Gallardo-Gómez Daniel, Del Pozo-Cruz Jesús, Pedder Hugo, Alfonso-Rosa Rosa M, Álvarez-Barbosa Francisco, Noetel Michael, Jasper Unyime, Chastin Sebastien, Ramos-Munell Javier, Del Pozo Cruz Borja
Departamento de Educación Física y Deportes, University of Seville, Sevilla, Spain.
Bristol Medical School (PHS), University of Bristol, Bristol, UK.
Br J Sports Med. 2023 Oct;57(19):1272-1278. doi: 10.1136/bjsports-2022-106409. Epub 2023 Aug 3.
To identify the optimal dose and type of physical activity to improve functional capacity and reduce adverse events in acutely hospitalised older adults.
Systematic review and Bayesian model-based network meta-analysis.
Four databases were searched from inception to 20 June 2022.
Randomised controlled trials that assessed the effectiveness of a physical activity-based intervention on at least one functional outcome in people aged ≥50 years hospitalised due to an acute medical condition were included. Pooled effect estimates (ie, standardised mean differences for functional capacity and the ratio of means for adverse events) were calculated using random treatment effects network meta-analysis models.
Nineteen studies (3842 participants) met the inclusion criteria. Approximately 100 Metabolic Equivalents of Task per day (METs-min/day) (40 min/day of light effort or ~25 min/day of moderate effort activities) was the minimal dose to improve the functional capacity of acute hospitalised older adults (standardised mean difference (SMD)=0.28, 95% credible interval (CrI) 0.01 to 0.55). The optimal dose was estimated at 159 METs-min/day (70 min/day of light effort or 40 min/day of moderate effort activities; SMD=0.41, 95% CrI 0.08 to 0.72). Ambulation was deemed the most efficient intervention, and the optimal dose was reached at 143 METs-min/day (50 min/day of slow-paced walking; SMD=0.76, 95% CrI 0.35 to 1.16), showing a high evidential power (87.68%). The minimal effective ambulation dose was estimated at 74 METs-min/day (~25 min/day of slow-paced walking; SMD=0.25, 95% CrI 0.01 to 0.41). Physical activity interventions resulted in a decrease in the rate of adverse events compared with usual care at discharge (ratio of means=0.96, 95% CrI 0.95 to 0.97; median time 7 days).
This meta-analysis yielded low to moderate evidence supporting the use of in-hospital supervised physical activity programmes in acutely hospitalised older adults. As little as ~25 min/day of slow-paced walking is sufficient to improve functional capacity and minimise adverse events in this population.
PROSPERO CRD42021271999.
确定最佳的身体活动剂量和类型，以改善急性住院老年患者的功能能力并减少不良事件。
系统评价和基于贝叶斯模型的网络荟萃分析。
检索了四个数据库，检索时间从建库至2022年6月20日。
纳入评估基于身体活动的干预措施对因急性疾病住院的≥50岁人群至少一项功能结局有效性的随机对照试验。使用随机治疗效应网络荟萃分析模型计算合并效应估计值（即功能能力的标准化均数差值和不良事件均数之比）。
19项研究（3842名参与者）符合纳入标准。每天约100代谢当量任务（METs - 分钟/天）（约40分钟/天的轻度活动或约25分钟/天的中度活动）是改善急性住院老年患者功能能力的最小剂量（标准化均数差值（SMD）=0.28，95%可信区间（CrI）0.01至0.55）。最佳剂量估计为159 METs - 分钟/天（约70分钟/天的轻度活动或约40分钟/天的中度活动；SMD = 0.41，95% CrI 0.08至0.72）。步行被认为是最有效的干预措施，在143 METs - 分钟/天（约50分钟/天的慢步走；SMD = 0.76，95% CrI 0.35至1.16）时达到最佳剂量，显示出较高的证据强度（87.68%）。步行的最小有效剂量估计为74 METs - 分钟/天（约25分钟/天的慢步走；SMD = 0.25，95% CrI 0.01至0.41）。与出院时的常规护理相比，身体活动干预导致不良事件发生率降低（均数之比 = 0.96，95% CrI 0.95至0.97；中位时间7天）。
这项荟萃分析提供了低到中等强度的证据，支持在急性住院老年患者中使用院内监督的身体活动计划。对于该人群，每天只需约25分钟的慢步走就足以改善功能能力并使不良事件最小化。
PROSPERO CRD42021271999。
