运动处方联合个体化营养干预对社区老年肌肉减少症患者的干预效果

于溯; 任龙兵; 孙艳格; 丁倩; 李晶; 辛小一

doi:10.16766/j.cnki.issn.1674-4152.004089

运动处方联合个体化营养干预对社区老年肌肉减少症患者的干预效果

doi: 10.16766/j.cnki.issn.1674-4152.004089

于溯¹,
任龙兵²,
孙艳格^1, ,,
丁倩³,
李晶¹,
辛小一¹

1.
北京市西城区首都医科大学附属复兴医院月坛社区卫生服务中心, 北京 100045
2.
北京大学医学部公共卫生学院中国卫生发展研究中心, 北京 100083
3.
北京市大兴区礼贤镇中心卫生院, 北京 102604

基金项目:

国家自然科学基金青年基金项目 72404010

首都卫生发展科研专项项目首发2022-3-70211

详细信息

通讯作者:
孙艳格，E-mail: 13488796993@163.com

中图分类号: R153.3 R455
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- 文章访问数: 8
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出版历程
- 收稿日期: 2024-12-18
- 网络出版日期: 2025-10-25

Effectiveness of exercise prescription combined with personalized nutrition intervention for community-dwelling older adults with sarcopenia

1.
Yuetan Community Health Center, Fuxing Hospital of Capital Medical University, Beijing 100045, China

摘要

摘要: 目的肌肉减少症严重影响老年人健康。为探索社区老年人肌肉减少症干预路径及干预效果，提高基层专病诊疗能力，该研究基于社区专病特色门诊，开展为期26周的老年肌少症患者运动处方联合个体化营养干预，评价其干预效果。方法采用连续招募的方式于2022年10月—2023年11月在首都医科大学附属复兴医院月坛社区卫生服务中心骨质疏松症专病特色门诊招募符合纳排标准的肌少症患者60人，通过掷硬币法将患者按照1∶1比例随机分为干预组(30人)和对照组(30人)。干预组包括营养评估及个性化营养干预联合每周≥90 min抗阻及有氧运动。对照组为常规门诊健康宣教。采用问卷及体格检查收集2组患者基本信息及干预前后肌少症相关指标及营养评估数据。结果 2组患者干预前各项指标差异无统计学意义。经过26周干预，干预组患者平均握力为(21.62±6.04)kg, 5次起坐试验时间为(11.27±3.19)s，简易体能状况量表为(10.43±2.60)分，对照组患者分别为(18.45±5.17)kg, (16.39±5.67)s，(7.13±2.76)分，干预组患者上述肌少症相关指标均显著优于对照组(P＜0.05)。2组患者肌肉量和6米步速差异无统计学意义。干预组患者干预后SARC-Calf量表筛查阳性率、衰弱率和营养不良率均显著低于对照组，肌少症相关健康素养水平均优于对照组(P＜0.05)。结论基于社区专病门诊开展运动处方联合个体化营养干预可以有效改善老年肌少症患者肌力、躯体功能、日常生活能力和生活质量。
- 肌少症 /
- 社区老年人群 /
- 营养干预 /
- 运动干预 /
- 效果分析
Abstract: Objective Sarcopenia severely affects the health of the elderly. To explore intervention approaches and evaluate the effectiveness of interventions for sarcopenia in community-dwelling older adults, as well as to enhance the capacity of primary care in specialized disease management, this study implemented a 26-week exercise prescription combined with personalized nutrition intervention for elderly patients with sarcopenia through a community-based specialized outpatient clinic, aiming to assess its intervention effects. Methods Participants were consecutively recruited from the Osteoporosis Specialty Clinic of Yuetan Community Health Service Center (affiliated with Capital Medical University Fuxing Hospital) between October 2022 and November 2023. A total of 60 sarcopenia patients who met the inclusion and exclusion criteria were enrolled and randomly assigned in a 1∶1 ratio to either the intervention group (n=30) or the control group (n=30) using a coin toss method. The intervention group included nutrition assessment and personalized nutrition intervention combined with no less than 90 minutes of resistance and aerobic exercise per week. The control group was routine outpatient health education. Questionnaires and physical examinations were used to collect sarcopenia-related indicators and nutritional evaluation data before and after intervention. Results There was no statistically significant difference in various indicators between the two groups before intervention. After 26 weeks of intervention, the intervention group showed significantly better sarcopenia-related indicators compared to the control group (all P < 0.05). Specifically, the intervention group had a higher mean handgrip strength [(21.62±6.04) kg vs. (18.45±5.17) kg], faster performance in the five-time sit-to-stand test [(11.27±3.19) s vs. (16.39±5.67) s], and higher scores on the short physical performance battery [(10.43±2.60) points vs. (7.13±2.76) points]. There was no statistically significant difference in muscle mass and 6-meter walking speed between the two groups. Additionally, the intervention group demonstrated significantly lower rates of SARC-Calf screening positivity, frailty, and malnutrition, along with higher health literacy levels related to sarcopenia compared to the control group post-intervention (P < 0.05). Conclusion Exercise prescription combined with individualized nutrition intervention based on community clinics can effectively improve grip strength, body function, daily living ability, and quality of life of elderly patients with sarcopenia.
- Sarcopenia /
- Community elderly population /
- Nutritional intervention /
- Exercise intervention /
- Effect analysis

