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Beijing Da Xue Xue Bao Yi Xue Ban. 2022 Jun 18; 54(3): 490–497.
Published online 2022 Apr 13. Chinese. doi: 10.19723/j.issn.1671-167X.2022.03.014
PMCID: PMC9197711

Language: Chinese | English

久坐行为与体育锻炼行为对职业人群焦虑倾向的联合作用

Joint association of sedentary behavior and physical activity on anxiety tendency among occupational population in China

刘 熠华

北京大学公共卫生学院社会医学与健康教育系, 北京 100191, Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China

Find articles by 刘 熠华

云 青萍

北京大学公共卫生学院社会医学与健康教育系, 北京 100191, Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China

Find articles by 云 青萍

张 蓝超

北京大学公共卫生学院社会医学与健康教育系, 北京 100191, Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China

Find articles by 张 蓝超

张 晓悦

北京大学公共卫生学院社会医学与健康教育系, 北京 100191, Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China

Find articles by 张 晓悦

林 郁婷

北京大学公共卫生学院社会医学与健康教育系, 北京 100191, Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China

Find articles by 林 郁婷

刘 芳静

北京大学公共卫生学院社会医学与健康教育系, 北京 100191, Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China

Find articles by 刘 芳静

郑 志杰

北京大学公共卫生学院社会医学与健康教育系, 北京 100191, Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China

Find articles by 郑 志杰

常 春

北京大学公共卫生学院社会医学与健康教育系, 北京 100191, Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China 北京大学公共卫生学院社会医学与健康教育系, 北京 100191, Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China BMI, body mass index.Gender  Male5 643 (47.4)1 662 (29.5)  Female6 260 (52.6)1 900 (30.4)Age/years  ≥402 071 (17.4)522 (26.7)< 0.01   < 408 832 (82.6)3 010 (30.6)Education level  College degree and below3 637 (30.6)1 008 (27.7)  Undergraduate and above8 266 (69.4)2 554 (30.9)Occupation  Office workers6 746 (56.7)2 074 (30.7)  Production operator1 632 (13.7)419 (25.7)< 0.01  Technical workers1 923 (16.2)536 (27.9)< 0.05  Others1 602 (13.5)533 (33.3)< 0.05Positions  General staff8 464 (71.1)2 517 (29.7)  Management3 439 (28.9)1 045 (30.4)BMI  Normal8 477 (71.3)2 503 (29.5)  Overweight2 706 (22.7)840 (31.0)  Obesity714 (6.0)217 (30.4)Average daily sitting time  ≥8 h9 083 (76.3)2 839 (25.6)< 0.01   < 8 h2 820 (23.7)723 (31.3)Average daily sleep time  ≤7 h3 616 (30.4)1 414 (39.1)< 0.01  >7 h8 287 (69.6)2 148 (25.9)Physical exercise  Low7 025 (59.0)2 399 (34.1)  Moderate2 799 (23.5)702 (25.1)< 0.01  High2 079 (17.5)461 (22.2)< 0.01Smoking  No9 682 (81.3)2 829 (29.2)< 0.01  Yes2 221 (18.7)733 (33.0)Total11 903 (100.0)3 562 (29.9)

调查人群中焦虑倾向的检出率为29.9%,其中40岁以上年龄组的焦虑倾向检出率低于40岁以下年龄组,生产操作人员和专业技术人员的焦虑倾向检出率低于办公室工作员工,差异均有统计学意义。单因素分析结果显示,不同静坐时间、体育锻炼水平、平均每天睡眠时间和是否吸烟亚组人群的焦虑倾向检出率差异均有统计学意义( P < 0.01, 表 1 )。

2.2. 职业人群平均每天的静坐时间

调查人群过去1周平均每天静坐时间为(9.43±3.63) h,久坐行为(即静坐时间超过8 h)的比例达到73.9%,女性久坐行为的发生率(84.7%)高于男性(61.9%),大学本科及以上学历人群久坐行为的发生率(85.9%)高于大专及以下学历人群(46.6%)。不同岗位类型的员工中,办公室工作员工久坐行为的发生率最高(89.4%)。超重或肥胖人群的久坐行为发生率(67.0%)低于BMI正常的人群(76.7%),差异均有统计学意义( 表 2 )。

