揭示运动干预对体弱老年人日常生活活动的各种影响：一项系统回顾和荟萃分析。

IF 12.4 1区医学 Q1 CELL BIOLOGY

Ageing Research Reviews Pub Date : 2025-09-05 DOI:10.1016/j.arr.2025.102893

Emma De Keyser , Jade Tambeur , Elke De Smedt , Lisa Schwab , Dimitri Vrancken , Wim Peersman , Lieven Annemans , Siddhartha Lieten , Dominique Van de Velde , Patricia De Vriendt , David Beckwée

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引用次数: 0

摘要

简介：老年人的虚弱会损害日常生活活动（ADL）。虽然运动干预可以改善肌肉力量和身体功能等因素，但它们对ADL能力的直接影响并不一致。本综述旨在评估运动对ADL能力的有效性，确定最有益的干预措施，并探索中介因素。方法：系统检索5个数据库，包括随机对照试验（rct），比较运动干预与常规护理，以日常生活能力为结果。采用Cochrane偏倚风险（ROB）工具评估方法学质量。采用随机效应模型进行meta分析，采用I²指数评估异质性。根据治疗效度（根据运动建议进行干预）、依从性、累积治疗效度和依从性、adl测量工具和ROB进行亚组分析。根据研究结果对介质进行分类。结果：5975篇文献中有24篇（20篇rct）符合标准。两个有高的ROB。运动改善ADL能力（标准化平均差= 0.59），但异质性高（I²= 83%），部分由测量工具和ROB解释。高治疗效度与较低的依从率相关，但显示高治疗效度和/或依从性的干预措施并未显示出更大的ADL表现改善。潜在的调节因素包括身体功能、认知、平衡信心、生活质量、社会心理因素、力量和自我感知的健康/疼痛。结论：运动可以提高ADL的表现，但结果的高度异质性限制了推广。有效的干预措施应结合身体、认知和社会心理因素，同时确保逐步进展，以平衡治疗有效性和依从性。未来的研究应利用中介分析来阐明潜在的机制。

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Unravelling the miscellaneous effects of exercise interventions on activities of daily living in frail older adults: A systematic review and meta-analysis

Introduction

Frailty in older adults impairs Activities of Daily Living (ADL). While exercise interventions improve factors like muscle strength and physical function, their direct impact on ADL ability is inconsistent. This review aims to assess the effectiveness of exercise on ADL ability, identify the most beneficial interventions, and explore mediators.

Method

A systematic search in five databases included randomized controlled trials (RCTs) on frail adults (60 +) comparing exercise interventions to usual care, with ADL ability as an outcome. Methodological quality was assessed using the Cochrane risk of bias (ROB) tool. Meta-analyses were performed using random effects models, with heterogeneity assessed by the I² index. Subgroup analyses were conducted based on therapeutic validity (intervention according to exercise recommendations), adherence, cumulative therapeutic validity and adherence, ADL-measurement tool and ROB. Mediators were categorized based on study findings.

Results

Of 5975 records, 24 papers (20 RCTs) met criteria. Two had high ROB. Exercise improved ADL ability (Standardised mean difference = 0.59) but heterogeneity was high (I² = 83 %), partly explained by measurement tool and ROB. High therapeutic validity was associated with lower adherence rates, but interventions showing high therapeutic validity and/or adherence did not show larger ADL performance improvements. Potential mediators include physical function, cognition, balance confidence, quality of life, psychosocial factors, strength and self-perceived health/pain.

Conclusion

Exercise improves ADL performance, but high heterogeneity in results limits generalizability. Effective interventions should integrate physical, cognitive, and psychosocial components while ensuring gradual progression to balance therapeutic validity with adherence. Future research should use mediation analyses to clarify underlying mechanisms.

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来源期刊

Ageing Research Reviews 医学-老年医学

CiteScore

19.80

自引率

2.30%

发文量

216

审稿时长

55 days

期刊介绍： With the rise in average human life expectancy, the impact of ageing and age-related diseases on our society has become increasingly significant. Ageing research is now a focal point for numerous laboratories, encompassing leaders in genetics, molecular and cellular biology, biochemistry, and behavior. Ageing Research Reviews (ARR) serves as a cornerstone in this field, addressing emerging trends. ARR aims to fill a substantial gap by providing critical reviews and viewpoints on evolving discoveries concerning the mechanisms of ageing and age-related diseases. The rapid progress in understanding the mechanisms controlling cellular proliferation, differentiation, and survival is unveiling new insights into the regulation of ageing. From telomerase to stem cells, and from energy to oxyradical metabolism, we are witnessing an exciting era in the multidisciplinary field of ageing research. The journal explores the cellular and molecular foundations of interventions that extend lifespan, such as caloric restriction. It identifies the underpinnings of manipulations that extend lifespan, shedding light on novel approaches for preventing age-related diseases. ARR publishes articles on focused topics selected from the expansive field of ageing research, with a particular emphasis on the cellular and molecular mechanisms of the aging process. This includes age-related diseases like cancer, cardiovascular disease, diabetes, and neurodegenerative disorders. The journal also covers applications of basic ageing research to lifespan extension and disease prevention, offering a comprehensive platform for advancing our understanding of this critical field.