Impact of exercise frequency on self-care ability maintaining in older adults: a community-based cohort study
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摘要:
目的 探讨锻炼频率对老年人生活自理能力维持的影响。 方法 基于2012-2020年广州市荔湾区南源社区队列的研究，对基线纳入的6 905名老年人进行随访，对其生活自理能力进行评分。对纳入分析的5 154人采用边际结构时依Cox比例风险回归模型，衡量老年人日常锻炼频率与维持生活自理能力之间的关系。 结果 过去1年中，有48.58%的研究对象每天锻炼。最后1次随访中，生活不能完全自理的老年人占4.2%，随访中位时间为3.63年。经校正混杂因素，与不锻炼相比，偶尔锻炼和每天锻炼不能维持生活自理能力的风险分别降低了44.9%(HR=0.551, 95% CI: 0.432~0.701)和39.9%(HR=0.601, 95% CI: 0.460~0.784)。分层分析发现，无论是偶尔锻炼还是每天锻炼，对于吸烟者而言，都不能有效降低他们无法维持生活自理能力的风险。从不吸烟者偶尔锻炼或每天锻炼能降低不能维持生活自理能力的风险，分别降低了45.8%(HR=0.542, 95% CI: 0.419~0.702)和39.7%(HR=0.603, 95% CI: 0.453~0.804)。对于饮酒者而言，无论是偶尔锻炼还是坚持每天锻炼，都不能有效降低他们无法维持生活自理能力的风险。从不饮酒者偶尔锻炼或每天锻炼能降低不能维持生活自理能力的风险，分别降低了45.1%(HR=0.549, 95% CI: 0.429~0.704)和39.4%(HR=0.606, 95% CI: 0.459~0.800)。 结论 老年人可以通过锻炼维持生活自理能力，但饮酒会减弱锻炼维持生活自理能力的效果，建议减少饮酒量或戒酒，并采取科学锻炼方式。 Abstract:Objective To investigate the impact of exercise frequency on the maintenance of elderly individuals' self-care ability. Methods A cohort study was conducted in Nanyuan Community, Liwan District, Guangzhou, from 2012 to 2020. A total of 6 905 elderly individuals were enrolled in the baseline survey and followed up for the evaluation of their self-care ability. Among the 5 154 participants included in the analysis, a marginal structural Cox proportional hazards regression model was employed to assess the relationship between daily exercise frequency and the maintenance of self-care ability among the elderly. Results Over the past year, 48.58% of study subjects exercised daily. At the last follow-up, 4.2% of the elderly were unable to take care of themselves completely, and the median follow-up time was 3.63 years. After adjusting for confounding factors, compared to no exercise, occasional exercise and daily exercise reduced the risk of not maintaining self-care ability by 44.9% (HR=0.551, 95% CI: 0.432-0.701) and 39.9% (HR=0.601, 95% CI: 0.460-0.784), respectively. The stratified analysis found that neither occasional nor daily exercise was effective in reducing the risk of smokers not being able to sustain their independence. However, for non-smokers, occasional and daily exercise reduced the risk by 45.8% (HR=0.542, 95% CI: 0.419-0.702) and 39.7% (HR=0.603, 95% CI: 0.453-0.804), respectively. For alcohol consumers, neither occasional exercise nor consistent daily exercise can effectively reduce the risk of losing the ability to maintain self-care. However, the risks of not maintaining self-care ability were more significantly reduced by occasional and daily exercise among non-drinkers, with reductions of 45.1%(HR=0.549, 95% CI: 0.429-0.704) and 39.4% (HR=0.606, 95% CI: 0.459-0.800), respectively. Conclusions Exercise can help elderly individuals maintain their self-care ability. Alcohol consumption among the elderly can attenuate the positive effects of physical exercise on maintaining self-care ability. It is recommended that elderly individuals reduce or abstain from alcohol consumption and adopt scientific exercise methods. -
Key words:
- Exercise frequency /
- Self-care ability /
- Older adults /
- Healthy lifestyle /
- Cohort
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表 1 广州市荔湾区南源社区2012-2021年≥65岁老年人的基线特征
