Effect of exercise intervention in elderly individuals with sarcopenia and its comorbidities: a meta-analysis

doi:10.12307/2026.019

Abstract

Abstract: OBJECTIVE: A great deal of evidence indicates that regular exercise can improve the health status of elderly individuals, including reducing overall and abdominal fat levels, increasing muscle mass and bone mineral density of the limbs, thereby preventing or delaying the onset of sarcopenia and its comorbidities. This study aims to determine the most reliable type, duration, and intensity of exercise interventions through meta-analysis to prevent, delay, and alleviate sarcopenia and its comorbidities in elderly individuals.
METHODS: Randomized controlled trials examining the effects of exercise interventions on elderly individuals with sarcopenia and its comorbidities were searched in the PubMed, Embase, Web of Science, Cochrane Library, CNKI, and WanFang databases. The Cochrane Risk of Bias Tool was used to assess the quality of the included studies, and RevMan 5.3 software was employed for meta-analysis. Subgroup analyses were conducted to explore the effects of different exercise intervention protocols on various outcome measures. In addition, Stata 16.0 software was used to perform sensitivity analysis to assess the stability of the results, and funnel plots and Egger’s test were employed to evaluate publication bias, ensuring the comprehensiveness and reliability of the results.
RESULTS: (1) Sixteen studies involving 861 patients with sarcopenia and its comorbidities were included. (2) The meta-analysis results indicated that, compared with the control group, exercise significantly improved grip strength, knee muscle strength, appendicular skeletal muscle mass, skeletal muscle index, Timed Up and Go test results, gait speed, and insulin-like growth factor 1 levels (P < 0.05). However, the effect of exercise intervention on the sit-to-stand test was not significantly improved (P > 0.05). (3) Based on the results of subgroup analysis, it is recommended that elderly patients with sarcopenia and its comorbidities engage in exercise at least three times per week, with each session lasting no more than 30 minutes or exceeding 45 minutes, for at least 12 weeks. The exercise protocol should be flexibly adjusted according to the patient’s health status and individual needs.
CONCLUSION: Exercise interventions significantly improve muscle mass, muscle strength, physical function, and insulin-like growth factor 1 levels in elderly individuals with sarcopenia and its comorbidities, thereby enhancing their quality of life. However, further research is needed to validate these findings and optimize specific intervention protocols.

Key words: elderly, sarcopenia and comorbidities, exercise, randomized controlled trial, muscle mass, muscle strength, meta-analysis

CLC Number:

Sun Jiahe, Shi Jipeng, Zhu Tianrui, Quan Helong, Xu Hongqi. Effect of exercise intervention in elderly individuals with sarcopenia and its comorbidities: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(4): 997-1007.

Figures/Tables 10

运动干预方案包括4部分内容，即运动方式、运动周期、运动频率、运动时间(表2)。运动方式划分为抗阻训练、有氧训练、全身振动训练等，抗阻联合有氧训练占比最高，为26.92%(7项)。运动周期8-24周不等，其中运动周期为12周的方案占比最高，为73.09%(19项)；每周运动频率为3次占比最高，为46.15%(12项)；每天运动时间≤30 min占比最高，为42.31%(11项)。 2.3 文献质量评价结果偏倚风险结果见图3，部分条目被评为“低风险”，因而此次研究所有文献均为B级。 2.4 主要结局指标 2.4.1 肌肉力量 (1)握力：20项随机对照试验(共13篇文献纳入此次研究，包含26项随机对照试验，若一篇文献中包含多种研究方法，则每种方法视为一项独立的研究)报告了患有肌少症及其合并症人群进行运动干预前后握力的结果[10-11，13-15，18-25](图4)，I2=0%，P=0.82，因此采用固定效应模型。由于握力测量的结局指标不同(惯用手、非惯用手、双手等)，因此使用SMD计算效应量大小，SMD=0.42，95%CI(0.29，0.55)，P < 0.001，证明运动干预能够改善握力，从而提高肌肉力量。为了评估有效的运动方案对患有肌少症及其合并症老年人握力的影响，亚组分析结果显示，运动方式、周期、频率以及时间均显著优于对照组(表3)。 (2)膝关节肌肉力量：24项随机对照试验测量了运动干预前后对膝关节肌肉力量的影响[10，15，17，19，22](图5)。I2=3%，P=0.43，因此采用固定效应模型。由于膝关节肌肉力量的单位不同(Nm、kg等)，因此使用SMD计算效应量大小，SMD=0.40，95%CI(0.27，0.54)，P < 0.001，证明运动干预是提高膝关节肌肉力量的有效方法。为了评估有效的运动方案对患有肌少症及其合并症老年人膝关节肌肉力量的影响(表3)，亚组分析结果显示，在运动方式中，与有氧训练(SMD=-0.01，95%CI：-0.48-0.45，P > 0.05)、全身振动训练(MD=2.20，95%CI：-1.96-6.35，P > 0.05)和抗阻"