表 2

不同特征职业人群静坐时间比较

Comparison of sitting time within different groups of occupational population

Items Work sitting time/h, x ± s Leisure sitting time/h, x ± s Transportation time/h, x ± s Percentage of SB (≥8 h in total), n (%)
* P < 0.05, ** P < 0.01. SB, sedentary behavior; BMI, body mass index.
Gender
Male 5.21±3.13 2.01±1.48 1.24±1.15 3 492 (61.9) **
Female 6.95±2.33 2.16±1.57 1.16±0.96 5 303 (84.7)
Age/years
≥40 6.14±2.91 2.12±1.56 1.19±1.05 8 233 (74.1)
< 40 6.06±2.70 1.97±1.38 1.26±1.06 562 (71.4)
Education level
College degree and below 4.14±3.22 1.82±1.49 1.06±1.22 1 696 (46.6) **
Undergraduate and above 7.00±2.20 2.21±1.53 1.26±0.97 7 099 (85.9)
Occupation
Office workers 7.24±1.91 2.26±1.58 1.18±0.94 6 029 (89.4)
Production operator 2.54±2.98 1.62±1.43 0.97±1.33 424 (26.0) **
Technical workers 6.39±2.73 1.99±1.40 1.23±1.01 1 431 (74.4) **
Others 4.77±2.81 1.98±1.42 1.45±1.19 911 (56.9) **
Positions
General staff 6.08±3.00 2.13±1.56 1.18±1.09 6 199 (73.2)
Management 6.25±2.53 2.00±1.45 1.23±0.98 2 596 (75.5)
BMI
Normal 6.34±2.76 2.12±1.54 1.17±1.02 6 501 (76.7)
Overweight 5.66±3.03 2.01±1.47 1.26±1.13 1 834 (67.8) **
Obesity 5.35±3.19 2.09±1.61 1.34±1.21 456 (63.9) **
Average daily sleep time
≥8 h 6.15±2.80 2.07±1.53 * 1.12±1.02 * 6 182 (74.6)
< 8 h 6.08±3.05 2.15±1.53 1.37±1.12 2 613 (72.3)
Physical exercise
Low 6.15±3.03 2.08±1.57 1.22±1.08 5 143 (73.2)
Moderate 6.21±2.63 2.09±1.46 1.19±1.02 2 141 (76.5)
High 5.93±2.63 2.11±1.49 1.14±1.01 1 511 (72.7)
Smoking
No 6.49±2.67 2.12±1.53 1.18±1.00 7 614 (78.6) **
Yes 4.54±3.16 1.97±1.51 1.29±1.26 1 181 (53.2)
Total 6.13±2.87 2.09±1.53 1.20±1.06 8 795 (73.9)

2.3. 职业人群焦虑倾向的影响因素

以是否存在焦虑倾向作为因变量,以性别、年龄(连续变量)、文化程度、职位、岗位类型、睡眠情况、吸烟、BMI、平均每日静坐时间和体育锻炼水平作为自变量,进行非条件二元Logistic向后逐步回归分析,结果显示与办公室工作人员相比,生产操作人员出现焦虑倾向的风险降低( OR =0.84,95% CI :0.72~0.97);吸烟( OR =1.24,95% CI :1.23~1.39)、更长的静坐时间和更低的体育锻炼水平是职业人群出现焦虑倾向的危险因素,平均每日更长的睡眠时间( OR =0.56,95% CI :0.51~0.61)是焦虑倾向的保护因素( 表 3 )。

表 3

焦虑倾向影响因素的Logistic回归分析

Logistic regression analysis on the influencing factors of anxiety

Variables OR (95% CI )
Age -0.01 0.99 (0.99-1.00) < 0.01
Occupation
Production operator -0.18 0.84 (0.72-0.97) < 0.05
Technical workers -0.10 0.90 (0.80-1.01)
Others 0.12 1.13 (0.99-1.28)
Office workers
Smoking
Yes 0.22 1.24 (1.23-1.39) < 0.001
No
Average daily sleep time
≥8 h -0.56 0.56 (0.51-0.61) < 0.001
< 8 h
Average daily sitting time
>12 h 0.80 2.22 (1.88-2.62) < 0.001
>8 h 0.47 1.60 (1.36-1.90) < 0.001
>4 h 0.34 1.41 (1.19-1.68) < 0.001
≤4 h
Physical exercise
Low 0.54 1.77 (1.58-1.99) < 0.001
Moderate 0.15 1.17 (1.02-1.33) 0.03
High

2.4. 久坐行为和体育锻炼对焦虑倾向的联合作用

按照各个组别焦虑倾向检出风险的 OR 值进行排序,结果显示随着每日平均静坐时间的增加伴随体育锻炼水平的降低,职业人群焦虑倾向的发生风险呈上升趋势,低水平体育锻炼且每日总静坐时间( OR =3.14,95% CI :2.07~4.78)或工作静坐时间( OR =2.67,95% CI :2.10~3.40)最高组人群的焦虑倾向检出风险最高。当每日总静坐时间 < 4 h/d时,任何体育锻炼水平组人群的焦虑倾向检出风险差异均无统计学意义( P >0.05, 图 1 )。在所有体育锻炼水平组别中,工作静坐时间超过8 h均是出现焦虑倾向的危险因素( 图 2 )。

体育锻炼和总静坐时间与焦虑倾向的联合(A)和分层(B)相关性分析

Joint (A) and stratified (B) associations of sitting time in total and physical activity with anxiety

A, joint associations of sitting time in total, the reference categories are the groups with the highest levels of physical activity in combination with < 4 h/d of sitting; B, stratified associations of sitting time in total, the reference categories is the group of < 4 h/d of sitting at each level of physical activity. HA, highly active; MA, moderated active; LA, low active; ST, sitting time.

