运动项目对预防高度失能的机构养老老年人健康相关生活质量下降的影响：一项随机对照试验

Effects of exercise programs to prevent decline in health-related quality of life in highly deconditioned institutionalized elderly persons: a randomized controlled trial.

作者信息

Dechamps Arnaud, Diolez Philippe, Thiaudière Eric, Tulon Aurore, Onifade Chérifa, Vuong Tuan, Helmer Catherine, Bourdel-Marchasson Isabelle

机构信息

Department of Physical Activity and Exercise Psychology, LACES 4140, Faculté des Sciences du Sport, Bordeaux, France.

出版信息

Arch Intern Med. 2010 Jan 25;170(2):162-9. doi: 10.1001/archinternmed.2009.489.

DOI:10.1001/archinternmed.2009.489

PMID:20101011

Abstract

BACKGROUND

Our objective was to assess the effects of targeted exercise programs on health-related quality of life compared with usual care based on the ability to perform activities of daily living (ADL) and the Neuropsychiatric Inventory scores in geriatric institutionalized persons.

METHODS

A randomized controlled trial of 2 exercise programs vs usual care was conducted in 160 institutionalized persons 65 years or older who were able to understand basic motor commands and to move from one position to another. Interventions were performed over 6 months and were either an adapted tai chi program (4 times 30 min/wk) or a cognition-action program (2 times 30-45 min/wk) that focused primarily on an adapted guidance of patient-centered communication skills. The control group received usual care. The study was conducted at 4 settings. The main outcomes were changes in health-related quality of life based on ADL and Neuropsychiatric Inventory scores after 12 months.

RESULTS

The control group experienced a decline in ADL over the 12-month period compared with the adapted tai chi and cognition-action groups, but the differences were not significant (P = .24 and P = .15, respectively). Also, the components of ADL, eg, ability to walk, continence, and nutrition, were maintained better in the intervention groups than in the control group. The total Neuropsychiatric Inventory score also worsened significantly in the control group, while it was unchanged or improved in the intervention groups. The differences between the cognition-action group and the control group were significant (P > .001). Neuropsychiatric diagnosis subgroups (such as dementia and psychosis) did not show a specific response from any intervention.

CONCLUSION

Adapted exercise programs can slow down the decline in health-related quality of life among heterogeneous, institutionalized elderly persons.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00623532.

摘要

背景

我们的目标是，基于老年机构化人群的日常生活活动（ADL）能力和神经精神科问卷评分，评估针对性运动项目与常规护理相比，对健康相关生活质量的影响。

方法

对160名65岁及以上、能够理解基本运动指令并能从一个位置移动到另一个位置的机构化人员进行了一项随机对照试验，比较2种运动项目与常规护理。干预持续6个月，干预项目为适应性太极拳项目（每周4次，每次30分钟）或认知 - 行动项目（每周2次，每次30 - 45分钟），后者主要侧重于以患者为中心的沟通技巧的适应性指导。对照组接受常规护理。该研究在4个场所进行。主要结局指标是12个月后基于ADL和神经精神科问卷评分的健康相关生活质量变化。

结果

与适应性太极拳组和认知 - 行动组相比，对照组在12个月期间ADL有所下降，但差异不显著（分别为P = 0.24和P = 0.15）。此外，干预组ADL的各个组成部分，如行走能力、大小便控制能力和营养状况，比对照组维持得更好。对照组的神经精神科问卷总分也显著恶化，而干预组则保持不变或有所改善。认知 - 行动组与对照组之间的差异显著（P > 0.001）。神经精神科诊断亚组（如痴呆和精神病）对任何干预均未表现出特定反应。