Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts.
Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts.
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DOI：
10.1016/s2468-2667(21)00302-9
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发表时间：
2022-03
影响因子：
50
通讯作者：
Fulton, Janet E.
中科院分区：
文献类型：
--
作者：
Paluch, Amanda E.;Bajpai, Shivangi;Bassett, David R.;Carnethon, Mercedes R.;Ekelund, Ulf;Evenson, Kelly R.;Galuska, Deborah A.;Jefferis, Barbara J.;Kraus, William E.;Lee, I. -Min;Matthews, Charles E.;Omura, John D.;Patel, Alpa, V;Pieper, Carl F.;Rees-Punia, Erika;Dallmeier, Dhayana;Klenk, Jochen;Whincup, Peter H.;Dooley, Erin E.;Gabriel, Kelley Pettee;Palta, Priya;Pompeii, Lisa A.;Chernofsky, Ariel;Larson, Martin G.;Vasan, Ramachandran S.;Spartano, Nicole;Ballin, Marcel;Nordstrom, Peter;Nordstrom, Anna;Anderssen, Sigmund A.;Hansen, Bjorge H.;Cochrane, Jennifer A.;Dwyer, Terence;Wang, Jing;Ferrucci, Luigi;Liu, Fangyu;Schrack, Jennifer;Urbanek, Jacek;Saint-Maurice, Pedro F.;Yamamoto, Naofumi;Yoshitake, Yutaka;Newton Jr, Robert L.;Yang, Shengping;Shiroma, Eric J.;Fulton, Janet E.
尽管每天步行10000步被广泛宣传为有益于健康，但几乎没有证据支持这一建议。我们的目标是确定每天的步数和步速与全因死亡率之间的关系。在这项荟萃分析中，我们通过先前发表的系统性综述和该领域的专家知识，确定了调查每日步数对成人(18岁≥)全原因死亡率影响的研究。我们要求参与研究的研究人员按照标准化方案处理他们的参与者水平的数据。主要结果是从死亡证明和国家登记中收集的全原因死亡率。我们分析了每日步数和步速与全因死亡率的剂量-反应关系。我们使用研究特定的每日步数四分位数进行Cox比例风险回归分析，并使用逆方差加权随机效应模型计算风险比(HR)。我们确定了15项研究，其中7项已发表，8项未发表，研究开始日期在1999年至2018年之间。总样本包括47471名成年人，其中3013人死亡(每1000个参与者年10.1人)，平均随访时间为7.1年(IQR 4.3-9.9；所有研究的总随访人数为297837人年)。四分位数中位数日步数分别为3553步、5801步、7842步和10901步。与最低四分位数相比，调整后的全因死亡率比为0.60(95%可信区间0.51~0.71)、0.55(0.49~0.62)，四分位数为0.47(0.39-0.57)。限制三次样条法显示60岁及以上成人死亡风险随每天步行数增加而递减，至6000-8000步/天，而60岁以下成人至8000-10000步/天。调整每天的步数，比较四分位数1和四分位数4，步频较高与死亡率之间的关联有所减弱，但在峰值30分钟(HR 0.67[95%CI 0.56-0.83])和峰值60分钟(0.67[0.50-0.90])时仍然显著，但在以每分钟40步或更快(1.12[0.96-1.32])和每分钟100步或更快(0.86[0.58-1.28])的步行速度下行走的时间(每天一分钟)并不显著。每天走的步数越多，全因死亡的风险就越低，最高可达不同年龄的水平。这一荟萃分析的结果可以用来为促进公共健康的体育活动提供STEP指南。
Although 10 000 steps per day is widely promoted to have health benefits, there is little evidence to support this recommendation. We aimed to determine the association between number of steps per day and stepping rate with all-cause mortality. In this meta-analysis, we identified studies investigating the effect of daily step count on all-cause mortality in adults (aged ≥18 years), via a previously published systematic review and expert knowledge of the field. We asked participating study investigators to process their participant-level data following a standardised protocol. The primary outcome was all-cause mortality collected from death certificates and country registries. We analysed the dose–response association of steps per day and stepping rate with all-cause mortality. We did Cox proportional hazards regression analyses using study-specific quartiles of steps per day and calculated hazard ratios (HRs) with inverse-variance weighted random effects models. We identified 15 studies, of which seven were published and eight were unpublished, with study start dates between 1999 and 2018. The total sample included 47 471 adults, among whom there were 3013 deaths (10.1 per 1000 participant-years) over a median follow-up of 7.1 years ([IQR 4.3–9.9]; total sum of follow-up across studies was 297 837 person-years). Quartile median steps per day were 3553 for quartile 1, 5801 for quartile 2, 7842 for quartile 3, and 10 901 for quartile 4. Compared with the lowest quartile, the adjusted HR for all-cause mortality was 0.60 (95% CI 0.51–0.71) for quartile 2, 0.55 (0.49–0.62) for quartile 3, and 0.47 (0.39–0.57) for quartile 4. Restricted cubic splines showed progressively decreasing risk of mortality among adults aged 60 years and older with increasing number of steps per day until 6000–8000 steps per day and among adults younger than 60 years until 8000–10 000 steps per day. Adjusting for number of steps per day, comparing quartile 1 with quartile 4, the association between higher stepping rates and mortality was attenuated but remained significant for a peak of 30 min (HR 0.67 [95% CI 0.56–0.83]) and a peak of 60 min (0.67 [0.50–0.90]), but not significant for time (min per day) spent walking at 40 steps per min or faster (1.12 [0.96–1.32]) and 100 steps per min or faster (0.86 [0.58–1.28]). Taking more steps per day was associated with a progressively lower risk of all-cause mortality, up to a level that varied by age. The findings from this meta-analysis can be used to inform step guidelines for public health promotion of physical activity.