运动锻炼对老年人睡眠干预效果分析 --基于Meta系统综述

Effects of Exercise on Sleep Intervention in Elderly People:A Meta-systematic Review

目的:运用Meta分析方法系统评价运动锻炼对老年人睡眠的干预效果,为老年人睡眠的实践干预提供有力的证据支持。方法:(1)于Web of Science、Pubmed、The Cochrane Library数据库检索文献,运用Cochrane量表评价纳入文献质量;(2)采用Revman5.3软件进行发表偏倚评价、异质性检验、亚组分析和Meta回归分析等。结果:(1)研究样本:16项RCT研究纳入本Meta分析,其中8项为健康老年人群,8项为非健康老年人群,共包含样本1116例;Cochrane量表评价项基本处于低风险,纳入文献总体方法学质量较好。(2)干预效果:①运动锻炼对老年人睡眠的综合改善效果为大效应量程度(P<0.05),其中对睡眠时间干预效应不显著(P>0.05);②身心健康状况对运动干预老年人睡眠效果的影响呈高异质性(I^(2)=84%,P<0.01),运动锻炼对身心健康老年人群睡眠(MD=-2.70,P<0.01)的干预效应量高于非健康老年人群(MD=-2.38,P<0.01)。(3)干预方案:①异质性检测表明运动锻炼方案中的运动内容、强度、单次持续时间、干预周频率、周期是影响老年人睡眠运动干预效果的重要因素(P<0.01);②对老年人睡眠的干预效应量大小依次为有氧运动(MD=-2.39,P<0.01)有氧与抗阻组合锻炼(MD=-1.92,P<0.01)和抗阻锻炼(MD=-1.37,P<0.05);③中等运动强度获得了改善老年人睡眠的最大干预效应(MD=-2.01,P<0.01),低到中等强度(MD=-1.76,P<0.01)与低强度(MD=-1.58,P<0.01)均为大干预效应,高强度为中等干预效应(MD=-0.62,P<0.05);④单次干预持续30~60 min(MD=-2.20,P<0.01)获得了对改善老年人睡眠的最大干预效,明显优于≤20 min(MD=-1.23,P<0.01)和70~90 min(MD=-0.91,P<0.05);⑤3次/周(MD=-1.95,P<0.01)获得改善老年人睡眠的最大干预效应,2次/周(MD=-1.62)和4次/周(MD=-1.78)为大干预效应(P<0.01),5次/周(MD=-0.71,P<0.05)为中等干预效应,大于5次/周的干预效应不显著(P>0.05);⑥12周运动周期获得了改善老年人睡眠的最大效应(MD=-1.76,P<0.01),16周(MD=-1.58)和24~26周(MD=-1.65)维持大干预效应(P<0.01)。结论:(1)运动锻炼能有效促进老年人睡眠的改善,其中对睡眠时间干预效果不显著;(2)运动锻炼对老年人睡眠的干预效果存在群体差异性,对身心健康老年人群睡眠的干预效果优于非健康老年人群;(3)每周锻炼3次(隔日进行第二次)、单次锻炼持续30~60 min、共持续12周以上的中等强度有氧运动锻炼方案更有可能获得改善老年人睡眠的理想干预效果。

In this study,meta-analysis was used to systematically evaluate the effect of exercise interventions on sleep in the elderly so as to providing reference for practical interventions on sleep in the elderly.Papers were searched in the Web of Science,Pubmed,and the Cochrane library databases.The Cochrane Quality Evaluation Scale was used for evaluation of the quality of the papers.Revman5.3 software was used for publication bias evaluation,heterogeneity test,subgroup analysis and meta regression analysis.It was shown that a total of 16 RCT studies were included in this Meta-analysis,8 in the healthy elderly population and 8 in the non-healthy elderly population,containing a total sample of 1116 cases.The Cochrane scale evaluations were largely at low risk and the overall methodological quality of the included literature was good.Exercise intervention effect revealed that the combined effect of exercise on sleep improvement of the elderly was at large effect level(P<0.05),of which the intervention effect on sleep duration was not significant(P>0.05).The effect of physical and mental health status on the exercise intervention for the sleep of the elderly was highly heterogeneous(I^(2)=84%,P<0.01).The intervention effect size on the sleep of healthy elderly group(MD=-2.70,P<0.01)was higher than that of non-healthy elderly group(MD=-2.38,P<0.01).For exercise intervention program,the heterogeneity test showed that the exercise content(I^(2)=85.3%),intensity(I^(2)=82.4%),single session duration(I^(2)=69.6%),frequency of intervention weeks(I^(2)=53.5%)and periodicity(I^(2)=45.8%)were significant factors influencing the effect of exercise interventions on sleep in the elder(P<0.01).The order of intervention effect on sleep in the elderly was aerobic exercise(MD=-2.39,P<0.01),combined aerobic and resistance exercises(MD=-1.92,P<0.01)and resistance exercises(MD=-1.37,P<0.05).Exercise intensity and moderate intensity obtained the maximum intervention effect for improving sleep in the elderly(MD=-2.01,P<0.01)Low to moderate intensity(MD=-1.76,P<0.01)and low intensity(MD=-1.58,P<0.01)both had a large intervention effect.High intensity had a medium intervention(MD=-0.62,P<0.05).Single session duration,30~60 min(MD=-2.20,P<0.01)obtained the maximum intervention effect on improving sleep in the elderly,which was significantly better than≤20min(MD=-1.23,P<0.01)and 70-90min(MD=-0.91,P<0.05).3 times/week(MD=-1.95,P<0.01)obtained the maximum intervention effect on improving sleep in the elderly.2 times/week(MD=-1.62)and 4 times/week(MD=-1.78)achieved large intervention effects(P<0.01).5 times/week(MD=-0.71)reached medium intervention effects(P<0.05).The intervention effect of>5 times/week was not significant(P>0.05).The exercise cycle,with the largest effect of improving sleep in the elderly obtained at 12 weeks(MD=-1.76,P<0.01).16 weeks(MD=-1.58)and 24-26 weeks(MD=-1.65)obtained the large intervention effect(P<0.01).It could be concluded that exercise could effectively improve sleep in healthy and unhealthy elderly people,while the effect of exercise interventions on sleep duration was not significant.There was group variability in the effects of exercise on sleep in the elderly,with better effects on sleep in the physically and mentally healthy elderly than in the non-healthy elderly.A medium intensity aerobic exercise programme of three sessions per week(with a second session every other day),with a single session lasting 30~60 min for about 12 weeks,was more likely to achieve the desired intervention effect of improving sleep in the elderly.