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Article(id=1324044540960703350, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044540067328424, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202601087, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1767628800000, receivedDateStr=2026-01-06, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793606418122, onlineDateStr=2026-11-02, pubDate=1777046400000, pubDateStr=2026-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793606418122, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793606418122, creator=13701087609, updateTime=1793606418122, updator=13701087609, issue=Issue{id=1324044540067328424, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='8', pageStart='1345', pageEnd='1536', issueExtLink='null', onlineDate='null', pubDate='1777046400000', pubDateStr='2026-04-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793606417910, creator='13701087609', updateTime=1793670137580, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324311799788602160, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044540067328424, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324311799788602161, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044540067328424, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1345, endPage=1350, ext={EN=ArticleExt(id=1324044541237527415, articleId=1324044540960703350, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Joint association of resting heart rate and physical activity with cardiovascular disease risk among middle-aged and older adults, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

Physical activity is effective in preventing and treating cardiovascular disease (CVD). However, high-level physical activity may pose potential health risks. An elevated resting heart rate is indicative of poor cardiovascular function, yet the safety of physical activity in individuals with high resting heart rates remains unclear. This study aimed to investigate the joint association of resting heart rate and physical activity with CVD risk to provide evidence for individualized exercise guidance.

Methods

This study included 5 672 middle-aged and older adults from the China Health and Retirement Longitudinal Study database. Generalized additive models were employed to explore the independent and joint associations of resting heart rate and physical activity with CVD risk. Multiple logistic regression was further used to examine their correlations, while three-dimensional surface plots and two-dimensional slice plots at fixed resting heart rate levels were generated to visualize the nonlinear associations.

Results

A significant nonlinear interaction was observed between resting heart rate, physical activity, and CVD risk (P for interaction <0.001). Compared with the reference group (normal resting heart rate and moderate physical activity), individuals with a resting heart rate >100 beats per minute and low physical activity had the highest risk of CVD (OR=6.223). Among those with high resting heart rate, moderate physical activity was associated with a possible increase in risk (OR=2.059), whereas high physical activity showed no statistically significant association with CVD risk (OR=0.956).

Conclusion

In individuals with a high resting heart rate, high-level physical activity is not associated with an increased risk of CVD. Increasing physical activity represents a universally applicable, low-cost, and effective health promotion strategy.

, authors=Jia-qi HUANG1, Li-jun LIANG1, Zhen-yu GAO1, Xiong XIAO1, 2, authorsList=Jia-qi HUANG, Li-jun LIANG, Zhen-yu GAO, Xiong XIAO, authorCompany=null, correspAuthors=Xiong XIAO, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324044542307074942, articleId=1324044540960703350, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=中老年人静息心率和体力活动与心血管疾病患病风险的关联研究, columnId=1228016567632462653, journalTitle=现代预防医学, columnName=流行病与统计方法, runingTitle=null, highlight=null, articleAbstract=
目的

体力活动能有效防治心血管疾病（cardiovascular disease，CVD），但高水平体力活动可能造成健康风险。较高静息心率提示心血管功能不良，在该人群中体力活动的安全性尚不明确。因此，本研究旨在通过探讨静息心率和体力活动与CVD风险的联合关联，为个体精准化运动指导提供依据。

方法

基于中国健康与养老追踪调查数据库，共纳入5 672名中老年人。采用广义相加模型探讨静息心率和体力活动与CVD风险的独立及联合关联，通过多元logistic回归进一步检验其相关性，绘制三维曲面图与固定静息心率的二维切片图以呈现非线性关联。

结果

静息心率和体力活动与CVD风险存在非线性交互作用（P交互<0.001）。与参照组（静息心率正常且体力活动中等）相比，静息心率>100次/分的低体力活动者CVD风险最高（OR=6.223），中体力活动者风险可能增加（OR=2.059），而高体力活动者CVD风险OR=0.956，无统计学意义。

结论

在较高静息心率人群中，高水平的体力活动没有表现出增加CVD的风险。增加体力活动是一项普适、低成本且有效的健康促进策略。

, authors=黄佳琪1, 梁丽君1, 高振宇1, 肖雄1, 2, authorsList=黄佳琪, 梁丽君, 高振宇, 肖雄, authorCompany=null, correspAuthors=肖雄, authorNote=

