PDF(Pubmed)
Abstract：
BACKGROUND: Pre-frailty is associated with increased healthcare utilization. Over the past decade, public health interventions such as community-based exercises to target pre-frailty have been increasingly studied. However, the effects of community-based exercises on clinical outcome measures amongst community-dwelling older adults with pre-frailty remain unclear. This review aims to better understand the effects of community-based exercise on physical function, cognition, quality of life and frailty status in community-dwelling pre-frail older adults. A secondary objective was to investigate the optimal exercise parameters on clinical outcomes.
METHODS: Searches of MEDLINE, CINAHL, Google Scholar and Web of Science databases were conducted. Articles were included if they were randomized controlled trials (RCTs), and excluded if the participants consist of less than 50% pre-frail community-dwelling older adults. Meta-analyses (where possible) with either a fixed- or random- effect(s) model, standardized mean difference (SMD), odds ratio (OR) and tests of heterogeneity were performed. Multivariable meta-regression was performed to identify predictors of statistically significant outcome measures. The risk of bias was assessed using the modified Cochrane Risk-of-Bias tool.
RESULTS: Twenty-two RCTs with 900 participants in the experimental group and 1015 participants in the control group were included. When compared to minimal intervention, community-based exercises significantly improved lower limb strength (10 RCTs, 384 participants in the experimental group and 482 participants in the control group) with SMD 0.67 (95% CI 0.29 to 1.04), and lower limb function (5 RCTs, 120 participants in the experimental group and 219 participants in the control group) with SMD 0.27 (95% CI 0.03 to 0.51). Those who have received community-based exercises were more likely to reverse from pre-frailty to healthy state (OR = 2.74, 95% CI 1.36 to 5.51) (6 RCTs, 263 participants in the experimental group and 281 participants in the control group). The frequency of exercise sessions was a significant predictor of the effect size for gait speed (P<0.05).
CONCLUSIONS: Community-based exercise intervention is superior to minimal intervention for improving health status in pre-frail older adults. This has implications on the implementation of community-based exercise intervention by healthcare providers and policymakers.
UNASSIGNED: Nil funding for this review. PROSPERO registration number CRD42022348556.
METHODS: Searches of MEDLINE, CINAHL, Google Scholar and Web of Science databases were conducted. Articles were included if they were randomized controlled trials (RCTs), and excluded if the participants consist of less than 50% pre-frail community-dwelling older adults. Meta-analyses (where possible) with either a fixed- or random- effect(s) model, standardized mean difference (SMD), odds ratio (OR) and tests of heterogeneity were performed. Multivariable meta-regression was performed to identify predictors of statistically significant outcome measures. The risk of bias was assessed using the modified Cochrane Risk-of-Bias tool.
RESULTS: Twenty-two RCTs with 900 participants in the experimental group and 1015 participants in the control group were included. When compared to minimal intervention, community-based exercises significantly improved lower limb strength (10 RCTs, 384 participants in the experimental group and 482 participants in the control group) with SMD 0.67 (95% CI 0.29 to 1.04), and lower limb function (5 RCTs, 120 participants in the experimental group and 219 participants in the control group) with SMD 0.27 (95% CI 0.03 to 0.51). Those who have received community-based exercises were more likely to reverse from pre-frailty to healthy state (OR = 2.74, 95% CI 1.36 to 5.51) (6 RCTs, 263 participants in the experimental group and 281 participants in the control group). The frequency of exercise sessions was a significant predictor of the effect size for gait speed (P<0.05).
CONCLUSIONS: Community-based exercise intervention is superior to minimal intervention for improving health status in pre-frail older adults. This has implications on the implementation of community-based exercise intervention by healthcare providers and policymakers.
UNASSIGNED: Nil funding for this review. PROSPERO registration number CRD42022348556.
摘要：
背景：前期虚弱与医疗保健利用率的提高有关。在过去的十年里，公共卫生干预措施，例如以社区为基础的针对脆弱前期的运动，已经得到越来越多的研究。然而,目前尚不清楚社区锻炼对有衰弱前期的社区居住老年人临床结局指标的影响.这篇综述旨在更好地了解基于社区的锻炼对身体功能的影响，认知，社区居住前虚弱老年人的生活质量和虚弱状况。次要目标是研究临床结果的最佳运动参数。
方法：搜索MEDLINE，CINAHL,进行了GoogleScholar和WebofScience数据库。如果文章是随机对照试验(RCTs)，如果参与者包括少于50％的脆弱社区居住老年人，则将其排除在外。使用固定或随机效应模型进行荟萃分析(在可能的情况下)，标准化平均差(SMD)，进行了比值比(OR)和异质性检验.进行多变量元回归以确定具有统计学意义的结果指标的预测因子。使用改良的Cochrane偏差风险工具评估偏差风险。
结果：纳入了22个随机对照试验，其中900名参与者为实验组，1015名参与者为对照组。与最小干预相比，以社区为基础的锻炼显著提高了下肢力量(10项随机对照试验，实验组384名参与者，对照组482名参与者），SMD为0.67（95％CI0.29至1.04），和下肢功能(5项随机对照试验，实验组120名参与者，对照组219名参与者），SMD为0.27（95％CI0.03至0.51）。那些接受过社区锻炼的人更有可能从衰弱前状态逆转到健康状态(OR=2.74，95%CI1.36至5.51)(6项随机对照试验，实验组263名参与者，对照组281名参与者）。运动次数是步态速度效应大小的显著预测指标(P<0.05)。
结论：基于社区的运动干预在改善体弱的老年人的健康状况方面优于最低限度的干预。这对医疗保健提供者和政策制定者实施基于社区的运动干预具有影响。
■本次审查没有资金。PROSPERO注册号CRD42022348556。
方法：搜索MEDLINE，CINAHL,进行了GoogleScholar和WebofScience数据库。如果文章是随机对照试验(RCTs)，如果参与者包括少于50％的脆弱社区居住老年人，则将其排除在外。使用固定或随机效应模型进行荟萃分析(在可能的情况下)，标准化平均差(SMD)，进行了比值比(OR)和异质性检验.进行多变量元回归以确定具有统计学意义的结果指标的预测因子。使用改良的Cochrane偏差风险工具评估偏差风险。
结果：纳入了22个随机对照试验，其中900名参与者为实验组，1015名参与者为对照组。与最小干预相比，以社区为基础的锻炼显著提高了下肢力量(10项随机对照试验，实验组384名参与者，对照组482名参与者），SMD为0.67（95％CI0.29至1.04），和下肢功能(5项随机对照试验，实验组120名参与者，对照组219名参与者），SMD为0.27（95％CI0.03至0.51）。那些接受过社区锻炼的人更有可能从衰弱前状态逆转到健康状态(OR=2.74，95%CI1.36至5.51)(6项随机对照试验，实验组263名参与者，对照组281名参与者）。运动次数是步态速度效应大小的显著预测指标(P<0.05)。
结论：基于社区的运动干预在改善体弱的老年人的健康状况方面优于最低限度的干预。这对医疗保健提供者和政策制定者实施基于社区的运动干预具有影响。
■本次审查没有资金。PROSPERO注册号CRD42022348556。
