不同体育锻炼对老年认知障碍患者认知功能和干预依从性的影响：系统综述和网络荟萃分析

IF 13.7 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical Psychology Review Pub Date : 2025-05-30 DOI:10.1016/j.cpr.2025.102604

Geng Li , Gesi Teng , Weikun Zhang , Tao Song , Yafen Li , Ziqin Wang , Antao Chen

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引用次数: 0

摘要

体育锻炼越来越被认为是老年人认知障碍的一种有益的非药物干预手段；然而，关于最佳运动类型及其可持续性的比较证据仍不清楚。本研究旨在比较不同运动方式对认知障碍老年人（≥60岁）认知和干预依从性的影响并进行排名。方法本系统综述在PROSPERO预注册（CRD42024497896），于2024年2月1日系统检索MEDLINE、Web of Science、Scopus、PsycINFO、PubMed和SPORTDiscus数据库，并于2025年3月16日更新检索，以确定随机对照试验（RCTs）。两名评论者独立筛选和评估了符合条件的研究，评估了体育锻炼干预对60岁以上认知障碍老年人整体认知和依从性的影响。次要结局包括随访的整体认知、认知子域、日常生活活动（ADL）、身体功能和神经精神症状。使用频率学框架进行网络元分析。根据累积排名曲线（SUCRA）对干预措施进行排名，并采用二维聚类排名图来确定平衡认知改善和依从性的最优干预措施。我们的网络荟萃分析评估了128项合格的随机对照试验，涉及12,403名认知障碍老年人（≥60岁）。身心锻炼是最有效的干预措施，在全球认知方面表现出最大的改善(supra = 95.9%；smd = 0.91；95% CI: 0.65-1.16)和更高的依从性(SUCRA = 93.6%；or = 1.31；95% CI: 1.02-1.68)。有氧运动、阻力运动和多组分运动也能显著改善认知，但依从性相对较低。此外，身心锻炼在认知子领域、功能结果和后续的整体认知方面显示出一致的益处。结论所有的体育锻炼方式都能显著改善认知，身心运动被认为是最佳的干预方式，表现出更好的认知效果、依从性和相关的功能益处。这些发现可以指导临床医生开发专门针对有认知障碍的老年人的循证运动处方。

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Comparative effects of different physical exercises on cognitive function and intervention adherence in older adults with cognitive impairment: A systematic review and network meta-analysis

Background

Physical exercise is increasingly recognized as a beneficial nonpharmacological intervention for cognitive impairment in older adults; however, comparative evidence regarding the optimal exercise type and its sustainability remains unclear. This study aimed to compare and rank different exercise modalities based on their effects on cognition and intervention adherence among older adults (≥60 years) with cognitive impairment.

Methods

This systematic review, preregistered in PROSPERO (CRD42024497896), systematically searched MEDLINE, Web of Science, Scopus, PsycINFO, PubMed, and SPORTDiscus databases through February 1, 2024, with an updated search on March 16, 2025, to identify randomized controlled trials (RCTs). Two reviewers independently screened and evaluated eligible studies assessing the effects of physical exercise interventions on global cognition and adherence among older adults aged ≥60 years with cognitive impairment. Secondary outcomes included follow-up global cognition, cognitive subdomains, activities of daily living (ADL), physical function, and neuropsychiatric symptoms. A network meta-analysis using a frequentist framework was conducted. Interventions were ranked according to the Surface Under the Cumulative Ranking Curve (SUCRA), and a two-dimensional cluster ranking plot was used to identify the optimal intervention balancing cognitive improvement and adherence.

Results

Our network meta-analysis evaluated 128 qualified RCTs involving 12,403 older adults (≥60 years) with cognitive impairment. Mind-body exercise emerged as the most effective intervention, demonstrating the greatest improvements in global cognition (SUCRA = 95.9 %; SMD = 0.91; 95 % CI: 0.65–1.16) and significantly higher adherence (SUCRA = 93.6 %; OR = 1.31; 95 % CI: 1.02–1.68) compared to controls. Aerobic, resistance, and multicomponent exercises also improved cognition significantly, but adherence was comparatively lower. Mind-body exercise additionally showed consistent benefits across cognitive subdomains, functional outcomes and follow-up global cognition.

Conclusions

All physical exercise modalities significantly improved cognition, yet mind-body exercise was identified as the optimal intervention, exhibiting superior cognitive effects, adherence, and related functional benefits. These findings can guide clinicians in developing evidence-based exercise prescriptions tailored specifically to older adults with cognitive impairment.

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来源期刊

Clinical Psychology Review PSYCHOLOGY, CLINICAL-

CiteScore

23.10

自引率

1.60%

发文量

期刊介绍： Clinical Psychology Review serves as a platform for substantial reviews addressing pertinent topics in clinical psychology. Encompassing a spectrum of issues, from psychopathology to behavior therapy, cognition to cognitive therapies, behavioral medicine to community mental health, assessment, and child development, the journal seeks cutting-edge papers that significantly contribute to advancing the science and/or practice of clinical psychology. While maintaining a primary focus on topics directly related to clinical psychology, the journal occasionally features reviews on psychophysiology, learning therapy, experimental psychopathology, and social psychology, provided they demonstrate a clear connection to research or practice in clinical psychology. Integrative literature reviews and summaries of innovative ongoing clinical research programs find a place within its pages. However, reports on individual research studies and theoretical treatises or clinical guides lacking an empirical base are deemed inappropriate for publication.