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中国全科医学

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运动剂量对老年肌肉减少性肥胖患者的影响：随机对照试验的Meta分析

李思旻1，张婷婷1，王鲲博2，杨建洲3，平卫伟3*   

  1. 1.046000 山西长治，长治医学院护理学院；2.410000 湖南长沙，中南大学湘雅医学院；3.046000 山西长治，长治医学院公共卫生与预防医学系
  • 收稿日期:2024-08-30 修回日期:2024-11-11 接受日期:2024-11-19
  • 通讯作者: 平卫伟，教授
  • 基金资助:
    山西省教学改革创新项目（J20231080）；山西省研究生教育创新计划各类课题（2023YZ38）

Effects of Exercise Dosage in Elderly Patients with Sarcopenia：a Randomized Controlled Trial Meta-analysis

LI Simin1，ZHANG Tingting1，WANG Kunbo2，YANG Jianzhou3，PING Weiwei3*   

  1. 1.College of Nursing，Changzhi Medical College，Changzhi 046000，China；2.Xiang Ya Medical College，Central South University，Changsha 410000，China；3.Department of Preventive Medicine，Changzhi Medical College，Changzhi 046000，China
  • Received:2024-08-30 Revised:2024-11-11 Accepted:2024-11-19
  • Contact: PING Weiwei，Professor

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摘要： 背景　随着全球人口老龄化，老年肌肉减少性肥胖成为常见且危害严重的疾病，其是肥胖伴骨骼肌质量与功能下降，会让老年人陷入运动量、肌肉量减少，肥胖加剧的恶性循环，严重影响内分泌代谢和心脑血管系统，增加了失能和死亡的风险。美国运动医学学会（ACSM）制定的运动指南，是运动领域的权威指引，就老年肌肉减少性肥胖患者而言，该指南涵盖了心肺运动、抗阻运动的运动强度、频率、持续时间等多维度的运动剂量建议。目的　分析ACSM高依从性的运动剂量与ACSM依从性低或不确定的运动剂量对老年肌肉减少性肥胖患者身体成分［体脂率、BMI、体质量、四肢骨骼肌质量（ASM）］和身体功能（握力、步速）的影响。方法　系统检索PubMed、Embase、Web of Science、Cochrane Library、Ovid和中国知网数据库（CNKI）中运动对老年肌肉减少性肥胖患者的相关研究，前4个数据库检索时间为建库至2023-12-26，Ovid、中国知网（CNKI）检索时间为建库至2024-01-14。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险，采用随机对照试验偏倚风险评估工具评价研究质量，采用Revman 5.4软件进行Meta分析，依据ACSM的依从情况，纳入研究被分为ACSM依从高亚组和ACSM依从性低或不确定亚组，分析两亚组体脂率、BMI、体质量、ASM、握力、步速的差异。使用均差（MD）作为合并效应量，使用Higgins I2统计评估各研究之间的异质性，逐一排除每项研究进行敏感性分析。结果　共纳入15项研究，包含810名参与者，其中有7项研究高度依从ACSM建议，8项研究低度依从ACSM建议或不确定。以体脂率为结局指标纳入11项研究，共580名参与者，ACSM高依从亚组的MD合并=-3.54（95%CI=-5.65~-1.44），ACSM低或不确定依从亚组的MD合并=-0.94（95%CI=-2.54~0.67）。以BMI为结局指标共纳入5项研究，共278名参与者，ACSM高依从亚组的MD合并=-1.98（95%CI=-3.02~-0.93），ACSM依从性低或不确定亚组的MD合并=-1.72（95%CI=-3.42~-0.03）。以体质量为结局指标纳入5项研究，共169名参与者，ACSM高依从亚组的MD合并=-4.85（95%CI=-7.84~-1.86），ACSM依从性低或不确定亚组的MD合并=-1.56（95%CI=-5.94~2.81）。以ASM为结局指标纳入4项研究，涉及218名参与者，ACSM高依从亚组的MD合并=-0.18（95%CI=-1.03~0.67），ACSM依从性低或不确定亚组的MD合并=-0.05（95%CI=-0.85~0.76）。以握力为结局指标纳入8项研究，共395名参与者，ACSM高依从亚组的MD合并=2.86（95%CI=0.76~4.97），ACSM依从性低或不确定亚组的MD合并=3.04（95%CI=-0.26~6.34）。以步速为结局指标纳入7项研究，共353名参与者，ACSM高依从亚组的MD合并=0.32（95%CI=0.23~0.41），ACSM依从性低或不确定亚组的MD合并=0.05（95%CI=-0.01~0.11）。结论　与ACSM依从性低的和不确定相比，对ACSM依从性高的运动措施对改善肌肉减少性肥胖患者的体脂率、体质量、握力、步速具有显著的效果，然而对于BMI的影响并不明显，运动干预对于ASM没有影响，需要进一步的研究来验证这些发现。

