法国巴黎大学Benjamin Landré团队研究了死亡前客观和自我报告的运动功能测量的终末期下降。这一研究成果于2021年8月5日发表在《英国医学杂志》上。
为了研究多重目标和自我报告的运动功能检测与死亡率的相关性，研究组在英国进行了一项前瞻性队列研究，1985-1988年招募35-55岁的参与者；在2007-2009年中增加一部分运动功能测试。
共有6194名参与者分别于2007-2009年（平均年龄65.6岁）、2012-2013年和2015-16年接受了运动功能测试。主要观察指标为2007-2019年间的全因死亡率与运动功能的客观测量（步行速度、握力和定时座椅起立）和自我报告测量（SF-36的身体成分总分以及日常生活基础性和工具性活动（ADL）限制）的相关性。
在平均10.6年的随访中，2007-2009年运动功能较差（病例/总数，610/5645）的参与者中，步行速度较差，死亡风险增加22%；握力较差，死亡风险增加15%；定时座椅起立较差，死亡风险增加14%，身体成分总分较低，死亡风险增加17%。基础性和工具性ADL受限与30%的死亡率风险增加相关。
当从2012-13年（平均随访6.8年）和2015-16年（平均随访3.7年）中提取指标时，这些相关性逐渐增强。轨迹分析显示，死亡者（484例）与幸存者（6194例）相比，在死亡前10年内的运动功能较差，死亡前9年的步行速度较差，死亡前7年的身体成分总分较低，死亡前4年的基础性和工具性ADL受限较大。这些差异在导致死亡的时间段内增加，包括定时座椅起立、身体成分总分和ADL限制。
研究结果表明，老年早期的运动功能降低与死亡率密切相关。
附：英文原文
Title: Terminal decline in objective and self-reported measures of motor function before death: 10 year follow-up of Whitehall II cohort study
Author: Benjamin Landré, Aurore Fayosse, Céline Ben Hassen, Marcos D Machado-Fragua, Julien Dumurgier, Mika Kivimaki, Séverine Sabia, Archana Singh-Manoux
Issue&Volume: 2021/08/05
Abstract:
Objectives To examine multiple objective and self-reported measures of motor function for their associations with mortality.
Design Prospective cohort study.
Setting UK based Whitehall II cohort study, which recruited participants aged 35-55 years in 1985-88; motor function component was added at the 2007-09 wave.
Participants 6194 participants with motor function measures in 2007-09 (mean age 65.6, SD 5.9), 2012-13, and 2015-16.
Main outcome measures All cause mortality between 2007 and 2019 in relation to objective measures (walking speed, grip strength, and timed chair rises) and self-reported measures (physical component summary score of the SF-36 and limitations in basic and instrumental activities of daily living (ADL)) of motor function.
Results One sex specific standard deviation poorer motor function in 2007-09 (cases/total, 610/5645) was associated with an increased mortality risk of 22% (95% confidence interval 12% to 33%) for walking speed, 15% (6% to 25%) for grip strength, 14% (7% to 23%) for timed chair rises, and 17% (8% to 26%) for physical component summary score over a mean 10.6 year follow-up. Having basic/instrumental ADL limitations was associated with a 30% (7% to 58%) increased mortality risk. These associations were progressively stronger when measures were drawn from 2012-13 (mean follow-up 6.8 years) and 2015-16 (mean follow-up 3.7 years). Analysis of trajectories showed poorer motor function in decedents (n=484) than survivors (n=6194) up to 10 years before death for timed chair rises (standardised difference 0.35, 95% confidence interval 0.12 to 0.59; equivalent to a 1.2 (men) and 1.3 (women) second difference), nine years for walking speed (0.21, 0.05 to 0.36; 5.5 (men) and 5.3 (women) cm/s difference), six years for grip strength (0.10, 0.01 to 0.20; 0.9 (men) and 0.6 (women) kg difference), seven years for physical component summary score (0.15, 0.05 to 0.25; 1.2 (men) and 1.6 (women) score difference), and four years for basic/instrumental ADL limitations (prevalence difference 2%, 0% to 4%). These differences increased in the period leading to death for timed chair rises, physical component summary score, and ADL limitations.
Conclusion Motor function in early old age has a robust association with mortality, with evidence of terminal decline emerging early in measures of overall motor function (timed chair rises and physical component summary score) and late in basic/instrumental ADL limitations.
DOI: 10.1136/bmj.n1743
Source: https://www.bmj.com/content/374/bmj.n1743
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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本期文章：《英国医学杂志》：Online/在线发表
