老年肌少症患者运动干预的最佳证据总结

doi:10.3761/j.issn.0254-1769.2021.10.020

摘要/Abstract

摘要：

目的评价并总结老年肌少症患者运动干预相关证据,为指导老年肌少症患者运动提供循证依据。方法计算机检索UpToDate、乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）图书馆、Cochrane Library、DynaMed、美国指南网、加拿大安大略注册护士协会指南网、苏格兰院间指南网、英国国家卫生与临床优化研究所指南网、国际指南网、加拿大医学会临床实践指南信息库、医脉通、PubMed、Web of Science、中国知网、中国生物医学文献数据库中关于老年肌少症患者运动干预措施的所有证据,包括指南、专家共识、临床决策、证据总结及系统评价,检索时间为建库至2021年2月20日。结果共纳入16篇文献,包括1篇指南、3篇专家共识、3篇临床决策、9篇系统评价。总结了包含运动评估、运动方式、运动强度、运动时间、运动方案制订原则、管理模式、注意事项、健康教育8个类别的29条证据。结论运动干预可以有效改善肌少症,该研究证据总结过程科学、严谨,内容较全面,医护人员在证据转化过程中应根据具体情境和患者个体因素选择最佳证据,指导老年肌少症患者安全有效地运动,提高生活质量。

关键词: 老年人, 肌少症, 运动干预, 循证护理学

Abstract:

Objective To search,evaluate and summarize the best evidence of exercise intervention in the elderly with sarcopenia,and to provide bases for guiding exercise in the elderly. Methods We searched the UpToDate,JBI,Cochrane Library,DynaMed,NGC,RNAO,SIGN,NICE,GIN,CPG,Yimaitong,PubMed,Web of Science,CNKI and CBM,including guidelines,expert consensuses,clinical decision-making,evidence summaries and systematic reviews. The retrieval time is from the establishment of the databases to February 20,2021. Results 16 articles were included,including 1 guideline,3 expert consensuses,3 clinical decision-making and 9 systematic reviews. 29 pieces of evidence were summarized in 8 areas,namely exercise evaluation,exercise style,exercise intensity,exercise time,exercise plan formulation principles,management mode,precautions,and health education. Conclusion The process of evidence production is scientific,rigorous,comprehensive and of high quality. Exercise intervention can effectively improve the sarcopenia. In the process of evidence transformation,medical staff should choose the best evidence according to the specific situation and individual factors of patients,and guide the elderly to exercise safely and effectively and improve the quality of life.

Key words: Aged, Sarcopenia, Exercise Intervention, Evidence-Based Nursing

沈睿, 王茜茜, 徐霓影, 任昕燕, 王俊杰. 老年肌少症患者运动干预的最佳证据总结[J]. 中华护理杂志, 2021, 56(10): 1560-1566.

SHEN Rui, WANG Xixi, XU Niying, REN Xinyan, WANG Junjie. Evidence summary of exercise intervention for elderly patients with sarcopenia[J]. Chinese Journal of Nursing, 2021, 56(10): 1560-1566.

图/表 4

图 1 文献检索筛选流程图

Figure 1 Flow chart of literature search and screening

表1 纳入文献的一般特征（n=16）

Table 1 Characteristics of included literatures（n=16）

表2 纳入的系统评价方法学质量评价结果（n=9）

Table 2 Quality evaluation results of included systematic review methodology（n=9）

表3 老年肌少症患者运动干预的最佳证据总结

Table 3 Summary of the best evidence of exercise intervention for sarcopenia in the elderly