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图 1 社区肌少症筛查诊断流程

Figure 1. Screening and diagnostic process for sarcopenia at a community health service center

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表 1 社区老年人肌少症运动干预处方

Table 1. Community health service center exercise prescription for elderly individuals with sarcopenia

阶段	类别	运动处方
第一阶段		5 min拉伸运动，防止肌肉拉伸
第二阶段	抗阻训练	卧位。a1.双桥运动：20个/组，3组/d(15 min)；b1.侧桥运动(左右)：20个/组，3组/d(15 min)；c1.空蹬自行车训练：10个/组，3组/d(15 min)；d1.直腿抬高训练(髋屈曲、外展、后伸)：20个/组，2组/d(15 min)
		坐位。a2.上肢哑铃举重训练(腕关节和上臂及肩屈曲、外展，后伸)：10个/组，3组/d(20 min)；b2.下肢弹力带抗阻训练(膝伸展)：20个/组，3组/d(10 min)；c3.股四头肌训练仪抗阻训练：20个/组，3组/d(20 min)
		立位。a3.下肢弹力带抗阻训练(髋屈曲、外展、后伸)：10个/组，3组/d(20 min)；b3.功率自行车抗阻训练(20 min)/组
	有氧运动	a4.散步：30 min；b4.快走：20 min；c4.慢跑：10 min
第三阶段	恢复整理	5 min轻柔拉伸，防止乳酸堆积
注：正式运动时间可根据实际情况自由组合，叠加运动时间需≥30 min，每周3~4次。每日运动做好组合记录。

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表 2 2组老年肌肉减少症患者基线资料比较

Table 2. Baseline comparison between two elderly groups of elderly patients with sarcopenia

项目	干预组(n=30)	对照组(n=30)	统计量	P值
一般人口学信息
性别[例(%)]			0.098^a	0.754
男性	6(20.0)	7(23.3)
女性	24(80.0)	23(76.7)
年龄(x±s，岁)	75.33±7.59	77.87±8.19	1.542^b	0.219
文化程度[例(%)]			0.789^a	0.374
中学及以下	20(66.7)	17(56.7)
大学及以上	10(33.3)	13(43.3)
居住情况[例(%)]
独居	7(23.3)	7(23.3)
共居(家人/保姆)	23(76.7)	23(76.7)
生活习惯[例(%)]
吸烟情况			0.185^a	0.667
从不吸烟	28(93.3)	26(86.7)
吸烟/戒烟	2(6.7)	4(13.3)
饮酒情况			0.267^a	0.605
从不饮酒	29(96.7)	27(90.0)
饮酒	1(3.3)	3(10.0)
饮食习惯			0.267^a	0.606
荤素均衡	14(46.7)	16(53.3)
素食为主	16(53.3)	14(46.7)
身体活动			3.896^a	0.143
每周至少锻炼5次	12(40.0)	10(33.3)
每周至少锻炼1次	15(50.0)	20(66.7)
几乎不锻炼	3(10.0)	0
失眠			3.300^a	0.069
否	17(56.7)	10(33.3)
是	13(43.3)	20(66.7)
睡眠时间(x±s，h)	6.07±1.23	5.93±0.87	0.485^b	0.629
疾病史[例(%)]
高血压	16(53.3)	17(56.7)	0.067^a	0.795
冠心病	7(23.3)	11(36.7)	1.270^a	0.260
脑卒中	2(6.7)	2(6.7)	＜0.001^a	0.999
糖尿病	9(30.0)	10(33.3)	0.077^a	0.781
血脂异常	15(50.0)	17(56.7)	0.268^a	0.605
骨质疏松	20(66.7)	24(80.0)	1.364^a	0.243
慢阻肺	0	1(3.3)	1.017^a	0.313
慢性肾脏病	2(6.7)	0	0.517^a	0.472
抑郁症	2(6.7)	2(6.7)	＜0.001^a	0.999
注：^a为χ²值, ^b为t值。

