抗阻运动对改善健康老年人平衡能力和预防跌倒的效果比较：系统评价和荟萃分析。

OBJECTIVE: Physical training (PT, e.g., Tai Chi and strength training) has been demonstrated to improve balance control and prevent falls. Recently, exergame intervention (EI) has emerged to prevent falls by enhancing both physical and cognitive functions in older adults. Therefore, we aim to quantitatively assess and compare the effects of PT and EI on the performance of balance control and fall prevention in healthy older adults via meta-analysis. METHODS: A search strategy based on the PICOS principle was used to find the publication in the databases of PubMed, EMBASE, Web of Science, Cochrane Library, and MEDLINE. The quality and risk of bias in the studies were independently assessed by two researchers. RESULTS: Twenty studies consisting of 845 participants were included. Results suggested that as compared to PT, EI induced greater improvement in postural control (sway path length, SMD = - 0.66, 95% CI - 0.91 to - 0.41, P < 0.001, I = 0%; sway speed, SMD = - 0.49, 95% CI - 0.71 to - 0.27, P < 0.001, I = 42%) and dynamic balance (SMD = - 0.19, 95% CI - 0.35 to - 0.03, P = 0.02, I = 0%) in healthy older adults. The EI with 90-119 min/week for more than 8-week significantly reduced falls. Subgroup analyses revealed that exergames, which were designed by the two principles of repeatedly performing diversified tasks and gradually increase the difficulty of the task, induced significant effects in improving balance control and falls prevention respectively (P = 0.03, P = 0.009). In addition, intervention that combines EI and PT induced significant improvement in postural control (P = 0.003). CONCLUSION: The exergame intervention, especially the combination of EI and PT, is a promising strategy to improve balance control and reduce falls in healthy older adults. Future studies with rigorous design, larger sample size, and follow-up assessments are needed to further assess the effectiveness of diverse exergame interventions in fall prevention and to quantify the "dose-effect" relationship, as well as the carry-over effect of such intervention, which will ultimately help optimize the rehabilitative strategies to improve balance control and prevent falls.

目的：身体训练（PT，如太极和力量训练）已被证明可改善平衡控制并预防跌倒。最近，运动游戏干预（EI）通过增强老年人的身体和认知功能而出现，以预防跌倒。因此，我们旨在通过荟萃分析定量评估和比较 PT 和 EI 对健康老年人平衡控制和跌倒预防表现的影响。

方法：基于 PICOS 原则的搜索策略用于在 PubMed、EMBASE、Web of Science、Cochrane Library 和 MEDLINE 数据库中查找出版物。两名研究人员独立评估研究的质量和偏倚风险。

结果：纳入了 20 项研究，共 845 名参与者。结果表明，与 PT 相比，EI 可更大程度地改善姿势控制（摆动路径长度，SMD = -0.66，95%CI -0.91 至 -0.41，P < 0.001，I = 0%；摆动速度，SMD = -0.49，95%CI -0.71 至 -0.27，P < 0.001，I = 42%）和健康老年人的动态平衡（SMD = -0.19，95%CI -0.35 至 -0.03，P = 0.02，I = 0%）。每周进行 90-119 分钟、超过 8 周的 EI 可显著减少跌倒。亚组分析显示，分别通过重复执行多样化任务和逐步增加任务难度这两个原则设计的运动游戏可分别显著改善平衡控制和预防跌倒（P = 0.03，P = 0.009）。此外，EI 和 PT 相结合的干预措施可显著改善姿势控制（P = 0.003）。

结论：运动游戏干预，特别是 EI 和 PT 的结合，是改善健康老年人平衡控制和减少跌倒的有前途的策略。需要进一步开展设计严谨、样本量更大、随访评估的研究，以进一步评估各种运动游戏干预预防跌倒的有效性，并量化此类干预的“剂量-效应”关系以及干预的延续效应，这将有助于优化改善平衡控制和预防跌倒的康复策略。