黄佳琪（2000—），女，硕士在读，研究方向：流行病与卫生统计学

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肖雄，E-mail：
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Characteristics of participants according to PA groups

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总体低体力活动中体力活动高体力活动P
n5 6721 8991 8821 891
静息心率（次/分）72.43±10.4173.49±10.6072.31±10.1171.49±10.41<0.001
年龄（岁）58.95±9.7661.89±10.7958.45±9.3756.49±8.14<0.001
女性3 098（54.6）738（58.2）1 071（56.9）908（48.0）<0.001
城镇490（8.6）205（16.2）180（9.6）47（2.5）<0.001
未婚及其他946（16.7）284（22.4）327（17.4）221（11.7）<0.001
学历<0.001
小学及以下3 911（69.0）830（65.5）1 263（67.1）1 367（72.4）
中学1 664（29.4）398（31.4）573（30.4）518（27.4）
大专及以上94（1.7）40（3.2）46（2.4）4（0.2）
不吸烟3 555（62.7）842（66.4）1 203（63.9）1 082（57.2）<0.001
饮酒<0.001
每月超过一次1 383（24.4）241（19.0）449（23.9）580（30.7）
每月少于一次435（7.7）81（6.4）156（8.3）154（8.1）
不喝3 852（67.9）946（74.6）1 277（67.9）1 156（61.2）
BMI（kg/m2）23.47±3.9223.70±4.2623.78±3.7822.95±3.65<0.001
无血脂异常5 062（90.9）1 092（87.3）1 655（89.8）1 748（94.3）<0.001
无高血压3 378（59.6）690（54.4）1 114（59.2）1 252（66.2）<0.001
无糖尿病4 912（86.8）1 060（83.7）1 638（87.2）1 679（89.0）<0.001
), ArticleFig(id=1324044549089264552, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044540960703350, language=CN, label=表1, caption=

不同体力活动分组的研究对象特征

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总体低体力活动中体力活动高体力活动P
n5 6721 8991 8821 891
静息心率（次/分）72.43±10.4173.49±10.6072.31±10.1171.49±10.41<0.001
年龄（岁）58.95±9.7661.89±10.7958.45±9.3756.49±8.14<0.001
女性3 098（54.6）738（58.2）1 071（56.9）908（48.0）<0.001
城镇490（8.6）205（16.2）180（9.6）47（2.5）<0.001
未婚及其他946（16.7）284（22.4）327（17.4）221（11.7）<0.001
学历<0.001
小学及以下3 911（69.0）830（65.5）1 263（67.1）1 367（72.4）
中学1 664（29.4）398（31.4）573（30.4）518（27.4）
大专及以上94（1.7）40（3.2）46（2.4）4（0.2）
不吸烟3 555（62.7）842（66.4）1 203（63.9）1 082（57.2）<0.001
饮酒<0.001
每月超过一次1 383（24.4）241（19.0）449（23.9）580（30.7）
每月少于一次435（7.7）81（6.4）156（8.3）154（8.1）
不喝3 852（67.9）946（74.6）1 277（67.9）1 156（61.2）
BMI（kg/m2）23.47±3.9223.70±4.2623.78±3.7822.95±3.65<0.001
无血脂异常5 062（90.9）1 092（87.3）1 655（89.8）1 748（94.3）<0.001
无高血压3 378（59.6）690（54.4）1 114（59.2）1 252（66.2）<0.001
无糖尿病4 912（86.8）1 060（83.7）1 638（87.2）1 679（89.0）<0.001
), ArticleFig(id=1324044549189927849, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044540960703350, language=EN, label=Table 2, caption=

Comparison of CVD risk across different groups of resting heart rate and physical activity

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静息心率（次/分）体力活动No.OR值（95%CI）P for Trend
<60低1492.187（1.329~3.507）①0.001
中1661.818（1.161~2.779）①
高2040.716（0.394~1.212）
60~100低1 7221.335（1.074~1.660）①<0.001
中1 7011.000
高1 6690.733（0.576~0.930）②
>100低286.223（1.901~20.638）①0.127
中152.059（0.524~6.767）
高180.956（0.138~3.875）
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不同静息心率与体力活动水平组合的心血管疾病风险比较

