摘要:

目的  評價中國職業(yè)人群肥胖強(qiáng)化健走處方干預(yù)效果，為推廣適合中國職業(yè)人群適宜的體重控制方案提供借鑒。

方法  基于2021年5 — 8月中國職業(yè)人群健走項目，招募來自全國12個省份的31528名在職人員進(jìn)行為期100 d的健走干預(yù)，根據(jù)是否接受強(qiáng)化干預(yù)分為強(qiáng)化干預(yù)組和陽性對照組（強(qiáng)化干預(yù)組實施4個健走處方，陽性對照組實行3個健走處方），對完成基線問卷調(diào)查和體格檢查且健走數(shù)據(jù)完整的28285名在職人員采用傾向得分匹配，共得到5208對10416名研究對象，比較2組職業(yè)人群干預(yù)前后體重、體質(zhì)指數(shù)、腰圍、臀圍和體脂率的變化情況以對中國職業(yè)人群肥胖強(qiáng)化健走處方的干預(yù)效果進(jìn)行評價。

結(jié)果  強(qiáng)化干預(yù)組職業(yè)人群萬步率、集中健走率、4個處方完成率、體重監(jiān)測完成率及陽性對照組萬步率、集中健走率、3個處方完成率P25值和平均值均 > 85 %，2組職業(yè)人群的干預(yù)依從性均較好；強(qiáng)化干預(yù)組和陽性對照組職業(yè)人群的體重、體質(zhì)指數(shù)、腰圍、臀圍、體脂率在干預(yù)前分別為（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）%，在干預(yù)后分別為（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）%；干預(yù)前后強(qiáng)化干預(yù)組和陽性對照組職業(yè)人群分別比較，干預(yù)前、后2組職業(yè)人群的體重、體質(zhì)指數(shù)、腰圍、臀圍和體脂率差異均有統(tǒng)計學(xué)意義（均P < 0.01）；干預(yù)前、后2組職業(yè)人群比較，干預(yù)前強(qiáng)化干預(yù)組職業(yè)人群的體重高于陽性對照組職業(yè)人群（t = – 3.25，P = 0.001）；協(xié)方差分析結(jié)果顯示，干預(yù)后強(qiáng)化干預(yù)組職業(yè)人群的體重、體質(zhì)指數(shù)和體脂率均低于陽性對照組職業(yè)人群（均P < 0.01）。通過多水平模型結(jié)合倍差法校正性別、年齡、文化程度、職業(yè)、居住地、是否患慢性病、慢性病知識得分、心理量表得分和睡眠時間等混雜因素后結(jié)果顯示，干預(yù)后強(qiáng)化干預(yù)組職業(yè)人群體脂率較陽性對照組多下降了0.29 %（t = – 2.05，P = 0.04）；進(jìn)一步進(jìn)行亞組分析結(jié)果顯示，干預(yù)前體質(zhì)指數(shù)水平為超重的職業(yè)人群通過強(qiáng)化干預(yù)可促進(jìn)體重、體質(zhì)指數(shù)和體脂率的下降，干預(yù)前體質(zhì)指數(shù)水平為肥胖的職業(yè)人群通過強(qiáng)化干預(yù)可促進(jìn)體質(zhì)指數(shù)和體脂率的下降，干預(yù)前體脂率水平為超重和肥胖的職業(yè)人群通過強(qiáng)化干預(yù)可促進(jìn)體脂率的下降。

結(jié)論  4個健走處方的強(qiáng)化干預(yù)模式可進(jìn)一步降低中國超重和肥胖職業(yè)人群的肥胖程度，對體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.

表  1   中國職業(yè)人群干預(yù)前、后肥胖相關(guān)指標(biāo)比較（$bar x pm s$）

肥胖相關(guān)指標(biāo)干預(yù)前干預(yù)后強(qiáng)化干預(yù)組陽性對照組強(qiáng)化干預(yù)組陽性對照組 體重（kg）65.98 ± 11.86 b65.23 ± 11.8764.18 ± 11.50 ac63.86 ± 11.58 a體質(zhì)指數(shù)23.77 ± 3.2923.78 ± 3.3023.18 ± 3.16 ac23.31 ± 3.19 a腰圍（cm）82.75 ± 10.2582.54 ± 10.1481.33 ± 10.05a81.09 ± 9.99 a臀圍（cm）96.15 ± 7.3796.06 ± 7.1795.16 ± 6.88 a94.97 ± 6.70 a體脂率（%）27.92 ± 6.1827.75 ± 6.3726.89 ± 6.11 ac27.00 ± 6.29 a 　　注：干預(yù)后與干預(yù)前同組別比較，a P < 0.01；與干預(yù)前陽性對照組比較，b P < 0.01；與干預(yù)后陽性對照組比較，c P < 0.01。

表  2   強(qiáng)化干預(yù)對中國職業(yè)人群肥胖相關(guān)指標(biāo)效應(yīng)的亞組分析

亞組體重體質(zhì)指數(shù)腰圍臀圍體脂率 性別 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） 年齡（歲） 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） 干預(yù)前體質(zhì)指數(shù)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 干預(yù)前腰圍水平 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） 干預(yù)前體脂率水平 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。 [1]

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