慢性病和功能障碍老年人身体活动的健康效果：系统综述的系统综述

doi:10.3969/j.issn.1006-9771.2022.09.002

Abstract

Abstract:

Objective To construct the scope and framework of physical activity interventions on the health and health-related conditions (functioning) of old people with chronic diseases and dysfunction using World Health Organization Family of International Classifications (WHO-FICs).
Methods The health and health-related conditions of the old people were systematically analyzed using International Classification of Diseases, Eleventh Revision (ICD-11), and International Classification of Functioning, Disability and Health (ICF). The systematic reviews about effects of physical activity interventions on the health and health-related conditions in the old people with chronic diseases and dysfunction were retrieved from PubMed, CBM, Scopus, Web of Science, Embase, CNKI, VIP and Wanfang Data from establishment to August 8th, 2022, and systematically reviewed.
Results Eleven systematic reviews were accepted, which were from six countries, involved 316 randomized controlled trials and 28 169 participants. The main topics included aging, public health, rehabilitation, physical exercise, etc. The main health and health related conditions for the old people were mainly dementia, Parkinson's disease, schizophrenia, depression, cognitive impairment; osteoporosis, osteoarthritis, sarcopenia; chronic heart failure, coronary heart disease, hypertension, stroke; type 2 diabetes; and chronic obstructive pulmonary disease; etc. For the interventions, physical activity mainly included balance, functional and endurance training, flexibility training; walking, stretching, upper and lower limb training; Yoga, Qigong, Taijiquan; etc. The proposed prescription was one to seven times a week, moderate intensity, and continued four weeks to ten years of duration. The health and health related outcomes included reduction of the risk of chronic diseases; improvement of overall cognitive function, mental function, muscular endurance, cardiopulmonary endurance, flexibility, etc.; enhancement of walking, movement, balance, flexibility, posture control, etc.; improvement of sleep quality, anxiety and stress; improvement of engagement in participation and interpersonal interaction, and happiness; etc.
Conclusion A conceptual framework of the health effects of participation in physical activity on the old people with chronic diseases and dysfunction is constructed using WHO-FICs. Health and health-related conditions for old people involve in the systems of cognitive, psychological and psychiatric system, skeletal, muscle and joints systems, cardiovascular and cerebrovascular systems, metabolic system, and respiratory system. The intervention programs include physical fitness, skills-oriented activity and sports event programs. The health and functional outcomes are mainly included reduction of risk of chronic disease, improvement of functioning, enhancement in physical activity skills, promotion of mental health, and improvement of quality of life and well-being.

Key words: elderly, chronic diseases, dysfunction, physical activity, exercise, rehabilitation, systematic review

CLC Number:

R592

YUAN Yuan,YANG Jian. Effect of physical activity on health conditions and functioning for aging people with chronic diseases and functioning: a systematic review of systematic reviews[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(9): 1003-1011.

