Effect of short-term intensive brisk walking prescription on obesity in Chinese occupational population: a pair matched-control study
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摘要:
目的 评价中国职业人群肥胖强化健走处方干预效果,为推广适合中国职业人群适宜的体重控制方案提供借鉴。 方法 基于2021年5 — 8月中国职业人群健走项目,招募来自全国12个省份的31528名在职人员进行为期100 d的健走干预,根据是否接受强化干预分为强化干预组和阳性对照组(强化干预组实施4个健走处方,阳性对照组实行3个健走处方),对完成基线问卷调查和体格检查且健走数据完整的28285名在职人员采用倾向得分匹配,共得到5208对10416名研究对象,比较2组职业人群干预前后体重、体质指数、腰围、臀围和体脂率的变化情况以对中国职业人群肥胖强化健走处方的干预效果进行评价。 结果 强化干预组职业人群万步率、集中健走率、4个处方完成率、体重监测完成率及阳性对照组万步率、集中健走率、3个处方完成率P25值和平均值均 > 85 %,2组职业人群的干预依从性均较好;强化干预组和阳性对照组职业人群的体重、体质指数、腰围、臀围、体脂率在干预前分别为(65.98 ± 11.86)kg和(65.23 ± 11.87)kg、(23.77 ± 3.29)和(23.78 ± 3.30)、(82.75 ± 10.25)cm和(82.54 ± 10.14)cm、(96.15 ± 7.37)cm和(96.06 ± 7.17)cm、(27.92 ± 6.18)%和(27.75 ± 6.37)%,在干预后分别为(64.18 ± 11.50)kg和(63.86 ± 11.58)kg、(23.18 ± 3.16)和(23.31 ± 3.19)、(81.33 ± 10.05)cm和(81.09 ± 9.99)cm、(95.16 ± 6.88)cm和(94.97 ± 6.70)cm、(26.89 ± 6.11)%和(27.00 ± 6.29)%;干预前后强化干预组和阳性对照组职业人群分别比较,干预前、后2组职业人群的体重、体质指数、腰围、臀围和体脂率差异均有统计学意义(均P < 0.01);干预前、后2组职业人群比较,干预前强化干预组职业人群的体重高于阳性对照组职业人群(t = – 3.25,P = 0.001);协方差分析结果显示,干预后强化干预组职业人群的体重、体质指数和体脂率均低于阳性对照组职业人群(均P < 0.01)。通过多水平模型结合倍差法校正性别、年龄、文化程度、职业、居住地、是否患慢性病、慢性病知识得分、心理量表得分和睡眠时间等混杂因素后结果显示,干预后强化干预组职业人群体脂率较阳性对照组多下降了0.29 %(t = – 2.05,P = 0.04);进一步进行亚组分析结果显示,干预前体质指数水平为超重的职业人群通过强化干预可促进体重、体质指数和体脂率的下降,干预前体质指数水平为肥胖的职业人群通过强化干预可促进体质指数和体脂率的下降,干预前体脂率水平为超重和肥胖的职业人群通过强化干预可促进体脂率的下降。 结论 4个健走处方的强化干预模式可进一步降低中国超重和肥胖职业人群的肥胖程度,对体脂率的健康受益更大。 Abstract:Objective To evaluate intervention effect of intensive brisk walking prescription on obesity in Chinese occupational population and to provide a reference for popularizing appropriate weight control program among occupational population in China. Methods All the participants of the study were from a 100-day vigorous walking program conducted among 31 528 in service employees in 12 provincial-level administrative divisions of China during May – August 2021 and the participants were divided into an intervention group required to complete a 4 sets of walking schedule in a day (10, 10, 15, 15 minutes of walking continuously at the speed of 100 – 150 steps per minute) and a positive control group with the same requirement as the intervention group but only 3 sets of waling schedule (10, 10, 15 minutes); the body weight in kg (BW) of the participants were measured at least once a week during the program period. From the 28 285 participants with complete information on baseline questionnaire survey and data on physical examination and vigorous waling, 5 208 pairs of intervention and control individuals were matched by tendency scores. The changes in BW, body mass index (BMI), waist circumference in cm (WC), hip circumference in cm (HC) and body fat rate in % (BFR) of the intervention and control individuals before and after the intervention were compared to evaluate the effect of intensive brisk walking prescription on the obesity indicators. Results For both the intervention and positive control group, the percentages and the 25th percentiles of the proportions of individuals having 10 000 steps walking per day, group walking, completing 4/3 sets of walking schedule, and BW measuring once a week were all more than 85%, indicating a good compliance with the program of the participants. Compared to those at the beginning of the intervention program, there were significant differences at the end of the intervention for both the intervention and the positive control groups in the average values of BW (64.18 ± 11.50 vs. 65.98 ± 11.86 and 63.86 ± 11.58 vs. 65.23 ± 11.87), BMI (23.18 ± 3.16 vs. 23.77 ± 3.29 and 23.31 ± 3.19 vs. 23.78 ± 3.30), WC (81.33 ± 10.05 vs. 82.75 ± 10.25 and 81.09 ± 9.99 vs. 82.54 ± 10.14), HC (95.16 ± 6.88 vs. 96.15 ± 7.37 and 94.97 ± 6.70 vs. 96.06 ± 7.17), and BFR (26.89 ± 6.11 vs. 27.92 ± 6.18 and 27.00 ± 6.29 vs. 27.75 ± 6.37), respectively (all P < 0.01). The BW