运动对预防老年人跌倒效果的网状Meta分析

doi:10.3969/j.issn.1006-9771.2021.05.009

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (5): 563-573.doi: 10.3969/j.issn.1006-9771.2021.05.009

运动对预防老年人跌倒效果的网状Meta分析

郭静霞^1,²,陈亮^1,²(),余启超²,吴渔²

^1.福建师范大学体育科学学院运动与健康福建省高校重点实验室，福建福州市 350117
^2.福建师范大学体育科学学院，福建福州市 350117

收稿日期:2020-11-24 修回日期:2021-03-19 出版日期:2021-05-25 发布日期:2021-05-26
通讯作者: 陈亮 E-mail:cullencl@126.com
作者简介:郭静霞(1997-)，女，汉族，湖北十堰市人，硕士研究生，主要研究方向：运动与健康|陈亮(1983-)，男，山东曲阜市人，博士，副教授，主要研究方向：运动训练理论。
基金资助:
国家社会科学基金青年项目(15CTY019);福建省社会科学规划项目(FJ2020B082)

Efficacy of Exercise on Fall in Old Adults: A Network Meta-analysis

Jing-xia GUO^1,²,Liang CHEN^1,²(),Qi-chao YU²,Yu WU²

^1.Provincial University Key Laboratory of Sport and Health Science, School of Physical Education and Sport Sciences, Fujian Normal University, Fuzhou, Fujian 350117, China
^2.School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, Fujian 350117, China

Received:2020-11-24 Revised:2021-03-19 Published:2021-05-25 Online:2021-05-26
Contact: Liang CHEN E-mail:cullencl@126.com
Supported by:
National Social Science Fund of China(15CTY019);Fujian Social Science Planning(FJ2020B082)

摘要/Abstract

摘要： 目的

系统评价运动对预防老年人跌倒的疗效。

方法

检索1980年至2020年7月Web of Science、PubMed、Cochrane Library、中国知网数据库有关运动对预防老年人跌倒的随机对照试验，采用Review Manager 5.3对纳入文献进行质量评价，应用R-Studio和Addis 1.16.6软件进行网状Meta分析。

结果

纳入172项研究，共9种运动干预手段。运动与认知结合训练减少老年人跌倒率最有效(OR = 0.26, 95%CI 0.14~0.49, P < 0.05)；全身振动结合运动训练对提高老年人Berg平衡量表评分(d = 6.3, 95%CI 3.5~9.2, P < 0.05)和计时起立-行走测试成绩(d = -4.5, 95%CI -6.8~-2.1, P < 0.05)方面最有效；血流限制训练对提高下肢肌力最有效(d = 12, 95%CI 7.4~16, P < 0.05)。

结论

认知与运动结合训练是降低老年人跌倒率最优先推荐的运动方式，太极拳和组合运动方式次之，单纯步态训练或抗阻训练效果最差。多种新型干预手段(血流限制、全身振动与运动结合、体感游戏等)对提高老年人身体功能有一定优势，可继续深入研究。

关键词: 运动, 老年, 跌倒, 平衡, 移动, 下肢肌力, 网状meta分析

Abstract: Objective

To evaluate the efficacy of exercise on preventing falls in the elderly.

Methods

Literatures of randomized controlled trials about exercises for prevention of falls in the elderly were retrieved from Web of Science, PubMed, Cochrane Library and CNKI from 1980 to July, 2020. The qualities were evaluated with Review Manager 5.3, and the data were analyzed with R-Studio and Addis 1.16.6.

Results

A total of 172 randomized controlled trials were finally included, with nine kinds of exercise intervention. The cognition and movement multitask training was the most effective to decrease fall rate (OR = 0.26, 95%CI 0.14 to 0.49, P < 0.05). The combined physical and whole body vibration training was the most effective to improve the score of Berg Balance Scale (d = 6.3, 95%CI 3.5 to 9.2, P < 0.05) and the time of Timed 'Up & Go' Test (d = -4.5, 95%CI -6.8 to -2.1, P < 0.05). The blood flow restriction training was the most effective to increase the lower limb muscle strength (d = 12, 95%CI 7.4 to 16, P < 0.05).

Conclusion

The cognition and movement multitask training is the first recommended exercise to prevent falls in the elderly, followed by Taiji Quan and multimodal training. Gait practice or resistance training are the least effective. A variety of new intervention methods (blood flow restriction training, combined physical and whole body vibration training, Wit Fit training, etc.) may improve the physical function of the elderly, and need further researches.

Key words: exercise, aged, fall, balance, mobility, lower limb muscle strength, network meta-analysis

中图分类号:

R592

郭静霞,陈亮,余启超,吴渔. 运动对预防老年人跌倒效果的网状Meta分析[J]. 《中国康复理论与实践》, 2021, 27(5): 563-573.