Figures/Tables 4

研究	国家	研究对象	健康和功能状况	干预环境	干预策略	比较	康复结局指标
Denham‐Jones等^[13](2022)	英国	> 60岁纳入文献87篇 n = 2221	骨关节炎肌少症手部疼痛颈部疼痛	社区家庭	瑜伽每周1~3次中等强度共8周~10年	与步行比较,瑜伽对肌少症的功能性方面更优群体锻炼的坚持程度高于家庭锻炼	疼痛生理功能生活质量
Lee等^[14](2020)	美国	> 62岁纳入文献18篇 n = 602	脑卒中	社区家庭由合格培训师或研究人员进行训练	有氧与抗阻训练每次20~30 min,每周3次中等强度共20周	每周训练3 d比训练2 d或4 d,步行能力增加无监督的比有监督的肌力和行走能力增强	心肺功能肌力行走能力
Gavelin等^[15](2021)	澳大利亚	65.0~87.2岁纳入文献45篇 n = 4052	轻度认知障碍痴呆帕金森病	未说明	有氧运动、力量或功能(步态或平衡)训练每次80~90 min,每周1~6次共8~40周	与体育锻炼相比,同时和连续训练对认知功能的影响更显著同时训练、顺序训练和体育锻炼对身体功能更为有效	有氧能力、力量、移动性、平衡或步态神经精神症状、抑郁、生活质量日常生活活动
Yen等^[16](2021)	中国	> 60岁纳入文献18篇	抑郁症	家庭实验室	虚拟现实游戏(自行车、舞蹈、皮划艇或拳击) 每次20~60 min,每周2~5次中等强度共4~26周	抑郁程度蹬固定自行车,VR皮划艇等	总体认知功能记忆注意力和执行功能抑郁发病率情绪、孤独感、成就感
Campos等^[17](2021)	巴西	平均71.3岁纳入文献16篇 n = 1707	骨关节炎骨质减少或骨质疏松症痴呆抑郁	热浴池桑拿室	水上运动(抗阻训练、肌肉激活、柔韧性、灵活性) 每周1~6次,每次15~90 min 中等强度共4~26周	水上运动比陆上运动有更多益处	生活质量跌倒恐惧认知功能情绪状态
Wen等^[18](2022)	中国	> 50岁纳入文献17篇 n = 204	关节炎带状疱疹慢性疼痛	社区家庭	太极拳、瑜伽、气功每次20~90 min 中等强度共6~52周	与太极拳和气功相比,瑜伽具有更大镇痛效果	疼痛强度身体功能生活质量
Taylor-Piliae等^[19](2020)	美国	平均66岁纳入文献15篇 n = 1853	慢性心力衰竭冠心病高血压脑卒中	医院社区家庭	太极拳 12~156次,平均36次中等强度共6~52周(平均17周)	与不干预相比,太极拳干预总体生活质量更佳冠心病患者比高血压患者心理健康水平改善更显著	生活质量心理焦虑压力焦虑抑郁
Mosalman Haghigh等^[20](2018)	澳大利亚	> 60岁纳入文献23篇 n = 9640	2型糖尿病	诊所健身房家庭	有氧训练、抗阻训练、有氧与抗阻训练联合每次25 min,每天2次,每周3 d, 中等强度共6~12个月	监督锻炼身体活动水平改善程度比无监督锻炼更高面对面干预的益处比远程干预大	身体活动水平血糖血压体质量指数血脂
Jadczak等^[21](2018)	澳大利亚	> 60岁纳入文献58篇 n = 6927	虚弱肌肉萎缩	社区家庭	抗阻训练、有氧、平衡和灵活性任务每次10~90 min,每周2~3次共5~72周	抗阻训练对肌力效果显著	肌力步速平衡身体表现
温柔等^[22](2021)	中国	> 60岁纳入文献8篇 n = 558	轻度认知障碍	社区家庭	舞蹈(广场舞、体育舞蹈、有氧舞蹈) 每次35~60 min,每周2~7次共3~12个月	与慢走相比,交谊舞和太极拳能更好改善平衡功能;与单纯服用药物相比,广场舞对整体认知功能效果明显,复发率降低	整体认知功能记忆功能执行功能平衡功能
Li 等^[23](2020)	中国	> 60岁纳入文献11篇 n = 405	慢性阻塞性肺疾病	家庭	抗阻训练(举重机、自由重量或弹性带) 每个动作重复3次,每次8~12组,每周3 d 50%~80% 1RM > 8周	与非运动干预相比,抗阻训练耐力增强,运动耐受时间改善	功能性运动能力耐力运动能力峰值运动能力

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人群(People)		干预策略	比较	结局
健康及健康相关状况	ICF编码	(Intervention)	(Comparison)	(Outcome)
认知、心理和精神系统疾病和功能骨骼关节肌肉系统疾病和功能心脑血管系统疾病和功能呼吸系统疾病和功能代谢系统疾病和功能	b身体功能 b1精神功能 b2感觉功能和疼痛 b4心血管、免疫、呼吸功能 b7神经肌肉骨骼功能 d活动和参与 d3交流 d4活动 d5自理 d7人际交往和人际关系	活动类型体适能类技能类运动项目类运动处方活动方式活动频率活动强度活动持续时间	人口学因素：性别、年龄环境：社区、家庭、康复机构疾病：健康及健康相关状况有无干预不同干预措施	治疗疾病促进健康改善身体功能促进心理健康提升活动和参与功能提高生活质量和福祉

