促进社区居民脑健康的运动干预方案的构建

Construction of a Community-based Physical Activity Intervention Program Promoting Brain Health

背景保持脑健康是健康老龄化的高阶目标,运动作为备受关注的促进脑健康和降低认知障碍风险的重要干预措施,在2019年WHO发布的《认知衰退与痴呆风险防控指南》(简称《指南》)中受到强烈推荐。但由于《指南》鲜少就运动类型、运动量和干预方式等方面做出具体指导,难以在社区内被付诸实践。目的构建促进我国社区居民脑健康的运动干预方案。方法于2021年12月,系统检索国内外有关运动促进脑健康的文献,由两名研究者独立筛选文献、对纳入文献进行方法学质量评价后,提取及汇总证据,经课题组讨论初步形成促进社区居民脑健康的运动干预方案。于2022年2—3月,采用专家函询法对13名专家进行两轮函询,通过计算专家积极系数、专家权威系数、专家协调系数,以及各级指标的权重和判断矩阵的一致性比率,最终确定运动干预方案。结果共检索到8943篇文献,最终纳入26篇文献,汇总得到涉及干预对象及运动原则、运动类型、运动强度及时间、运动效果及其评价、运动注意事项5个方面的27条证据。经课题组讨论初步构建的促进社区居民脑健康的运动干预方案由6项一级指标、32项二级指标构成。两轮专家函询问卷回收率均为100.0%,专家权威系数分别为0.940和0.925,Kendall’s W系数分别为0.257(χ2=123.386,P<0.001)和0.275(χ2=139.548,P<0.001)。最终形成的促进社区居民脑健康的运动干预方案包括一级指标7项(干预对象及运动原则、干预前评估、干预形式、运动类型、运动强度及时间、运动效果及其评价、运动注意事项)、二级指标33项。7项一级指标的权重分别为0.213、0.213、0.213、0.066、0.116、0.116、0.066,各层级指标判断矩阵的一致性比率均<0.1000。结论促进社区居民脑健康的运动干预方案具有科学性和实用性,可为社区医护人员开展促进脑健康的运动干预工作提供指导。

Background Maintaining brain health is an advanced goal of healthy ageing.As an important intervention to promote brain health and reduce the risk of cognitive impairment,physical activity is highly recommended in the WHO Guidelines on Risk Reduction of Cognitive Decline and Dementia.However,due to the lack of specific guidance on the types of exercise,amount of exercise and intervention methods,it is difficult to carry out physical activity in the community.Objective To construct a community-based physical activity intervention program to promote brain health in community-dwelling Chinese residents.Methods A draft of Community-based Physical Activity Intervention Program Promoting Brain Health(CPAIPPBH)was developed in December 2021 based on the evidence extracted from studies searched systematically after being screened and assessed in terms of quality by two researchers independently,and review results of our research group.Then from February to March 2022,the draft was revised in accordance with the results of a two-round email-based Delphi survey with 13 experts,and response rate,authority coefficient,Kendall’s W,weight of each indicator,and the logical consistency of indicators at all levels were calculated,and finally the formal version was developed.Results Altogether,26 out of the 8 943 searched studies were enrolled,from which 27 pieces of evidence were summarized,involving target group and principles of physical activity,type of physical activity,intensity and time of physical activity,effect and relevant evaluation of physical activity,and considerations for physical activity.The draft CPAIPPBH consisted of 6 primary indicators and 32 secondary indicators.The response rate,authority coefficient,and Kendall’s W were 100.0%,0.940,and 0.257(χ~2=123.386,P<0.001),respectively,for the first round of survey,and were 100.0%,0.925,and 0.275(χ2=139.548,P<0.001),respectively,for the second round of survey.The final program includes 7 primary indicators(including target group and principles of physical activity,pre-intervention assessment,form of intervention,type of physical activity,intensity and time of physical activity,effect and relevant evaluation of physical activity,and considerations for physical activity,with corresponding weights of 0.213,0.213,0.213,0.066,0.116,0.116,0.066,respectively)and 33 secondary indicators.The consistency ratios of primary and secondary indicators were all <0.100 0.Conclusion The CPAIPPBH developed by us has proven to be scientific and practical,which could be used to guide the management of community-based physical activity interventions for brain health by community medical workers.