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静息心率（次/分）体力活动No.OR值（95%CI）P for Trend
<60低1492.187（1.329~3.507）①0.001
中1661.818（1.161~2.779）①
高2040.716（0.394~1.212）
60~100低1 7221.335（1.074~1.660）①<0.001
中1 7011.000
高1 6690.733（0.576~0.930）②
>100低286.223（1.901~20.638）①0.127
中152.059（0.524~6.767）
高180.956（0.138~3.875）
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中老年人静息心率和体力活动与心血管疾病患病风险的关联研究
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黄佳琪 1 , 梁丽君 1 , 高振宇 1 , 肖雄 1, 2
现代预防医学 | 流行病与统计方法 2026,53(8): 1345-1350
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现代预防医学 |流行病与统计方法 2026 , 53 (8) : 1345 -1350
中老年人静息心率和体力活动与心血管疾病患病风险的关联研究
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黄佳琪1, 梁丽君1, 高振宇1, 肖雄1, 2
作者信息
  • 1.四川大学华西公共卫生学院/华西第四医院流行病与卫生统计学系，四川　成都　610041
  • 2.主动健康与食品营养安全四川省重点实验室
通讯作者:
肖雄，E-mail：
作者简介:

黄佳琪（2000—），女，硕士在读，研究方向：流行病与卫生统计学

Joint association of resting heart rate and physical activity with cardiovascular disease risk among middle-aged and older adults
Jia-qi HUANG1, Li-jun LIANG1, Zhen-yu GAO1, Xiong XIAO1, 2
Affiliations
  • Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2026-04-25 doi: 10.20043/j.cnki.MPM.202601087
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摘要
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目的

体力活动能有效防治心血管疾病（cardiovascular disease，CVD），但高水平体力活动可能造成健康风险。较高静息心率提示心血管功能不良，在该人群中体力活动的安全性尚不明确。因此，本研究旨在通过探讨静息心率和体力活动与CVD风险的联合关联，为个体精准化运动指导提供依据。

方法

基于中国健康与养老追踪调查数据库，共纳入5 672名中老年人。采用广义相加模型探讨静息心率和体力活动与CVD风险的独立及联合关联，通过多元logistic回归进一步检验其相关性，绘制三维曲面图与固定静息心率的二维切片图以呈现非线性关联。

结果

静息心率和体力活动与CVD风险存在非线性交互作用（P交互<0.001）。与参照组（静息心率正常且体力活动中等）相比，静息心率>100次/分的低体力活动者CVD风险最高（OR=6.223），中体力活动者风险可能增加（OR=2.059），而高体力活动者CVD风险OR=0.956，无统计学意义。

结论

在较高静息心率人群中，高水平的体力活动没有表现出增加CVD的风险。增加体力活动是一项普适、低成本且有效的健康促进策略。

静息心率  /  体力活动  /  心血管疾病  /  广义相加模型
Objective

Physical activity is effective in preventing and treating cardiovascular disease (CVD). However, high-level physical activity may pose potential health risks. An elevated resting heart rate is indicative of poor cardiovascular function, yet the safety of physical activity in individuals with high resting heart rates remains unclear. This study aimed to investigate the joint association of resting heart rate and physical activity with CVD risk to provide evidence for individualized exercise guidance.

Methods

This study included 5 672 middle-aged and older adults from the China Health and Retirement Longitudinal Study database. Generalized additive models were employed to explore the independent and joint associations of resting heart rate and physical activity with CVD risk. Multiple logistic regression was further used to examine their correlations, while three-dimensional surface plots and two-dimensional slice plots at fixed resting heart rate levels were generated to visualize the nonlinear associations.

Results

A significant nonlinear interaction was observed between resting heart rate, physical activity, and CVD risk (P for interaction <0.001). Compared with the reference group (normal resting heart rate and moderate physical activity), individuals with a resting heart rate >100 beats per minute and low physical activity had the highest risk of CVD (OR=6.223). Among those with high resting heart rate, moderate physical activity was associated with a possible increase in risk (OR=2.059), whereas high physical activity showed no statistically significant association with CVD risk (OR=0.956).

