双任务干预改善健康老年人平衡功能效益的系统综述

doi:10.3969/j.issn.1006-9771.2022.12.007

摘要/Abstract

摘要：

目的系统综述双任务干预对健康老年人平衡功能干预的有效性。

方法检索Web of Science核心合集、PubMed、CNKI和万方数据库，搜索双任务干预健康老年人平衡功能影响的随机对照试验(RCTs)，检索时间2010年1月至2022年11月。利用物理治疗证据数据库(PEDro)量表评价文献质量。由两名研究人员根据纳入、排除标准进行文献筛选、数据提取和风险偏倚评估。

结果最终纳入14篇双任务干预健康老年人平衡功能的RCTs研究，来自10个国家，共涉及1 279例健康老年人，来源于运动心理、运动康复、老年人康复等研究领域。PEDro量表平均分为7.85分。老年人平衡功能干预中的双任务模式主要有运动-认知、运动-运动和认知-认知3种类型。其中运动干预方式为平衡训练和力量训练等体适能类、姿势控制和步态练习等运动技能类。运动-认知双任务干预是在运动干预的基础上同步进行认知干预，如记忆、注意和执行功能等；运动-运动双任务干预是在运动干预的基础上同步进行持物练习、日常事务等次要运动干预；认知-认知双任务干预要求被试同时执行两项认知任务。双任务干预老年人平衡功能主要表现在3个方面。①平衡功能：保持站姿和移动自身。②平衡功能相关的体适能：下肢肌力功能等。③平衡功能相关的心理和整体健康功能：单任务步行、双任务步行、日常事务、跌倒频率、跌倒恐惧、平衡信心等。

结论双任务和单任务干预模式均能够改善健康老年人平衡功能和相关体适能，提高站姿稳定性和自身移动能力，改善下肢力量和下肢活动功能，降低跌倒风险和恐惧心理感。特别是双任务干预模式在提高双任务平衡控制表现方面优于单任务干预模式，更能够提升日常生活能力和整体健康发展。

关键词: 双任务干预, 健康老年人, 平衡功能, 系统综述

Abstract:

Objective To conduct systematic review on the benefits of dual-task intervention on balance function for healthy aged people.

Methods The Web of Science core collection, PubMed, CNKI, and Wanfang database were searched for randomized controlled trial (RCTs) on the effects of dual-task interventions on balance function in healthy aged people from January 1st, 2010, to November, 2022. The quality of the literature was evaluated with the Physiotherapy Evidence Database (PEDro) scale. Literature screening, data extraction, and risk bias assessment were performed by two researchers based on inclusion and exclusion criteria.

Results Fourteen RCTs of dual-task interventions for balance function in healthy older adults from ten countries with a total of 1 279 healthy aged people from the research fields of sport psychology, exercise rehabilitation, and geriatric rehabilitation were finally included. The mean score of the PEDro scale was 7.85. The main types of dual-task modalities for balance function interventions for aged people were motor-cognitive, motor-motor and cognitive-cognitive. Within these, the main motor intervention modalities were physical fitness such as balance training and strength training, and motor skill such as postural control and gait exercises. Motor-cognitive dual-task interventions referred to simultaneously performing motor and cognitive skills exercises, such as memory, attention and executive functions. Motor-motor dual-task interventions referred to simultaneously performing motor and second motor exercises, such as object-holding exercises and daily routines. Cognitive-cognitive dual-task interventions referred to simultaneously performing two cognitive exercises. The efftects of dual-task intervention model on balance function of aged people might be in three aspects. (1) Balance function: maintaining standing posture and moving oneself. (2) Balance function-related physical fitness: lower limb muscle strength functions, etc. (3) Balance function-related mental and overall health functioning: single-task walking, dual-task walking, daily life, falling possibility, fear of falling, balance confidence, etc.

Conclusion Both dual-task and single-task intervention modes could improve the balance function and related physical fitness of healthy aged people, improve the stability of standing posture and self-mobility, improve the strength and function of lower limbs, and reduce the risk of falls and psychological fear. In particular, the dual-task intervention model is superior to the single-task intervention model in improving dual-task balance control performance, and was more able to improve the ability of daily living and overall health development.

Key words: dual-task intervention, healthy aged people, balance function, systematic review

中图分类号:

R493

兰文岑,张丹璇,王斌. 双任务干预改善健康老年人平衡功能效益的系统综述[J]. 《中国康复理论与实践》, 2022, 28(12): 1426-1434.

LAN Wencen,ZHANG Danxuan,WANG Bin. Benefits of dual-task intervention on balance function for healthy aged people: a systematic review[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(12): 1426-1434.

