人类的衰老过程是普遍的,无处不在,不可避免。每个生理功能都在不断减弱。两种不同的衰老表型之间有一定的范围,由生活模式塑造-经验和行为,特别是通过是否存在身体活动(PA)和有组织的锻炼(即,久坐不动的生活方式)。衰老和久坐的生活方式与肌肉功能和心肺健康的下降有关,导致执行日常活动和维持独立运作的能力受损。然而,在存在足够的运动/PA的情况下,随着年龄的增长,肌肉和有氧能力的这些变化显着减弱。此外,结构化运动和整体PA作为许多慢性病的预防策略都发挥着重要作用,包括心血管疾病,中风,糖尿病,骨质疏松,和肥胖;改善流动性,心理健康,和生活质量;降低死亡率,除了其他好处。值得注意的是,运动干预计划改善了虚弱的标志(低体重,力量,移动性,PA水平,能量)和认知,从而优化老化过程中的功能能力。在这些病理条件下,运动被用作治疗剂,并遵循以下原则:确定疾病的原因,然后以循证剂量使用药剂来消除或缓解疾病。因此,PA/结构化练习的处方应基于预期结果(例如,一级预防,健康或功能状态或疾病治疗的改善),个性化,像任何其他医疗一样调整和控制。此外,与其他治疗剂一致,运动显示出剂量反应效应,可以使用不同的方式个性化,适合于健康状态或医疗状况的体积和/或强度。重要的是,运动疗法通常同时针对几个生理系统,而不是像通常的药物治疗方法那样针对单一结果。有的疾病,运动是一种替代药物治疗(如抑郁症),从而有助于解除潜在不适当药物的处方(PIMS).还有其他疾病目前没有有效的药物治疗(如肌肉减少症或痴呆),它可能在预防和治疗中起主要作用。因此,这一共识声明为在老年人中使用运动和PA促进健康和疾病预防和治疗提供了基于证据的理由.运动处方是根据随机对照试验中研究的特定方式和剂量来讨论的,因为它们在减轻衰老的生理变化方面的有效性。疾病预防,和/或改善患有慢性疾病和残疾的老年人。提出了建议,以弥合当前文献中的空白,并优化运动/PA作为预防药物和治疗剂的使用。
The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this
consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.