PDF(Pubmed)
Abstract：
Evidence regarding the dose-response curve shapes of physical activity (PA) and sedentary time (ST) in older adults with functional disability (FD) is extremely limited. Moreover, these associations may differ depending on with/without frailty. We examined the dose-response associations between moderate-to-vigorous PA (MVPA) and ST with FD among older adults with/without frailty.
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.
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.
摘要：
■关于患有功能性残疾（FD）的老年人的身体活动（PA）和久坐时间（ST）的剂量反应曲线形状的证据极为有限。此外，这些关联可能会有所不同，这取决于是否有弱点。我们检查了有/没有虚弱的老年人中中度至重度PA（MVPA）和ST与FD之间的剂量反应关系。
■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。
■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。
