下肢抗阻训练对老人步行能力及平衡能力影响的Meta分析

A Meta-analysis regarding the effect of lower limb resistance training on walking ability and balance ability in the elderly

目的:大量研究已证实下肢抗阻训练对增加老年人骨骼肌含量、降低肌肉减少症发生率具有较为显著的效果。关于下肢抗阻训练是否能够对老年人步行能力及平衡能力产生积极影响,目前存在较大争议。因此,文章通过Meta分析判断下肢抗阻训练对老年人步行能力和平衡能力的干预效果,为老年人抗阻训练标准化运动处方制定提供理论依据。方法:计算机检索Cochrane Library、PubMed、Web of Science、EBSCO Host、万方和中国知网数据库,收集下肢抗阻训练对老年人步行能力与平衡能力影响的随机对照试验。由2名研究者依据Cochrane系统评价手册,对所筛选文献进行方法学质量评价,提取主要结局指标(起立-行走计时测试时间、常规步行速度、功能性前伸测试距离、睁眼单腿站立测试时间)以及次要结局指标(最大步行速度)。采用RevMan 5.3软件对纳入文献进行Meta分析。结果:①最终纳入14项符合标准的随机对照试验,经文献质量评价后,所有文献除选择性报告和其他偏倚风险均为不清楚外,纳入文献质量整体较好;②此14项研究共纳入551例受试者,试验组285例,对照组266例;③Meta分析结果显示,与对照组相比,下肢抗阻训练能够明显改善80岁以下老年人的起立-行走计时测试时间(60-69岁:MD=-0.99,95%CI:-1.90至-0.08,P<0.05;70-79岁:MD=-1.17,95%CI:-2.50至-0.08,P<0.01),睁眼单腿站立测试时间(MD=3.92,95%CI:2.46-5.38,P<0.01),功能性前伸距离(MD=4.85,95%CI:1.93-6.63,P<0.01),其中12周以上的训练对起立-行走计时测试时间结果的异质性更小(I2=0),但下肢抗阻训练对80岁以上老年人起立-行走计时测试时间(MD=-4.92,95%CI:-15.65-5.81,P=0.37)、所有试验组受试者正常步行速度(MD=0.03,95%CI:-0.05-0.10,P=0.46)及最大步行速度(MD=0.08,95%CI:-0.02-0.17,P=0.11)改善效果不明显。结论:①下肢抗阻训练能够提高老年人平衡能力以及80岁以下老年人的起立-行走计时测试水平,对于正常步行速度和最大步行速度无显著影响;②未来对于老年人的运动处方制定应该更加标准和完善,同时在运动处方的制定过程中需要区别不同年龄段老年人的身体特征,从而保障运动处方在不同年龄段人群实施过程中的科学性和有效性。

OBJECTIVE:A large number of studies have confirmed that lower limb resistance training has a significant effect on increasing skeletal muscle content and reducing the incidence of myopenia in the elderly.At present,there is a great controversy about whether lower limb resistance training can have a positive impact on the walking ability and balance ability of the elderly.Therefore,this Meta-analysis focuses on the intervention effect of lower limb resistance training on walking ability and balance ability of the elderly,so as to provide a theoretical basis for the formulation of standardized exercise prescription for the elderly.METHODS:A computer-based search was conducted in the English databases of Cochrane Library,PubMed,Web of Science,EBSCO Host,and the Chinese databases of WanFang and CNKI.Randomized controlled trials addressing the effect of lower limb resistance training on walking ability and balance ability in the elderly were collected.Two researchers independently evaluated the methodological quality of the included articles according to the Cochrane system evaluation manual,and extracted the main outcome indicators,including time up-and-go(TUG)test,routine walking speed,functional extension test(FET),one-leg stand with eyes open(OLSO)test,and secondary outcome index,maximum walking speed.The included articles were analyzed using RevMan 5.3 software for a Meta-analysis.RESULTS:Fourteen randomized controlled trials were finally included.After the quality evaluation,except for selective reports and other bias risks that were unclear,the overall quality of the articles included was good.A total of 551 subjects were included in these 14 trials,including 285 in experimental group and 266 in the control group.Compared with the control group,lower limb resistance training could significantly improve the TUG time of the elderly under 80 years old[for 60-69 years old,mean difference(MD)=-0.99,95%confidence interval:-1.90 to-0.08,P<0.05;for 70-79 years old,MD=-1.17,95%CI:-2.50 to-0.08,P<0.01],OLSO time(MD=3.92,95%CI:2.46 to 5.38,P<0.01),FET distance(MD=4.85,95%CI:1.93 to 6.63,P<0.01),and the heterogeneity of TUG time was smaller after more than 12 weeks of training(I^(2)=0).However,the lower limb resistance training had no significant effect on normal walking speed(MD=0.03,95%CI:-0.05 to 0.10,P=0.46)and maximum walking speed(MD=0.08,95%CI:-0.02 to 0.17,P=0.11)in all the subjects as well as on TUG time(MD=-4.92,95%CI:-15.65 to 5.81,P=0.37)in people over 80 years old.CONCLUSION:Lower limb resistance training can effectively improve the balance ability of the elderly and the TUG level of the elderly under 80 years old,but there is no significant change in normal walking speed and maximum walking speed.In the future,the formulation of exercise prescription for the elderly should be more standardized and improved and verified.Importantly,the physical characteristics of the elderly at different ages should be distinguished in the formulation of exercise prescriptions,so as to ensure the scientificity and effectiveness of exercise prescriptions in the implementation of different age groups.