休閒時間體育活動對社會經濟地位、生活方式風險和心理健康的健康益處：一項多隊列研究

Health benefits of leisure-time physical activity by socioeconomic status, lifestyle risk, and mental health: a multicohort study

——《柳葉刀/公共衛生》2025年，第10卷，第2期——

<The Lancet / Public Health> Volume 10, Issue 2, 2025

【摘要】背景：我們建議所有5歲及以上的人定期進行體育鍛煉，但不同人群亞群所獲得的健康益處可能有所不同。本研究的目的是研究不同風險因素水平的亞群中這些益處在未患重大非傳染性疾病的年限方面的變化。方法：我們的分析基於IPD-Work Consortium的初始健康歐洲成年人和英國生物庫研究中的初始健康參與者的多隊列研究。基線（1986-2010年）自我報告的休閒時間體育鍛煉水平分為低（無或很少）、中等（介於低和推薦水平之間）和世衛組織推薦（每周≥2.5小時中等或≥1.25小時劇烈體育鍛煉）。我們根據基線時的社會經濟因素、生活方式和心理健康狀況將研究人群分為36個重疊亞組，並評估了總人群和亞組40歲至75歲之間的無病年限，包括冠心病、中風、2型糖尿病、癌症、哮喘和慢性阻塞性肺病。結果：評估了14項IPD-Work研究，排除了6項研究，原因是缺少結果數據和無法匯總數據，最終納入了8項研究，共有124,909名參與者。在因流行疾病排除7,685名參與者和因數據缺失排除9,265名參與者後，樣本由IPD-Work聯盟的107,959名最初健康的歐洲成年人（63,567名 [58.9%] 名女性和44,392名 [41.1%] 名男性）組成。對於英國生物樣本庫樣本，共邀請了9238453人，8736094人（94.6%）未回復，502359人參加了基線檢查。在排除73460名參與者後，428899名參與者至少有一項體力活動指標的數據。236258人（55.1%）為女性，192641人（44.9%）為男性。在160萬人年的風險期內，21231名IPD-Work參與者患上了非傳染性疾病，而480萬人年的風險期內，101319名英國生物樣本庫參與者患上了非傳染性疾病。與身體活動量較少的人相比，那些在閒暇時間達到推薦身體活動水平的人可額外獲得1.1（95% CI 1.0–1.2）至2.0（1.7–2.3）年的無病年數，具體取決於性別和研究。在IPD-Work和英國生物銀行隊列的男性中，目前吸煙者（2.4 [95% CI 2.1–2.8]）的無病年數增幅大於從不吸煙者（0.7 [0.5–0.9]）；受教育程度低者（1.4 [1.1–1.7]）的無病年數增幅大於受教育程度高者（0.8 [0.7–1.0]）；社會經濟地位低者（1.7 [1.5–2.0]）的無病年數增幅大於社會經濟地位高者（0.9 [0.7–1.1]）；有抑鬱症狀者 (1.6 [1.3–1.9]) 與無抑鬱症狀者 (1.0 [0.9–1.1]; p值範圍<0.0001–0.0008) 的比例也存在類似差異。女性吸煙者 (2.3 [95% CI 1.9–2.7] vs 0.9 [0.7–1.1])、社會經濟地位者 (1.7 [1.4–2.0] vs 0.8 [0.5–1.0])、抑鬱症狀者 (1.4 [1.1–1.7] vs 1.0 [0.9–1.1]) 的比例也存在類似差異，重度飲酒者與中度飲酒者的比例也存在類似差異 (1.4 [1.1–1.6] vs 0.9 [0.7–1.1]; p值範圍<0.0001–0.010)。在BMI、抑鬱史和男性飲酒方面，風險組和非風險組在體育鍛煉相關的健康收益方面沒有差異（p 值範圍為 0.11–0.86）。解釋：除了證實閒暇時間體育鍛煉與不同人口亞群無病年限增加之間的關聯外，我們的研究結果還表明，這些健康益處在具有預先存在的健康風險或弱勢背景的個體中往往比在具有更有利風險因素特徵的個體中更為明顯。這表明，加強全民體育鍛煉計劃可以幫助減少健康差距，而將體育鍛煉納入針對社會劣勢、不健康生活方式和抑鬱症的有針對性戰略可能會提高其有效性。

[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.

論文原文：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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