Physical activity and lung function-Cause or consequence?
Physical activity and lung function-Cause or consequence?
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DOI：
10.1371/journal.pone.0237769
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发表时间：
2020-08-20
期刊：
影响因子：
3.7
通讯作者：
Garcia-Aymerich, Judith
中科院分区：
文献类型：
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作者：
Bedard, Annabelle;Carsin, Anne-Elie;Garcia-Aymerich, Judith
人们担心，在以前的吸烟者纵向研究中提出的体力活动与更好的肺功能的正相关是由于反向因果关系。为了研究这一点，我们应用了结构方程模型（SEM），一种探索性方法，和边际结构模型（MSM），一种因果推理框架的方法，用于纠正反向因果关系和时间依赖性混杂，并估计因果效应，来自欧洲共同体呼吸健康调查参与者的数据（ECRHS，一项多中心欧洲队列研究，于1991-1993年开始，采用ECRHS I，并进行了两次随访：1999-2003年的ECRHS II和2010-2014年的ECRHS III）。753例受试者在ECRHS II报告了当前吸烟，在ECRHS I、II和III报告了重复的肺功能数据，在ECRHS II和III报告了体力活动数据，在ECRHS I和II报告了潜在混杂因素，这些受试者被纳入分析。SEM显示，体力活动和肺功能在两个方向上都呈正相关。MSM提示体力活动对肺功能有保护作用（平均β的总体差异（95% CI），比较活跃与非活跃个体：58 mL（21-95）的用力呼气量在一秒和83 mL（36-130）的用力肺活量）。我们的研究结果表明，双向因果关系，并支持一个真正的保护作用，体育活动对吸烟者的肺功能，后占反向因果关系和时间依赖性混杂。
Concerns exist that the positive association of physical activity with better lung function, which has been suggested in previous longitudinal studies in smokers, is due to reverse causation. To investigate this, we applied structural equation modeling (SEM), an exploratory approach, and marginal structural modeling (MSM), an approach from the causal inference framework that corrects for reverse causation and time-dependent confounding and estimates causal effects, on data from participants in the European Community Respiratory Health Survey (ECRHS, a multicentre European cohort study initiated in 1991-1993 with ECRHS I, and with two follow-ups: ECRHS II in 1999-2003, and ECRHS III in 2010-2014). 753 subjects who reported current smoking at ECRHS II, with repeated data on lung function at ECRHS I, II and III, physical activity at ECRHS II and III, and potential confounders at ECRHS I and II, were included in the analyses. SEM showed positive associations between physical activity and lung function in both directions. MSM suggested a protectivecausaleffect of physical activity on lung function (overall difference in mean beta (95% CI), comparing active versus non-active individuals: 58 mL (21-95) for forced expiratory volume in one second and 83 mL (36-130) for forced vital capacity). Our results suggest bi-directional causation and support a true protective effect of physical activity on lung function in smokers, after accounting for reverse causation and time-dependent confounding.