We included 7,480 initially nondisabled adults (3,795 men and 3,685 women) aged 65-84 years in Ota City, Tokyo, Japan. MVPA and ST were evaluated using the International Physical Activity Questionnaire-Short Form. FD was prospectively identified using a nationally unified database of the long-term care insurance system. Frailty was determined using Check-List 15, validated against Fried\'s frailty criteria. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of MVPA and ST for FD were calculated, and dose-response curves were examined using restricted cubic splines.
During 3.6 years of follow-up, 1,001 (13.4%) participants had FD. Among all participants, compared with no MVPA, the HRs for FD reduced linearly up to approximately 2000 metabolic equivalents (METs)■min/week of MVPA, and the lowest HR (HR: 0.61, 95% CI: 0.51-0.74) was reached at around 3,000-4,000 METs■min/week. Although the shape of this association was consistent regardless of with/without frailty, the magnitude of the association tended to be stronger in frail older adults than in non-frail older adults. Compared with those for the median (300 min/day) of ST, the HRs for FD increased linearly as ST reached approximately 600 min/day or more, independent of MVPA, with a maximum HR of 1.31 (95% CI: 1.01-1.71) for 1,080 min/day among all participants. This association was more pronounced among non-frail older adults but not statistically significant among frail older adults.
Higher MVPA levels consistently reduced the incidence of FD regardless of frailty in a significant inverse nonlinear dose-response manner. A significant positive nonlinear dose-response association between ST and FD risk was identified among non-frail older adults but not among frail older adults. Increasing MVPA and reducing prolonged ST are important for preventing FD among non-frail older adults. However, reducing ST alone may be insufficient; increasing MVPA, even if by only small increments, is highly recommended for frail older adults.
■我们包括大田市65-84岁的7,480名初始非残疾成年人(3,795名男性和3,685名女性)。东京,日本。使用国际身体活动问卷简表评估MVPA和ST。FD是使用长期护理保险制度的全国统一数据库进行前瞻性识别的。使用检查表15确定脆弱,并根据Fried的脆弱标准进行验证。计算FD的MVPA和ST的多变量校正风险比(HRs)和95%置信区间(CIs),和剂量反应曲线使用有限的三次样条检查。
■在3.6年的随访期间,1,001名(13.4%)参与者患有FD。在所有参与者中,与没有MVPA相比,FD的HR线性降低至大约2000代谢当量(MET)■分钟/周的MVPA,最低的HR(HR:0.61,95%CI:0.51-0.74)达到约3,000-4,000MET■min/周。尽管这种联系的形式是一致的,无论是否脆弱,与不虚弱的老年人相比,虚弱的老年人的关联程度往往更强.与ST的中位数(300分钟/天)相比,当ST达到约600分钟/天或更长时间时,FD的HR线性增加,独立于MVPA,所有参与者的1,080分钟/天的最大HR为1.31(95%CI:1.01-1.71)。这种关联在非虚弱的老年人中更为明显,但在虚弱的老年人中没有统计学意义。
■较高的MVPA水平始终以明显的逆非线性剂量反应方式降低FD的发生率,而与虚弱无关。在非虚弱的老年人中发现ST和FD风险之间存在显着的非线性剂量反应正相关,但在虚弱的老年人中则没有。增加MVPA和减少延长ST对于预防非虚弱老年人的FD很重要。然而,仅减少ST可能是不够的;增加MVPA,即使只有很小的增量,强烈建议体弱的老年人。