关键词: 肌少症, 肌肉减少性肥胖, 肥胖症, 老年人, 美国运动医学学会, 运动剂量

Abstract: Background　With the aging of the global population，sarcopenic obesity in the elderly has become a common and serious disease.It is characterized obesity accompanied by a decrease in skeletal muscle mass and function，which traps the elderly in a vicious cycle of reduced physical activity，muscle mass，and aggravated obesity，severely endocrine metabolism and the cardiovascular system，and increasing the risk of disability and death. The exercise guidelines formulated by the American College of Sports Medicine（ACSM）are guidance in the field of exercise. For patients with sarcopenic obesity，the guidelines cover multi-dimensional exercise dosage recommendations such as exercise intensity，frequency，and duration for cardiorespiratory exercise and resistance exercise. Objective　Analyze the effects of exercise dosage with high adherence to ACSM and exercise dosage with low or uncertain adherence to ACSM on body composition［body fat percentage，BMI，body mass，appendicular skeletal muscle mass（ASM）］ and physical function（grip strength，gait speed）in elderly patients with sarcopenic obesity. Methods　The related studies of exercise on elderly sarcopenic obesity patients were retrieved from PubMed， Embase，Web of Science，Cochrane Library，Ovid and China National Knowledge Infrastructure（CNKI）. For the first four databases，the search time was from the establishment of the database to December 26 2023. For Ovid and CNKI，the search time was from the establishment of the database to January 14，2024. .Two researchers independently screened the literature， extracted data，and evaluated the risk of bias of the included studies. The quality of the Randomized controlled trial was assessed using the risk of bias assessment tool，and a meta-analysis was conducted using Revman 5.4 software，Based on the compliance with ACSM，the included studies were divided into the subgroup with high compliance with ACSM and the subgroup with low or uncertain compliance with ACSM，and the differences of body fat percentage，BMI，body mass，ASM，grip strength，and gait speed between the two were analyzed. Using mean difference（MD）as the pooled effect size heterogeneity between studies was assessed using Higgins I 2 statistics，with each study excluded one by one for sensitivity analysis. Results　A total of 15 studies with 810 participants were included，with 7 studies with high adherence to ACSM recommendations and 8 studies with low adherence to ACSM recommendations or uncertainty. Eleven studies with body fat percentage as an outcome measure were included，involving a total of 580 participants，with MD consolidation in the high adherence group=-3.54（95%CI=-5.65~-1.44） and MD consolidation in the low or indeterminate adherence group=-0.94（95%CI=-2.54~0.67）. A total of 5 studies with BMI as an outcome measure were included，involving 278 participants，with a combined MD of=-1.98（95%CI=-3.02~-0.93）for the ACSM high adherence group and=-1.72（95%CI=-3.42~-0.03）for the ACSM low or indeterminate group. Five studies with body mass as an outcome measure were included，with a total of 169 participants，and the MD pooled for the ACSM high adherence group=-4.85.（95%CI=-7.84~-1.86）and the MD pooled for the ACSM low or indeterminate group=-1.56（95%CI=-5.94~2.81）. Four studies were included with ASM as the outcome measure，involving 218 participants，and the MD pooled for the ACSM high adherence group=-0.18（95%CI=-1.03~0.67）and the MD pooled for the ACSM low or indeterminate group=-0.05（95%CI=-0.85~0.76）. Eight studies with grip strength as an outcome measure were included，with a total of 395 participants，and the MD pooled for the ACSM high adherence group=2.86（95%CI=0.76~4.97）and the MD pooled for the ACSM low or indeterminate group=3.04（95%CI=-0.26~6.34）. Seven studies with gait speed as an outcome measure were included，with a total of 353 participants，with a combined MD of 0.32（95%CI=0.23~0.41）in the ACSM high adherence group and 0.05（95%CI=-0.01~0.11） in the ACSM low or indeterminate group. Conclusions　The results of the study show that exercise measures with high adherence to ACSM have a significant effect on improving the body fat percentage，body mass，grip strength，and gait speed of patients with sarcopenic obesity，compared to those with low and uncertain adherence to ACSM. However，the effect on BMI is not，and exercise intervention has no effect on ASM，which needs further research to verify these findings.

Key words: Sarcopenia, Obesity, Aged, American College of Sports Medicine, Exercise dosage, Muscle-reducing obesity

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