Conclusion

In individuals with a high resting heart rate, high-level physical activity is not associated with an increased risk of CVD. Increasing physical activity represents a universally applicable, low-cost, and effective health promotion strategy.

Resting heart rate  /  Physical activity  /  Cardiovascular disease  /  Generalized additive model
黄佳琪, 梁丽君, 高振宇, 肖雄. 中老年人静息心率和体力活动与心血管疾病患病风险的关联研究. 现代预防医学, 2026 , 53 (8) : 1345 -1350 . DOI: 10.20043/j.cnki.MPM.202601087
Jia-qi HUANG, Li-jun LIANG, Zhen-yu GAO, Xiong XIAO. Joint association of resting heart rate and physical activity with cardiovascular disease risk among middle-aged and older adults[J]. Modern Preventive Medicine, 2026 , 53 (8) : 1345 -1350 . DOI: 10.20043/j.cnki.MPM.202601087
正文
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1　前言
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心血管疾病（cardiovascular disease，CVD）是我国乃至全球范围内的主要死亡原因，据我国国家心血管病中心统计表明，截至2023年，我国CVD患病人数已达3.3亿，且患病率持续上升[1-2]。在人口老龄化进程加速的背景下，采取有效的措施干预心血管疾病发生发展，对减轻心血管疾病负担、提升全民健康水平具有重要的公共卫生意义[3]。
体力活动（physical activity，PA）作为可改变的健康生活方式，在个体和群体层面的CVD防控起着核心作用[4]。大量的科学研究支持体力活动能降低心脏代谢风险及相关临床终点事件的发生[5-6]。然而，并非所有情况的体力活动对每个人都是适宜的。对于心血管功能异常的个体而言，高强度或高总量的体力活动可能诱发或加重心律失常，甚至引发危及生命的事件[7-8]。静息心率（resting heart rate，RHR）是日常和临床中广泛测量的简单、易得的指标，能反映自主神经系统及心血管功能，与体力活动能力呈负相关[9]。很多流行病学研究表明，较高的RHR与未来心血管疾病发生独立相关[10-11]。对于存在潜在心血管健康风险的较高RHR个体而言，体力活动伴随着心输出量和肌肉摄氧量的短暂增加，这可能对已受损的心血管系统带来额外负担。然而，现有的研究和指南大都采取“一刀切”的方式鼓励群体进行体力活动，关于不同静息心率和体力活动水平人群的精准运动处方的研究仍较有限。目前，只有两项分别来自挪威和韩国的研究探讨了二者与心血管疾病的联合关联，表明在RHR较高的个体中，与较低PA的人群相比，较高PA的CVD风险更低[12-13]。然而，既往的联合研究采用线性建模且根据主观方式分组PA和RHR，忽视了PA、RHR与CVD风险的非线性剂量-反应关系[14-15]，会导致信息损失、区组间效应跳跃等问题，不能准确评估实际影响。
因此，本研究基于中国健康与养老追踪数据库（China Health and Retirement Longitudinal Study，CHARLS），构建包含张量平滑的广义相加模型，旨在探讨我国中老年人群PA和RHR与CVD的非线性联合关联，并进一步识别不同静息心率个体中较低CVD风险的体力活动水平，为中老年人群采取个性化运动干预措施提供科学依据。
2　方法
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2.1　研究对象
