即使每天只有少量運動也可以減少死亡率


  【24drs.com】兩篇新分析的作者們表示,相較於鼓勵每個人達到每週中等強度運動150分鐘以上的現行指引,鼓勵久坐不動的成人每天稍微動一動,可以產生更廣泛的人群健康益處。
  
  作者們在1月21日的BMJ期刊發表的兩篇文章中表示,雖然150分鐘依舊是理想目標,對於多數久坐不動者以及部分年長者而言仍有障礙,事實上,對於多數久坐者,不用達到150分鐘就可以顯著降低死亡率風險。
  
  法國Toulouse大學醫院Philipe de Souto Barreto博士在第一篇文章寫道,指引對於這些完全久坐不動的人是令人沮喪的,因為令他們感到被迫且太難了,特別是他們年長時。
  
  亞特蘭大喬治亞科技大學應用生理學院Phillip B. Sparling教授針對年長者進行的另一篇分析中寫道,我們認為,對於何時應建議病患運動,醫師應鼓勵人們增加小量活動程度,而不是聚焦在(指引的)建議。
  
  資料顯示,在過去廿年來,久坐不動的人對於增加活動呼籲的反應最少。Barreto博士報告指出,在1996至2014年間,全美人口中,沒有進行體能活動的人口佔比穩定維持在25%,相對的,有在運動的人變得更常運動,參與足夠運動的人口比率從1996年的22%增加到2014年的51.6%。
  
  許多研究顯示,坐太久與各種原因死亡率增加有關,心血管疾病與癌症死亡率也比較高;久坐也與心臟病、癌症及第二型糖尿病發生率較高有關。
  
  Sparling教授等人分析了「美國國家健康和營養調查」的7,000名20-79歲者的加速度計數據,這些資料顯示,各年齡層的中等與高強度運動程度低,只有20-29 歲的年輕人有達到建議的每天運動30分鐘,同時,研究發現所有的成人都是每天坐7小時以上,之前的研究認為這與死亡率增加有關,年輕成人(20-29歲)每天坐7.7小時,年長者(70-79歲)每天坐9.6小時,英國的一篇研究結果與此類似。
  
  總的來說,美國和英國的這些加速度計研究結果指出,即使根據年齡相關的體能衰退校正運動強度,只有10-15%自由生活的老年人達到「足夠活動」的最低標準(每週>150分鐘的中等強渡活動)。
  
  兩篇分析的作者都指出,許多研究顯示,增加任何運動都有幫助。在Barreto博士檢視的七篇大型縱向、觀察型研究中,研究者們指出,久坐不動最嚴重者與稍微積極活動者之間的死亡率風險差異最大,Barreto博士寫道,這表示久坐不動者只要有稍微增加體能活動,就可以大幅降低各種原因死亡率風險。除了其中一篇,其它六篇都顯示,相較於不活動的人,有點積極的人,其死亡率風險比較低,在這些研究中,有點積極的人,死亡率減少範圍為14% - 37%。
  
  Barreto博士報告指出,挪威一篇有56,072人的研究中,每週一次運動課程的人,心血管死亡率低於沒有活動者,有運動男性的相對風險是沒運動男性的0.71 (95%信心區間0.59 - 0.86),至於女性,單次運動課程使風險更大幅降低、達0.56 (95%信心區間0.44 - 0.71)。
  
  Barreto博士寫道,應採取緩慢進展的方式推廣小幅增加體能活動,以使健康效益最大化以及潛在風險最小化。
  
  Sparling教授建議,運動建議應聚焦在導入每天輕度活動,每天增加輕度活動量30分鐘,可建議每小時站起來或散步個1、2分鐘減少久坐,可以建議人們在廣告時間離開椅子走走、講電話時也順便走動、每天散步5分鐘3次。
  
  Sparling博士等人寫道,我們並非建議放棄每週150分鐘這個標準,我們的目標是提醒大家根據既有的指引提供諮商時要有廣闊的視野,整天隨時活動的方法可以幫助年長者與久坐不動者朝向達成建議的活動程度。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7154&x_classno=0&x_chkdelpoint=Y
  

Even a Little More Daily Activity May Reduce Mortality Levels

By Jenni Laidman
Medscape Medical News

Encouraging sedentary adults to move just a little more every day could produce more widespread population health benefits than urging everyone to meet the current guideline of 150 minutes or more of moderate activity each week, say the authors of two new analyses.

