Evaluation criteria of moderate to vigorous physical activity in overweight or obese adolescents
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摘要:
目的 验证现有的青少年运动强度切点标准对超重或肥胖青少年中高强度身体活动的判断能力，为科学指导运动实践提供理论支持。 方法 采用活动计数、步数和心率指标，共纳入15个青少年中高强度切点标准；对广州市94名超重或肥胖青少年进行自由状态下3~7 km/h走、跑测试，同步佩戴MetaMax 3B气体代谢分析仪、Polar遥测心率和Actigraph w-GT3x BT三轴运动加速度计采集能量消耗、活动计数、心率和步数。 结果 所有切点标准与“金标准”两者间的Kappa一致性系数(0.27~0.53)＜0.60且差异性检验P值均 < 0.01，表明一致性不强且有统计学意义。各切点标准诊断结果中，敏感度低(49.11~67.59)、特异性高(92.5~97.65)、-LR高(0.14~0.52，＞0.1)和DOR低(8.26~25.19，＜30)表明漏判率高；特异性低(36.75~69.41)、敏感度高(84.82~96.36)和+LR低(1.52~9.83，＜10)表明误判率高；AUC为0.67~0.80，表明诊断价值较低。 结论 现有的运动强度切点标准判断超重或肥胖青少年中高强度身体活动一致性不强且诊断能力低，建立了适宜超重或肥胖青少年中高强度身体活动评价标准。 Abstract:Objective To verify the current cut-off points of physical activity intensity for adolescents to assess moderate to vigorous physical activity (MVPA) among overweight or obese adolescents. Methods The total activity counts, heart rate and steps indicators most commonly used to reflect physical activity intensity were adopted, and a total of 15 MVPA cut-off points standards for adolescents were included. Ninety-four overweight or obese adolescents were tested for walking and running at 3-7 km/h in a free state, while simultaneously wearing MetaMax 3B gas metabolism analyzer, polar belt and actigraph w-GT3x BT triaxial accelerometer to collect energy consumption and activities count, heart rate and steps. Kappa consistency test and paired χ2 test were used for statistical analysis. Results Kappa consistency coefficients (0.27-0.53) < 0.60 between all cut-off points standards and the "gold standard" and the P < 0.01, indicating that the consistency is varied and not strong. In the standard diagnosis of each cut points, low sensitivity (49.11-67.59), high specificity (92.50-97.65), high -LR (0.14-0.52, >0.1) and low DOR(8.26-25.19, < 30) indicated high rate of misdiagnosis. Low specificity (36.75-69.41), high sensitivity (84.82-96.36) and low +LR(1.52-9.83, < 10) indicated a high rate of misdiagnosis; AUC of 0.67-0.80 suggested lower diagnostic performance. Conclusion Existing physical activity intensity cut-off points for overweight or obese adolescents were not consistent with MVPA and have low diagnostic capabilities. The following criteria of MVPA for overweight or obese adolescents are supposed. -
Key words:
- Overweight /
- Obesity /
- Motor activity /
- Reference standards /
- Adolescent
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表 1 纳入的运动强度切点标准特征
Table 1. Included physical activity intensity cut-off points standard feature
切点标准 第一作者与年份 年龄/岁 BMI/ (kg·m-2) 运动项目 中等强度(3~ < 6 METs) 大强度(≥6 METs) 活动计数/(次·min-1) Romanzini2014(VT)[11] 10~15 19.9±0.1 自由走2，4 km/h，跑7.2 km/h；篮、足、排球；跳绳 2 424~3 272 ≥3 272 Romanzini2014(VM3)[11] 10~15 19.9±0.1 自由走2，4 km/h，跑7.2 km/h；篮、足、排球；跳绳 3 028~4 448 ≥4 448 Vanhelst2011(VT)[12] 13.2±1.1 - 自由走1.5，3 km/h，跑4，6 km/h、室内游戏、踢足球 1 901~3 919 ≥3 919 Treuth2004(VT)[13] 13~15 23.4±5.8 自由走4，5.6 km/h，跑8 km/h、踏板操、扫地、功率自行车、投球、阶梯走80步/min 3 000~5 201 ≥5 201 Puyan2002(VT)[14] 6~16 18.7±2.2 跑台走4，6.4 km/h，跑9.7 km/h，自由活动(自由走跑、篮球、桨球、呼啦圈等) 3 200~8 201 ≥8 201 