中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (26): 4257-4264.doi: 10.12307/2021.130

• 组织构建循证医学 evidence-based medicine in tissue construction • 上一篇    

下肢抗阻训练对老人步行能力及平衡能力影响的Meta分析

伍朝明，孙君志   

  1. 成都体育学院运动医学与健康研究所，四川省成都市   610041
  • 收稿日期:2020-10-09 修回日期:2020-10-12 接受日期:2020-11-28 出版日期:2021-09-18 发布日期:2021-05-14
  • 通讯作者: 孙君志，博士，高级实验师，成都体育学院运动医学与健康研究所，四川省成都市 610041
  • 作者简介:伍朝明，男，1995年生，湖南省新晃县人，汉族，成都体育学院在读硕士，主要从事运动与健康相关研究。
  • 基金资助:
    “十二五”国家科技支撑计划课题(2012BAK21B01-2)

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

Wu Chaoming, Sun Junzhi   

  1. Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu 610041, Sichuan Province, China
  • Received:2020-10-09 Revised:2020-10-12 Accepted:2020-11-28 Online:2021-09-18 Published:2021-05-14
  • Contact: Sun Junzhi, PhD, Senior experimentalist, Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu 610041, Sichuan Province, China
  • About author:Wu Chaoming, Master candidate, Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu 610041, Sichuan Province, China
  • Supported by:
    the "Twelfth Five-Year" National Science and Technology Support Project, No. 2012BAK21B01-2

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摘要：

文题释义：
抗阻训练：是完全依靠自身力量克服外界或自身阻力的训练方式，包括等张训练、等长训练和等动训练。
起立-行走计时测试：是一种快速定量评定功能性步行能力的方法，用于评定一般老年人及老年病患者功能性步行能力及预测摔倒的可能性。

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。

https://orcid.org/0000-0001-7869-0898 (伍朝明)

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 下肢抗阻训练, 老年人, 步行, 平衡, 速度, 行走, 前伸, 站立, Meta分析

Abstract:

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 (I2=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.

Key words: lower limb resistance training, elderly, walking ability, balance ability, speed, walking, extension, stand up, Meta-analysis

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