联合有氧训练(SMD=0.35，95%CI：0.00-0.71，P=0.05)相比，抗阻训练(SMD=0.69，95%CI：0.21-1.17，P < 0.05)、抗阻联合平衡训练(MD=7.85，95%CI：5.56-10.14，P < 0.001)对增加老年人膝关节肌肉力量有更显著的促进效果；而运动周期> 8周(SMD=0.44，95%CI：0.28-0.59，P < 0.001)或≤8周(SMD=0.29，95%CI：0.02-0.56，P < 0.05)均能产生中等效应量的影响；将运动频率分为≥3次/周(SMD=0.44，95%CI：0.28-0.59，P < 0.001)和< 3次/周(SMD=0.29，95%CI：0.02-0.56，P < 0.05)，均能产生中等效应量的影响；运动时间≤30 min/d(SMD=0.64，95%CI：0.45-0.84，P < 0.001)相比> 30 min/d(SMD=0.18，95%CI：-0.01-0.36，P > 0.05)，对增加老年人膝关节肌肉力量有更显著的促进效果，呈现中等效应。 2.4.2 肌肉质量肌肉质量是指全身或特定部位(如四肢)的骨骼肌含量，是评估肌少症的核心指标之一。同时，肌肉质量减少也是肌少症的必要诊断条件。 (1)四肢骨骼肌质量：6项随机对照试验测量了运动干预前后对四肢骨骼肌质量的影响[14，20，22-23](图6)。I2=21%，P=0.28，因此采用固定效应模型。由于四肢骨骼肌质量的单位不同(kg，%)，因此使用SMD计算效应量大小，SMD=0.33，95%CI：0.10-0.55，P < 0.05，证明运动干预是可以帮助改善四肢骨骼肌质量。 (2)骨骼肌指数：4项随机对照试验报告了患有肌少症及其合并症人群进行运动干预前后骨骼肌指数的结果[11，15，18](图7)，I2=0%，P=0.84，因此采用固定效应模型。MD=0.25，95%CI：0.02-0.48，P < 0.05，证明运动干预是改善骨骼肌指数有效的干预措施。 2.4.3 身体功能身体功能反映个体完成日常活动(如行走、起立、站立等)的能力，是评估肌少症严重程度的重要标志。身体功能的减退不仅包括下肢力量和步态的减弱，还涉及平衡能力、运动协调性等方面。 (1)起立-行走计时测试：共有7项随机对照试验报告了患有肌少症及其合并症人群进行运动干预前后起立-行走计时测试的结果[15-16，21，25](图8)，I2=48%，P=0.07，故使用固定效应模型计算效应量大小，SMD=-0.75，95%CI(-1.09，-0.40)，P < 0.000 1，运动干预能够改善起立-行走计时测试。为了评估有效的运动方案对患有肌少症及其合并症的老年人起立-行走计时测试的影响(表3)，亚组分析结果显示，在运动方式中，与有氧训练(MD=-1.74，95%CI：-3.71-0.24，P > 0.05)相比，全身振动训练(MD=-1.13，95%CI：-2.10至-0.16，P < 0.05)和抗阻联合有氧训练(MD=-2.22，95%CI：-2.97至-1.46，P < 0.001)，对提高老年人起立-行走计时测试的时间均有显著促进效果；将运动频率分为>每周3次(MD=-1.95，95%CI：-2.81至-1.09，P < 0.001)和≤每周3次(MD=-1.13，95%CI：-2.10至-0.16，P < 0.05)，均能产生效果；运动时间≥每天40 min(MD=-2.34，95%CI：-3.0至-1.67，P < 0.001)和<每天40 min(MD=-0.97，95%CI：-1.67至-0.27，P < 0.05)，均能显著提高老年人起立-行走计时测试的时间。 (2)步速：共有13项随机对照试验报告了患有肌少症及其合并症人群进行运动干预前后步速测试的结果[11，13-16，18-19，23，25](图9)，I2=62%，P=0.002，因此采用随机效应模型。由于步速测量的结局指标不同(3 m步速测试、6 m步速测试等)，因此使用SMD计算效应量大小，SMD=0.48，95%CI：0.19-0.77，P < 0.05，说明运动干预能够提高步速。为了评估有效的运动方案对患有肌少症及其合并症的老年人步速的影响(表3)，亚组分析结果显示，在运动方式中，与抗阻训练(SMD=0.36，95%CI：-0.09-0.81，P > 0.05)，全身振动训练(MD=0.02，95%CI：-0.04-0.09，P > 0.05)，抗阻联合有氧训练相比(SMD=0.35，95%CI：-0.24-0.94，P > 0.05)，抗阻联合平衡训练(SMD=1.19，95%CI：0.78-1.60，P < 0.001)，对提高老年人步速有更"

