休闲时间体育活动对社会经济地位、生活方式风险和心理健康的健康益处：一项多队列研究
休闲时间体育活动对社会经济地位、生活方式风险和心理健康的健康益处：一项多队列研究
Health benefits of leisure-time physical activity by socioeconomic status, lifestyle risk, and mental health: a multicohort study
——《柳叶刀/公共卫生》2025年，第10卷，第2期——
【摘要】背景：我们建议所有5岁及以上的人定期进行体育锻炼，但不同人群亚群所获得的健康益处可能有所不同。本研究的目的是研究不同风险因素水平的亚群中这些益处在未患重大非传染性疾病的年限方面的变化。方法：我们的分析基于IPD-Work Consortium的初始健康欧洲成年人和英国生物库研究中的初始健康参与者的多队列研究。基线（1986-2010年）自我报告的休闲时间体育锻炼水平分为低（无或很少）、中等（介于低和推荐水平之间）和世卫组织推荐（每周≥2.5小时中等或≥1.25小时剧烈体育锻炼）。我们根据基线时的社会经济因素、生活方式和心理健康状况将研究人群分为36个重叠亚组，并评估了总人群和亚组40岁至75岁之间的无病年限，包括冠心病、中风、2型糖尿病、癌症、哮喘和慢性阻塞性肺病。结果：评估了14项IPD-Work研究，排除了6项研究，原因是缺少结果数据和无法汇总数据，最终纳入了8项研究，共有124,909名参与者。在因流行疾病排除7,685名参与者和因数据缺失排除9,265名参与者后，样本由IPD-Work联盟的107,959名最初健康的欧洲成年人（63,567名 [58.9%] 名女性和44,392名 [41.1%] 名男性）组成。对于英国生物样本库样本，共邀请了9238453人，8736094人（94.6%）未回复，502359人参加了基线检查。在排除73460名参与者后，428899名参与者至少有一项体力活动指标的数据。236258人（55.1%）为女性，192641人（44.9%）为男性。在160万人年的风险期内，21231名IPD-Work参与者患上了非传染性疾病，而480万人年的风险期内，101319名英国生物样本库参与者患上了非传染性疾病。与身体活动量较少的人相比，那些在闲暇时间达到推荐身体活动水平的人可额外获得1.1（95% CI 1.0–1.2）至2.0（1.7–2.3）年的无病年数，具体取决于性别和研究。在IPD-Work和英国生物银行队列的男性中，目前吸烟者（2.4 [95% CI 2.1–2.8]）的无病年数增幅大于从不吸烟者（0.7 [0.5–0.9]）；受教育程度低者（1.4 [1.1–1.7]）的无病年数增幅大于受教育程度高者（0.8 [0.7–1.0]）；社会经济地位低者（1.7 [1.5–2.0]）的无病年数增幅大于社会经济地位高者（0.9 [0.7–1.1]）；有抑郁症状者 (1.6 [1.3–1.9]) 与无抑郁症状者 (1.0 [0.9–1.1]; p值范围<0.0001–0.0008) 的比例也存在类似差异。女性吸烟者 (2.3 [95% CI 1.9–2.7] vs 0.9 [0.7–1.1])、社会经济地位者 (1.7 [1.4–2.0] vs 0.8 [0.5–1.0])、抑郁症状者 (1.4 [1.1–1.7] vs 1.0 [0.9–1.1]) 的比例也存在类似差异，重度饮酒者与中度饮酒者的比例也存在类似差异 (1.4 [1.1–1.6] vs 0.9 [0.7–1.1]; p值范围<0.0001–0.010)。在BMI、抑郁史和男性饮酒方面，风险组和非风险组在体育锻炼相关的健康收益方面没有差异（p 值范围为 0.11–0.86）。解释：除了证实闲暇时间体育锻炼与不同人口亚群无病年限增加之间的关联外，我们的研究结果还表明，这些健康益处在具有预先存在的健康风险或弱势背景的个体中往往比在具有更有利风险因素特征的个体中更为明显。这表明，加强全民体育锻炼计划可以帮助减少健康差距，而将体育锻炼纳入针对社会劣势、不健康生活方式和抑郁症的有针对性战略可能会提高其有效性。
[Summary] Background: Regular physical activity is recommended for all aged 5 years and older, but the health benefits gained might differ across population subgroups. The aim of this study was to examine these benefits in terms of years lived free from major non-communicable diseases in subgroups with varying levels of risk factors. Methods: Our analysis was based on a multicohort study of initially healthy European adults from the IPD-Work Consortium and initially healthy participants from the UK Biobank study. Self-reported leisure-time physical activity levels at baseline (1986–2010) were categorised as low (no or very little), intermediate (between low and recommended levels), and WHO-recommended (≥2·5 h of moderate or ≥1·25 h of vigorous physical activity per week). We divided the study population into 36 overlapping subgroups based on socioeconomic factors, lifestyle, and mental health at baseline, and assessed disease-free years between ages 40 years and 75 years for both the overall population and subgroups, accounting for coronary heart disease, stroke, type 2 diabetes, cancer, asthma, and chronic obstructive pulmonary disease. Findings: 14 IPD-Work studies were assessed and six studies were excluded due to missing outcome data and unavailable data for pooling, resulting in the inclusion