45- 59 years old, overweight and obese people to choose high level of physical activity. People aged 60-74 years and with normal BMI can benefit from moderate or high levels of physical activity. There is no clear recommendation with sufficient evidence for people aged ≥ 75 years old and lean peoplewho should make decisions according to their own specific situations.