Department of Medicine, Division of Geriatrics, Gerontology & Palliative Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Geriatrics Research Education & Clinical Center (GRECC), South Texas Veterans Healthcare System, San Antonio, TX, USA.
Geriatrics Research Education & Clinical Center (GRECC), South Texas Veterans Healthcare System, San Antonio, TX, USA; School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Clin Ther. 2019 Mar;41(3):376-386. doi: 10.1016/j.clinthera.2019.01.006. Epub 2019 Mar 7.
Frailty is a syndrome of vulnerability and physical decline with aging that increases risk for disability, hospitalizations, and death. To date, interventions for frailty have primarily focused on exercise and/or nutritional interventions, many of which show improvement in frailty-related characteristics, such as gait speed and lower extremity strength and function. The goal of this article was to review prior research studies investigating interventions for frailty and review the literature with regard to the role of insulin resistance and inflammation in the development of frailty. Also included is a discussion of potential therapeutic interventions for frailty.
A literature search was conducted by using PubMed and the search terms frailty, interventions, and older adults. This review focused on larger studies (N ≥ 100 participants) that examined the effect of specific interventions on frailty as a primary outcome or on measures that are closely related to frailty, such as gait speed, muscle strength, and/or sarcopenia.
The results of prior studies of exercise interventions for the frailty syndrome as the primary outcome are mixed, with some but not all showing benefit. However, many exercise interventions have demonstrated improvement in components of frailty, such as strength, gait speed, and physical activity. The evidence shows that regular physical activity is beneficial for frail older adults or those at high risk of frailty and that the adverse effects related to exercise are minimal compared with the potential gains. However, questions remain as to the optimal type and duration of exercise and whether results of clinical trials are easily and feasibly implemented in a clinical setting in individuals whose motivation for exercise may be low. There is now increasing interest in pharmacologic agents that could potentially be useful in the prevention or treatment of frailty, in part based on advances in basic biology of aging research demonstrating that pharmacological agents extend lifespan in rodents. Several studies now show that obesity, insulin resistance, inflammation, and diabetes are associated with and predict frailty. Because metformin targets insulin resistance and inflammation, it is a plausible pharmacologic agent to prevent frailty. A clinical trial is underway to examine metformin's usefulness in frailty prevention.
Although the benefits of exercise are known, adherence to these regimens may be difficult for individual older adults due to lack of motivation, access, or limitations due to chronic medical conditions. Studies are currently underway to examine novel agents for the prevention of frailty in older adults.
衰弱是一种与衰老相关的脆弱和身体衰退综合征，会增加残疾、住院和死亡的风险。迄今为止，针对衰弱的干预措施主要集中在运动和/或营养干预上，其中许多干预措施显示出与衰弱相关特征的改善，例如步态速度和下肢力量和功能。本文的目的是回顾先前研究衰弱干预措施的研究，并回顾关于胰岛素抵抗和炎症在衰弱发展中的作用的文献。还讨论了衰弱的潜在治疗干预措施。
使用 PubMed 进行文献检索，并使用“衰弱”、“干预”和“老年人”等检索词。本综述重点关注较大规模的研究（N≥100 名参与者），这些研究检查了特定干预措施对衰弱作为主要结果或对与衰弱密切相关的措施（例如步态速度、肌肉力量和/或肌肉减少症）的影响。
作为主要结果的针对衰弱综合征的运动干预的先前研究结果参差不齐，有些研究显示有益，但并非所有研究都显示有益。然而，许多运动干预措施已经显示出衰弱的某些组成部分的改善，例如力量、步态速度和身体活动。证据表明，有规律的体育活动对虚弱的老年人或有衰弱高风险的人有益，与潜在收益相比，与运动相关的不良影响很小。然而，关于最佳类型和持续时间的运动以及临床试验的结果是否容易和可行地在那些运动动机可能较低的个体的临床环境中实施，仍存在疑问。由于衰老研究的基础生物学的进步表明，药物可以延长啮齿动物的寿命，因此现在人们对潜在有用的药物越来越感兴趣。一些研究表明，肥胖、胰岛素抵抗、炎症和糖尿病与衰弱有关，并可预测衰弱。由于二甲双胍针对胰岛素抵抗和炎症，因此是预防衰弱的合理药物。一项临床试验正在进行中，以研究二甲双胍在预防衰弱方面的作用。
虽然运动的益处是已知的，但由于缺乏动机、缺乏机会或由于慢性疾病的限制，个别老年人可能难以遵守这些方案。目前正在进行研究，以检查用于预防老年人衰弱的新型药物。