Although the 150-minute goal is still ideal, the authors say, it may be a barrier to the most sedentary and to some older people. In fact, it may take far less than 150 minutes to achieve a significant reduction in mortality risk in sedentary people, they write in two articles published January 21 in the BMJ.

"Guidelines may be discouraging for fully sedentary people, who have reported feeling 'being pushed too hard,' especially as they get older," writes Philipe de Souto Barreto, PhD, a researcher at Gerontopole of Toulouse, University Hospital of Toulouse, France, in the first article.

Writing in a separate analysis focused on older adults, Phillip B. Sparling, EdD, professor, School of Applied Physiology, Georgia Institute of Technology, Atlanta, and colleagues comment: "We argue that when advising patients on exercise doctors should encourage people to increase their level of activity by small amounts rather than focus on the recommended levels."

The sedentary population has been the least responsive to calls for increased physical activity during the last 2 decades, data show. Across the US population, the percentage of people engaging in no physical activity has remained stable, at 25%, between 1996 and 2014, Dr Barreto reports. In contrast, people who were active became more active, with the number of people who participate in sufficient physical activity rising from 22% in 1996 to 51.6% in 2014.

A mounting body of research shows that too much sitting is associated with increased all-cause mortality, as well as higher mortality from cardiovascular disease and cancer. Sitting is also associated with a higher incidence of heart disease, cancer, and type 2 diabetes.

Dr Sparling and colleagues analyzed accelerometer data from 7000 adults, aged 20 to 79 years, in the US National Health and Nutrition Examination Survey. Those data show low levels of moderate and vigorous physical activity in all age groups, with only the youngest adults, ages 20 to 29 years, reaching the recommended 30 minutes of exercise daily. At the same time, the study found that all adults sat longer than 7 hours a day, the amount identified in earlier research as being associated with increased mortality. The youngest people (aged 20 to 29 years) sat 7.7 hours daily, and the oldest group (70 to 79 years) sat 9.6 hours daily. A study in the United Kingdom found similar results.

"Collectively, these accelerometer findings from the US and UK indicate that, even when exercise intensity is adjusted for age related decline in physical capacity, only some 10-15% of free living, older adults are meeting the minimum standard for 'sufficient activity' (>150 min/week of moderate intensity activity)."

Several studies have shown the benefits of any increase in exercise, the authors of both analyses report. In seven large longitudinal, observational studies Dr Barreto examined, researchers showed that the greatest differences in mortality risk were between the most sedentary and the slightly more active, "suggesting that sedentary people can greatly reduce their risk of all cause mortality with relatively minor increments in physical activity," Dr Barreto writes. All but one of the seven studies showed that people judged "somewhat active" were at a lower mortality risk compared with inactive people, with risk reductions for the "somewhat active" group ranging from 14% to 37% across the studies.

In a study conducted in Norway among 56,072 people, those who engaged in a single weekly exercise session had lower cardiovascular mortality than inactive people, Dr Barreto reports, leading to a relative risk in men of 0.71 (95% confidence interval, 0.59 - 0.86) compared with inactive men. In women, the single session dropped the relative risk even more dramatically, to 0.56 (95% confidence interval, 0.44 - 0.71).

"Small incremental increases in physical activity should be promoted in a slowly progressive manner to maximise health benefits and minimise potential adverse effects," Dr Barreto writes.

Dr Sparling advises that exercise recommendations focus on introducing light activity throughout the day, increasing light activities by 30 minutes daily, and reducing prolonged sitting by suggesting standing or strolling 1 or 2 minutes every hour. People could be advised to get up from their chair during commercials, pace during telephone conversations, and take 5-minute walks three times a day.

"We are not proposing that the 150 minute a week standard be abandoned," Dr Sparling and colleagues write. "Rather, our purpose is to remind colleagues that a broad perspective to counselling is already embedded in the guidelines and that a whole day approach for older sedentary patients may help them move towards the recommended activity levels."

The authors have disclosed no relevant financial relationships.

BMJ. Published online January 21, 2015.

    
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