Table 1. Baseline characteristics of the elderly aged ≥65 years from 2012 to 2021 in Nanyuan Community, Liwan District, Guangzhou
特征
Characteristic全部All 最后1次随访能完全自理
The last follow-up showed complete self-care ability最后1次随访不能完全自理
The last follow-up showed partial inability for self-care$\chi^2$/t值
valueP值
value研究参与数量Participants 5 154 4 940 214 随访中位时间/年The median follow-up time /year 3.30 3.29 3.63 协变量Demographics 锻炼频率①Exercise frequency① 6.19 0.045 不锻炼Never exercise 2 016(39.12) 1 915(38.76) 101(47.20) 偶尔锻炼Occasionally exercise 634(12.30) 610(12.35) 24(11.21) 每天锻炼Every day exercise 2 504(48.58) 2 415(48.89) 89(41.59) 年龄/岁Age /years 70.86(6.23) 70.72(5.95) 70.96(6.42) -0.94 0.173 性别① Gender① 3.28 0.070 男性Male 2 175(42.20) 2 098(42.47) 77(35.98) 女性Female 2 979(57.80) 2 842(57.53) 137(64.02) BMI/(kg·m-2)① 0.03 0.870 ＜24 2 744(53.24) 2 828(57.25) 116(54.21) ≥24 2 410(46.76) 2 312(42.75) 98(45.79) 吸烟① Smoking① 5.57 0.018 从不吸烟Never smoke 4 255(82.56) 4 065(82.29) 190(88.79) 吸烟② Smoking② 899(17.44) 875(17.71) 24(11.21) 饮酒① Drinking① 1.80 0.179 从不饮酒Never drinke 4 725(91.68) 4 523(91.56) 202(94.39) 饮酒③ Drinking③ 429(8.32) 417(8.44) 12(5.61) 注：①以人数(占比/%)表示；②吸烟包括正在吸烟和曾经吸烟已经戒烟；③饮酒包括有饮酒情况和曾经饮酒已经戒酒。
Note: ① Number of people (proportion/%)；②Smoking include both current smokers and those who have quit smoking; ③ Drinking include both current drinkers and those who have quit drinking.
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表 2 锻炼频率对生活自理能力的影响
Table 2. The effect of exercise frequency on self-care abilities
锻炼频率Exercise frequency HR值value(95% CI) 模型1 Model 1 模型2 Model 2 模型3 Model 3 不锻炼Never exercise 1.00 1.00 1.00 偶尔锻炼Occasionally exercise 0.46(0.36~0.57) 0.54(0.43~0.69) 0.55(0.43~0.70) 每天锻炼Every day exercise 0.54(0.41~0.70) 0.60(0.45~0.79) 0.60(0.46~0.79) 注：模型1，无调整因素；模型2，调整因素为年龄、性别、BMI、吸烟、饮酒；模型3，基于与模型2相同的协变量，对模型2进行了边际结构时依Cox比例风险回归模型的拟合。
Note: Model 1, no adjustment factors; Model 2, adjusted for age, gender, BMI, smoking, and drinking; Model 3, based on the same covariates as Model 2, a marginal structural Cox proportional hazards regression model was fitted to Model 2.
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表 3 锻炼频率对自理能力影响的分层分析与交互作用
Table 3. Stratified analysis and interaction effect of exercise frequency on the impact of self-care abilities
特征Characteristic HR值value(95% CI) P交互值value 不锻炼Never exercise 偶尔锻炼Occasionally exercise 每天锻炼Every day exercise 分层分析Stratified analysis 性别Gender 0.367 男性Male 1.00 0.605 (0.406~0.901) 0.597 (0.393~0.908) 女性Female 1.00 0.514 (0.378~0.699) 0.599 (0.423~0.847) BMI/(kg·m-2) 0.204 ＜24 1.00 0.578 (0.412~0.811) 0.715 (0.491~1.043) ≥24 1.00 0.528 (0.373~0.747) 0.503 (0.347~0.728) 吸烟Smoking 0.504 从不吸烟Never smoke 1.00 0.542 (0.419~0.702) 0.603 (0.453~0.804) 吸烟Smoking 1.00 0.643 (0.331~1.248) 0.639 (0.294~1.387) 饮酒Drinking 0.002 从不饮酒Never drinke 1.00 0.549 (0.429~0.704) 0.606 (0.459~0.800) 饮酒Drinking 1.00 0.493 (0.164~1.488) 0.488 (0.175~1.355) 注：结果是在调整性别、年龄、BMI、吸烟和饮酒的边际结构时依Cox比例风险回归模型下估计的。所有分层分析均对剩余的协变量进行了调整。
Note: The results are estimated under the marginal structural Cox proportional hazards regression model based on adjustment factors including gender, age, BMI, smoking, and drinking. All stratified analyses were adjusted for the remaining covariates.
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