Jing-xia GUO,Liang CHEN,Qi-chao YU,Yu WU. Efficacy of Exercise on Fall in Old Adults: A Network Meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(5): 563-573.

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运动(ICF编码)	定义	机制	评价指标
BFR (d420、b730)	通过特殊加压装置对肢体施加140~200 mmHg压强，以增强肌力	使静脉血流闭塞，同时部分阻塞动脉血流	TUGT、下肢肌力
CMM (d450、d410、d420、b730)	将心理学理论和范式与游戏化思维结合，以各种多任务练习为特色设计的训练	增强记忆力、注意力和自我保护意识等，提高对任务相关刺激的选择性反应	跌倒率、BBS、TUGT、下肢肌力
MT (d450、d410、d420、b730)	将平衡、抗阻、有氧等多种形式的运动进行组合	多种形式运动对力量、耐力、平衡稳定性等产生交互影响	跌倒率、BBS、TUGT、下肢肌力
RT (d450、d420、b730)	采用外部负荷对特定或全身肌群进行的力量训练	使肌肉面积增加，质量提高，调节中枢神经系统兴奋性	跌倒率、TUGT、下肢肌力
PE (d450、d410、d420、b730)	不进行抗阻练习且采用单一形式的运动	对受试者缺失的能力进行针对性训练	跌倒率、BBS、TUGT、下肢肌力
TC (d450、d410、d420、b730)	一种中国传统拳术	增强核心肌群力量，并通过身心调节提高练习者的协调性	跌倒率、BBS、TUGT、下肢肌力
WBV (d450、d410、d420、b730)	将频率为25~35 Hz的低强度机械振动作用于身体，引起全身肌肉震荡的训练方法	肌肉发生周期性拉长与缩短，进而兴奋肌梭，引起骨骼肌收缩	跌倒率、BBS、TUGT、下肢肌力
PWBV (d410、d420、b730)	将WBV与RT、平衡等训练形式相结合	将全身振动引起的被动收缩与主动收缩相结合，弥补单一运动的不足	BBS、TUGT、下肢肌力
Wii (d410、d420、b730)	通过肢体运动操控电子游戏的交互式训练方法	通过多样化的运动增加训练趣味性，提高训练动机和注意力	BBS、TUGT、下肢肌力

基本信息		文献数(n)	研究对象数(n)
年龄(岁)	60~75	87	9629
	≥ 75	85	11009
运动方式	BFR	8	203
	CMM	5	477
	MT	71	11194
	PE	28	2325
	RT	16	1491
	TC	27	4422
	WBV	25	1666
	PWBV	4	185
	Wii	13	518
运动干预时间(周)	≤ 12	90	5764
	> 12	82	14874
每周运动时间(h)	< 2	33	4935
	2~< 3	62	8589
	≥ 3	77	7114
健康状况	无特殊疾病	127	17436
	帕金森病	9	827
	脑卒中/脑卒中	14	788
	骨质疏松/关节炎	11	600
	其他	11	987
运动场所	家庭	26	3907
	小组/社区/疗养院	98	14273
	跑步机/特殊辅助仪器	48	2458
结局指标	跌倒率	54	12065
	BBS	44	3193
	TUGT	84	7117
	下肢肌力	66	6021
文献质量评价	A	4	517
	B	168	20121
	C	0	0

运动方式	跌倒率		BBS		TUGT		下肢肌力
运动方式	研究数	I2	研究数	I2	研究数	I2	研究数	I2
BFR	—	—	—	—	2	55.6%	6	77.9%
CMM	3	42.6%	—	—	2	87.6%	—	—
MT	26	69.4%	17	95.2%	28	94.2%	37	98.5%
PE	4	0.0%	9	85.6%	11	91.8%	11	87.4%
RT	4	60.0%	—	—	4	96.2%	21	98.4%
TC	17	37.8%	6	74.4%	10	73.3%	7	85.4%
WBV	3	0.0%	2	86.9%	13	54.6%	22	76.9%
PWBV	—	—	2	0.0%	1	—	—	—
Wii	—	—	6	56.3%	8	38.3%	2	22.1%

运动方式	跌倒率	BBS	TUGT	下肢肌力
BFR	—	—	0.01	0.99
CMM	0.95	0.40	0.05	—
MT	0.00	0.00	0.00	0.00
PE	0.00	0.01	0.00	0.00
PWBV	—	0.58	0.93	—
RT	0.01	—	0.00	0.01
TC	0.01	0.00	0.00	0.00
WBV	0.02	0.00	0.00	0.00
Wii	—	0.00	0.01	0.00

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运动对预防老年人跌倒效果的网状Meta分析

Efficacy of Exercise on Fall in Old Adults: A Network Meta-analysis

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