Association of Daily Sitting Time and Leisure-Time Physical Activity With Survival Among US Cancer Survivors
Association of Daily Sitting Time and Leisure-Time Physical Activity With Survival Among US Cancer Survivors
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DOI：
10.1001/jamaoncol.2021.6590
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发表时间：
2022-01-06
期刊：
影响因子：
28.4
通讯作者：
Yang, Lin
中科院分区：
文献类型：
--
作者：
Cao, Chao;Friedenreich, Christine M.;Yang, Lin
重要性 久坐行为，尤其是久坐和缺乏体力活动，可能会影响癌症后的生存。 目的 研究每日静坐时间和休闲时间体力活动与癌症幸存者死亡率结果的独立和联合关系。 设计、环境和参与者 来自美国的具有全国代表性的癌症幸存者样本前瞻性队列，年龄为 40 岁或以上（n = 1535；加权人口，14 002 666） 2007 年至 2014 年全国健康和营养检查调查。参与者与截至 2015 年 12 月 31 日的访谈和体检日期的死亡率数据相关联。每日静坐时间和休闲时间体力活动 (LTPA) 是使用全球体力活动调查问卷自我报告的。数据分析于 2021 年 1 月 1 日至 5 月 1 日进行。 主要结果和指标 全因死亡率、癌症特异性死亡率和非癌症死亡率。 结果 在 1535 名癌症幸存者中（平均 [SE] 年龄，65.1 [0.4] 岁；828 [60.1%] 女性；945 [83.1%] 非西班牙裔白人），950 (56.8%) 报告上周的 LTPA 为每周 0 分钟 (min/wk)（不活动）； 226 名 (15.6%) 报告 LTPA 少于 150 分钟/周（活动不足）； 359 名 (27.6%) 报告 LTPA 为 150 分钟/周或以上（主动）； 553 人 (35.4%) 表示每天坐的时间为 6 至 8 小时 (h/d)； 328 人（24.9%）表示每天坐的时间超过 8 小时。值得注意的是，574 名 (35.8%) 癌症幸存者报告称，每天静坐时间超过 6 小时时未出现 LTPA。在长达 9 年的随访期间（中位数为 4.5 年；6980 人年），有 293 人死亡（癌症 114 人；心脏病 41 人；其他原因 138 人）。多变量模型显示，与不运动相比，运动与全因死亡率（风险比 [HR]，0.34；95% CI，0.20-0.60）和癌症特异性死亡率（HR，0.32；95% CI，0.15-0.70）风险较低相关。与每天久坐时间少于 4 小时的人相比，每天久坐时间超过 8 小时的全因死亡率（HR，1.81；95% CI，1.05-3.14）和癌症特异性死亡率（HR，2.27；95% CI，1.08-4.79）风险较高。在联合分析中，久坐与活动不足的癌症幸存者死亡风险增加相关。具体而言，不活动和活动不足的幸存者报告，每天静坐超过 8 小时的总体死亡风险（HR，5.38；95% CI，2.99-9.67）和癌症特异性死亡风险（HR，4.71；95% CI，1.60-13.9）最高。 结论和相关性 在这项针对美国癌症幸存者全国代表性样本的队列研究中，长时间坐着与缺乏身体活动相结合，导致死亡风险最高。活动非常普遍，并且与各种原因死亡和癌症的最高风险相关。
IMPORTANCE Sedentary behaviors, particularly prolonged sitting and lack of physical activity, may influence survival after cancer.OBJECTIVE To examine the independent and joint associations of daily sitting time and leisure-time physical activity with mortality outcomes among cancer survivors.DESIGN, SETTING, AND PARTICIPANTS A prospective cohort of a nationally representative sample of cancer survivors, age 40 years or older (n = 1535; weighted population, 14 002 666), from the US National Health and Nutrition Examination Survey from 2007 to 2014. Participants were linked to mortality data from their interview and physical examination date through December 31, 2015. Daily sitting time and leisure-time physical activity (LTPA) were self-reported using the Global Physical Activity Questionnaire. Data analyses were performed from January 1 to May 1, 2021.MAIN OUTCOMES AND MEASURES All-cause, cancer-specific, and noncancer mortality.RESULTS Among 1535 cancer survivors (mean [SE] age, 65.1 [0.4] years; 828 [60.1%] females; 945 [83.1%] non-Hispanic White individuals), 950 (56.8%) reported LTPA of 0 minutes per week (min/wk) during the previous week (inactive); 226 (15.6%) reported LTPA of less than 150 min/wk (insufficiently active); 359 (27.6%) reported LTPA of 150 min/wk or more (active); 553 (35.4%) reported sitting for 6 to 8 hours per day (h/d); and 328 (24.9%) reported sitting for more than 8 h/d. Of note, 574 (35.8%) cancer survivors reported no LTPA with concurrent sitting of more than 6 h/d. During the follow-up period of up to 9 years (median, 4.5 years; 6980 person-years), there were 293 deaths (cancer, 114; heart diseases, 41; other causes, 138). Multivariable models showed that being physically active was associated with lower risks of all-cause (hazard ratio [HR], 0.34; 95% CI, 0.20-0.60) and cancer-specific (HR, 0.32; 95% CI, 0.15-0.70) mortality compared with inactivity. Sitting more than 8 h/d was associated with higher risks of all-cause (HR, 1.81; 95% CI, 1.05-3.14) and cancer-specific (HR, 2.27; 95% CI, 1.08-4.79) mortality compared with those sitting less than 4 h/d. In the joint analyses, prolonged sitting was associated with an increased risk of death among cancer survivors who were not sufficiently active. Specifically, inactive and insufficiently active survivors reported sitting more than 8 h/d had the highest overall (HR, 5.38; 95% CI, 2.99-9.67) and cancer-specific (HR, 4.71; 95% CI, 1.60-13.9) mortality risks.CONCLUSIONS AND RELEVANCE In this cohort study of a nationally representative sample of US cancer survivors, the combination of prolonged sitting with lack of physical activity was highly prevalent and was associated with the highest risks of death from all causes and cancer.