of eight studies with 124 909 participants. After the exclusion of 7685 participants due to prevalent diseases and 9265 due to missing data, the sample consisted of 107 959 initially healthy European adults (63 567 [58·9%] females and 44 392 [41·1%] males) from the IPD-Work consortium. For the UK Biobank sample, 9 238 453 million individuals were invited, 8 736 094 (94·6%) were non-respondents, and 502 359 participated in the baseline examination. After the exclusion of 73 460 participants, 428 899 participants had data on at least one measure of physical activity. 236 258 (55·1%) were female and 192 641 (44·9%) were male. During 1·6 million person-years at risk, 21 231 IPD-Work participants developed a non-communicable disease, while 101 319 UK Biobank participants developed a non-communicable disease over 4·8 million person-years at risk. Compared with individuals with low physical activity, those meeting the recommended physical activity levels during leisure-time gained an additional 1·1 (95% CI 1·0–1·2) to 2·0 (1·7–2·3) disease-free years, depending on sex and study. In males from the IPD-Work and UK Biobank cohorts, greater gains in disease-free years were observed in current smokers (2·4 [95% CI 2·1–2·8]) versus never smokers (0·7 [0·5–0·9]); those with low education (1·4 [1·1–1·7]) versus high education (0·8 [0·7–1·0]); low socioeconomic status (1·7 [1·5–2·0]) versus high socioeconomic status (0·9 [0·7–1·1]); and those with (1·6 [1·3–1·9]) versus without depressive symptoms (1·0 [0·9–1·1]; p value range <0·0001–0·0008). Similar differences were seen in women for smoking (2·3 [95% CI 1·9–2·7] vs 0·9 [0·7–1·1]), socioeconomic status (1·7 [1·4–2·0] vs 0·8 [0·5–1·0]), depressive symptoms (1·4 [1·1–1·7] vs 1·0 [0·9–1·1]), and for heavy drinkers compared with moderate drinkers (1·4 [1·1–1·6] vs 0·9 [0·7–1·1]; p value range <0·0001–0·010). No differences in physical activity-related health gains were observed between risk groups and non-risk groups by BMI, history of depression, and, in men, alcohol use (p value range 0·11–0·86). Interpretation: In addition to confirming the association between leisure-time physical activity and increased disease-free years across population subgroups, our findings show that these health benefits are often more pronounced among individuals with pre-existing health risks or disadvantaged backgrounds than in those with more favourable risk factor profiles. This suggests that enhancing population-wide physical activity initiatives could help reduce health disparities, while incorporating physical activity into targeted strategies addressing social disadvantage, unhealthy lifestyles, and depression might enhance their effectiveness.
论文原文：Solja T Nyberg, Philipp Frank, Jaana Pentti, et al. (2025). Health benefits of leisure-time physical activity by socioeconomic status, lifestyle risk, and mental health: a multicohort study. The Lancet / Public Health, Volume 10, Issue 2, Pages 124-135, February 2025.
https://doi.org/10.1016/S2468-2667(24)00300-1
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