抗阻运动对中老年女性下肢肌肉力量及功能干预效果的Meta分析
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摘要
系统评估抗阻运动对中老年女性下肢肌肉力量及功能的影响,探讨不同抗阻运动方案对下肢肌肉力量的干预效果,为中老年女性抗阻运动处方的制定提供科学依据。方法:计算机检索PubMed、EBSCO Host、Web of Science、中国知网(CNKI)数据库,检索期限均为建库至2017年12月31日,收集抗阻运动干预中老年女性下肢肌肉力量及功能指标的随机对照实验,依据纳入标准和排除标准进行文献筛选,应用Cochrane偏倚风险工具对纳入文献进行方法学质量评价,并运用ReMan 5.3.5软件进行合并效应量分析。结果:共纳入16个随机对照试验,总样本量为545人,中等质量研究11篇,高质量研究5篇。Meta分析结果显示,抗阻运动可显著提高中老年女性下肢肌肉力量和肌肉功能,合并效应量分别为:下肢肌肉力量MD=16.52,95%CI为[10.93,22.11],P<0.01;起立走-计时测试MD=-1.03,95%CI为[-1.26,-0.80],P<0.01;步行时间MD=-0.60,95%CI为[-0.83,-0.37],P<0.01。肌肉力量与步行时间异质性较为明显(分别为I2=85%,I2=92%)。通过对下肢肌肉力量的Meta亚组分析显示,运动周期12～52周、运动时间45～50 min/次或60～90 min/次、运动频率2～3次/周、组间间歇时间1～2 min、运动强度65%～85%1RM的抗阻运动均能够显著提高中老年女性的下肢肌肉力量;同时运动时间与强度可能是研究异质性的来源。结论:抗阻运动能够有效提高中老年女性下肢肌肉力量和肌肉功能,但受纳入研究质量、数量及混杂因素的影响,未来应开展更多规范、高质量的研究加以验证。
Objective: To evaluate the effect of resistance training on low extremity muscle strength and function in middle-aged and elderly women, exploring the influence of different resistance training programs and providing scientific basis. Methods: Search literatures in PubMed, EBSCO Host, Web of Science and CNKI databases, from the time of database construction to Dec 31, 2017, collecting related randomized controlled trials. Literature screening was conducted based on inclusion criteria and exclusion criteria, using the Cochrane bias risk assessment tools to evaluate the methodological quality, and the relevant data were analyzed by Re Man5.3.5 software. Result: There are 16 studies, 545 samples included, with 11 studies graded as moderate quality, and 5 as high degree; meta-analysis showed that resistance training can significantly improve low extremity muscle strength in middle-aged and elderly women, muscle strength(MD=16.52,95% CI 为[10.93～22.11],P<0.01), timed up and go(MD=-1.03,95%CI 为 [-1.26～-0.80],P<0.01)and walking time(MD=-0.60,95%CI 为 [-0.83～-0.37],P<0.01),but muscle strength and walking time heterogeneity were more obvious(I2=85%,I2=92% respectively); the subgroup analysis shows that a training period of 12-52 weeks,a training time of 45-50 min, 60-90 min, a training frequency of 2 or 3 sessions a week, a rest of 1-2 min between sets and a training intensity of 65%-85%1 RM can significantly increase low extremity muscle strength;and the time and intensity may be the source of heterogeneity. Conclusion: Resistance training can significantly improve the low extremity muscle strength in middle-aged and elderly women. However, due to the limitations of the included studies, more high quality studies are required.
Objective: To evaluate the effect of resistance training on low extremity muscle strength and function in middle-aged and elderly women, exploring the influence of different resistance training programs and providing scientific basis. Methods: Search literatures in PubMed, EBSCO Host, Web of Science and CNKI databases, from the time of database construction to Dec 31, 2017, collecting related randomized controlled trials. Literature screening was conducted based on inclusion criteria and exclusion criteria, using the Cochrane bias risk assessment tools to evaluate the methodological quality, and the relevant data were analyzed by Re Man5.3.5 software. Result: There are 16 studies, 545 samples included, with 11 studies graded as moderate quality, and 5 as high degree; meta-analysis showed that resistance training can significantly improve low extremity muscle strength in middle-aged and elderly women, muscle strength(MD=16.52,95% CI 为[10.93～22.11],P<0.01), timed up and go(MD=-1.03,95%CI 为 [-1.26～-0.80],P<0.01)and walking time(MD=-0.60,95%CI 为 [-0.83～-0.37],P<0.01),but muscle strength and walking time heterogeneity were more obvious(I2=85%,I2=92% respectively); the subgroup analysis shows that a training period of 12-52 weeks,a training time of 45-50 min, 60-90 min, a training frequency of 2 or 3 sessions a week, a rest of 1-2 min between sets and a training intensity of 65%-85%1 RM can significantly increase low extremity muscle strength;and the time and intensity may be the source of heterogeneity. Conclusion: Resistance training can significantly improve the low extremity muscle strength in middle-aged and elderly women. However, due to the limitations of the included studies, more high quality studies are required.
