肌少症老年人运动康复的健康效益：系统综述的系统综述

doi:10.3969/j.issn.1006-9771.2023.00.003

Abstract

Abstract:

Objective To analyze the disease and functioning characteristics of older adults with sarcopenia, the main exercise rehabilitation interventions, and its health benefits.

Methods Literature related to exercise rehabilitation for older adults with sarcopenia was searched in PubMed, Medline, Embase, Cochrane Library and CNKI, from 2013 to 2023. The quality of included systematic reviews were evaluated. ICD-11 and ICF classification systems, and PICO framework from PRISMA guideline were used to report characteristics of the disease and functioning of the population, the exercise rehabilitation interventions, and its health benefits.

Results Finally, seven systematic reviews from Netherlands, Spain, China, Brazil and Mexico were included, covering 98 related randomized controlled trials, involving 19 794 participants. These systematic reviews mainly came from the journals in the fields of aging, rehabilitation, nutrition, public health and physical exercise, and were published between 2018 and 2023. Exercise rehabilitation for sarcopenia were categorized into three types: exercise rehabilitation, exercise rehabilitation combined with nutritional supplementation, and exercise rehabilitation combined with nursing care. Interventions primarily included aerobic training, resistance training, gait training, strength training, and balance and flexibility exercises. The intervention frequency was six to 150 minutes, one to five times a week, with intensities ranging from low to high, over a duration of six to 144 weeks. The health benefits for older adults with sarcopenia from exercise rehabilitation were reflected in improvement in physical function and structure, and enhancement in activity and participation. In terms of body function and structure, exercise rehabilitation improved muscle strength, control, coordination, gait, balance, leg extension, leg press, back strength and grip strength, and increased muscle quality. In terms of activity and participation, exercise rehabilitation improved physical activity performance, such as walking speed and time of ﬁve-repetition chair stand test.

Conclusion Exercise rehabilitation for sarcopenia includes exercise rehabilitation, exercise rehabilitation combined with nutritional supplementation, and exercise rehabilitation combined with nursing care. Exercise rehabilitation can improve the physical function and structure, and enhance activity and participation.

Key words: elderly, sarcopenia, exercise rehabilitation, systematic review

CLC Number:

R685

QIAO Hujun, HAO Xin, LIU Xiaoyan, WANG Guoxiang. Health benefits of exercise rehabilitation in older adults with sarcopenia: a systematic review of systematic reviews[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(11): 1296-1303.

