Meta-analysis of dose-effect of exercise on improving muscle health in community-dwelling older adults with sarcopenia

doi:10.12307/2025.791

Abstract

Abstract:

OBJECTIIVE: The positive role of exercise intervention in the prevention and treatment of sarcopenia has received widespread attention, but the optimal exercise dose for elderly sarcopenic patients still needs to be further determined. The article explored the dose-effect relationship between various elements of exercise prescription and the improvement of muscle mass, muscle strength and physical function in community-dwelling elderly patients with sarcopenia, aiming to provide scientific support for the development of exercise prescription for community-dwelling elderly patients with sarcopenia.

METHODS: Literature published from the inception to October 9, 2024 in PubMed, EMBASE, Scopus, Web of Science, CNKI, WanFang, VIP, and CBMdisc databases was systematically searched. Meta-analysis was performed using RevMan 5.3 software. Standardized mean difference (SMD) and its 95%CI were used as effect statistics.
RESULTS: (1) A total of 11 randomized controlled trials were included, with 348 in the trial group and 304 in the control group. (2) Meta-analysis results showed that exercise improved appendicular skeletal muscle mass index, grip strength, and walking speed in elderly patients with sarcopenia (SMDs 0.46, 0.63, 0.67, P < 0.05). (3) When the frequency of exercise was 2-3 days/week, appendicular skeletal muscle mass index (SMD=0.57, 95%CI: 0.28-0.86, P < 0.001), grip strength (SMD=0.70, 95%CI: 0.37-1.02, P < 0.001), and walking speed (SMD=0.69, 95%CI: 0.20-1.18, P=0.006) were effectively improved in elderly patients with sarcopenia. (4) When the duration of exercise was 25-60 minutes per session, appendicular skeletal muscle mass index (SMD=0.28, 95%CI: 0.07-0.50, P=0.01), grip strength (SMD=0.37, 95%CI: 0.16-0.59, P < 0.001), and walking speed (SMD=0.39, 95%CI: 0.06-0.73, P=0.02) were effectively improved in elderly patients with sarcopenia. (5) When the exercise intensity was moderate, appendicular skeletal muscle mass index (SMD=0.69, 95%CI: 0.35-1.03, P < 0.001), and grip strength (SMD=0.36, 95%CI: 0.09-0.64, P=0.009), and walking speed (SMD=0.91, 95%CI: 0.34-1.47, P=0.002) were effectively improved in elderly patients with sarcopenia. (6) When the dose of exercise cycle was 8-12 weeks, appendicular skeletal muscle mass index (SMD=0.42, 95%CI: 0.20-0.64, P < 0.001), grip strength (SMD=0.45, 95%CI: 0.26-0.64, P < 0.001), and walking speed (SMD=0.76, 95%CI: 0.27-1.25, P=0.002) were effectively improved in elderly patients with sarcopenia.
CONCLUSION: Active, regular exercise can improve muscle health in older adults with sarcopenia. It is recommended that older patients with sarcopenia exercise at least 2 to 3 days per week, 25 to 60 minutes each time, lasting for 8 to 12 weeks of moderate intensity exercise to improve muscle health.

Key words: sarcopenia, exercise, dose effect, exercise dose, meta-analysis, muscle mass, muscle strength, physical function

CLC Number:

Jiang Siqi, Huang Huanhuan, Yu Xinyu, Peng Ying, Zhou Wei, Zhao Qinghua. Meta-analysis of dose-effect of exercise on improving muscle health in community-dwelling older adults with sarcopenia[J]. Chinese Journal of Tissue Engineering Research, 2025, 29(29): 6295-6304.