引文
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[2]MARTONE A M, LATTANZIO F, ABBATECOLA A M, et al. Treating sarcopenia in older and oldest old[J]. Curr Pharm Des, 2015, 21(13):1715.
[3]NEWMAN A B, KUPELIAN V, VISSER M, et al. Sarcopenia:alternative definitions and associations with lower extremity function[J]. J Am Geriatr Soc, 2003, 51(11):1602.
[4]LANDI F, LIPEROTI R, RUSSO A, et al. Sarcopenia as a risk factor for falls in elderly individuals:results from the ilsirente study[J]. Clin Nutr,2012, 31(5):652.
[5]ERIM Z, BEG M F, BURKE D T, et al. Effects of aging on motor-unit control properties[J]. J Neurophysiol, 1999, 82(5):2081.
[6]JANSSEN I, SHEPARD D S, KATZMARZYK P T, et al. The healthcare costs of sarcopenia in the united states[J]. J Am Geriatr Soc, 2004, 52(1):80.
[7]HANSE M. Female hormones:do they influence muscle and tendon protein metabolism[J]. Proc Nutr Soc,2018,77(1):32.
[8]陈敏,林轶凡,孙建琴,等.老年人随年龄增加肌肉衰减变化特点研究[J].肠外与肠内营养,2012,19(5):263.
[9]王颖,宋永丽,孟丽苹,等.齐齐哈尔市1836名体检成年人骨骼肌量及其与年龄的关联研究[J].中华预防医学杂志, 2016, 50(3):235.
[10]夏志伟,孟丽苹,满青青,等.北京市老年人肌肉衰减综合征膳食因素分析[J].卫生研究, 2016, 45(3):388.
[11]PAHOR M, GURALNIK J M, AMBROSIUS W T, et al. Effect of structured physical activity on prevention of major mobility disability in older adults:the LIFE study randomized clinical trial[J].JAMA,2014,311(23):2387.
[12]BANN D, CHEN H, BONELL C, et al. Socioeconomic differences in the benefits of structured physical activity compared with health education on the prevention of major mobility disability in older adults:the LIFE study[J].J Epidemiol Community Health, 2016, 70(9):930.
[13]KOBAYASHI Y, UEYASU Y, YAMASHITA Y, et al. Effects of 4 weeks of explosive-type strength training for the plantar flexors on the rate of torque development and postural stability in elderly individuals[J]. Int J Sports Med, 2016, 37(6):470.
[14]CHODZKO-ZAJKO W J, PROCTOR D N, FIATARONE SINGH M A,et al. Exercise and physical activity for older adults[J]. Med Sci Sport Exer, 2009, 41(6):992.
[15]王正珍. ACSM运动测试与运动处方指南[M].9版.北京:北京体育大学出版社,2010:208.
[16]LIBERATI A, ALTMAN D G, TETZLAFF J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions:explanation and elaboration[J].BMJ,2009, 6(4):1.
[17] ANONYMOUS. Physical activity and public health in older adults:recommendation from the american college of sports medicine and the american heart association(ACSM/AHA)[J]. Geriatr Nurs, 2007, 28(6):339.
[18]NUNES P R, OLIVEIRA A A, MARTINS F M, et al. Effect of resistance training volume on walking speed performance in postmenopausal women:a randomized controlled trial[J]. Exp Gerontol, 2017, 97:80.
[19]NICHOLSON V P, MCKEAN M R, SLATER G J, et al. Low-load very high-repetition resistance training attenuates bone loss at the lumbar spine in active post-menopausal women[J]. Calcified Tissue Int, 2015,96(6):490.
[20] STRANDBERG E, EDHOLM P, PONSOT E, et al. Influence of combined resistance training and healthy diet on muscle mass in healthy elderly women:a randomized controlled trial[J]. J Appl Physiol, 2015,119(8):918.
