Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis

BMJ - Trang l4570
Ulf Ekelund1,2, Jakob Tarp2, Jostein Steene‐Johannessen2, Bjørge Herman Hansen2, Barbara J. Jefferis3, Morten Wang Fagerland2,4, Peter H. Whincup5, Keith M. Diaz6, Steven P. Hooker7, Ariel Chernofsky8, Martin G. Larson8, Nicole L. Spartano9, Ramachandran S. Vasan10, Ing‐Mari Dohrn11, María Hagströmer11,12, Charlotte L. Edwardson13,14, Thomas Yates13,14, Eric J. Shiroma15, Sigmund A. Anderssen2, I‐Min Lee16,17
1Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
2Department of Sports Medicine, Norwegian School of Sport Sciences, PO Box 4014, Ullevål Stadion, 0806, Oslo, Norway
3Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London. London, UK
4Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
5Population Health Research Institute, St George's, University of London, London, UK
6Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, USA
7College of Health and Human Services, San Diego State University, San Diego, CA, USA
8Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
9Department of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, MA, USA
10Departments of Medicine and Epidemiology, Boston University School of Medicine and Boston University School of Public Health, Boston, MA, USA
11Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet, Stockholm, Sweden
12Function area Occupational Therapy and Physiotherapy, Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
13Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
14NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
15Neuro-epidemiology Section, National Institute of Ageing, National Institutes of Health, Bethesda, MD, USA
16Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
17Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.

Tóm tắt

AbstractObjectiveTo examine the dose-response associations between accelerometer assessed total physical activity, different intensities of physical activity, and sedentary time and all cause mortality.DesignSystematic review and harmonised meta-analysis.Data sourcesPubMed, PsycINFO, Embase, Web of Science, Sport Discus from inception to 31 July 2018.Eligibility criteriaProspective cohort studies assessing physical activity and sedentary time by accelerometry and associations with all cause mortality and reported effect estimates as hazard ratios, odds ratios, or relative risks with 95% confidence intervals.Data extraction and analysisGuidelines for meta-analyses and systematic reviews for observational studies and PRISMA guidelines were followed. Two authors independently screened the titles and abstracts. One author performed a full text review and another extracted the data. Two authors independently assessed the risk of bias. Individual level participant data were harmonised and analysed at study level. Data on physical activity were categorised by quarters at study level, and study specific associations with all cause mortality were analysed using Cox proportional hazards regression analyses. Study specific results were summarised using random effects meta-analysis.Main outcome measureAll cause mortality.Results39 studies were retrieved for full text review; 10 were eligible for inclusion, three were excluded owing to harmonisation challenges (eg, wrist placement of the accelerometer), and one study did not participate. Two additional studies with unpublished mortality data were also included. Thus, individual level data from eight studies (n=36 383; mean age 62.6 years; 72.8% women), with median follow-up of 5.8 years (range 3.0-14.5 years) and 2149 (5.9%) deaths were analysed. Any physical activity, regardless of intensity, was associated with lower risk of mortality, with a non-linear dose-response. Hazards ratios for mortality were 1.00 (referent) in the first quarter (least active), 0.48 (95% confidence interval 0.43 to 0.54) in the second quarter, 0.34 (0.26 to 0.45) in the third quarter, and 0.27 (0.23 to 0.32) in the fourth quarter (most active). Corresponding hazards ratios for light physical activity were 1.00, 0.60 (0.54 to 0.68), 0.44 (0.38 to 0.51), and 0.38 (0.28 to 0.51), and for moderate-to-vigorous physical activity were 1.00, 0.64 (0.55 to 0.74), 0.55 (0.40 to 0.74), and 0.52 (0.43 to 0.61). For sedentary time, hazards ratios were 1.00 (referent; least sedentary), 1.28 (1.09 to 1.51), 1.71 (1.36 to 2.15), and 2.63 (1.94 to 3.56).ConclusionHigher levels of total physical activity, at any intensity, and less time spent sedentary, are associated with substantially reduced risk for premature mortality, with evidence of a non-linear dose-response pattern in middle aged and older adults.Systematic review registrationPROSPERO CRD42018091808.

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