参考文献 35

[1]	Dent E, Morley JE, Cruz-Jentoft AJ, et al. International clinical practice guidelines for sarcopenia(ICFSR):screening,diagnosis and management[J]. J Nutr Health Aging, 2018, 22(10):1148-1161. DOI PMID
[2]	Beaudart C, McCloskey E, Bruyère O. et al. Sarcopenia in daily practice:assessment and management[J]. BMC Geriatr, 2016, 16(1):170. DOI URL
[3]	Anker SD, Morley JE, von Haehling S. Welcome to the icd-10 code for sarcopenia[J]. J Cachexia Sarcopenia Muscle, 2016, 7(5):512-514. DOI URL
[4]	Chen LK, Woo J, Assantachai P, et al. Asian working group for sarcopenia:2019 consensus update on sarcopenia diagnosis and treatment[J]. J Am Med Dir Assoc, 2020, 21（3）:300-307.e302. DOI URL
[5]	蔡东臻, 李行, 吴琪俊, 等. 骨骼肌减少症与代谢综合征关系的研究进展[J]. 公共卫生与预防医学, 2021, 32(2):121-125.
	Cai DZ, Li H, Wu QJ, et al. Research progress on the relationship between sarcopenia and metabolic syndrome[J]. J Public Heal Prev Med, 2021, 32(2):121-125.
[6]	Yang LJ, Wu GH, Yang YL, et al. Nutrition,physical exercise,and the prevalence of sarcopenia in elderly residents in nursing homes in China[J]. Med Sci Monit, 2019, 25:4390-4399. DOI URL
[7]	Cruz-Jentoft AJ, Sayer AA. Sarcopenia[J]. Lancet, 2019, 393(10191):2636-2646. DOI PMID
[8]	Bloom I, Shand C, Cooper C, et al. Diet quality and sarcopenia in older adults:a systematic review[J]. Nutrients, 2018, 10(3):308-335. DOI URL
[9]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
	Zhu Z, Hu Y, Xing WJ, et al. The composition of different types of evidence based problems[J]. J Nurses Train, 2017, 32(21):1991-1994.
[10]	Alper BS, Haynes RB. EBHC pyramid 5.0 for accessing prea-ppraised evidence and guidance[J]. Evid Based Med, 2016, 21(4):123-125. DOI URL
[11]	Foster MJ, Shurtz S. Making the critical appraisal for summaries of evidence(CASE) for evidence-based medicine(EBM):critical appraisal of summaries of evidence[J]. J Med Libr Assoc, 2013, 101(3):192-198. DOI URL
[12]	Hoffmann-Eβer W, Siering U, Neugebauer EA, et al. Guideline appraisal with agree ii:systematic review of the current evidence on how users handle the 2 overall assessments[J]. Plos One, 2017, 12(3):e0174831. DOI URL
[13]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018:81-82.
	Hu Y, Hao YF. Evidence based nursing[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018:81-82.
[14]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018:56-93.
	Hu Y, Hao YF. Evidence based nursing[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018:56-93.
[15]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurs Train, 2015, 30(11):964-967.
[16]	中华医学会骨质疏松和骨矿盐疾病分会. 肌少症共识[J]. 中华骨质疏松和骨矿盐疾病杂志, 2016, 9(3):215-227.
	Osteoporosis and Bone Mineral Salt Diseases Branch of Chinese Medical Association. Consensus on sarcopenia[J]. Chin J Osteop Bon Min Res, 2016, 9(3):215-227.
[17]	孙建琴, 张坚, 常翠青, 等. 肌肉衰减综合征营养与运动干预中国专家共识(节录)[J]. 营养学报, 2015, 37(4):320-324.
	Sun JQ, Zhang J, Chang CQ, et al. Chinese expert consensus on nutrition and exercise intervention for muscle wasting syndrome(excerpt)[J]. Acta Nutr Sin, 2015, 37(4):320-324.
[18]	中华医学会老年医学分会老年康复学组, 肌肉衰减综合征专家共识撰写组. 肌肉衰减综合征中国专家共识(草案)[J]. 中华老年医学杂志, 2017, 36(7):711-718.
	Geriatric rehabilitation group of Chinese geriatric society, writing group of Chinese expert consensus on the management of sarcopenia in China. Expert consensus on the management of sarcopenia in China(Draft)[J]. Chin J Geria, 2017, 36(7):711-718.