[21] RAMIREZ-CAMPILLO R, CASTILLO A, DE LA FUENTE C I, et al.High-speed resistance training is more effective than low-speed resistance training to increase functional capacity and muscle performance in older women[J]. Exp Gerontol, 2014(58):51.
[22]FARINATTI P T, GERALDE A A, BOTTARO M F, et al. Effects of different resistance training frequencies on the muscle strength and functional performance of active women older than 60 years[J]. J Strength Cond Res, 2013, 27(8):2225.
[23]CONCEICAO M S, BONGANHA V, VECHIN F C, et al. Sixteen weeks of resistance training can decrease the risk of metabolic syndrome in healthy postmenopausal women[J]. Clin Interv Aging, 2013, 8(3):1221.
[24]GERAGE A M, FORJAZ C L, NASCIMENTO M A, et al. Cardiovascular adaptations to resistance training in elderly postmenopausal women[J]. Int J Sports Med, 2013, 34(9):806.
[25]LUSTOSA L P, PEREIRA L S M, COELHO F M, et al. Impact of an exercise program on muscular and functional performance and plasma levels of Interleukin 6 and soluble receptor tumor necrosis factor in prefrail community-dwelling older women:a randomized controlled Trial[J]. Arch Phys Med Rehabil, 2013, 94(4):660.
[26]PINTO R S, CORREA C S, RADAELLI R, et al. Short-term strength training improves muscle quality and functional capacity of elderly women[J]. Age, 2014, 36(1):365.
[27]MARQUES E A, WANDERLEY F, MACHADO L, et al. Effects of resistance and aerobic exercise on physical function, bone mineral density,OPG and RANKL in older women[J]. Exp Gerontol, 2011, 46(7):524.
[28]ORSATTI F L, NAHAS E A, MAESTA N, et al. Plasma hormones, muscle mass and strength in resistance-trained postmenopausal women[J].Maturitas, 2008, 59(4):394.
[29]HAYKOWSKY M, MCGAVOCK J, VONDER M I, et al. Effect of exercise training on peak aerobic power, left ventricular morphology, and muscle strength in healthy older women[J]. J Gerontol A Biol Sci Med Sci, 2005, 60(3):307.
[30]BEMBEN D A, FETTERS N L, BEMBEN M G, et al. Musculoskeletal responses to high-and low-intensity resistance training in early postmenopausal women[J]. Med Sci Sports Exerc, 2000, 32(11):1949.
[31]RHODES E C, MARTIN A D, TAUNTON J E, et al. Effects of one year of resistance training on the relation between muscular strength and bone density in elderly women[J]. Brit J Sport Med, 2000, 34(1):18.
[32]MORGANTI C M, NELSON M E, FIATARONE M A, et al. Strength improvements with 1 yr of progressive resistance training in older women[J]. Med Sci Sports Exerc, 1995, 27(6):906.
[33]CHARETTE S L, MCEVOY L, PYKA G, et al. Muscle hypertrophy response to resistance training in older women[J]. J Appl Physiol, 1991,70(5):1912.
[34] CHAPMAN P P, WHITEHEAD J R, BINKERT R H. The 225-1b reps-to-fatigue test as a submaximal estimate of 1-RM bench press performance in college football players[J]. J Strength Cond Res, 1998,12(4):258.
[35]LANDER J. Maximum based on reps[J]. NSCA Journal, 1985, 6(6):60.
[36]PETERSON M D, RHEA M R, SEN A, et al. Resistance exercise for muscular strength in older adults:a meta-analysis[J]. Ageing Res Rev, 2010, 9(3):226
[37]王光平,张开发.抗阻运动对老年人肌肉力量影响的元分析[J].体育学刊, 2011, 18(5):132.
[38] LIU C, LATHAM N K. Progressive resistance strength training for improving physical function in older adults[J]. Int J Older People Nurs,2011, 6(3):244.
[39]张凡,张广美.女性绝经综合征的研究进展[J].中国临床研究,2017, 30(8):1131.
[40]LOWE D A, BALTGALVIS K A, GREISING S M. Mechanisms behind estrogens’beneficial effect on muscle strength in females[J]. Exerc Sport Sci Rev, 2010, 38(38):61.
[41]叶柳,翁清.女性血清睾酮水平与代谢综合征的相关性分析[J].健康研究, 2016, 36(3):249.
[42]EI KHOUDARY S R, BROOKS M M, THURSTON R C, et al. Lipoprotein subclasses and endogenous sex hormones in women at midlife[J]. J Lipid Res, 2014, 55(7):1498.
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