Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina.
Department of internal medicine, section on gerontology and geriatric medicine, Winston-Salem, North Carolina.
J Gerontol A Biol Sci Med Sci. 2019 Oct 4;74(11):1821-1827. doi: 10.1093/gerona/glz050.
The movement profile of older adults with compromised function is unknown, as is the relationship between these profiles and the development of major mobility disability (MMD)-a critical clinical outcome. We first describe the dimensions of movement in older adults with compromised function and then examine whether these dimensions predict the onset of MMD.
Older adults at risk for MMD (N = 1,022, mean age = 78.7 years) were randomized to receive a structured physical activity intervention or health education control. We assessed MMD in 6-month intervals (average follow-up of 2.2 years until incident MMD), with activity assessed at baseline, 6-, 12- and 24-month follow-up via accelerometry.
A principal components analysis of 11 accelerometer-derived metrics yielded three components representing lifestyle movement (LM), extended bouts of moderate-to-vigorous physical activity (MVPA), and stationary body posture. LM accounted for the greatest proportion of variance in movement (53%). Within health education, both baseline LM (HR = 0.74; 95% CI 0.62 to 0.88) and moderate-to-vigorous physical activity (HR = 0.69; 95% CI 0.54 to 0.87) were associated with MMD, whereas only LM was associated with MMD within physical activity (HR = 0.74; 95% CI 0.61 to 0.89). There were similar nonlinear relationships present for LM in both physical activity and health education (p < .04), whereby risk for MMD was lower among individuals with higher levels of LM.
Both LM and moderate-to-vigorous physical activity should be central in treatment regimens for older adults at risk for MMD.
clinicaltrials.gov Identifier NCT01072500.
功能受损的老年人的运动模式尚不清楚，这些模式与主要移动障碍（MMD）的发展之间的关系也不清楚——这是一个关键的临床结果。我们首先描述了功能受损的老年人的运动维度，然后研究了这些维度是否可以预测 MMD 的发生。
有发生 MMD 风险的老年人（N=1022，平均年龄=78.7 岁）被随机分配接受结构化的体育活动干预或健康教育对照。我们每 6 个月评估一次 MMD（平均随访 2.2 年，直到发生 MMD 事件），在基线、6 个月、12 个月和 24 个月的随访时使用加速度计评估活动。
11 项加速度计衍生指标的主成分分析产生了三个代表生活方式运动（LM）、适度到剧烈体力活动（MVPA）的延长时段和静止身体姿势的成分。LM 占运动变化的最大比例（53%）。在健康教育组中，基线 LM（HR=0.74；95%CI0.62 至 0.88）和适度到剧烈体力活动（HR=0.69；95%CI0.54 至 0.87）都与 MMD 相关，而只有 LM 与体育活动中的 MMD 相关（HR=0.74；95%CI0.61 至 0.89）。在体育活动和健康教育中，LM 也存在类似的非线性关系（p<0.04），即在 LM 水平较高的个体中，MMD 的风险较低。
生活方式运动和适度到剧烈体力活动都应该是有 MMD 风险的老年人治疗方案的核心。
clinicaltrials.gov 标识符 NCT01072500。