Figures/Tables 3

作者	国家	样本特征	干预类型	干预情境	运动康复干预方案	比较	健康结局指标
Vlietstra等^[11](2018)	荷兰	纳入文献：6篇样本量：480 平均年龄：60岁以上	身体活动	居家锻炼与康复社区治疗与康复	运动康复干预方案：抗阻运动(步态训练、平衡训练和力量训练)；积极的家庭锻炼计划(全身振动训练) 干预频率：每次6~60 min，每周2~3次干预强度：中等干预持续时间：12~24周	与对照组相比，干预组老年人伸膝力量显著改善	身体结构与功能肌力随着锻炼而改善(伸膝力量) 四肢肌肉质量显著改善腿部肌肉质量显著改善
Escriche-Escuder等^[12](2021)	西班牙	纳入文献：7篇样本量：235 平均年龄：60岁以上	身体活动	未提及	运动康复干预方案：抗阻运动、有氧运动干预频率：每周2~3次干预强度：中至高等干预持续时间：12~36周	与对照组相比，运动组肌力提高，其中大多数对照组采用了不同的运动方式与对照组相比，运动组身体表现改善效果更明显，如运动执行时间减少，平衡功能改善	身体结构与功能肌力(握力)显著改善平衡功能改善活动和参与缩短患者5次坐立测试时间步行速度显著改善
Shen等^[13](2023)	中国	纳入文献：42篇样本量：3 728 平均年龄：72.9岁	身体活动结合营养计划的身体活动	社区治疗与康复医疗机构治疗与康复	结合护理和营养的运动康复方案运动康复干预方案：抗阻运动、有氧运动、平衡运动干预频率：未提及干预强度：未提及干预持续时间：8~144周	与普通护理相比，有营养或无营养的抗阻运动以及抗阻运动与有氧和平衡训练相结合是提高生活质量的最有效干预措施与单独运动相比，在运动中添加营养干预对握力的影响更大与对照组相比，有或无营养的抗阻和平衡运动对改善身体功能最有效与社区康复相比，结合营养的抗阻运动和平衡运动对在医院的老年人的握力影响更大	身体结构与功能肌力(握力)显著改善平衡功能改善活动和参与显著缩短老年人5次坐立测试时间
Lee 等^[14](2018)	中国	纳入文献：10篇样本量：12 512 平均年龄：60岁以上	身体活动结合护理的运动康复	居家锻炼与康复社区治疗与康复医疗机构治疗与康复	结合护理的运动康复方案运动康复干预方案：有氧、抗阻、力量、平衡和柔韧性训练；结合集体锻炼和应对策略、营养、健康教育和问题解决干预干预频率：每次50~150 min，每周2~4次干预强度：低至高等干预持续时间：24~96周	与单纯的运动康复干预相比，使用综合护理形式的运动康复干预更有助于提高老年人握力与低强度运动干预相比，中等强度或剧烈强度体育活动更有助于改善老年人的身体功能表现与单一方式的运动干预相比，混合训练形式更有助于改善老年人肌肉质量	身体结构与功能握力显著提高骨骼肌质量有所改善肌肉质量有所改善活动和参与步行速度显著提高
Barajas-Galindo 等^[15](2021)	西班牙	纳入文献：12篇样本量：954 平均年龄：60岁以上	身体活动(有氧、抗阻、平衡训练、步行) 结合营养计划的身体活动结合护理的运动康复	居家锻炼与康复社区治疗与康复医疗机构治疗与康复	多模式运动康复方案：力量训练和多模式运动(包括神经肌肉、抗阻和有氧运动的组合)、步行干预频率：每次20~90 min，每周2~4次干预强度：低至高等干预持续时间：6~72周	与低强度的力量训练相比，高强度力量训练对老年人的肌力改善效果更明显与单一运动训练相比，多模式运动干预措施对老年人身体功能及其表现有效且耐受性更好与低锻炼频率的组相比，锻炼频率更频繁(每周2次以上)的老年人功能改善效果更好	身体结构与功能肌力得到改善
De Mello等^[16](2019)	巴西	纳入文献：5篇样本量：300 平均年龄：60岁以上	身体活动(抗阻、平衡训练)	未提及	运动康复方案：抗阻运动(上肢、下肢弹力带练习) 干预频率：每次35~60 min，每周2~3次干预强度：中至高等干预持续时间：12周	与干预前相比，抗阻运动能显著改善老年人的肌力	身体结构与功能肌力得到显著改善活动和参与步行速度显著提高
Hernández-Lepe 等^[17](2023)	墨西哥	纳入文献：16篇样本量：1 585 平均年龄：60岁以上	身体活动(有氧、抗阻、平衡训练、步态训练) 结合营养计划的身体活动	居家锻炼与康复社区治疗与康复	结合营养的运动康复方案运动康复干预方式：抗阻运动(负重和弹力带练习)、平衡运动和有氧训练、步态训练干预频率：每周1~5次干预强度：未提及干预持续时间：8~24周	与单一运动训练相比，坚持联合干预(运动+补充营养)对老年人肌力、步态稳定性等功能改善效果更佳	身体结构与功能维持并增加肌力肌肉质量增加步态稳定性腿部伸展、腿举、背部力量或握力测试结果显著改善

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人群(Population)	干预(Intervention)	比较(Comparison)	结局(Outcome)
疾病和残疾类别	康复干预类型	干预类型	身体功能与结构
肌少症(FB3Z 未特指的肌肉疾患)	运动康复(有氧、抗阻、平衡训练、步行)	干预方案	(上肢、下肢、躯干)肌肉力量(b730 肌肉力量功能)
主要运动功能障碍	结合营养计划的运动康复	干预人群	(上肢、下肢、躯干)肌肉耐力(b740 肌肉耐力功能)
肌肉力量低下(b730 肌肉力量功能)	结合护理的运动康复	干预情境	(上肢、下肢、躯干)肌肉质量(s770 与运动有关的附属肌肉骨骼的结构)
活动表现不佳	运动康复干预方案		(上肢、下肢、躯干)肌肉控制和协调 (b760 随意运动控制功能)
年龄：60岁以上	干预方式		步态功能(b770 步态功能)
	干预频率		平衡功能(b760 随意运动控制功能)
	干预强度		腿部伸展、腿举、背部力量或握力(b710 关节活动功能、b720 骨骼活动功能)
	干预持续时间		活动和参与
	运动康复干预情境		步行速度(d450 步行)
	居家锻炼与康复		5次坐立测试时间(b710 关节活动功能、b720 骨骼活动功能)
	社区治疗与康复
	医疗机构治疗与康复