研究	国家	研究对象	健康和功能状况	干预环境	干预策略	比较	康复结局指标
Denham‐Jones等^[13](2022)	英国	> 60岁纳入文献87篇 n = 2221	骨关节炎肌少症手部疼痛颈部疼痛	社区家庭	瑜伽每周1~3次中等强度共8周~10年	与步行比较,瑜伽对肌少症的功能性方面更优群体锻炼的坚持程度高于家庭锻炼	疼痛生理功能生活质量
Lee等^[14](2020)	美国	> 62岁纳入文献18篇 n = 602	脑卒中	社区家庭由合格培训师或研究人员进行训练	有氧与抗阻训练每次20~30 min,每周3次中等强度共20周	每周训练3 d比训练2 d或4 d,步行能力增加无监督的比有监督的肌力和行走能力增强	心肺功能肌力行走能力
Gavelin等^[15](2021)	澳大利亚	65.0~87.2岁纳入文献45篇 n = 4052	轻度认知障碍痴呆帕金森病	未说明	有氧运动、力量或功能(步态或平衡)训练每次80~90 min,每周1~6次共8~40周	与体育锻炼相比,同时和连续训练对认知功能的影响更显著同时训练、顺序训练和体育锻炼对身体功能更为有效	有氧能力、力量、移动性、平衡或步态神经精神症状、抑郁、生活质量日常生活活动
Yen等^[16](2021)	中国	> 60岁纳入文献18篇	抑郁症	家庭实验室	虚拟现实游戏(自行车、舞蹈、皮划艇或拳击) 每次20~60 min,每周2~5次中等强度共4~26周	抑郁程度蹬固定自行车,VR皮划艇等	总体认知功能记忆注意力和执行功能抑郁发病率情绪、孤独感、成就感
Campos等^[17](2021)	巴西	平均71.3岁纳入文献16篇 n = 1707	骨关节炎骨质减少或骨质疏松症痴呆抑郁	热浴池桑拿室	水上运动(抗阻训练、肌肉激活、柔韧性、灵活性) 每周1~6次,每次15~90 min 中等强度共4~26周	水上运动比陆上运动有更多益处	生活质量跌倒恐惧认知功能情绪状态
Wen等^[18](2022)	中国	> 50岁纳入文献17篇 n = 204	关节炎带状疱疹慢性疼痛	社区家庭	太极拳、瑜伽、气功每次20~90 min 中等强度共6~52周	与太极拳和气功相比,瑜伽具有更大镇痛效果	疼痛强度身体功能生活质量
Taylor-Piliae等^[19](2020)	美国	平均66岁纳入文献15篇 n = 1853	慢性心力衰竭冠心病高血压脑卒中	医院社区家庭	太极拳 12~156次,平均36次中等强度共6~52周(平均17周)	与不干预相比,太极拳干预总体生活质量更佳冠心病患者比高血压患者心理健康水平改善更显著	生活质量心理焦虑压力焦虑抑郁
Mosalman Haghigh等^[20](2018)	澳大利亚	> 60岁纳入文献23篇 n = 9640	2型糖尿病	诊所健身房家庭	有氧训练、抗阻训练、有氧与抗阻训练联合每次25 min,每天2次,每周3 d, 中等强度共6~12个月	监督锻炼身体活动水平改善程度比无监督锻炼更高面对面干预的益处比远程干预大	身体活动水平血糖血压体质量指数血脂
Jadczak等^[21](2018)	澳大利亚	> 60岁纳入文献58篇 n = 6927	虚弱肌肉萎缩	社区家庭	抗阻训练、有氧、平衡和灵活性任务每次10~90 min,每周2~3次共5~72周	抗阻训练对肌力效果显著	肌力步速平衡身体表现
温柔等^[22](2021)	中国	> 60岁纳入文献8篇 n = 558	轻度认知障碍	社区家庭	舞蹈(广场舞、体育舞蹈、有氧舞蹈) 每次35~60 min,每周2~7次共3~12个月	与慢走相比,交谊舞和太极拳能更好改善平衡功能;与单纯服用药物相比,广场舞对整体认知功能效果明显,复发率降低	整体认知功能记忆功能执行功能平衡功能
Li 等^[23](2020)	中国	> 60岁纳入文献11篇 n = 405	慢性阻塞性肺疾病	家庭	抗阻训练(举重机、自由重量或弹性带) 每个动作重复3次,每次8~12组,每周3 d 50%~80% 1RM > 8周	与非运动干预相比,抗阻训练耐力增强,运动耐受时间改善	功能性运动能力耐力运动能力峰值运动能力

健康状况	体适能类	技能类	运动项目类
认知、心理和精神	有氧运动力量或功能训练(步态或平衡)	热身运动步行伸展平衡运动运动协调练习单域计算机认知训练多域计算机认知训练	水上运动舞蹈练习瑜伽普拉提气功太极拳 VR游戏
骨骼关节肌肉	水上运动抗阻训练肌肉激活柔韧性训练灵活性练习有氧运动	热身运动步行伸展平衡运动运动协调练习单跳跃锻炼课程耐力训练上下肢练习呼吸肌训练和步行	瑜伽太极拳气功
心脑血管	灵活性训练平衡练习运动协调练习有氧训练抗阻训练	渐进式站立训练热身运动步行伸展	太极拳
呼吸	有氧训练抗阻训练		瑜伽太极拳气功
代谢	有氧训练抗阻训练		瑜伽太极拳气功

Effect of physical activity on health conditions and functioning for aging people with chronic diseases and functioning: a systematic review of systematic reviews

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