Objective: To explore the association between physical activity (PA) level and all-cause mortality in the elderly with different obesity status in Beijing. Methods: The study subjects were from the Cardiovascular and Cognitive Healthy Study in Middle-Aged and Elderly Residents of Beijing, a total of 3 746 individuals aged ≥60 years in the baseline survey between 2013 and 2015 were included in the study. Questionnaire survey and physical examination were conducted to collect the basic information of the individuals. The metabolic equivalent of the elderly was used to calculate the PA level, and an international PA questionnaire was used to determine the PA intensity. BMI, waist-to-height ratio (WHtR) and a body shape index (ABSI) were used to evaluate individuals' obesity status. The distribution of different PA levels under different obesity states was described by using bar chart and cumulative percentage bar chart. Cox proportional hazard regression model was used to analyze the correlation between the level of PA and all-cause mortality risk in different types of obesity status. Results: By December 31, 2019, the median follow-up time was 5.46 years, and the mortality density was 244.55/10 000 person-years. Compared with the individuals in high-PA intensity group, the all-cause mortality risk increased by 41% (HR=1.41, 95%CI: 1.14-1.76) and 122% (HR=2.22, 95%CI: 1.76-2.81), respectively, in moderate and low PA intensity groups. Compared with the individuals in high-PA intensity-high-obesity group, based on the BMI, the all-cause mortality risk increased by 85% (HR=1.85, 95%CI: 1.08-3.16) and 250% (HR=3.50, 95%CI: 2.01-6.10) in those in moderate-PA intensity-high-obesity group and in low-intensity-high-obesity group. Based on the WHtR, the all-cause mortality risk increased by 53% (HR=1.53, 95%CI: 1.02-2.29) and 218% (HR=3.18, 95%CI: 2.09-4.86), respectively, in those with moderate-PA intensity-high-obesity and those with low-PA intensity-high-obesity. According to the ABSI, the all-cause mortality risk increased by 120% in those in low-PA intensity-high-obesity group (HR=2.20, 95%CI: 1.53-3.18). Based on any one of the indicators BMI, WHtR, or ABSI, there was no significant difference in all-cause mortality risk between high-intensity-moderate-obesity group and high-intensity-low-obesity group (all P>0.05). Conclusions: PA level is closely associated with the all-cause mortality risk in the elderly in communities of Beijing. Increasing PA level can not only reduce the all-cause mortality risk but also reduce even eliminate the excess all-cause mortality risk associated with obesity.
目的： 探讨北京市不同肥胖状态老年人群体力活动水平与全因死亡的关联。 方法： 研究对象来自北京市中老年居民心血管与认知健康研究，将2013-2015年基线调查的3 746名≥60岁老年人纳入研究。采用问卷调查和体格检查收集研究对象各项基本特征，采用≥60岁老年人代谢当量计算个体活动水平，采用国际体力活动问卷判定体力活动强度等级，采用BMI、腰高比（WHtR）、身体形态指数（ABSI）评价个体肥胖状态。使用柱状图、累计百分比柱状图描述不同肥胖状态下不同体力活动水平的分布情况。使用Cox比例风险回归模型分析不同肥胖状态下体力活动水平与全因死亡风险的相关性。 结果： 截至2019年12月31日，中位随访时间为5.46年，死亡密度为244.55/万人年。与高强度组相比，中、低强度组全因死亡风险分别增加41%（HR=1.41，95%CI：1.14~1.76）和122%（HR=2.22，95%CI：1.76~2.81）。以高强度-高肥胖组作为参照组，基于BMI指标，中强度-高肥胖组和低强度-高肥胖组全因死亡风险分别增加85%（HR=1.85，95%CI：1.08~3.16）和250%（HR=3.50，95%CI：2.01~6.10）；基于WHtR指标，中强度-高肥胖组和低强度-高肥胖组全因死亡风险分别增加53%（HR=1.53，95%CI：1.02~2.29）和218%（HR=3.18，95%CI：2.09~4.86）；基于ABSI指标，低强度-高肥胖组全因死亡风险增加120%（HR=2.20，95%CI：1.53~3.18）；基于BMI、WHtR、ABSI指标的高强度-中肥胖组和高强度-低肥胖组全因死亡风险差异无统计学意义（均P>0.05）。 结论： 北京市老年人群体力活动水平与全因死亡风险密切相关，提升体力活动水平不仅能降低全因死亡风险，还能减少或消除由肥胖所带来的超额全因死亡风险。.