体育锻炼和工作静坐时间与焦虑倾向的联合(A)和分层(B)相关性分析

Joint (A) and stratified (B) associations of work sitting time and physical activity with anxiety

A, joint associations of work sitting time, the reference categories are the groups with the highest levels of physical activity in combination with ≤4 h/d of sitting; B, stratified associations of work sitting time, the reference categories is the group of ≤4 h/d of sitting at each level of physical activity. HA, highly active; MA, moderated active; LA, low active; WST, work sitting time.

分层分析结果显示,不同体育锻炼水平组中,静坐时间与出现焦虑倾向风险呈相似正相关趋势,但阈值有所变化。在高水平体育锻炼组,静坐时间>12 h/d才是焦虑倾向的危险因素;在中水平体育锻炼组,该阈值下降为静坐时间>8 h/d;而在低水平体育锻炼组,静坐时间>4 h/d即为焦虑倾向的危险因素。

3. 讨论

本研究中调查对象焦虑倾向的检出率为29.9%,该数据低于《中国国民心理健康发展报告(2020)》中报道的科技工作者的焦虑检出率(55.5%),但高于医务工作者的焦虑检出率(19.8%)。本研究调查人群的工作职位主要是企业的普通员工,工作压力相对较小,但依然提示当前我国职业人群的心理健康现况不容乐观。本研究显示,40岁以下职业人群的焦虑检出率高于40岁以上人群。《中国国民心理健康发展报告(2020)》指出,18~34岁青年的焦虑和抑郁症状检出率显著高于其他年龄段成人,与本研究结果一致,提示需重视青年职业人群心理健康问题的预防和干预。在员工焦虑倾向的多因素分析中发现,除静坐行为和体育锻炼行为外,年龄、吸烟和睡眠质量同样是其影响因素,本研究结果与既往研究结果一致 [ 10 - 12 ]

本次调查的职业人群平均每天静坐时间达到9.4 h,高于美国一项回顾性研究中的7.7 h [ 13 ] 以及韩国卫生统计局数据报告的8.3 h [ 14 ] ,且总体静坐时间中,6.1 h来自于工作时的被动静坐时间。女性的静坐时间要显著高于男性,文化程度更高的人群久坐行为更为严重。同时,有60%的调查对象仅为低体育锻炼水平,提示当前国内职业人群的久坐现象和缺乏体育锻炼现象已十分严重,针对性地改善这两种现象是未来工作场所健康促进的重要方向之一。另外,BMI正常的人群比超重或肥胖人群更易发生久坐行为,原因可能与成年人尤其是女性会主动控制体质量的行为有关 [ 15 ]

本研究发现,平均每日静坐时间的长短与焦虑倾向检出率呈明显的正相关趋势,且在不同体育锻炼水平组中存在相同趋势。一项久坐行为与成人患抑郁症风险相关性的回顾性研究显示,久坐行为导致抑郁发生的影响机制主要是心理健康层面的社交退缩假说,该假说认为长时间使用电子设备等行为会促使人远离其他直接的社会交往和身体活动,进而导致抑郁等心理疾病检出风险的增加 [ 16 - 17 ] 。久坐行为导致焦虑产生的直接生物学机制尚不清楚,但静坐在通常情况下是一种可以按比例替代运动的行为 [ 18 - 19 ] 。体育锻炼可以通过刺激大脑与焦虑抑郁相关的区域、减少炎症发生等机制来发挥对心理健康的保护作用,其他潜在机制需要在未来研究中进一步发掘。

本研究通过联合相关性分析发现,更高水平的体育锻炼行为可以弥补部分静坐时间过长对员工焦虑带来的负面影响。一项包含100万人的随访数据显示,每日更高水平的体育活动可以减轻甚至消除过长时间坐姿导致的全因死亡风险的增加 [ 9 ] ,另一项随访研究也证明了体育活动对心脑血管疾病影响的相同结论 [ 20 ] ,本研究结果也证明了两种行为与焦虑问题相似的联合相关性。出现这种结果的原因可能是过长的静坐时间导致每日体育锻炼水平下降,进而抵消了体育锻炼对人们心理健康的保护作用。

本研究存在局限性,首先,本研究为横断面研究,无法做出因果推断,久坐行为与发生焦虑的因果关联需要进一步研究证实;其次,本次调查的企业为自愿报名参与项目的企业而非随机抽样,可能与国内职业人群总体存在一定差异;第三,工作场所通常代表一个较为复杂的工作环境,包括工作设备和条件以及周围同事等,由多维度之间的交互作用共同组成,职业人群焦虑的影响因素较为广泛,本次调查中控制的协变量有限,导致研究结果可能在一定程度上存在限制。

综上所述,当前国内职业人群久坐行为严重,作为心理健康疾患的重要影响因素之一,控制久坐行为可以成为未来工作场所心理健康促进中潜在的干预方向,需在未来健康教育与促进中进一步重视。加强体育锻炼行为可以在一定程度上减轻久坐带来的危害,未来相关心理健康疾患干预计划中可以将两种行为相结合,以达到更好的干预效果。

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