显著促进效果；而运动周期>12周(SMD=0.46，95%CI：0.12-0.79，P < 0.05)和≤12周(SMD=0.49，95%CI：0.10-0.88，P < 0.05)均能产生中等效应量的影响；在运动频率中，相比≤3次/周(SMD=0.22，95%CI：-0.00-0.45，P=0.05)，> 3次/周(SMD=0.99，95%CI：0.44-1.54，P < 0.001)的改善呈现较大效应量；相比< 45 min/d(SMD=0.25，95%CI：0.00-0.49，P=0.05)，运动时间≥45 min/d (SMD=0.76，95%CI：0.22-1.29，P < 0.05)的改善呈现较大效应量。 (3)坐立测试：9项随机对照试验报告了患有肌少症及其合并症人群进行运动干预前后坐立测试的结果[15-16，19，21，23-24](图10)，I2=83%，P < 0.000 1，因此采用随机效应模型。由于坐立测试测量的结局指标不同(5次坐立测试，30 s坐立测试)，因此使用SMD计算效应量大小，SMD=-0.27，95%CI：-0.76-0.23，P > 0.05，结果显示运动干预组与对照组坐立测试无显著性差异。为评估有效的运动方案对患有肌少症及其合并症老年人坐立测试的影响(表3)，亚组分析结果显示，在运动方式中，相比全身振动训练(MD=-0.48，95%CI：-1.61-0.64，P > 0.05)，有氧训练(SMD=0.70，95%CI：0.32-1.08，P < 0.001)和抗阻联合平衡训练(MD：-3.52，95%CI：-4.92至-2.13，P < 0.001)对提高老年人坐立测试的时间有更显著的促进效果；而运动频率>每周3次(SMD=-0.49，95%CI：-1.77-0.78，P > 0.05)和≤每周3次(SMD=-0.16，95%CI：-0.68-0.36，P > 0.05)均与对照组相比均无显著性差异；运动时间≥60 min/d (SMD=0.27，95%CI：-0.51-1.06，P=0.05)和< 60 min/d (SMD=-0.43，95%CI：-0.99-0.12，P > 0.05)，与对照组相比均无显著性差异。 2.5 次要结局指标胰岛素样生长因子1通过促进肌肉合成代谢、抑制炎症老化及运动诱导表达，多靶点干预肌少症，因此作为次要结局指标纳入此次研究结果。胰岛素样生长因子1：共有7项随机对照试验报告了患有肌少症及其合并症人群进行运动干预前后胰岛素样生长因子1水平[10，12，22](图11)，I2=16%，P=0.31，因此采用固定效应模型。使用SMD计算效应量大小，SMD=0.30，95%CI(0.04，0.56)，P < 0.05，与对照组相比，运动干预后胰岛素样生长因子1水平显著增高。 2.6 文献偏倚分析结果采用漏斗图和Egger检验对纳入研究数量≥10篇的结局指标进行发表偏倚检测(图12)。结果显示，膝关节肌肉力量的漏斗图分布对称，Egger检验P=0.321，提示该指标不存在显著的发表偏倚。而握力和步速的漏斗图虽然对称性较差，提示可能存在发表偏倚，但Egger检验结果显示，膝关节肌肉力量和步速均未达到显著性水平(P=0.246，0.191)，表明所纳入的研究未出现显著的发表偏倚。采用剔除法对纳入研究≥5项的结局指标进行逐一剔除分析。敏感性分析结果显示，合并效应量的方向未发生改变，表明此次Meta分析的结果具有较好的稳健性(图13)。"

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