Figures/Tables 13

为3-7分，3项研究的得分为6分或以上[31-33]，见表1。根据Cochrane偏倚风险评估工具评估得出的偏倚风险结果，如图3，4所示。10篇文献报告了随机序列产生的具体方法[24，26-34]，这些方法包括随机数字表法和基于计算机的随机序列法；3篇文献采用了密封信封等方法来实现分配隐藏[27，31-32]；1篇文章没有描述样本缺失原因[24]；所有文献均未出现选择性报告的情况。此外，由于运动干预的特殊性，施盲难度较大，这可能对纳入文献的方法学质量产生了一定影响。 2.3 Meta分析结果运动干预可以显著改善老年肌少症患者的ASMI (SMD=0.46，95%CI：0.13-0.79，P= 0.006)、握力(SMD=0.63，95%CI：0.36- 0.90，P < 0.001)和步速(SMD=0.67，95%CI：0.31-1.03，P < 0.001)，见图5。 2.3.1 不同运动频率对老年肌少症患者的影响共计9篇文献被纳入运动频率对老年肌少症患者影响的Meta分析[24-27，29-32，34]，8篇文献提供了ASMI变化的数据[24-25，27-31，34]，9篇记录了握力改善情况[24-27，29-32，34]，7篇研究揭示了步速变化[24-26，30-32，34]。研究显示，每周两三天的运动对老年肌少症患者ASMI(SMD=0.57，95%CI：0.28-0.86，P < 0.001)、握力(SMD=0.70，95%CI：0.37-1.02，P < 0.001)和步速(SMD=0.69，95%CI：0.20-1.18，P= 0.006)的改善具有中等效应作用；每周四五天的运动仅对老年肌少症患者步速的改善产生中等效应作用(SMD=0.56，95%CI：0.11-1.00，P=0.02)，见图6。 2.3.2 不同运动时间对老年肌少症患者的影响单次运动时间的Meta分析共纳入9篇文献[24-26，28-32，34]，其中7篇文献可获得ASMI的结局指标[24-25，28-31，34]，8篇文献可获得握力的结局指标[24-26，29-32，34]，7篇可获得步速的结局指标[24-26，30-32，34]。亚组分析结果显示，每次运动25-60 min对提高老年肌少症患者的ASMI (SMD=0.28，95%CI：0.07-0.50，P=0.01)、握力(SMD=0.37，95%CI：0.16- 0.59，P < 0.001)和步速(SMD=0.39，95%CI：0.06-0.73，P=0.02)均产生较小的效应量；每次运动> 60 min且≤"

80 min对改善其握力产生较小的效应量(SMD=0.47，95%CI：0.13-0.80，P=0.006)，对提高其步速产生较大的效应量(SMD=1.44，95%CI：0.61-2.27，P < 0.001)，见图7。 2.3.3 不同运动强度对老年肌少症患者的影响 7篇文献报告了单次运动的强度[24-26，28，31-32，34]，其中5篇文献与ASMI有关[24-25，28，31，34]，6篇文献与握力有关[24-26，31-32，34]，6篇与步速有关[24-26，31-32，34]。不同运动强度的合并效应量显示：低强度运动对改善老年肌少症患者的握力有中等大小效应影响(SMD=0.51，95%CI：0.05-0.96，P=0.03)；中等强度对改善其握力(SMD=0.36，95%CI：0.09-0.64，P=0.009)有较小效应影响，对改善其ASMI(SMD=0.69，95%CI：0.35-1.03，P < 0.001)有中等程度效应影响，对改善其步速(SMD=0.91，95%CI：0.34-1.47，P=0.002)产生较大效应影响，见图8。 2.3.4 不同运动周期对老年肌少症患者的影响纳入11篇文献的运动周期Meta分析显示，其中8篇提供了ASMI改善的数据[24-25，27-31，34]，10篇报告了握力改善的数据[24-27，29-34]，8篇提供了步速改善的数据[24-26，30-34]。研究发现，8-12周的运动对老年肌少症患者ASMI(SMD=0.42，95%CI：0.20-0.64，P < 0.001)和握力(SMD= 0.45，95%CI：0.26-0.64，P < 0.001)的改善呈现较小效应量，对步速(SMD=0.76，95%CI：0.27-1.25，P= 0.002)的改善表现为中等效应；> 12周且≤24周的运动对握力的改善有较大效应(SMD=0.91，95%CI：0.20- 1.62，P=0.01)，对步速的改善为中等效应(SMD=0.50，95%CI：0.13-0.87，P=0.008)，见图9。 2.4 敏感性分析结果采用剔除法逐一剔除各项研究，敏感性分析结果显示，合并效应量未发生方向性改变，提示Meta分析的结果较稳健，见图10。 2.5 发表偏倚分析通过绘制漏斗图评估发表偏倚，结果显示各研究左右分布稍有不对称，提示文章存在一定的发表偏倚，这可能与纳入的部分研究质量较低、样本量较小有关，见图11。"

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