Cross-sectional and prospective cohort data analysis of physical activity and hea

描述（由申请人提供）：目前的公共卫生指南建议每周五天进行至少30分钟的中等强度有氧（耐力）体力活动，或每周三天进行至少20分钟的高强度有氧体力活动。准则明确承认，大多数健康福利的最大受益点尚未确定。我们对全国跑步者健康的最初7.8年随访显示，超过目前的指导水平与白内障（35%），黄斑变性（54%），高血压（30%），高胆固醇血症（47%），糖尿病（68%），痛风（45%），胆囊疾病（52%），憩室疾病（48%），良性前列腺增生（33%）和非致命性中风（60%）。为了进一步证明超过指导活动水平的潜在益处，我们建议在1998-2000年期间基线调查的45，685名国家步行者健康研究参与者和59，165名第二次国家跑步者健康研究参与者中比较中等强度（步行）和剧烈强度体力活动（跑步）与总死亡率和特定原因死亡率，在1991年至1993年期间，对54,960名参加原始国家跑步者健康研究的参与者进行了基线调查。我们估计，在200万人年的随访期间，将发生26，172例死亡，包括863例致命的结肠癌，426例乳腺癌和501例前列腺癌，以及8，030例癌症，5，714例缺血性心脏病死亡和2，259例致命的心肌梗死。需要3年的支持，以获得和分析国家死亡指数检索的死因，以便：1：在步行者（N= 45，685）和联合跑步者队列（N= 114，719）中分别定义总死亡率和死因特异性死亡率与体力活动量、持续时间、强度和频率的剂量-反应关系。2：测试是否等效剂量（即，中等强度（步行，N= 45，685）和高强度活动（跑步，N= 59，165）的MET-小时）在总死亡率和死因特异性死亡率方面产生了相当的降低。第三章：在联合跑步者队列中测试心肺健康是否显著预测总死亡率和死因特异性死亡率，而不依赖于体力活动（N= 84，120，代表72%的样本报告10公里的表现时间）。第四章：在原始跑步者队列（N= 54，960）中测试第一次和第二次调查之间7.8年的活动变化是否影响随后11年随访期间的总死亡率和特定原因死亡率。第五章：在步行者（N= 45，685）和跑步者（N= 114，125）中分别测试是否或最长的日常步行或跑步（包括马拉松训练）显著预测总死亡率和死因特异性死亡率，而与日常体力活动无关。6：测试体重或体型是否介导目标1-5的关系和差异。公共卫生相关性：叙述本申请要求为主要研究者提供工资支持，以应用其20年的生物统计学经验分析大型步行者和跑步者队列，以确定剧烈运动、马拉松参与的健康益处，以及与心血管疾病、糖尿病、高血压、痛风、胆囊疾病、良性前列腺增生和其他健康终点的其他变量的相互作用。本申请只涉及对实际数据的解释，而不涉及收集新数据。其主要目标是更好地确定身体活动的剂量和强度，以实现最佳健康。

DESCRIPTION (provided by applicant): Current public health guidelines recommend moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. The guidelines specifically acknowledge that the point of maximum benefit for most health benefits has not been established. Our initial 7.8-year follow-up of the National Runners' Health showed that exceeding the current guideline levels was associated with significantly lower risks of cataracts (35%), macular degeneration (54%), hypertension (30%), hypercholesterolemia (47%), diabetes (68%), gout (45%), gallbladder disease (52%), diverticular disease (48%), benign prostate hyperplasia (33%), and nonfatal stroke (60%). To further demonstrate the potential benefits of exceeding guideline activity levels, we propose to compare moderate-intensity (walking) and vigorous intensity physical activity (running) to total and cause- specific mortality in 45,685 participants of the National Walkers' Health Study and 59,165 participants of the second National Runners' Health Study who surveyed at baseline between 1998-2000, and 54,960 participants of the original National Runners' Health Study were surveyed at baseline between 1991 and 1993. We estimate that 26,172 deaths will have occurred during the two million person years of follow-up, including 863 fatal colon, 426 breast, and 501 prostate, and 8,030 total cancers, 5,714 ischemic heart disease deaths, and 2,259 fatal myocardial infarctions. Three-year support is requested to obtain and analyze the National Death Index retrieval of cause of death in order to: 1: Define separately within the walkers' (N=45,685) and the combined runners' cohort (N=114,719) the dose- response relationships of total and cause-specific mortality vs. the amount, duration, intensity, and frequency of physical activity. 2: Test whether equivalent doses (i.e., MET-hours) of moderate-intensity (walking, N=45,685) and vigorous- intensity activity (running, N=59,165) yield comparable reductions in total and cause-specific mortality. 3: Test within the combined runners' cohorts whether cardiorespiratory fitness significantly predicts total and cause-specific mortality independent of physical activity (N=84,120, representing 72% of the sample reporting 10-km performance times). 4: Test within the original runners' cohort (N=54,960) whether change in activity during the 7.8 years between the first and second survey affects total and cause-specific mortality during the subsequent 11-year follow-up. 5: Test separately within the walkers (N=45,685) and combined runners' cohorts (N=114,125) whether or longest usual walk or run (including marathon training) significantly predicts total and cause-specific mortality independent of usual physical activity. 6: Test whether body weight or size mediates the relationships and differences of aims 1-5. PUBLIC HEALTH RELEVANCE: Narrative This application requests salary support for the principal investigator to apply his 20 years of biostatistical experience to analyze a large cohort of walkers and runners to determine the health benefits of vigorous exercise, marathon participation, and interactions with other variables on cardiovascular disease, diabetes, hypertension, gout, gallbladder disease, benign prostatic hyperplasia and other health endpoints. This application is concerned exclusively with the interpretation of actual data and not the collection of new data. The major objective is to better define the dose and intensity of physical activity for optimal health.