CHARLS是一项针对中国45岁及以上中老年家庭及其配偶的全国性调查队列。基线调查于2011年开展，覆盖全国28个省份，共纳入17 708名研究对象。CHARLS项目的详细设计与实施方案参见既往文献[16]。该项目已获得北京大学生物医学伦理委员会批准（IRB00001052-11015），所有参与者在调查开始前均通过签署知情同意书确认知情同意。为扩大样本量并提高研究结果的外推性，本研究采用了CHALRS项目的基线数据，排除体力活动（n=7 917）、静息心率（n=3 871）或心血管疾病状况（n=248）缺失者，最终纳入分析的研究对象共计5 672人。
2.2　静息心率和体力活动
静息心率的测量与血压测量同步进行，使用的设备为经过验证的电子血压计（欧姆龙HEM-7200）。本研究取三次测量的平均值以最小化随机误差。根据静息心率的临床正常值参考范围，研究对象可以划分为三个水平：<60次/分、60~100次/分和>100次/分[9]。
体力活动信息采用标准化问卷收集，该问卷为国际体力活动问卷（IPAQ）的修订版本[17]。具体而言，调查对象被询问一周内至少10分钟的体力活动的持续时间、天数和强度。每日体力活动持续时间分为五组：<10分钟、10~29分钟、30~119分钟、120~239分钟和≥240分钟。参考既往研究[18]，为便于计算并应对CHARLS数据中缺乏具体活动时长的问题，各时长组别以其中位数值代表。每周体力活动总时间通过每周天数乘以每日持续时间计算得出。采用代谢当量值来表示体力活动强度[19]。与以往文献一致[20-21]，高强度、中等强度体力活动和步行分别赋值8.0、4.0和3.3。体力活动总量=8.0×每周高强度体力活动时间+4.0×每周中等强度体力活动时间+3.3×每周步行时间。体力活动按照三分位数三分类，此分组用于比较不同组别间的差异。
2.3　协变量
基于既有文献与理论基础[13,22-23]，本研究选取可能影响体力活动、静息心率及心血管疾病风险的社会人口和健康相关因素作为协变量，旨在控制潜在混杂。社会人口因素包括年龄、性别（男，女）、居住地（农村，城镇）、教育程度（小学及以下、中学，大专及以上）、婚姻状况（已婚，未婚及其他）。健康相关因素包括身体质量指数（BMI，kg/m2）、吸烟、饮酒（每月超过一次、每月少于一次，不喝）、血脂异常、高血压和糖尿病患病情况。
2.4　CVD的评估
根据问卷的自我报告，患有被医生诊断为心脏病（如心肌梗塞、冠心病、心绞痛、充血性心力衰竭和其他心脏疾病）或中风中的任意一种被定义为CVD患者。
2.5　统计分析
首先，研究对象的基本特征根据不同体力活动水平分组以均数±标准差或频数（百分比）进行描述。连续变量的组间比较采用单因素方差分析，分类变量的组间差异采用Pearson χ2检验。然后，构建静息心率和体力活动与心血管疾病风险的线性和非线性模型，通过似然比检验评估非线性模型是否具有统计学优势。非线性分析采用广义相加模型（generalized additive model，GAM），使用二项分布的Logit连接函数，采用薄板回归样条进行平滑拟合。依据赤池信息准则（Akaike information criterion，AIC）最小选择自由度（静息心率k=5，最小AIC=4 583.193；体力活动k=3，最小AIC=4 463.21）。平滑参数λ通过限制最大似然法自动优化。接下来，构建多元logistic回归模型分析不同静息心率和体力活动组合的CVD风险，将连续变量转化为分类变量（静息心率：<60，60~100，>100次/分；体力活动：按三分位数划分），计算调整后比值比（odds ratio，OR）和95%置信区间（confidence interval，CI）。进一步探讨静息心率和体力活动的联合非线性关联，构建了包含张量积平滑项的双变量GAM模型。对于双变量交互项，同样依据AIC最小选择k值组合（静息心率k=7，体力活动k=3，AIC=4 443.338），平滑参数通过限制最大似然法优化。最后，联合交互关联通过三维曲面图进行可视化呈现，并绘制了静息心率固定于多个水平（50、60、70、80、90、100、110及120次/分）时的二维切面图，以揭示不同静息心率水平下体力活动与CVD风险的非线性关联。本研究所有分析均使用R软件（版本4.2.2）完成，检验水准α=0.05。
3　结果
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3.1　研究对象特征
