Chinese Journal of Tissue Engineering Research ›› 2025, Vol. 29 ›› Issue (26): 5662-5672.doi: 10.12307/2025.740
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Zhu Tianrui, Shi Jipeng, Sun Jiahe, Wang Luyi, Zhang Chen, Xu Hongqi, Quan Helong
Received:
2024-09-14
Accepted:
2024-11-04
Online:
2025-09-18
Published:
2025-02-28
Contact:
Shi Jipeng, PhD, Associate professor, Master’s supervisor, Research Center of Exercise Capacity Assessment and Promotion, School of Physical Education, Northeast Normal University, Changchun 130024, Jilin Province, China
About author:
Zhu Tianrui, Master’s candidate, Research Center of Exercise Capacity Assessment and Promotion, School of Physical Education, Northeast Normal University, Changchun 130024, Jilin Province, China
Supported by:
CLC Number:
Zhu Tianrui, Shi Jipeng, Sun Jiahe, Wang Luyi, Zhang Chen, Xu Hongqi, Quan Helong. Effectiveness of different exercise regimens to reduce fall risks in older adults: a Meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2025, 29(26): 5662-5672.
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2.2 纳入研究的基本特征 经过筛选,共纳入45篇文献[24-68],其中包含54项研究,即1篇文献中若包含多种研究方法,则每种研究方法算作1项研究。54项研究共包含3 074名受试者(试验组1 717名,对照组1 362名),多为社区群体,纳入群体年龄多为60-75岁,由于部分研究并没有报告性别比例,因此无法对总体性别比例进行计算,通过已知数据发现男女比例接近1∶2。由于干预方案无法对受试者进行隐藏,仅有部分研究采用盲法,因此没有列出(表1)。 根据先前研究,将干预方式划分为身心运动、有氧运动、抗阻运动和多成分运动[69-72]。由于以步行为主的运动仅有3项研究[38,53,67],其中2项干预方式对受试者认知能力存在一定影响,总体运动强度较低,因此3项研究归为身心运动组。身心运动以中国传统武术或平衡性功能练习为主,共有37项(68.5%)研究;抗阻运动多以弹力带锻炼为主,共7项(13.0%)研究;多成分运动主要以奥塔戈运动为主,共10项(18.5%)研究。运动周期4-48周不等,其中运动周期为12-24周的方案占比最高,为 35.2%(19项);每周运动频率小于3次占比最高,为44.4%(25项);每次运动时间≥30 min,但不超过45 min占比最高,为33.3%(18项)(表2)。 2.3 纳入文献的质量 在纳入的54项研究中,共有32项研究采用了随机分配方法并进行了说明。由于试验方案的特点,对试验人员和研究对象采用盲法存在一定困难,共24项采用了单盲或双盲的方案,12项研究明确说明分配方案采用隐蔽性处理。54项研究数据均报告完整,并对部分失访原因进行说明。研究方法学上整体质量较高(图2)。 2.4 发表偏倚检验 在运动干预对老年人单腿站立(睁眼)、单腿站立(闭眼)、功能性前伸测试、起立-行走测试、Berg平衡测试、5次坐立测试、30 s坐立测试、SPPB测试、FES-I测试干预效果的分析中,分别对纳入10项研究以上的干预分组做漏斗图分析,漏斗图显示两侧基本左右对称分布在漏斗图顶部,形成倒置漏斗形(图3)。 对包含10项研究以上的干预分组进行Begg检验和Egger检验,单腿站立(睁眼)、Berg平衡测试、5次坐立测试、30 s坐立测试Egger检验均提示不存在发表偏倚(P > 0.05)(图4)。在起立-行走测试纳入研究中,Begg检验(P=0.011)和Egger检验结果(P < 0.01)均提示存在偏倚,进行剪补法后发现结果没有发生逆转,较为稳健。 2.5 Meta分析结果 2.5.1 运动干预对老年人跌倒风险影响的Meta分析 运动干预对老年人跌倒风险的影响主要通过单脚站立(睁眼)、单脚站立(闭眼)、功能性前伸、起立-行走测试、Berg平衡量表、"
5次坐立、30 s坐立、SPPB测试和FES-I测试共9项干预结果进行比较分析。上述各项测试分别纳入11项、3项、9项、34项、14项、15项、11项、10项和6项研究,均存在一定异质性,采用随机效应模型得到合并后总效应量(表3)。除单脚站立(闭眼)合并效应量结果无统计学意义(P=0.31)外,各项测试合并效应量均具有统计学意义,表明运动干预能够有效降低老年人跌倒风险(图5)。 2.5.2 运动干预对老年人跌倒风险影响的亚组Meta分析 为探究平衡能力(睁眼单脚站立、功能性前伸、起立-行走测试、Berg平衡量表测试)、下肢肌力(30 s坐立测试、5次坐立测试、SPPB测试)、心理效能(国际版跌倒效能量表)干预结果异质性的来源,分别进行敏感性分析和亚组分析发现,无法通过剔除个别研究而使异质性明显降低。因此,为进一步探究潜在异质性来源,对潜在的调节变量进行亚组分析,确定各亚组合并效应量。亚组分析结果表明不同运动方案组成要素对老年人跌倒风险筛查指标影响效果不同(表4)。 在此研究中,通过对单脚站立(睁眼)测试运动周期各亚组所纳入研究逐一剔除发现,剔除效应量为负值的SITTHIRACHA等[67]和TIMON 等(1)[31]以及效应量较小的SALES等[66],均可分别使其所在亚组异质性大幅度降低,合并效应量具有统计学意义,结果显示干预总周期12周以上但不超过24周合并效应量最高,MD=21.06,95%CI(12.84,29.28),这"
与过往研究结果基本一致。单脚站立(闭眼)纳入文献较少,并未进行亚组分析。在功能性前伸测试合并结果中多成分运动的合并效应量高于仅采用身心运动的合并效应量,仅采用身心运动的亚组中6项研究异质性较高,BAO等[41]和GRANACHER等[40]2项研究甚至在运动干预后出现老年人功能性前伸成绩下降的结果,主要原因可能是由于测试的天花板效应以及运动强度较低,2项研究试验组对象的功能性前伸测试成绩在干预前均接近该亚组内最高水平,2项研究的干预方案也均是基于家庭环境中进行。在FES-I测试合并结果中DONATONI DA SILVA等[58]研究导致了身心运动亚组结果异质性高,且结果不具有统计学意义。运动评估的学习效果和霍索恩效应可能是引起异质性的主要原因[73],将其剔除后,SMD=-1.22,95%CI(-1.83,-0.61),结果具有统计学意义。"
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