บ้าออกกำลังมาก กับโรคไขสันหลังฝ่อ กล้ามเหี่ยวอ่อนแรง Lifetime Physical Activity and the Risk of Amyotrophic Lateral Sclerosis Mark H B Huisman, Meinie Seelen, Sonja W de Jong, Kirsten R I S Dorresteijn, Perry T C van Doormaal, Anneke J van der Kooi, Marianne de Visser, Helenius Jurgen Schelhaas, Leonard H van den Berg, Jan Herman Veldink J Neurol Neurosurg Psychiatry. 2013;84(9):976-981. Abstract and Introduction Abstract Background It has been hypothesised that physical activity is a risk factor for developing amyotrophic lateral sclerosis (ALS), fuelled by observations that professional soccer players and Gulf War veterans are at increased risk. In a population based study, we determined the relation between physical activity and risk of sporadic ALS, using an objective approach for assessing physical activity. Methods 636 sporadic ALS patients and 2166 controls, both population based, completed a semistructured questionnaire on lifetime history of occupations, sports and hobbies. To objectively compare the energy cost of a lifetime history of occupational and leisure time physical activities and to reduce recall bias, metabolic equivalent scores were assigned to each activity based on the Compendium of Physical Activities. Results ALS patients had significantly higher levels of leisure time physical activity compared with controls (OR 1.08, 95% CI 1.02 to 1.14, p=0.008). No significant difference was found between patients and controls in the level of vigorous physical activities, including marathons and triathlons, or in occupational activity. Cumulative measures of physical activity in quartiles did not show a dose–response relationship. Conclusions An increased risk of ALS with higher levels of leisure time physical activity was found in the present study. The lack of association with occupational physical activity and the absence of a dose–response relationship strengthen the hypothesis that not increased physical activity per se but rather a genetic profile or lifestyle promoting physical fitness increases ALS susceptibility. Introduction Sporadic amyotrophic lateral sclerosis (ALS) is believed to be a complex disease, with multiple genetic and environmental factors causing motor neuron degeneration.[1] Ever since Lou Gehrig, the legendary 1930s baseball player known as The Iron Horse, died from ALS, it has been hypothesised that physical activity is a risk factor for developing this disease. Although assuming an association based on an individual well known patient is fraught with risk, the hypothesis has been fuelled by recent observations that professional soccer and football players, and Gulf War veterans, are at increased risk of sporadic ALS.[2–6] Several theories have been proposed that may explain the possible association of physical activity with ALS susceptibility.[7–9] Although some studies have suggested a relation between physical activity and the risk of ALS, the results may have been biased due to methodological shortcomings inherent in studying a relatively low incidence disease.[3, 10–13] A population based case control study can alleviate some of these limitations and, therefore, provide a high level of evidence in ALS exogenous risk factor studies. We performed a large population based case control study in The Netherlands to determine the relation between physical activity and the risk of sporadic ALS, adjusted for known risk factors, using an objective quantitative approach for assessing physical activity, and taking into account the lifetime history of occupational and leisure time activities of each patient and control. To minimise recall bias, we measured the energy cost of the lifetime history of occupational and leisure time physical activities in an objective manner by assigning metabolic equivalent (MET) scores to each activity based on the Compendium of Physical Activities.[14] Methods Study Population The Prospective ALS study The Netherlands (PAN) is a population based case control study performed in The Netherlands during the period 1 January 2006 to 31 December 2010. Complete case ascertainment was ensured by continuous recruitment through multiple sources: neurologists, rehabilitation physicians, the Dutch Neuromuscular Patient Association and our ALS website. All patients diagnosed with possible, probable (laboratory supported) or definite ALS according to the revised El Escorial criteria were included.[15] Medical records were scrutinised for eligibility of patients, excluding patients with an ALS mimic syndrome or with a first, second or third degree family member with ALS. As exogenous factors—probably—had only a minor role in the development of ALS in patients with the highly penetrant C9ORF72 repeat expansion, these patients, 43 in total, were excluded from our analysis.[16–18] To ascertain population based controls, the general practitioner of the participating patient was asked to select individuals from his register in alphabetical order starting at the surname of the patient. The Dutch health care system ensures that every inhabitant is registered with a general practitioner, which makes this roster representative of the population. Controls were matched to patients for gender and age (±5 years). This study, however, did not use individual matching, meaning that some general practitioners delivered several controls while others delivered none. As can be seen in , our case and control groups were well matched for age and gender. Blood relatives or spouses of patients were not eligible to be controls, to prevent over matching. Table 1. Baseline demographic and clinical characteristics of participants Characteristic ALS patients (n=636) Controls (n=2166) p Value Male (n (%)) 395 (62.1) 1259 (58.1) 0.17 Age (years) (median (range))* 63 (23 to 87) 62 (20 to 91) 0.91 Site of onset (n (%)) Bulbar 204 (32.3) Spinal 427 (67.7) El Escorial classification (n (%)) Definite 112 (17.8) Probable 280 (44.6) Probable lab supported 111 (17.7) Possible 119 (18.9) Education (n (%)) No education 2 (0.3) 3 (0.1) Primary school 54 (8.5) 131 (6.1) Junior vocational education 127 (20.0) 356 (16.5) Lower general secondary education 149 (23.4) 474 (21.9) 0.02 Intermediate vocational education 106 (16.7) 410 (18.9) Higher general secondary education 45 (7.1) 186 (8.6) College/university 153 (24.1) 604 (27.9) BMI (kg/m2) (median (range)) 24.1 (12 to 48) 25.6 (16 to 53)
Posted on: Wed, 04 Dec 2013 02:00:30 +0000
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