Association of Daily Step Count and Step Intensity With Mortality Among US Adults
Association of Daily Step Count and Step Intensity With Mortality Among US Adults
复制标题
DOI：
10.1001/jama.2020.1382
复制
发表时间：
2020-03-24
影响因子：
120.7
通讯作者：
Matthews, Charles E.
中科院分区：
文献类型：
--
作者：
Saint-Maurice, Pedro F.;Troiano, Richard P.;Matthews, Charles E.
重要性目前尚不清楚每天的步数和强度是否与较低的死亡率相关。目的描述步数和强度与死亡率之间的剂量反应关系。设计，地点，和参与者在国家健康和营养检查调查中至少40岁的美国成年人的代表性样本，他们佩戴加速计长达7天（2003 - 2006年）。死亡率确定至2015年12月。EXPOSURES加速度计测量的每天步数和3步强度测量（延长回合节奏、峰值30分钟节奏和峰值1分钟节奏[步/分钟]）。加速计数据是基于基线时7天内获得的测量结果。主要结果和测量主要结果是全因死亡率。次要结局为心血管疾病（CVD）和癌症死亡率。使用三次样条和四分位数分类法估计风险比（HR）、死亡率和95% CI，调整了年龄、性别、种族/民族、教育、饮食、吸烟状况、体重指数、自我报告的健康状况、活动受限、糖尿病、中风、心脏病、心力衰竭、癌症、慢性支气管炎和肺气肿的诊断。（平均年龄56.8岁; 2435名[54%]女性; 1732名[36%]肥胖者）平均佩戴加速度计5.7天，平均每天佩戴14.4小时。平均每天步行9124步。在平均10.1年的随访中，有1165例死亡，包括406例CVD和283例癌症死亡。全因死亡的未校正发病率密度为76.7/1000人-年每天步行少于4000步的655人（419人死亡）;每1000人年21.4人（488人死亡），1727人每天走4000至7999步;每1000人年6.9人（176人死亡）的1539人谁采取了8000至11999步，每天和4.8每1000人年（82人死亡）的919人谁采取了至少12000步每天。与每天走4000步相比，每天走8000步与全因死亡率显著降低相关（HR，0.49 [95% CI，0.44 - 0.55]），每天走12000步也是如此（HR，0.35 [95% CI，0.28 - 0.45]）。按高峰30个步调计算的全因死亡率的未校正发病率密度为32.9/1000人-年（406例死亡）每分钟走18.5至56.0步的1080人;每1000人年12.6例死亡（207例死亡），1153人每分钟走56.1至69.2步; 6.8/1000人年（124人死亡）的1074人谁采取了69.3至82.8步每分钟;和5.3每1000人年（108人死亡）的1037人谁采取了82.9至149.5步每分钟。在调整每天总步数后，更大的步数强度与更低的死亡率没有显著相关性（例如，峰值30节奏的最高与最低四分位数：HR，0.90 [95% CI，0.65 - 1.27];趋势的P值= 0.34）。结论和相关性基于美国成年人的代表性样本，每天走更多的步数与较低的全因死亡率显著相关。在调整每天总步数后，步数强度与死亡率之间没有显著相关性。
IMPORTANCE It is unclear whether the number of steps per day and the intensity of stepping are associated with lower mortality.OBJECTIVE Describe the dose-response relationship between step count and intensity and mortality.DESIGN, SETTING, AND PARTICIPANTS Representative sample of US adults aged at least 40 years in the National Health and Nutrition Examination Survey who wore an accelerometer for up to 7 days ( from 2003-2006). Mortality was ascertained through December 2015.EXPOSURES Accelerometer-measured number of steps per day and 3 step intensity measures (extended bout cadence, peak 30-minute cadence, and peak 1-minute cadence [steps/min]). Accelerometer data were based on measurements obtained during a 7-day period at baseline.MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular disease (CVD) and cancer mortality. Hazard ratios (HRs), mortality rates, and 95% CIs were estimated using cubic splines and quartile classifications adjusting for age; sex; race/ethnicity; education; diet; smoking status; body mass index; self-reported health; mobility limitations; and diagnoses of diabetes, stroke, heart disease, heart failure, cancer, chronic bronchitis, and emphysema.RESULTS A total of 4840 participants (mean age, 56.8 years; 2435 [54%] women; 1732 [36%] individuals with obesity) wore accelerometers for a mean of 5.7 days for a mean of 14.4 hours per day. The mean number of steps per day was 9124. There were 1165 deaths over a mean 10.1 years of follow-up, including 406 CVD and 283 cancer deaths. The unadjusted incidence density for all-cause mortality was 76.7 per 1000 person-years (419 deaths) for the 655 individuals who took less than 4000 steps per day; 21.4 per 1000 person-years (488 deaths) for the 1727 individuals who took 4000 to 7999 steps per day; 6.9 per 1000 person-years (176 deaths) for the 1539 individuals who took 8000 to 11 999 steps per day; and 4.8 per 1000 person-years (82 deaths) for the 919 individuals who took at least 12 000 steps per day. Compared with taking 4000 steps per day, taking 8000 steps per day was associated with significantly lower all-cause mortality (HR, 0.49 [95% CI, 0.44-0.55]), as was taking 12 000 steps per day (HR, 0.35 [95% CI, 0.28-0.45]). Unadjusted incidence density for all-cause mortality by peak 30 cadence was 32.9 per 1000 person-years (406 deaths) for the 1080 individuals who took 18.5 to 56.0 steps per minute; 12.6 per 1000 person-years (207 deaths) for the 1153 individuals who took 56.1 to 69.2 steps per minute; 6.8 per 1000 person-years (124 deaths) for the 1074 individuals who took 69.3 to 82.8 steps per minute; and 5.3 per 1000 person-years (108 deaths) for the 1037 individuals who took 82.9 to 149.5 steps per minute. Greater step intensity was not significantly associated with lower mortality after adjustment for total steps per day (eg, highest vs lowest quartile of peak 30 cadence: HR, 0.90 [95% CI, 0.65-1.27]; P value for trend =.34).CONCLUSIONS AND RELEVANCE Based on a representative sample of US adults, a greater number of daily steps was significantly associated with lower all-cause mortality. There was no significant association between step intensity and mortality after adjusting for total steps per day.