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表 3 2组老年肌肉减少症患者体格检查、辅助检查及肌少症相关指标比较(x±s)

Table 3. Comparison of physical exams, tests, and sarcopenia markers between two groups of elderly sarcopenia patients (x±s)

项目	干预组(n=30)	对照组(n=30)	t值	P值
体格检查
身高(m)	1.58±0.09	1.58±0.09	0.241	0.810
体重(kg)	48.23±7.70	48.95±6.29	0.398	0.692
BMI	19.02±2.11	19.45±1.56	0.897	0.374
臂中围(cm)	23.21±2.10	23.65±2.39	0.745	0.459
小腿围(cm)	30.48±2.25	31.14±1.70	1.293	0.201
生化检查
白蛋白(g/L)	43.96±2.00	43.86±2.80	0.162	0.872
总胆固醇(mmol/L)	5.23±1.13	4.83±0.98	1.453	0.152
血红蛋白(g/L)	132.93±9.50	131.79±14.95	0.351	0.727
血清25羟-维生素D(ng/mL)	22.19±9.69	23.28±11.62	0.392	0.696
肌少症相关指标
最大握力(kg)	18.53±3.81	18.83±5.06	0.261	0.795
肌肉质量(kg/m²)	4.81±0.98	5.12±0.90	1.271	0.209
6米步速(m/s)	0.78±0.20	0.77±0.21	0.195	0.846
5次起坐试验(s)	14.87±6.60	14.86±4.14	0.002	0.998

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表 4 2组老年肌肉减少症患者干预后肌少症相关指标比较

Table 4. Comparison of sarcopenia-related indicators between two groups of elderly sarcopenia patients after intervention

项目	干预组(n=30)	对照组(n=30)	统计量	P值
最大握力(x±s，kg)	21.62±6.04	18.45±5.17	2.186^a	0.033
肌肉质量(x±s，kg/m²)	5.06±1.06	5.14±0.97	0.278^a	0.782
6米步速(x±s，m/s)	0.85±0.21	0.77±0.22	1.441^a	0.155
5次起坐试验(x±s，s)	11.27±3.19	16.39±5.67	4.167^a	＜0.001
简易体能状况量表(x±sx±s，分)	10.43±2.60	7.13±2.76	4.768^a	＜0.001
SARC-CalF评分(x±sx±s，分)	10.03±3.68	11.53±3.95	1.521^a	0.134
SARC-CalF筛查阳性[例(%)]	12(40.0)	24(80.0)	8.403^b	0.004
Fried衰弱表型[例(%)]			30.840^b	＜0.001
无衰弱	18(60.0)	0
衰弱前期	8(26.7)	7(23.3)
衰弱	4(13.3)	23(76.7)
微型营养评估得分(x±s，分)	22.82±2.47	20.91±2.64	2.882^a	0.006
微型营养评估分级[例(%)]			6.674^b	0.010
营养状况良好	12(40.0)	4(13.3)
存在营养不良风险	18(60.0)	24(80.0)
营养不良	0	2(6.7)
注：^a为t值, ^b为χ²值。

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表 5 2组老年肌肉减少症患者干预后肌少症危险因素的知晓率及症状自评情况比较[例(%)]

Table 5. Comparison of awareness rates of sarcopenia risk factors and self-assessed symptoms between two groups of elderly sarcopenia patients after intervention [cases(%)]

项目	干预组(n=30)	对照组(n=30)	χ²值	P值
肌少症危险因素知晓情况			24.320	＜0.001
全部知晓	6(20.0)	1(3.3)
部分知晓	21(70.0)	5(16.7)
不知道	3(10.0)	24 80.0)
自觉肌少症，是	29(96.7)	21(70.0)	5.880	0.015
肌少症症状自评
不能快速过马路	8(26.7)	23(76.7)	13.081	＜0.001
上楼需要拐杖	3(10.0)	10(33.3)	3.535	0.060
弯腰困难	12(40.0)	26(86.7)	12.129	＜0.001
害怕跌倒	20(66.7)	29(96.7)	7.124	0.008
感觉肌肉虚弱	11(36.7)	28(93.3)	18.755	＜0.001

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