Ferrucci Luigi, Cooper Rachel, Shardell Michelle, Simonsick Eleanor M, Schrack Jennifer A, Kuh Diana
National Institute on Aging, Baltimore, Maryland.
Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, UK.
J Gerontol A Biol Sci Med Sci. 2016 Sep;71(9):1184-94. doi: 10.1093/gerona/glw043. Epub 2016 Mar 14.
Mobility is the most studied and most relevant physical ability affecting quality of life with strong prognostic value for disability and survival. Natural selection has built the "engine" of mobility with great robustness, redundancy, and functional reserve. Efficient patterns of mobility can be acquired during development even by children affected by severe impairments. Analogously, age-associated impairments in mobility-related physiological systems are compensated and overt limitations of mobility only occur when the severity can no longer be compensated. Mobility loss in older persons usually results from multiple impairments in the central nervous system, muscles, joints, and energetic and sensory physiological systems. Early preclinical changes in these physiological systems that precede mobility loss have been poorly studied. Peak performance, rate of decline, compensatory behaviors, or subclinical deterioration of physiological resources may cumulatively influence both timing of mobility loss and chances of recovery, but their role as risk factors has not been adequately characterized. Understanding the natural history of these early changes and intervening on them would likely be the most effective strategy to reduce the burden of disability in the population. For example, young women with low bone peak mass could be counseled to start strength resistance exercise to reduce their high risk of developing osteoporosis and fracture later in life. Expanding this approach to other physiological domains requires collecting and interpreting data from life course epidemiological studies, establishing normative measures of mobility, physical function, and physical activity, and connecting them with life course trajectories of the mobility-relevant physiological domains.
运动能力是研究最多且与生活质量最相关的身体能力，对残疾和生存具有很强的预后价值。自然选择构建了具有高度稳健性、冗余性和功能储备的运动“引擎”。即使是受严重损伤影响的儿童，在发育过程中也能获得有效的运动模式。类似地，与运动相关的生理系统中与年龄相关的损伤会得到代偿，只有当严重程度无法再得到代偿时，才会出现明显的运动受限。老年人的运动能力丧失通常是由中枢神经系统、肌肉、关节以及能量和感觉生理系统的多种损伤导致的。在运动能力丧失之前，这些生理系统的早期临床前变化一直未得到充分研究。生理资源的峰值表现、下降速率、代偿行为或亚临床恶化可能会累积影响运动能力丧失的时间和恢复的机会，但其作为风险因素的作用尚未得到充分描述。了解这些早期变化的自然史并对其进行干预，可能是减轻人群残疾负担的最有效策略。例如，可以建议骨峰值质量低的年轻女性开始进行力量抵抗运动，以降低她们日后患骨质疏松症和骨折的高风险。将这种方法扩展到其他生理领域需要收集和解释来自生命历程流行病学研究的数据，建立运动能力、身体功能和身体活动的规范测量方法，并将它们与与运动相关的生理领域的生命历程轨迹联系起来。
