School of Nursing, Peking University, China.
School of Nursing, Peking University, China.
Arch Gerontol Geriatr. 2023 Nov;114:105083. doi: 10.1016/j.archger.2023.105083. Epub 2023 Jun 22.
Frailty is a well-recognized risk factor for adverse health-related outcomes in aging population. However, little is known about the dynamic changing nature of frailty and the potential for it to be modified within the scope of exercise. Currently, there has not been a systematic review of the impact of Otago exercise program (OEP) implementation specifically for the frail or pre-frail older adults.
To determine the effectiveness of Otago exercise program on the degree of frailty, physical balance ability, mobility, grip strength and health-related quality of life in older adults with frailty or pre-frailty.
We conducted literature searching in seven electronic databases, as well as hand-search of reference of included studies from inception to December 2022. Eligible studies included clinical trials of pre-frail or frail elderly receiving OEP interventions reporting on the relevant outcomes. The effect size was evaluated using standardized mean differences (SMDs) and its 95% confidence interval with random effects models. Risk of bias was appraised independently by two authors.
10 trials containing 8 RCTs and 2 non-RCTs studies were included. Five studies were evaluated with some concerns in the evidence quality. The results showed that the OEP intervention could possibly reduce the level of frailty (SMD=-1.14, 95% CI: -1.68∼-0.06, P < 0.01) and improve the mobility (SMD=-2.15, 95% CI: -3.35∼-0.94, P < 0.01) and physical balance ability (SMD=2.59, 95% CI: 1.07-4.11), P = 0.01), and enhance their grip strength (SMD=1.68, 95% CI=0.05∼3.31, P = 0.04). However, no statistically significant effect of OEP on quality of life (SMD=-1.517, 95% CI=-3.18∼0.15, P = 0.07) in frail elderly was found based on the current evidence. The subgroup analysis indicated that participant age, different intervention total duration and per min of each session have varying degrees of impact on frail or pre-frail older people.
The OEP intervention targeting older adults with frailty or pre-frailty are effective in reducing frailty, improving physical balance ability, mobility, and grip strength with low to moderate certainty. More rigorous and tailored research are still needed in the future to further enrich the evidence in these fields.
衰弱是老龄化人口中与健康相关的不良结局的公认危险因素。然而，对于衰弱的动态变化性质以及在运动范围内进行衰弱干预的潜力知之甚少。目前，尚无针对虚弱或虚弱前期老年人的奥塔哥运动计划（OEP）实施效果的系统评价。
确定奥塔哥运动计划对虚弱或虚弱前期老年人衰弱程度、身体平衡能力、移动能力、握力和健康相关生活质量的影响。
我们在七个电子数据库中进行了文献检索，并对纳入研究的参考文献进行了手工检索，检索范围从开始到 2022 年 12 月。纳入的研究包括接受 OEP 干预的虚弱或虚弱前期老年人的临床试验，报告了相关结局。使用标准化均数差（SMD）及其 95%置信区间和随机效应模型评估效应量。两位作者独立评估偏倚风险。
共纳入 10 项试验，其中 8 项为 RCT，2 项为非 RCT 研究。5 项研究的证据质量存在一定的担忧。结果表明，OEP 干预可能降低衰弱程度（SMD=-1.14，95%CI：-1.68∼-0.06，P<0.01），改善移动能力（SMD=-2.15，95%CI：-3.35∼-0.94，P<0.01）和身体平衡能力（SMD=2.59，95%CI：1.07∼4.11），P=0.01），并增强握力（SMD=1.68，95%CI=0.05∼3.31，P=0.04）。然而，根据目前的证据，OEP 对虚弱老年人的生活质量（SMD=-1.517，95%CI=-3.18∼0.15，P=0.07）没有统计学上的显著影响。亚组分析表明，参与者年龄、不同的干预总持续时间和每次干预的每分钟对虚弱或虚弱前期老年人有不同程度的影响。
针对虚弱或虚弱前期老年人的 OEP 干预在降低衰弱程度、改善身体平衡能力、移动能力和握力方面是有效的，具有低到中度的确定性。未来仍需要更严格和更有针对性的研究，以进一步丰富这些领域的证据。