本研究纳入5 672名研究对象，其中14%（n=793）的中老年人患有心血管疾病。体力活动的三分位数为35.70、150.47、428.40 METs-h/w。静息心率为<60、60~100，>100次/分的分别有519、5 092、61人。与体力活动水平较低的相比，随着体力活动的增加，研究对象年龄更小、更多男性、更多农村居住、更多已婚、学历更低、更多吸烟、更多饮酒、更多未自我报告患有高血压、糖尿病和血脂异常。见表1。
3.2　静息心率、体力活动与CVD的独立关联
似然比检验结果显示，静息心率和体力活动的非线性模型优于线性模型（静息心率χ2=26.43，P<0.001；体力活动χ2=6.002，P=0.011）。静息心率与CVD风险大致呈“U”型，在60~90次/分的范围内，CVD风险较低；随着体力活动的增加，CVD风险呈下降趋势，且在大于150 METs-h/w后趋势减缓，见图1。
3.3　静息心率和体力活动与CVD的logistic回归分析
控制混杂因素后，在静息心率为<60和60~100次/分的人群中，随着体力活动的增加，CVD风险降低（趋势P<0.001，表2）。这个趋势在静息心率>100次/分时不显著。在静息心率正常范围的人群中，与体力活动中等的相比，体力活动较低和较高的CVD风险分别约为1.34和0.73倍（OR=1.335，95%CI：1.074~1.660；OR=0.733，95%CI：0.576~0.930）。在静息心率较高（>100次/分）的人群中，与静息心率正常（60~100次/分）且体力活动中等相比，低体力活动者CVD风险最高（OR=6.223），中体力活动者风险可能增加（OR=2.059），而高体力活动者CVD风险OR=0.956，无统计学意义。静息心率<60次/分且体力活动较高的人群的CVD风险相对最低（OR=0.716，95%CI：0.394~1.212）。见表2。
3.4　静息心率和体力活动与CVD的联合非线性关联
引入张量平滑项的广义相加模型显示，静息心率和体力活动与CVD风险的联合非线性交互作用具有统计学意义（似然比检验χ2=62.81，P<0.001）。具体而言，静息心率与CVD风险的影响随体力活动水平的不同而变化：在体力活动水平较高时，即使静息心率升高，CVD风险仍维持在相对较低水平，表明充分的体力活动可缓冲高静息心率带来的风险；反之，在体力活动不足的情况下，较低的静息心率并未显示出预期的保护作用，CVD风险反而有所增加，提示静息心率与体力活动在影响CVD风险时存在相互依赖的协同关系。交互作用具体见图2。
3.5　固定静息心率的体力活动与CVD的关联
在不同静息心率水平下，CVD风险均随体力活动水平的增加呈下降趋势，且该关联呈现非线性特征，即当体力活动达到一定水平后，CVD风险降低趋于平缓。具体变化模式见图3。
4　讨论
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本研究基于具有全国代表性的中老年人群数据，首次探讨了静息心率和体力活动与心血管疾病风险的联合非线性关联。结果表明，静息心率与CVD风险大致呈“U”型关联，体力活动增加与CVD风险下降呈非线性相关，且二者存在联合交互关联。其中体力活动是主导，表现为：较高静息心率与CVD风险增加相关，但在PA水平较高时，即使静息心率升高，CVD风险仍维持在相对较低水平；在不同静息心率人群中，随着体力活动水平增加，CVD风险均呈下降趋势。这表明增加体力活动是一项普适、低成本且有效的健康促进策略，且在不同静息心率的人群中均适用。
与既往研究一致，本研究证实体力活动能显著降低CVD风险，且存在一定的阈值[4,6]。不同的是，本研究人群的体力活动中位数水平为88METs-h/w，远高于世界卫生组织（World Health Organization，WHO）推荐的最低剂量（约10METs-h/w）。这可能源于样本中包含较多从事农牧业的中老年人（城镇人口仅占8.6%），并且本研究采用总体力活动而非仅休闲PA进行评估，从而更全面反映了实际活动情况。研究发现，随着体力活动增加，CVD风险持续降低，但在超过WHO推荐最低剂量15倍后（约150METs-h/w），风险降低幅度趋于平缓。规律的体力活动在心血管疾病的一级和二级预防中起着重要作用，其保护机制可能通过改善心肺功能、调控心血管危险因素实现，包括促进骨骼肌适应、改善血糖控制、减轻炎症反应及抗动脉粥样硬化等[24]。
本研究还发现RHR与CVD风险的“U”型关联，与中等静息心率相比，心率较低或较高均与CVD风险升高有关。既往的研究已证实较高的RHR是CVD风险的独立影响因素，其机制可能涉及增加心肌耗氧、加剧氧化应激、导致心肌功能障碍、引起内皮功能异常以及加速动脉粥样硬化进展，从而促进心血管疾病和死亡的发生率增加[11]。值得注意的是，本研究发现当RHR较低时（<60次/分），CVD风险也略有升高。一种可能的解释是，心动过缓受试者中可能存在亚临床窦房结功能障碍[25]。此外，服用调节心率药物的个体中，较低的静息心率也与CVD风险及死亡率相关[26]。
