每天多一步 健康一大步 ——JAMA最新研究显示“增加步数可明显降低全因死亡率”

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导读



俗语道,“饭后百步走 活到九十九”,然而,每天步行步数的增多真的会让我们的健康受益吗?而JAMA的最近研究显示,确实是这样的——“增加步数可明显降低全因死亡率”!


背景



尚不清楚每天的步数和步行强度是否与较低的死亡率有关,为描述步数与强度和死亡率之间的剂量反应关系,研究者采用研究进行了评估。


方法



在美国国家健康和营养检查调查中,至少40岁的美国成年人的代表性样本佩戴了最多7天的加速度计(从2003年至2006年)。 确定死亡率直至201512月。主要结局是全因死亡率, 次要结局是心血管疾病(CVD)和癌症死亡率。 使用三次样条和根据“年龄;性别; 种族/民族; 教育; 饮食; 吸烟状况;体重指数;自我报告的健康状况; 流动性限制; 并诊断出糖尿病,中风,心脏病,心力衰竭,癌症,慢性支气管炎和肺气肿”调整的四分位数分类来估算危险比(HRs),死亡率和95%CI


结果


1)共有4840名参与者参与这项研究:平均年龄56.8岁; 其中女性2435人 [54%];肥胖个体 1732人 [36%];平均每天佩戴加速度计5.7天,平均每天14.4小时,每天的平均步骤数为9124。

2)全因死亡率:每天步行4000步左右>每天步行8000步左右>每天步行12000步左右。每天步行8000步时的全因死亡率相较于4000步明显降低!

3)1分钟内的步数多少(即:脚步快慢)与全因死亡率无关!


结论


根据美国成年人的代表性样本,更多的日常步数与较低的全因死亡率显着相关; 每天调整总步数后,步数强度与死亡率之间无显着关联。


所以,我们还是要多走一走,“饭后百步走 活到九十九”!



原文阅读

IMPORTANCE

It is unclear whether the number of steps per day and the intensity of stepping are associated with lower mortality.


OBJECTIVE

Describe the dose-response relationship between step count and intensity and mortality.


DESIGN, SETTING, AND PARTICIPANTS

Representative sample of US adults aged at least 40

years in the National Health and Nutrition Examination Survey who wore an accelerometer for up to 7 days ( from 2003-2006). Mortality was ascertained through December 2015.


EXPOSURES 

Accelerometer-measured number of steps per day and 3 step intensity measures (extended bout cadence, peak 30-minute cadence, and peak 1-minute cadence [steps/min]). Accelerometer data were based on measurements obtained during a 7-day period at baseline.


MAIN OUTCOMES AND MEASURES

The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular disease (CVD) and cancer mortality. Hazard ratios (HRs),mortality rates, and 95% CIs were estimated using cubic splines and quartile classifications adjusting for age; sex; race/ethnicity; education; diet; smoking status; body mass index;self-reported health; mobility limitations; and diagnoses of diabetes, stroke, heart disease,heart failure, cancer, chronic bronchitis, and emphysema.


RESULTS

A total of 4840 participants (mean age, 56.8 years; 2435 [54%] women; 1732 [36%] individuals with obesity) wore accelerometers for a mean of 5.7 days for a mean of 14.4 hours per day. The mean number of steps per day was 9124. There were 1165 deaths over a mean 10.1 years of follow-up, including 406 CVD and 283 cancer deaths. The unadjusted incidence density for all-cause mortality was 76.7 per 1000 person-years (419 deaths) for the 655 individuals who took less than 4000 steps per day; 21.4 per 1000 person-years (488 deaths) for the 1727 individuals who took 4000 to 7999 steps per day; 6.9 per 1000 person-years (176 deaths) for the 1539 individuals who took 8000 to 11 999 steps per day; and 4.8 per 1000 person-years (82 deaths) for the 919 individuals who took at least 12 000 steps per day. Compared with taking 4000 steps per day, taking 8000 steps per day was associated with significantly lower all-cause mortality (HR, 0.49 [95% CI, 0.44-0.55]), as was taking 12 000 steps per day (HR, 0.35 [95% CI, 0.28-0.45]). Unadjusted incidence density for all-cause mortality by peak 30 cadence was 32.9 per 1000 person-years (406 deaths) for the 1080

individuals who took 18.5 to 56.0 steps per minute; 12.6 per 1000 person-years (207 deaths) for the 1153 individuals who took 56.1 to 69.2 steps per minute; 6.8 per 1000 person-years (124 deaths) for the 1074 individuals who took 69.3 to 82.8 steps per minute; and 5.3 per 1000 person-years (108 deaths) for the 1037 individuals who took 82.9 to 149.5 steps per minute. Greater step intensity was not significantly associated with lower mortality after adjustment for total steps per day (eg, highest vs lowest quartile of peak 30 cadence:

HR, 0.90 [95% CI, 0.65-1.27]; P value for trend = .34).


CONCLUSIONS AND RELEVANCE

Based on a representative sample of US adults, a greater

number of daily steps was significantly associated with lower all-cause mortality. There was no significant association between step intensity and mortality after adjusting for total steps per day.




Reference:Saint-Maurice, P. F., Troiano, R. P., Bassett, D. R., Graubard, B. I., Carlson, S. A., Shiroma, E. J.,  Matthews, C. E. (2020). Association of Daily Step Count and Step Intensity With Mortality Among US Adults. JAMA, 323(12), 1151. doi:10.1001/jama.2020.1382

       


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