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纳入文献基本特征"

纳入文献	国家	样本特征	纳入人群	身体活动干预策略/处方	比较	康复结局指标
Wollesen等^[7](2017)	德国	T1(n = 29)：双任务，(70.7±4.9)岁 T2(n = 23)：单任务运动，(71.7±4.9)岁 T3(n = 26)：对照组，(73.7±5.0)岁	具有独立生活能力、无重大疾病、无慢性病的老年人	①干预时间：60 min。②干预周期：12周。③干预频次：每周1次。④干预地点：体育馆。⑤干预内容：单任务运动进行力量训练；双任务进行多种双任务力量训练。	与单任务运动干预相比，双任务干预更有利于增加单任务步态中的步长和步态线，双任务步态中的步长。	从事多项任务(d220) 跌倒感(b2402) 步行(d450)
Akin等^[18](2021)	土耳其	T1(n = 25)：运动-认知双任务，(65.88±4.58)岁 T2(n=25)：运动-运动双任务， (69.56±9.03)岁	无平衡障碍史、无重大疾病的老年人	①干预时间：40 min。②干预周期：8周。③干预频次：未提及。④干预地点：未提及。⑤干预内容：运动-认知双任务在姿势控制练习的同时进行递减计算任务；运动-运动双任务在姿势控制练习的同时进行持物练习。	与运动-认知双任务干预相比，运动-运动双任务干预更有利于改善股四头肌、双侧腓肠肌和胫骨前肌等肌力；两种训练在改善功能性移动和跌倒恐惧方面无显著性差异。	跌倒感(b2402) 下肢肌肉力量功能(b7303) 移动自身(d420)
Azadian等^[19](2016)	伊朗	T1(n = 10)：运动-认知双任务， (73.9±5.5) 岁 T2(n = 10)：单任务认知，(73.8±3.9)岁 C(n = 10)：(73.7±4.4)岁	无平衡障碍的老年人	①干预时间：45 min。②干预周期：8周。③干预频次：每周3次，④干预地点：未提及。⑤干预内容：运动-认知在姿势控制和步态练习时进行递增负荷认知干预；单任务认知进行执行功能训练。	双任务和单任务认知训练改善步态的时空参数；与双任务相比，单任务认知训练更有利于改善步速、步长时间和支撑时间。	步态功能(b770)
Barban等^[20](2017)	意大利	T1(n = 121)：运动-认知双任务，(74.5±7.9)岁 T2(n = 118)：单任务认知，(74.1±7.2)岁 T3(n = 119)：单任务运动，(75.5±8.5)岁 C(n = 123)：(76±8.8)岁	具有跌倒风险的老年人	①干预时间：60 min。②干预周期：12周。③干预频次：每周2次。④干预地点：居家/医院。⑤干预内容：单任务运动进行平衡和步态训练；单任务认知进行执行功能和注意训练；运动-认知双任务连续完成运动和认知练习；对照组进行简单认知练习。	双任务和单任务运动干预均能提高平衡和步态能力，减少跌倒恐惧。各指标在训练间无显著性差异。	跌倒感(b2402) 移动自身(d420)
Bischoff等^[21](2021)	德国	T(n = 14)：认知-运动双任务， (83.6±7.3)岁 C(n = 10)：(83.8±5.7)岁	具有一定认知行为和行动能力的老年人	①干预时间：45~60 min。②干预周期：16周。③干预频次：每周2次。④干预地点：养老院。⑤干预内容：运动认知双任务进行平衡、力量和耐力练习时进行认知游戏干预。	双任务干预提高下肢功能。	下肢肌肉力量功能(b7303)
Brustio等^[22](2018)	意大利	T1(n = 22)：运动-运动双任务， (74.3±2.6)岁 T2(n = 19)：单任务运动，(75.2±3.4)岁 C(n = 60)：(74±3.2)岁	具有独立生活能力、认知能力、无重大疾病的老年人	①干预时间：60 min。②干预周期：16周。③干预频次：每周2次。④干预地点：未提及。⑤干预内容：单任务运动进行平衡和步行练习；运动-运动双任务在平衡和步行练习时进行日常事务练习。	双任务干预提高动态平衡。步速在双任务和单任务运动干预间无显著性差异。	从事多项任务(d220) 移动自身(d420) 步行(d450)
Eggenberger等^[23](2015)	瑞士	T1(n = 22)：运动-认知双任务， (78.5±5.1)岁 T2(n = 24)：舞蹈，(77.3±6.3)岁 T3(n = 25)：单任务运动，(80.8±4.7)岁	具有独立生活能力、无行走障碍的老年人	①干预时间：60 min。②干预周期：26周。③干预频次：每周2次。④干预地点：医院。⑤干预内容：舞蹈进行虚拟视频舞蹈；单任务运动进行步行练习；运动-认知双任务在步行练习的同时进行记忆练习。	舞蹈和双任务干预提高下肢功能、步速和步长，降低步态变异性跌倒恐惧和跌倒频率。各指标在训练间无显著性差异。	从事多项任务(d220) 跌倒感(b2402) 下肢肌肉力量功能(b7303) 步行(d450)