朱琳2012(VT)[9] 11~14 20.4±3.1 跑台走3~6 km/h，跑8 km/h，跳绳1 min，第三套广播体操 2 151~4 936 ≥4 936 朱琳2012(VM3)[9] 11~14 20.4±3.1 跑台走3~6 km/h，跑8 km/h，跳绳，广播体操 3 783~6 169 ≥6 169 心率/(次·min-1) 朱琳2012(HR)[9] 11~14 20.4±3.1 跑台3~6 km/h走，7~8 km/h跑, 广播体操，跳绳 125~159 ≥159 Vanhelst2011(HR)[12] 13.2±1.1 无 自由走1.5，3 km/h，跑4，6 km/h、室内游戏、踢足球 126~163.4 ≥163.4 朱琳2014(HR%)[15] 11~14 21.9±5.9 广播体操、跳绳、跑台走3~6 km/h，跑7~8 km/h 55~97 ≥97 Chandler2015(HRR%)[16] 8~12 19.6±1.1 散步、游乐场(单杠、攀岩等)、戏水池、游泳、有氧耐力跑 50~70 ≥70 步数/(步·min-1) Saunders2014[17] 10~17 男21.9±5.5，女22.3±3.6 跑台走跑1，2.2，3.8，5.9，6.5 km/h 110~130 ≥130 Harrington2012[18] 15.8±0.4 21.7±2.8 跑台走跑3.2，4.8，5.6，6.4，7 km/h 91~138 ≥138 Tudorlocke2018[19] 15~17 22.4±6.3 跑台走跑0.8 ~ 8 km/h 101.3~126.3 ≥126.3 朱琳2013[20] 11~14 20.6±3.3 跑台走3 ~ 6 km/h，跑7~8 km/h 121~144 ≥144 注： VT(vertical)反映垂直轴的活动计数；VM3(vector magnitude)综合反映矢状轴、冠状轴、垂直轴的三轴向量幅值；心率变化率(percentage of heart rate, HR%)=(运动心率-安静心率)/安静心率×100%；心率储备百分比(percentage of heart rate reserve, HRR%)=(运动心率-安静心率)/(最大心率-安静心率)×100%。 
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表 2 切点标准与金标准对超重或肥胖青少年MVPA的效标判断结果
Table 2. Validation results of MVPA between cut-off points and gold standard in the diagnosis of overweight or obese adolescents
切点标准 作者与年份 一致性检验 差异性检验 诊断指标检验 Kappa(95%CI) P值 Bowker P值 敏感度/% 特异性/% AUC +LR -LR DOR 活动计数/ Romanzini2014(VT)[11] 0.47(0.38~0.56) ＜0.01 113.62 ＜0.01 77.78 82.5 0.80 4.44 0.27 16.44 (次·min-1) Romanzini2014(VM3)[11] 0.37(0.25~0.48) ＜0.01 96.79 ＜0.01 91.98 41.25 0.67 1.57 0.19 8.26 Vanhelst2011(VT)[12] 0.46(0.36~0.57) ＜0.01 29.77 ＜0.01 86.73 62.5 0.75 2.31 0.21 11.00 Treuth2004(VT)[13] 0.41(0.33~0.49) ＜0.01 89.30 ＜0.01 67.59 92.5 0.80 9.01 0.35 25.74 Puyan2002(VT)[14] 0.35(0.28~0.43) ＜0.01 185.86 ＜0.01 61.42 93.75 0.78 9.83 0.41 23.98 朱琳2012(VT)[9] 0.49(0.39~0.59) ＜0.01 17.86 ＜0.01 82.41 75.00 0.79 3.30 0.23 14.35 朱琳2012(VM3)[9] 0.42(0.32~0.52) ＜0.01 27.27 ＜0.01 78.70 72.5 0.76 2.86 0.29 9.86 心率/ 朱琳2012(HR)[9] 0.44(0.33~0.55) ＜0.01 22.30 ＜0.01 91.45 48.45 0.70 1.77 0.18 9.83 (次·min-1) Vanhelst2011(HR)[12] 0.43(0.33~0.54) ＜0.01 15.57 ＜0.01 91.42 47.96 0.70 1.76 0.18 9.78 朱琳2014(HR%)[15] 0.53(0.42~0.63) ＜0.01 15.57 ＜0.01 91.97 57.32 0.75 2.15 0.14 15.36 Chandler2015(HRR%)[16] 0.33(0.25~0.41) ＜0.01 50.30 ＜0.01 96.36 36.75 0.67 1.52 0.1 15.20 步数/ Saunders2014[17] 0.40(0.032~0.47) ＜0.01 110.76 ＜0.01 65.77 92.94 0.79 9.32 0.37 25.19 (步·min-1) Harrington2012[18] 0.49(0.39~0.59) ＜0.01 14.98 ＜0.01 84.82 69.41 0.77 2.77 0.22 12.59 Tudor2018[19] 0.51(0.42~0.60) ＜0.01 50.00 ＜0.01 80.06 82.35 0.81 4.54 0.24 18.92 朱琳2013[20] 0.27(0.21~0.33) ＜0.01 176.41 ＜0.01 49.11 97.65 0.73 20.87 0.52 40.13
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表 3 超重或肥胖青少年活动计数、心率和步数指标MVPA评价标准的ROC曲线结果
Table 3. ROC results of MVPA between physical activity counts, heart rate and steps in overweight or obese adolescents
指标 敏感度/% 特异性/% 约登指数 AUC MVPA评价标准 活动计数VT 80.70 80.70 0.63 0.87 ≥2 326次/min 活动计数VM 75.20 76.30 0.51 0.84 ≥3 888次/min 心率 75.00 83.58 0.60 0.86 ≥130次/min HR% 81.80 82.10 0.64 0.88 ≥59.3% HRR% 77.65 85.07 0.63 0.88 ≥39.1% 步数 79.76 83.53 0.63 0.86 ≥102步/min
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