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多组分干预预防体弱老年人行动障碍安全有效
作者:小柯机器人 发布时间:2022/5/15 14:06:39

意大利天主圣心大学Emanuele Marzetti团队研究了多组分干预预防体弱老年人行动障碍的效果。2022年5月11日,《英国医学杂志》发表了这一成果。

为了确定基于体力活动、技术支持和营养咨询的多组分干预措施是否能预防身体虚弱和肌肉减少症老年人的行动障碍,2016年1月至2019年10月31日,研究组在11个欧洲国家的16个临床机构进行了一项评估者盲的随机对照试验。共招募了1519名70岁及以上、在社区居住,身体虚弱、肌肉减少、或同时伴有低功能状态的男性和女性,低功能状态定义为简易体能状况量表(SPPB)评分为3到9分,四肢瘦体重(ALM)低,仅能独立行走400米。

760名参与者被随机分为多组分干预组,759人接受了健康老龄化教育(对照组)。多组分干预包括每周在中心进行两次中等强度的体育活动,每周在家最多进行四次。活动测定数据用于定制干预措施。参与者还接受了个性化的营养咨询。对照组参与者每月接受一次健康老龄化教育。干预和随访持续了36个月。

主要结局是行动障碍(在<15分钟内无法独立行走400米)。将持续性行动障碍(连续两次无法行走400米)以及从基线检查到24个月和36个月的身体表现、肌力和四肢瘦体重的变化作为预先计划的次要结局进行分析。对基线SPPB得分为3-7分(1205例)的参与者进行初步比较。SPPB评分为8分或9分(314例)的患者分别进行分析,以进行探索。

1519名参与者(1088名为女性)的平均年龄为78.9岁。平均随访26.4个月。在SPPB评分为3-7分的参与者中,多组分干预组中283/605(46.8%)人出现行动障碍,对照组中316/600(52.7%)人,危险比为0.78,组间差异显著。多组分干预组中127/605(21.0%)人出现持续性行动障碍,对照组中150/600(25.0%)人,危险比为0.79,组间差异不显著。

多组分干预组与对照组在24个月和36个月时SPPB评分的组间差异分别为0.8分和1.0分,差异均显著,且有利于多组分干预组。多组分干预组女性在24个月时的握力下降幅度显著小于对照组,相差0.9千克,差异显著。在24个月和36个月时,多组分干预组女性的四肢瘦体重降低分别比对照组少0.24千克和0.49千克,组间差异显著。

多组分干预组中237/605(39.2%)人发生严重不良事件,对照组中216/600(36.0%)人,风险比为1.09;在SPPB评分为8或9分的参与者中,多组分干预组中46/155(29.7%)人出现行动障碍,对照组中38/159(23.9%)人,危险比为1.25,差异均不显著。

研究结果表明,多组分干预与身体虚弱、肌肉减少和SPPB评分为3-7分的老年人的行动障碍发生率降低有关。在易受伤害的老年人中,为保护其行动能力应特别关照身体虚弱和肌肉减少者。

附:英文原文

Title: Multicomponent intervention to prevent mobility disability in frail older adults: randomised controlled trial (SPRINTT project)

Author: Roberto Bernabei, Francesco Landi, Riccardo Calvani, Matteo Cesari, Susanna Del Signore, Stefan D Anker, Raphael Bejuit, Philippe Bordes, Antonio Cherubini, Alfonso J Cruz-Jentoft, Mauro Di Bari, Tim Friede, Carmen Gorostiaga Ayestarán, Harmonie Goyeau, Pálmi V Jónsson, Makoto Kashiwa, Fabrizia Lattanzio, Marcello Maggio, Luca Mariotti, Ram R Miller, Leocadio Rodriguez-Maas, Regina Roller-Wirnsberger, Ingrid Ryznarová, Joachim Scholpp, Annemie M W J Schols, Cornel C Sieber, Alan J Sinclair, Anna Skalska, Timo Strandberg, Achille Tchalla, Eva Topinková, Matteo Tosato, Bruno Vellas, Stephan von Haehling, Marco Pahor, Ronenn Roubenoff, Emanuele Marzetti

Issue&Volume: 2022/05/11

Abstract:

Objective To determine whether a multicomponent intervention based on physical activity with technological support and nutritional counselling prevents mobility disability in older adults with physical frailty and sarcopenia.