[19]	Mitch TH. Geriatric health maintenance[EB/OL].（2021-01-02）[2021-02-08]. http://www-uptodate-cn-s.webvpn.zju.edu.cn/.
[20]	Miriam CM. Physical activity and exercise in older adults.[EB/OL].（2020-12-16）[2021-01-13]. http://www-uptodate-cn-s.webvpn.zju.edu.cn/.
[21]	Austin B. Practical guidelines for implementing a strength trai-ning program for adults.[EB/OL].（2020-12-20） [2021-01-21]. http://www-uptodate-cn-s.webvpn.zju.edu.cn/.
[22]	Bao W, Sun Y, Zhang T, et al. Exercise programs for muscle mass,muscle strength and physical performance in older adults with sarcopenia:a systematic review and meta-analysis[J]. Aging Dis, 2020, 11(4):863-873. DOI URL
[23]	Sarabon N, Kozinc Ž, Löfler S, et al. Resistance exercise,electrical muscle stimulation,and whole-body vibration in older adults:systematic review and meta-analysis of randomized controlled trials[J]. J Clin Med, 2020, 9(9):2902. DOI URL
[24]	de Mello RGB, Dalla Corte RR, Gioscia J, et al. Effects of physical exercise programs on sarcopenia management,dynapenia,and physical performance in the elderly:a systematic review of randomized clinical trials[J]. J Aging Res, 2019, 2019:1959486.
[25]	Beckwée D, Delaere A, Aelbrecht S, et al. Exercise interventions for the prevention and treatment of sarcopenia:a syste-matic umbrella review[J]. J Nutr Health Aging, 2019, 23(6):494-502. DOI PMID
[26]	Hughes L, Paton B, Rosenblatt B, et al. Blood flow restriction training in clinical musculoskeletal rehabilitation:a systematic review and meta-analysis[J]. Br J Sports Med, 2017, 51(13):1003-1011. DOI URL
[27]	Moore SA, Hrisos N, Errington L, et al. Exercise as a treatment for sarcopenia:an umbrella review of systematic review evidence[J]. Physiotherapy, 2020, 107:189-201. DOI URL
[28]	Lee SY, Tung HH, Liu CY, et al. Physical activity and sarcope-nia in the geriatric population:a systematic review[J]. J Am Med Dir Assoc, 2018, 19(5):378-383. DOI URL
[29]	Wilson SG, Pedro CV. Effect of interventions with exercise and/or supplementation on muscle mass of elderly people with sarcopenia:a meta-analysis[J]. Revista de Ciencias del Ejercicio y la Salud, 2019, 17(1):1-22.
[30]	Csapo R, Alegre LM. Effects of resistance training with moderate vs heavy loads on muscle mass and strength in the elderly:a meta-analysis[J]. Scand J Med Sci Sports, 2016, 26(9):995-1006. DOI URL
[31]	Distefano G, Goodpaster BH. Effects of exercise and aging on skeletal muscle[J]. Cold Spring Harb Perspect Med, 2018, 8(3):a029785. DOI URL
[32]	Lopes KG, Bottino DA, Farinatti P, et al. Strength training with blood flow restriction-a novel therapeutic approach for older adults with sarcopenia? A case report[J]. Clin Interv Aging, 2019, 14:1461-1469. DOI URL
[33]	Papadopoulou SK. Sarcopenia:a contemporary health problem among older adult populations[J]. Nutrients, 2020, 12(5):1293. DOI URL
[34]	Seldeen KL, Lasky G, Leiker MM, et al. High intensity interval training improves physical performance and frailty in aged mice[J]. J Gerontol A Biol Sci Med Sci, 2018, 73(4):429-437. DOI URL
[35]	Seldeen KL, Redae YZ. Short session high intensity interval training and treadmill assessment in aged mice[J]. J Vis Exp, 2019, 2(144):e59138.