中年增加運動最終可以降低死亡風險


  March 13, 2009 — 根據線上發表在3月6日BMJ期刊上的一項以群眾為基礎的世代研究結果,中年時增加運動最終可以降低死亡風險,與持續維持高運動活力的男性相同。
  
  來自瑞典Uppsala大學的Liisa Byberg與其同事們表示,在西方國家,大約一半的中年男性並未規律地運動。我們並不知道在中年時增加運動量是否可以降低死亡率,然而,在年輕時維持不常運動似乎是有害的。如果對於死亡率的影響與其他生活型態改變的效應相同,與病患溝通其潛在健康好處將會更加容易。
  
  這項研究的目的在於評估中年後改變運動量是否會影響死亡率,且比較其變化與戒菸的效應。在Uppsala,瑞典的2,205位年齡在50歲以上的男性,在1970年到1973年之間被選出,後續追蹤長達35年,到60、70、77與82歲時再次接受評估。這項研究主要試驗終點是整體(所有原因)死亡率。
  
  在低、中與高運動量組,絕對死亡率分別為每1,000人每年27.1、23.6與18.4%,高運動量組與低運動量的死亡率相對下降32%,與中運動量相比相對下降22%。
  
  在5年的後續追蹤中,在50歲到60歲之間增加運動量的男性與較高的死亡率有關(校正後危險比值[HR]為2.64;95%信賴區間[CI]為1.32-5.27,相較於未改變的高運動量組)。然而,在10年的後續追蹤中,這些男性的運動量增加使得他們的死亡率下降到與未改變的高運動組一樣(HR為1.10;95% CI為0.87-1.38)。
  
  死亡率的下降與運動量增加有關(HR相較於未改變的低運動量組為0.51;95% CI為0.26-0.97),與戒菸(HR相較於繼續抽菸為0.64;95% CI為0.53-0.78)相當。
  
  研究作者們寫到,中年增加運動量與持續維持高運動量的男性相比,最終將可以降低死亡率。下降的幅度與戒菸相當。
  
  這項研究的限制包括僅侷限於男性樣本、使用問卷粗略地評估運動量、誤分類的風險可能導致低估研究結果、與最終觀察值推進技巧相關的潛在誤差。
  
  研究作者的結論是,推動增加中年運動量,即使是中年或是年齡更大的男性,都是很重要的。中年增加運動量在經過長達10年沒有好處的起始期後,可以延長壽命。
  
  瑞典研究局贊助這項研究。研究作者們表示沒有相關資金上的往來。

Increasing Physical Activity in Middle Age Eventually Lowers Mortality Risk

By Laurie Barclay, MD
Medscape Medical News

March 13, 2009 — Increased physical activity in middle age is eventually associated with reduced mortality risk to the same level as that in men with constantly high physical activity, according to the results of a population-based cohort study reported in the March 6 Online First issue of the BMJ.

"About half of all middle aged men in the West do not take part in regular physical activity," write Liisa Byberg, from Uppsala University in Uppsala, Sweden, and colleagues. "Whereas being physically inactive in younger years seems detrimental, we do not know whether an increase in exercise level later in life reduces mortality rates. If the impact on mortality could be compared with the effects of other changes in lifestyle habits it would be easier to communicate this potential health benefit."

The goal of this study was to assess how change in level of physical activity after middle age affects mortality rates and to compare that change vs the effect of smoking cessation. In Uppsala, Sweden, 2205 men aged 50 years from 1970 to 1973 were followed up for 35 years and were reevaluated at ages 60, 70, 77, and 82 years. The primary study endpoint was total (all-cause) mortality.

In the groups with low, medium, and high physical activity, the absolute mortality rate was 27.1, 23.6, and 18.4 per 1000 person-years, respectively, with a relative rate reduction attributable to high physical activity being 32% vs low physical activity and 22% vs medium physical activity.

During the first 5 years of follow-up, men who increased their physical activity level between the ages of 50 and 60 years continued to have higher mortality rates (adjusted hazard ratio [HR], 2.64; 95% confidence interval [CI], 1.32 - 5.27, vs unchanged high physical activity). However, after 10 years of follow-up, increased physical activity in these men was associated with decreased mortality rates to the level of men with unchanged high physical activity (HR, 1.10; 95% CI, 0.87 - 1.38).

This reduction in mortality rates associated with increased physical activity (HR vs unchanged low physical activity, 0.51; 95% CI, 0.26 - 0.97) was comparable vs quitting smoking (HR vs continued smoking, 0.64; 95% CI, 0.53 - 0.78).

"Increased physical activity in middle age is eventually followed by a reduction in mortality to the same level as seen among men with constantly high physical activity," the study authors write. "This reduction is comparable with that associated with smoking cessation."

Limitations of this study include sample restricted to men; crude assessment of physical activity by questionnaire, with risk for misclassification possibly leading to underestimation of the results; and possible bias related to the technique of last observed value carried forward.

"Efforts for promotion of physical activity, even among middle aged and older men, are important," the study authors conclude. "Increased physical activity in middle age increases longevity after an induction period of up to 10 years of no benefit."

The Swedish Research Council supported this study. The study authors have disclosed no relevant financial relationships.

BMJ. Published online March 6, 2009.

    



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