本研究重点探讨了静息心率和体力活动与CVD风险的联合关联。研究揭示，二者存在非线性交互关联，静息心率与CVD风险的关联随体力活动水平的不同而变化。在体力活动水平较高时，即使静息心率升高，CVD风险仍维持在相对较低水平，提示在本研究群体中，体力活动并未带来心血管健康风险。既往研究表明，高水平的体力活动导致的风险主要表现为心血管事件（猝死）或心血管疾病死亡率，但仍存在争议[8,27-28]。然而，一项有关高水平体力活动与死亡风险的荟萃分析表明，即使活动量超过WHO推荐最低运动剂量的7倍，也未观察到心血管疾病及全因死亡风险的增加[29]。在我国，随着城市化进程，多数人群久坐时间增加、体力活动不足，由低体力活动导致的CVD死亡率高于全球预期[30]。因此，对于静息心率较高的中国人群，更应鼓励积极参与体力活动，而不必过度担忧其可能带来的健康风险。此外，本研究在静息心率>100次/分且体力活动较低的分组中观察到CVD风险异常升高（OR=6.22）。这一结果可能反映了反向因果关系，即心血管功能障碍同时导致心率升高与活动能力下降。受横断面设计所限，上述机制暂无法明确。极高的OR值也可能部分受到该组样本量小、残余混杂或偶然因素的影响。该发现应视为重要的探索性信号，未来需通过前瞻性研究并结合客观监测数据，进一步验证较高心率人群中体力活动的保护作用及其机制。
本研究也存在若干的局限性。首先，本研究的体力活动数据和CVD事件通过自我报告的问卷收集所得，可能会存在回忆偏倚和报告偏倚。第二，研究对象来自中国中老年人群，结果外推需谨慎。第三，尽管本研究调整了多个混杂，但可能存在无法控制的残余混杂。例如，影响心率的药物（如β受体阻滞剂、钙通道阻滞剂等）使用。由于本研究未系统收集详细的用药史，所以无法在分析中对其进行校正。第四，本研究的分组分析存在样本量局限。静息心率>100次/分者仅61例，在进一步按体力活动水平分为低、中、高三组后，各分组样本量显著不足。尽管本研究采用连续变量模型探索了非线性关联，但分组分析中过小的样本量导致OR值的置信区间较宽，统计检验效能不足，降低了该部分结果的可信度与稳定性。因此，相关分组分析应被视为探索性发现，其确切关联模式需在未来大样本研究中加以验证。最后，本研究是一项横断面调查，虽然揭示了静息心率和体力活动与CVD风险存在非线性交互关联，但由于研究设计的局限性无法确定其因果关联：即是较高静息心率和体力活动减少增加CVD风险，还是已有亚临床CVD导致静息心率升高和体力活动能力下降。未来的研究，可纳入多样化人群，使用客观的身体活动监测仪来测量体力活动水平，结合医院或社区诊断病历确定CVD情况，采用前瞻性的研究设计更深入揭示静息心率和体力活动与CVD风险的因果关系。
综上所述，本研究发现静息心率升高和体力活动不足均与CVD风险相关，且二者存在联合交互。重要的是，即使在静息心率较高的人群中，高体力活动者没有表现出CVD风险的增加。这一结果可为静息心率偏高者提供参考，表明参与体力活动不仅是安全的，而且对整体健康有益。本研究鼓励公众积极参与体力活动，并为制定有针对性的体力活动推荐提供了科学依据。
基金
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  • 国家自然科学基金面上项目(82574204)
文献
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2026年第53卷第8期
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doi: 10.20043/j.cnki.MPM.202601087
  • 接收时间：2026-01-06
  • 首发时间：2026-11-02
  • 出版时间：2026-04-25
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  • 收稿日期：2026-01-06
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    1.四川大学华西公共卫生学院/华西第四医院流行病与卫生统计学系，四川　成都　610041
    2.主动健康与食品营养安全四川省重点实验室

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