间歇与持续训练对体力活动不足成人生活质量影响的Meta分析

Effects of interval and continuous training on the quality of life in physically inactive adults:a meta-analysis

目的:高强度间歇训练(high-intensity interval training,HIIT)和中等强度持续训练(moderate-intensity continuous training,MICT)对临床慢性病患者生活质量均有改善作用,但其对于体力活动不足成人的应用效果与调节因素尚不明确。文章旨在探究HIIT与MICT对体力活动不足成人生活质量的应用效果与调节因素。方法:在Web of Science核心合集、Medline(EBSCO Host)、PubMed和Cochrane Library数据库中进行文献检索,检索时限为各数据库建库至2023年9月。纳入文献类型为随机对照试验,研究对象为体力活动不足成人。采用RevMan 5.4软件和GRADE证据评价框架对纳入文献进行质量评价。使用R Studio(版本4.2.0)进行随机效应模型的主效应合并。亚组分析、回归分析和敏感性分析用于探讨研究异质性来源和调节因素。结果:①纳入32项中等至高质量的随机对照试验,共2083名体力活动不足成人对象(HIIT组474例;MICT组708例;对照组901例)。②相比于无训练对照组,HIIT(Hedges’g=0.61;95%CI:0.40-0.83;I2=45%)与MICT(Hedges’g=0.66;95%CI:0.25-1.08;I2=89%)均能显著提升生活质量。当直接比较HIIT与MICT时,二者之间的影响未观察到显著差异(Hedges’g=-0.01;95%CI:-0.23-0.21;I2=0%)。③亚组分析结果显示,HIIT和MICT在提高身体层面的生活质量更为有效(HIIT:Hedges’g=0.82 vs.0.75;MICT:Hedges’g=0.74 vs.0.55),而骑行在提高整体生活质量方面有更好的趋势(HIIT:Hedges’g=0.74 vs.0.36;MICT:Hedges’g=1.08 vs.0.52)。④回归分析未识别出任何显著的调节因素(所有因素P>0.05)。⑤上述Meta分析均未发现发表偏倚(Egger检验P>0.05)。结论:①中高级别的证据表明,HIIT与MICT均能改善体力活动不足成人的生活质量,且二者之间的干预效果类似。因此,在选择这两种方案时,需综合考虑安排灵活性、时间经济性以及应用可行性等因素制订个性化运动方案。②文章推荐在应用HIIT时,3次/周,使用低量方案(例如,每次5组,每组1 min),以80%-95%最大心率进行骑行可达理论最佳改善效果。③尽管MICT可提高生活质量,但尚无充分证据显示增加运动时长会带来额外益处。因此,建议在实施MICT时,每周进行3次以上,每次训练时长控制在25-60 min,并以50%-75%最大心率进行骑行,以达到理论上预期的最佳改善效果。

OBJECTIVE:High-intensity interval training(HIIT)and moderate-intensity continuous training(MICT)can improve the quality of life of patients with clinical chronic diseases,but their application effects and regulatory factors in adults with insufficient physical activity are still unclear.This study aimed to explore the application effects and regulatory factors of HIIT and MICT on the quality of life of adults with insufficient physical activity.METHODS:A systematic literature search was conducted in databases including Web of Science Core Collection,Medline(EBSCO Host),PubMed,and Cochrane Library.The search time limit was from the establishment of each database to September 2023.The types of included literature were randomized controlled trials,and the research subjects were physically inactive adults.RevMan 5.4 software and the GRADE evidence evaluation framework were used to assess the quality of the included literature.Main effects pooling of random effects models was performed using R Studio(version 4.2.0).Subgroup analyses,regression analyses,and sensitivity analyzes were used to explore the sources of study heterogeneity and moderators.RESULTS:(1)Thirty-two randomized controlled trials of moderate to high quality were included,involving 2083 physically inactive adults(HIIT group n=474;MICT group n=708;control group n=901).(2)Compared with the non-training control group,HIIT[Hedges’g=0.61;95%confidence interval(CI):0.40-0.83;I2=45%]and MICT(Hedges’g=0.66;95%CI:0.25-1.08;I2=89%)significantly improved the quality of life.Direct comparison studies of HIIT and MICT found no significant differences in the quality of life(Hedges’g=-0.01;95%CI:-0.23-0.21;I2=0%).(3)Subgroup analysis showed that HIIT and MICT were more effective in improving the physical components of the quality of life(HIIT:Hedges’g=0.82 vs.0.75;MICT:Hedges’g=0.74 vs.0.55),while cycling had a better trend in improving overall quality of life(HIIT:Hedges’g=0.74 vs.0.36;MICT:Hedges’g=1.08 vs.0.52).(4)Additionally,regression analysis did not identify any significant moderators(P>0.05 for all factors).(5)None of the above meta-analyses found publication bias(Egger test P>0.05).CONCLUSION:(1)Moderate to high level evidence shows that both HIIT and MICT can improve the quality of life of adults with insufficient physical activity,and the intervention effects between the two are similar.Therefore,when choosing between these two options,it is necessary to comprehensively consider factors such as time economy,scheduling flexibility,and application feasibility to formulate a personalized exercise plan.(2)This study recommends that when applying HIIT,a low-volume protocol(for example,5 groups each time,1 minute each),3 times/week,and ride at 80%-95%of the maximum heart rate is used to achieve the theoretical best improvement effect.(3)Although MICT improves the quality of life,there is insufficient evidence that increasing exercise duration brings additional benefits.Therefore,this study recommends that when MICT is conducted,it should be carried out more than three times a week,with each training duration controlled between 25 and 60 minutes,and cycling at 50%-75%of the maximum heart rate,in order to achieve the theoretically expected best improvement effect.