太极拳与健康教育对社区老年高血压衰弱患者的干预比较。
Tai Chi versus health education as a frailty intervention for community-dwelling older adults with hypertension.
机构信息
Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, 92093, US.
Sam and Rose Stein Institute for Research On Aging, University of California San Diego, La Jolla, CA, 92093, US.
出版信息
Aging Clin Exp Res. 2023 Oct;35(10):2051-2060. doi: 10.1007/s40520-023-02504-w. Epub 2023 Jul 17.
BACKGROUND
Frailty is associated with poor outcomes among older adults with hypertension and complicates its pharmacological management. Here, we assessed whether 12-weeks of instructor-guided, group Tai Chi (TC) practice improved frailty relative to Healthy Aging Practice-centered Education (HAP-E) classes in older adults with hypertension.
METHODS
Secondary analysis of a randomized controlled trial in San Diego County, USA, of 167 community-dwelling individuals aged ≥ 60 yrs (70% female; 72.1 ± 7.5 yrs), defined as non-frail (66%) or frail (34%) based on 53-item deficit accumulation frailty index (FI). Linear mixed-effects models were used to assess pre-to-post intervention differences in FI and logistic regression to explore differential odds of clinically meaningful FI change.
RESULTS
One hundred thirty-one participants completed post-intervention assessments. Frailty decreased pre-to-post intervention in the TC (ΔFI = - 0.016, d = - 0.39, - 0.75 to - 0.03), but not the HAP-E arm (ΔFI = - 0.009, d = - 0.13, - 0.52-0.27), despite no significant group differences between the TC and HAP-E arms (d = - 0.11, - 0.46-0.23). Furthermore, greater odds of improved FI were observed for frail participants in the TC (OR = 3.84, 1.14-14.9), but not the HAP-E (OR = 1.34, 0.39-4.56) arm. Subgroup analysis indicated treatment effects in TC were attributed to frail participants (frail: ΔFI = - 0.035, d = - 0.68, -1.26 to - 0.08; non-frail: ΔFI = - 0.005, d = - 0.19, - 0.59-0.22), which was not the case in the HAP-E arm (frail: ΔFI = - 0.017, d = - 0.23, - 0.81-0.35; non-frail: ΔFI = - 0.003, d = - 0.07, - 0.47-0.33). Frail participants were no more likely to drop-out of the study than non-frail (71% vs. 69% retained).
CONCLUSIONS
Twelve weeks of twice-weekly guided TC practice was well-tolerated, associated with decreases in frailty, and increased odds of clinically meaningful FI improvement at post-intervention.
背景
衰弱与老年高血压患者的不良结局相关，且使其药物治疗复杂化。在这里，我们评估了 12 周有指导的小组太极拳（TC）练习是否比以健康老龄化为中心的教育（HAP-E）课程更能改善高血压老年人的衰弱状况。
方法
对美国圣地亚哥县的一项随机对照试验进行二次分析，纳入了 167 名年龄在 60 岁及以上的社区居民（70%为女性；72.1±7.5 岁），根据 53 项缺陷累积衰弱指数（FI）分为非衰弱（66%）或衰弱（34%）。采用线性混合效应模型评估 FI 干预前后的差异，采用逻辑回归探索 FI 有临床意义变化的差异概率。
结果
131 名参与者完成了干预后的评估。TC 组的衰弱程度在干预前后有所下降（FI 变化= -0.016，d=-0.39，-0.75 至 -0.03），而 HAP-E 组则没有（FI 变化= -0.009，d=-0.13，-0.52 至 0.27），尽管 TC 组和 HAP-E 组之间没有显著的组间差异（d=-0.11，-0.46 至 -0.23）。此外，TC 组的衰弱参与者更有可能改善 FI（OR=3.84，1.14-14.9），而 HAP-E 组则没有（OR=1.34，0.39-4.56）。亚组分析表明，TC 组的治疗效果归因于衰弱参与者（衰弱：FI 变化= -0.035，d=-0.68，-1.26 至 -0.08；非衰弱：FI 变化= -0.005，d=-0.19，-0.59 至 -0.22），而 HAP-E 组则没有（衰弱：FI 变化= -0.017，d=-0.23，-0.81 至 -0.35；非衰弱：FI 变化= -0.003，d=-0.07，-0.47 至 -0.33）。衰弱参与者比非衰弱参与者更不可能退出研究（71% vs. 69%保留）。
结论
每周两次的指导 TC 练习 12 周耐受良好，与衰弱程度降低以及干预后 FI 有临床意义改善的可能性增加相关。
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