作者	国家	样本特征	干预类型	干预情境	运动康复干预方案	比较	健康结局指标
Vlietstra等^[11](2018)	荷兰	纳入文献：6篇样本量：480 平均年龄：60岁以上	身体活动	居家锻炼与康复社区治疗与康复	运动康复干预方案：抗阻运动(步态训练、平衡训练和力量训练)；积极的家庭锻炼计划(全身振动训练) 干预频率：每次6~60 min，每周2~3次干预强度：中等干预持续时间：12~24周	与对照组相比，干预组老年人伸膝力量显著改善	身体结构与功能肌力随着锻炼而改善(伸膝力量) 四肢肌肉质量显著改善腿部肌肉质量显著改善
Escriche-Escuder等^[12](2021)	西班牙	纳入文献：7篇样本量：235 平均年龄：60岁以上	身体活动	未提及	运动康复干预方案：抗阻运动、有氧运动干预频率：每周2~3次干预强度：中至高等干预持续时间：12~36周	与对照组相比，运动组肌力提高，其中大多数对照组采用了不同的运动方式与对照组相比，运动组身体表现改善效果更明显，如运动执行时间减少，平衡功能改善	身体结构与功能肌力(握力)显著改善平衡功能改善活动和参与缩短患者5次坐立测试时间步行速度显著改善
Shen等^[13](2023)	中国	纳入文献：42篇样本量：3 728 平均年龄：72.9岁	身体活动结合营养计划的身体活动	社区治疗与康复医疗机构治疗与康复	结合护理和营养的运动康复方案运动康复干预方案：抗阻运动、有氧运动、平衡运动干预频率：未提及干预强度：未提及干预持续时间：8~144周	与普通护理相比，有营养或无营养的抗阻运动以及抗阻运动与有氧和平衡训练相结合是提高生活质量的最有效干预措施与单独运动相比，在运动中添加营养干预对握力的影响更大与对照组相比，有或无营养的抗阻和平衡运动对改善身体功能最有效与社区康复相比，结合营养的抗阻运动和平衡运动对在医院的老年人的握力影响更大	身体结构与功能肌力(握力)显著改善平衡功能改善活动和参与显著缩短老年人5次坐立测试时间
Lee 等^[14](2018)	中国	纳入文献：10篇样本量：12 512 平均年龄：60岁以上	身体活动结合护理的运动康复	居家锻炼与康复社区治疗与康复医疗机构治疗与康复	结合护理的运动康复方案运动康复干预方案：有氧、抗阻、力量、平衡和柔韧性训练；结合集体锻炼和应对策略、营养、健康教育和问题解决干预干预频率：每次50~150 min，每周2~4次干预强度：低至高等干预持续时间：24~96周	与单纯的运动康复干预相比，使用综合护理形式的运动康复干预更有助于提高老年人握力与低强度运动干预相比，中等强度或剧烈强度体育活动更有助于改善老年人的身体功能表现与单一方式的运动干预相比，混合训练形式更有助于改善老年人肌肉质量	身体结构与功能握力显著提高骨骼肌质量有所改善肌肉质量有所改善活动和参与步行速度显著提高
Barajas-Galindo 等^[15](2021)	西班牙	纳入文献：12篇样本量：954 平均年龄：60岁以上	身体活动(有氧、抗阻、平衡训练、步行) 结合营养计划的身体活动结合护理的运动康复	居家锻炼与康复社区治疗与康复医疗机构治疗与康复	多模式运动康复方案：力量训练和多模式运动(包括神经肌肉、抗阻和有氧运动的组合)、步行干预频率：每次20~90 min，每周2~4次干预强度：低至高等干预持续时间：6~72周	与低强度的力量训练相比，高强度力量训练对老年人的肌力改善效果更明显与单一运动训练相比，多模式运动干预措施对老年人身体功能及其表现有效且耐受性更好与低锻炼频率的组相比，锻炼频率更频繁(每周2次以上)的老年人功能改善效果更好	身体结构与功能肌力得到改善
De Mello等^[16](2019)	巴西	纳入文献：5篇样本量：300 平均年龄：60岁以上	身体活动(抗阻、平衡训练)	未提及	运动康复方案：抗阻运动(上肢、下肢弹力带练习) 干预频率：每次35~60 min，每周2~3次干预强度：中至高等干预持续时间：12周	与干预前相比，抗阻运动能显著改善老年人的肌力	身体结构与功能肌力得到显著改善活动和参与步行速度显著提高
Hernández-Lepe 等^[17](2023)	墨西哥	纳入文献：16篇样本量：1 585 平均年龄：60岁以上	身体活动(有氧、抗阻、平衡训练、步态训练) 结合营养计划的身体活动	居家锻炼与康复社区治疗与康复	结合营养的运动康复方案运动康复干预方式：抗阻运动(负重和弹力带练习)、平衡运动和有氧训练、步态训练干预频率：每周1~5次干预强度：未提及干预持续时间：8~24周	与单一运动训练相比，坚持联合干预(运动+补充营养)对老年人肌力、步态稳定性等功能改善效果更佳	身体结构与功能维持并增加肌力肌肉质量增加步态稳定性腿部伸展、腿举、背部力量或握力测试结果显著改善

Health benefits of exercise rehabilitation in older adults with sarcopenia: a systematic review of systematic reviews

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