Jehu等^[24](2017)	加拿大	T1(n = 15)：运动-运动双任务， (68.7±5.5)岁 T2(n = 24)：单任务运动，(70.2±6.3)岁 C(n = 12)：(66.7±4.2)岁	健康老年人	①干预时间：60 min。②干预周期：12周。③干预频次：每周3次。④干预地点：未提及。⑤干预内容：单任务运动进行平衡和步行练习；运动-认知双任务在平衡和步行练习时进行持物练习。	双任务和单任务运动干预均提高单任务和双任务条件下的动态平衡，各指标在训练间无显著性差异。	从事多项任务(d220) 移动自身(d420)
Laatar等^[25](2018)	突尼斯	T1(n = 12)：双任务，(66.29±3.61)岁 T2(n = 12)：单任务运动(67.45±2.38)岁	能独立行走、无重大疾病的老年人	①干预时间：60 min。②干预周期：12周。③干预频次：每周3次。④干预地点：未提及。⑤干预内容：单任务运动进行平衡练习；双任务在平衡练习时进行认知或持物练习。	双任务和单任务运动干预均能减少姿势摆动，提高动态平衡、下肢力量和耐力和功能性移动性。双任务比单任务运动干预更能提高步速。	下肢肌肉力量功能(b7303) 保持站姿(b4154) 移动自身(d420) 步行(d450) 自理(d5)
Javadpour等^[26](2022)	伊朗	T1(n = 23)：运动-认知双任务，(68.86±3.48)岁 T2(n = 23)：单任务运动， (67.65±2.42)岁 C(n = 23)：(69.34±3.77)岁	能够独立行走、无重大疾病的老年人	①干预时间：40~60 min。②干预周期：6周。③干预频次：每周3次。④干预地点：未提及。⑤干预内容：单任务运动进行步行练习；运动-认知双任务在步态练习时进行递减任务。	双任务和单任务运动干预均能提高站姿稳定性、步速、步态稳定、跌倒恐惧和平衡信心。各指标在训练干预间无显著性差异。	从事多项任务(d220) 跌倒感(b2402) 保持站姿(b4154) 移动自身(d420) 步行(d450)
Rezola-Pardo等^[27](2019)	西班牙	T1(n = 42)：运动-认知双任务， (84.9±6.7)岁 T2(n = 43)：单任务运动， (85.3±7.1)岁	具有独立行走能力老年人	①干预时间：40~60 min。②干预周期：6周。③干预频次：每周3次。④干预地点：健身房。⑤干预内容：单任务运动进行力量和平衡训练；运动-认知双任务在力量和平衡训练时进行注意、执行功能和记忆练习。	双任务和单任务运动干预均能提高步速和下肢功能，单任务运动干预更有利于改善下肢功能。	从事多项任务(d220) 下肢肌肉力量功能(b7303) 移动自身(d420) 步行(d450)
Trombini-Souza等^[28](2022)	巴西	T1(n = 30)：固定焦点的双任务， (67±5)岁 T2(n = 30)：可变焦点的双任务， (66±4)岁	无慢性疾病、能够独立行走的老年人	①干预时间：60 min。②干预周期：24周。③干预频次：每周2次。④干预地点：健身房。⑤干预内容：改变注意焦点的双任务练习。	两组双任务干预均能减少跌倒恐惧，提高平衡信心。各指标在训练干预间无显著性差异。	跌倒感(b2402)
Wollesen等^[29](2017)	德国	T1(n = 26)：运动-认知双任务， (72.2±4.6)岁 T2(n = 30)：运动-认知双任务， (69.8±5.7)岁 C1(n = 19)：(72.9±4.4)岁 C2(n = 20)：(72.7±5.3)岁	具有独立生活能力、能够独立行走、无重大疾病的老年人	①干预时间：60 min。②干预周期：12周。③干预频次：每周1次。④干预地点：体育馆。⑤干预内容：运动-认知双任务在步行同时进行执行功能等练习。	双任务干预可增加高跌倒恐惧者的步态线，减少跌倒恐惧水平。	从事多项任务(d220) 跌倒感(b2402) 步行(d450)
Wongcharoen等^[30](2017)	泰国	T1(n = 15)：运动-认知双任务，(71.87±4.57)岁 T2(n = 15)：认知-认知双任务，(74.73±5.97)岁 T3(n = 15)：单任务运动， (73.53±5.94)岁 T4(n = 15)：单任务认知，(72.4±6.3)岁	无任何影响行走疾病的老年人	①干预时间：60 min。②干预周期：4周。③干预频次：每周3次。④干预地点：体育馆。⑤干预内容：单任务运动进行姿势控制练习；单任务认知进行步态相关的认知练习；运动-认知双任务同时执行上述运动训练和认知练习；认知-认知双任务进行两项认知练习。	运动-认知双任务干预可增加步长、步速和步态稳定，认知-认知双任务干预没有改善平衡能力。	从事多项任务(d220) 步行(d450)

表3

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