渐进性抗阻训练对骨质疏松患者自我效能及骨密度改善的影响

Effect of health management of progressive resistance training on the self-efficacy and bone mineral density improvement in patients with osteoporosis

目的探讨渐进性抗阻训练对骨质疏松患者自我效能及骨密度改善的影响。方法本研究为横断面研究,选取2019年9月到2022年3月在浙江省中医药大学附属江南医院诊治的156例原发性骨质疏松患者作为研究对象,对其临床资料进行分析。其中78例患者接受的是常规骨质疏松药物治疗同时给予常规健康教育和同伴教育,设为对照组。另外78例患者在对照组的基础上,健康管理方案中还增加了渐进性抗阻训练,设为观察组。结合两组6个月的随访记录,分析患者干预前和干预6个月后自我效能水平的变化及骨密度的改善情况。采用χ^(2)检验、t检验对上述指标进行统计学分析。结果观察组的饮食、心理、运动、用药的依从性分别为97.4%、97.4%、98.7%、97.4%,均高于对照组89.7%、87.2%、88.5%、87.2%;观察组干预前后的自我效能评分为(110.09±11.73)与(217.05±8.12)分、焦虑评分为(46.44±3.17)与(31.92±3.28)分、抑郁评分为(51.60±3.42)与(33.32±2.98)分、骨质疏松知识评分为(14.99±2.14)与(24.40±1.28)分,对照组患者干预前后的自我效能评分为(110.81±12.53)与(185.36±12.29)分、焦虑评分为(46.92±2.18)与(36.53±3.54)分、抑郁评分(51.56±3.93)与(39.02±2.65)分、骨质疏松知识评分为(14.76±2.93)与(20.11±1.84)分,两组患者干预前评分差异均无统计学意义(均P>0.05);在干预6个月后观察组的各项评分显著均高于对照组(P<0.05)。观察组患者干预前的腰椎(L1~4)骨密度、股骨粗隆骨密度及髋部骨密度分别为(0.869±0.127)、(0.608±0.110)和(0.740±0.138)分,干预后分别为(0.915±0.107)、(0.654±0.108)和(0.785±0.134)分;对照组干预前的L1-4骨密度、股骨粗隆骨密度及髋部骨密度分别为(0.833±0.126)、(0.607±0.114)和(0.738±0.135)分,干预后分别为(0.869±0.114)、(0.643±0.114)和(0.748±0.124)分,干预后观察组L1-4骨密度高于对照组(P<0.05)。两组干预前各项骨密度与干预后的股骨粗隆骨密度及髋部骨密度差异均无统计学意义(均P>0.05)。结论在药物治疗的同时进行渐进性抗阻训练可以有效改善骨质疏松患者的骨密度水平。

Objective To explore the effect of health management of progressive resistance training on self-efficacy and bone mineral density(BMD)improvement in osteoporosis patients.Methods It was a cross-sectional study.Clinical data of 156 patients with primary osteoporosis treated in Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine from September 2019 to March 2022 were analyzed retrospectively.A simple random sampling method was implied,and 78 patients were set as control group,they were treated with conventional osteoporosis drugs and routine health education and peer education.And the other 78 patients were set as observation group,and progressive resistance training was added to the health management program in these patients on the basis of the intervention of the control group.Combined with the 6-month follow-up records of the two groups,the changes of self-efficacy level and the improvement of BMDin the two groups before and after the intervention were analyzed and compared.The above indexes were statistically analyzed with χ^(2) test or t test.Results The compliance of diet,psychology,exercise and medication in the observation group was 97.4%,97.4%,98.7% and 97.4%,respectively,which were all higher than those in the control group(89.7%,87.2%,88.5%and 87.2%).The self-efficacy score before and after intervention in the observation group was 110.09±11.73 and 217.05±8.12,the anxiety score was 46.44±3.17 and 31.92±3.28,the depression score was 51.60±3.42 and 33.32±2.98,the osteoporosis knowledge score was 14.99±2.14 and 24.40±1.28,respectively;and those were 110.81±12.53 and 185.36±12.29,46.92±2.18 and 36.53±3.54,51.56±3.93 and 39.02±2.65,14.76±2.93 and 20.11±1.84 respectively in the control group;and there was no statistically significant difference in above-mentioned indexes between the two groups before the intervention(all P>0.05);but after 6 months of intervention,the above-mentioned scores of the observation group were all significantly superior than those in the control group(all P<0.05).The BMD of lumbar spine L1-4,femoral trochanter and hip in the observation group before intervention was 0.869±0.127,0.608±0.110 and 0.740±0.138,respectively,and after the intervention,it was 0.915±0.107,0.654±0.108 and 0.785±0.134,respectively;the BMD of lumbar spine L1-4,femoral trochanter and hip in the control group was 0.833±0.126,0.607±0.114 and 0.738±0.135,respectively before intervention,and it was 0.869±0.114,0.643±0.114 and 0.748±0.124,respectively after intervention.After intervention,the lumbar L1-4 bone density in the observation group was higher than that in the control group,the difference was statistically significant(P<0.05).There was no significant difference in all the BMD before intervention and the BMD of the femoral trochanter and the hip after intervention between the two groups(all P>0.05).Conclusion The health management of progressive resistance training combined with drug therapy can effectively improve the BMD in patients with osteoporosis.