of the intensive intervention group was significantly higher than that of positive control group at the beginning of the intervention (t = – 3.25, P = 0.0012). The results of covariance analysis showed that the BW, BMI and BFR of the intensive intervention group were significantly lower than those of positive control group by the end of intervention (all P < 0.01). After adjusting confounding factors such as sex, age, residence, education, occupation, chronic disease, score for knowledge about chronic disease, psychological scale score and sleeping time, the results of multilevel model combined with multiple difference method revealed a higher decline of 0.29% in BFR of intensive intervention group compared to that of positive control group at the end of intensive intervention (t = – 2.05, P = 0.04). Further subgroup analysis demonstrated that the intensive intervention promoted the decrease of BW, BMI and BFR for the individuals with the BMI indicating overweight status, the decrease of BMI and BFR for the individuals with the BMI indicating obesity status, and the decrease of BFR for the individuals with the BMI indicating both overweight or obesity at the beginning of the intervention. Conclusion The short-term intensive intervention with four sets of vigorous walking schedule could reduce obesity indicators among overweight and obese in service employees in China, especially for the decline of body fat rate. -
Key words:
- intensive walking prescription /
- obesity /
- intervention effect /
- occupational population
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表 1 中国职业人群干预前、后肥胖相关指标比较(
$\bar x \pm s$ )肥胖相关指标 干预前 干预后 强化干预组 阳性对照组 强化干预组 阳性对照组 体重(kg) 65.98 ± 11.86 b 65.23 ± 11.87 64.18 ± 11.50 ac 63.86 ± 11.58 a 体质指数 23.77 ± 3.29 23.78 ± 3.30 23.18 ± 3.16 ac 23.31 ± 3.19 a 腰围(cm) 82.75 ± 10.25 82.54 ± 10.14 81.33 ± 10.05a 81.09 ± 9.99 a 臀围(cm) 96.15 ± 7.37 96.06 ± 7.17 95.16 ± 6.88 a 94.97 ± 6.70 a 体脂率(%) 27.92 ± 6.18 27.75 ± 6.37 26.89 ± 6.11 ac 27.00 ± 6.29 a 注:干预后与干预前同组别比较,a P < 0.01;与干预前阳性对照组比较,b P < 0.01;与干预后阳性对照组比较,c P < 0.01。 表 2 强化干预对中国职业人群肥胖相关指标效应的亚组分析
亚组 体重 体质指数 腰围 臀围 体脂率 性别 男性 – 0.53( – 1.35~0.30) – 0.16( – 0.42~0.10) 0.11( – 0.62~0.84) 0.07( – 0.52~0.65) – 0.28( – 0.64~0.09) 女性 – 0.37( – 0.93~0.19) – 0.12( – 0.32~0.08) – 0.02( – 0.58~0.55) – 0.02( – 0.49~0.44) – 0.33( – 0.68~0.03) 年龄(岁) 20~29 – 0.11( – 1.30~1.09) – 0.01( – 0.43~0.40) 0.03( – 1.09~1.15) – 0.14( – 1.05~0.77) – 0.02( – 0.75~0.70) 30~39 – 0.62( – 1.56~0.32) – 0.23( – 0.55~0.09) 0.07( – 0.83~0.96) – 0.10( – 0.83~0.64) – 0.49( – 1.01~0.03) 40~49 – 0.59( – 1.32~0.15) – 0.18( – 0.43~0.06) 0.07( – 0.62~0.76) 0.15( – 0.42~0.72) – 0.38( – 0.77~0.01) 50~65 – 0.12( – 1.18~0.94) – 0.02( – 0.35~0.32) – 0.11( – 1.10~0.87) 0.03( – 0.76~0.83) – 0.15( – 0.68~0.38) 干预前体质指数水平 正常 – 0.23( – 0.64~0.18) – 0.06( – 0.18~0.07) 0.13( – 0.32~0.59) 0.11( – 0.28~0.51) – 0.25( – 0.52~0.01) 超重 – 0.61( – 1.15~ – 0.07) a – 0.20( – 0.33~ – 0.06) b – 0.14( – 0.75~0.46) – 0.09( – 0.61~0.44) – 0.29( – 0.51~ – 0.07) a 肥胖 – 1.08( – 2.18~0.03) – 0.41( – 0.74~ – 0.07) a 0.45( – 0.78~1.68) 0.11( – 0.96~1.18) – 0.65( – 1.05~ – 0.25) b 干预前腰围水平 正常 – 0.35( – 0.85~0.15) – 0.10( – 0.27~0.07) – 0.02( – 0.40~0.37) 0.15( – 0.27~0.58) – 0.28( – 0.60~0.05) 中心性肥胖前期 – 0.42( – 1.13~0.30) – 0.14( – 0.39~0.11) – 0.02( – 0.35~0.31) – 0.04( – 0.61~0.53) – 0.25( – 0.68~0.17) 中心性肥胖 – 0.57( – 1.37~0.23) – 0.16( – 0.42~0.11) 0.16( – 0.42~0.74) – 0.13( – 0.71~0.45) – 0.34( – 0.72~0.03) 干预前体脂率水平 正常 – 0.29( – 0.96~0.37) – 0.05( – 0.24~0.14) 0.14( – 0.53~0.81) 0.04( – 0.52~0.61) 0.06( – 0.27~0.39) 超重 – 0.42( – 0.95~0.11) – 0.10( – 0.24~0.04) 0.17( – 0.44~0.77) 0.16( – 0.36~0.68) – 0.36( – 0.57~ – 0.16) b 肥胖 – 0.53( – 1.19~0.13) – 0.20( – 0.42~0.02) – 0.22( – 0.90~0.47) – 0.19( – 0.76~0.39) – 0.49( – 0.81~ – 0.16) b 注:a P < 0.05;b P < 0.01。 -
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