农村代谢综合征老年人身体活动建议:一项基于无切点身体活动指标的研究

    Physical Activity Recommendations for Rural Older Adults with Metabolic Syndrome: A Study Based on Cut-point-free Physical Activity Indicators

    • 摘要:
      目的 基于无切点加速度计指标平均加速度(average acceleration, AvAcc)与强度梯度(intensity gradient,IG),检验AvAcc、IG与农村老年人代谢综合征(metabolic syndrome,MetS)的关联,并构建AvAcc的年龄百分位参考曲线。
      方法 纳入1 525名农村老年人,连续7 d腕部佩戴加速度计测量AvAcc、IG以评估身体活动的总量和强度。依据2个指标中位数分类并交叉组合为高AvAcc高IG组、高AvAcc低IG组、低AvAcc高IG组、低AvAcc低IG组。依据《中国2型糖尿病防治指南(2020年版)(下)》界定MetS。采用多因素logistic回归探讨AvAcc、IG及其组合与MetS的关联,限制性立方样条检验AvAcc与MetS的剂量−效应关联,广义加性模型构建AvAcc−年龄百分位曲线。
      结果 AvAcc升高与MetS OR值降低显著相关(P<0.05),而IG与MetS的关联未达统计学显著性(P>0.05)。与低AvAcc低IG组相比,高AvAcc高IG组、高AvAcc低IG组均与MetS OR值降低显著相关(P<0.05)。限制性立方样条显示,AvAcc与MetS存在剂量−效应关联,MetS OR值最低处对应每日累计步行时长≥30 min(其中快走≥5 min,步速分别约4.6 km/h与6.5 km/h)的活动模式。百分位曲线显示,AvAcc随年龄增长下降,且70岁后降速加快;72岁前AvAcc超过50%的同龄人,其MetS OR值较低;但72岁后需超过75%的同龄人,才能保证其MetS OR值较低。
      结论 农村老年人身体活动总量与MetS呈显著剂量−效应关系。达到一定活动总量(无论活动强度)与MetS低发生概率相关。每日至少累积步行30 min(4.6 km/h),其中包含至少5 min快走(6.5 km/h),与更好的代谢健康状况相关。70岁后老年人身体活动总量显著下降,而72岁以上老年人身体活动总量超过75%的同龄人,其代谢健康状况相对更好。

       

      Abstract: Objective: To investigate the association between the cut-point-free physical activity metrics—average acceleration (AvAcc), intensity gradient (IG), and metabolic syndrome (MetS) among rural older adults in China, and to establish the age percentile curves for AvAcc. Methods: A total of 1 525 rural older adults wore wrist-worn accelerometers for seven consecutive days to measure AvAcc and IG. Based on median values of the two metrics, participants were dichotomized and categorized into four subgroups: high AvAcc-high IG group, high AvAcc-low IG group, low AvAcc-high IG group, and low AvAcc-low IG group. MetS was defined according to the Guidelines for the Prevention and Treatment of Type 2 Diabetes in China(2020 edition, part 2). Multivariable logistic regression was used to examine the associations of AvAcc, IG, and their combinations with MetS. Restricted cubic splines (RCS) were applied to explore the dose-response associations between AvAcc and MetS, while generalized additive models were employed to construct percentile curves for AvAcc across age groups. Results: Higher AvAcc was significantly associated with lower odds ratio (OR) value of MetS (P<0.05), whereas no significant association was observed for IG (P>0.05). Compared with low AvAcc-low IG group, both of the high AvAcc-high IG and high AvAcc-low IG groups showed significant associations in MetS OR (P<0.05). RCS analysis demonstrated a linear dose-response association between AvAcc and MetS, with the lowest OR for MetS observed at ≥30 min/day of cumulative walking, including ≥5 min of brisk walking (≈4.6 and 6.5 km/h, respectively). Percentile curves indicated that AvAcc naturally declined with age, accelerating markedly after 70 years. Before the age of 72, participants with AvAcc exceeding 50% of their peers had lower MetS OR values. However, after the age of 72, the MetS OR value was relatively low only when the AvAcc exceeded 75% peers. Conclusions: Among rural older adults, physical activity volume is significantly associated with MetS in a dose-response manner. Regardless of intensity, individuals with higher total volume of activity tend to have a lower OR of MetS. Accumulating at least 30 minutes of walking per day (4.6 km/h), including at least 5 minutes of brisk walking (6.5 km/h), is associated with better metabolic health. After 70, activity levels decline significantly, and among those aged 72 and older, only individuals whose physical activity exceeded 75% peers tend to have more favorable metabolic profiles.

       

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