Design Evaluator blinded, randomised controlled trial.

Setting 16 clinical sites across 11 European countries, January 2016 to 31 October 2019.

Participants 1519 community dwelling men and women aged 70 years or older with physical frailty and sarcopenia, operationalised as the co-occurrence of low functional status, defined as a short physical performance battery (SPPB) score of 3 to 9, low appendicular lean mass, and ability to independently walk 400 m. 760 participants were randomised to a multicomponent intervention and 759 received education on healthy ageing (controls).

Interventions The multicomponent intervention comprised moderate intensity physical activity twice weekly at a centre and up to four times weekly at home. Actimetry data were used to tailor the intervention. Participants also received personalised nutritional counselling. Control participants received education on healthy ageing once a month. Interventions and follow-up lasted for up to 36 months.

Main outcome measures The primary outcome was mobility disability (inability to independently walk 400 m in <15 minutes). Persistent mobility disability (inability to walk 400 m on two consecutive occasions) and changes from baseline to 24 and 36 months in physical performance, muscle strength, and appendicular lean mass were analysed as pre-planned secondary outcomes. Primary comparisons were conducted in participants with baseline SPPB scores of 3-7 (n=1205). Those with SPPB scores of 8 or 9 (n=314) were analysed separately for exploratory purposes.

Results Mean age of the 1519 participants (1088 women) was 78.9 (standard deviation 5.8) years. The average follow-up was 26.4 (SD 9.5) months. Among participants with SPPB scores of 3-7, mobility disability occurred in 283/605 (46.8%) assigned to the multicomponent intervention and 316/600 (52.7%) controls (hazard ratio 0.78, 95% confidence interval 0.67 to 0.92; P=0.005). Persistent mobility disability occurred in 127/605 (21.0%) participants assigned to the multicomponent intervention and 150/600 (25.0%) controls (0.79, 0.62 to 1.01; P=0.06). The between group difference in SPPB score was 0.8 points (95% confidence interval 0.5 to 1.1 points; P<0.001) and 1.0 point (95% confidence interval 0.5 to 1.6 points; P<0.001) in favour of the multicomponent intervention at 24 and 36 months, respectively. The decline in handgrip strength at 24 months was smaller in women assigned to the multicomponent intervention than to control (0.9 kg, 95% confidence interval 0.1 to 1.6 kg; P=0.028). Women in the multicomponent intervention arm lost 0.24 kg and 0.49 kg less appendicular lean mass than controls at 24 months (95% confidence interval 0.10 to 0.39 kg; P<0.001) and 36 months (0.26 to 0.73 kg; P<0.001), respectively. Serious adverse events occurred in 237/605 (39.2%) participants assigned to the multicomponent intervention and 216/600 (36.0%) controls (risk ratio 1.09, 95% confidence interval 0.94 to 1.26). In participants with SPPB scores of 8 or 9, mobility disability occurred in 46/155 (29.7%) in the multicomponent intervention and 38/159 (23.9%) controls (hazard ratio 1.25, 95% confidence interval 0.79 to 1.95; P=0.34).

Conclusions A multicomponent intervention was associated with a reduction in the incidence of mobility disability in older adults with physical frailty and sarcopenia and SPPB scores of 3-7. Physical frailty and sarcopenia may be targeted to preserve mobility in vulnerable older people.

DOI: 10.1136/bmj-2021-068788

Source: https://www.bmj.com/content/377/bmj-2021-068788

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj