Mo Yihan, Chen Linghui, Zhou Yuxin, Bone Anna, Maddocks Matthew, Evans Catherine J
Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
J Cachexia Sarcopenia Muscle. 2024 Dec;15(6):2208-2233. doi: 10.1002/jcsm.13576. Epub 2024 Sep 18.
Sedentary behaviour and physical inactivity are independent risk factors for sarcopenia for long-term care facility residents. Understanding the components, mechanisms and context of interventions that target change in these risk factors can help optimize sarcopenia management approaches. This study aimed to identify, appraise and synthesize the interventions targeting sedentary behaviour and physical inactivity, construct a Theory of Change logic model, inform complex sarcopenia intervention development and identify areas for improvement.
Eight electronic databases, including Embase and Web of Science, were searched for eligible interventional studies from inception until February 2024. Narrative synthesis was used. The Theory of Change was applied to develop a logic model presenting the synthesized results. A Cochrane risk of bias assessment tool was used for quality appraisal.
The study included 21 articles involving 1014 participants, with mean ages ranging from 72.5 to 90.4 years. The proportion of female participants ranged from 8.0% to 100.0%. The applied sarcopenia diagnosis criteria varied, including those of the Asian Working Group for Sarcopenia and the European Working Group on Sarcopenia in Older People. The overall risk of bias in the included studies was moderate. Interventions primarily targeted physical inactivity, with resistance training being the most common intervention type. The reporting of intervention adherence was insufficient (only 11 out of 21 included studies provided adherence reports), and adherence overall and by intervention type was not possible to discern due to inconsistent criteria for high adherence across these studies. Four categories of intervention input were identified: educational resources; exercise equipment and accessories; monitoring and tailoring tools; and motivational strategies. Intervention activities fell into five categories: determining the intervention plan; educating; tailoring; organizing, supervising, assisting and motivating; and monitoring. While sarcopenia-related indicators were commonly used as desired outcomes, intermediate outcomes (i.e., sedentary time and physical activity level) and other long-term outcomes (i.e., economic outcomes) were less considered. Contextual factors affecting intervention use included participant characteristics (i.e., medical condition and education level) and intervention provider characteristics (i.e., trustworthiness).
The findings led to the development of a novel logic model detailing essential components for interventions aimed at managing sarcopenia in long-term care facilities, with a focus on addressing sedentary behaviour and physical inactivity. Future sarcopenia interventions in long-term care facilities should fully attend to sedentary behaviour, enhance adherence to interventions through improved education, monitoring, tailoring and motivation and establish an agreed standard set of outcome measures.
久坐行为和缺乏身体活动是长期护理机构居民肌肉减少症的独立风险因素。了解针对这些风险因素变化的干预措施的组成部分、机制和背景，有助于优化肌肉减少症的管理方法。本研究旨在识别、评估和综合针对久坐行为和缺乏身体活动的干预措施，构建一个变革理论逻辑模型，为复杂的肌肉减少症干预措施开发提供信息，并确定改进领域。
检索了包括Embase和Web of Science在内的八个电子数据库，以查找从数据库建立至2024年2月的符合条件的干预性研究。采用叙述性综合分析。应用变革理论来开发一个逻辑模型，以呈现综合结果。使用Cochrane偏倚风险评估工具进行质量评估。
该研究纳入了21篇文章，涉及1014名参与者，平均年龄在72.5岁至90.4岁之间。女性参与者的比例从8.0%到100.0%不等。所应用的肌肉减少症诊断标准各不相同，包括亚洲肌肉减少症工作组和欧洲老年人肌肉减少症工作组的标准。纳入研究的总体偏倚风险为中等。干预措施主要针对缺乏身体活动，阻力训练是最常见的干预类型。干预依从性的报告不足（21项纳入研究中只有11项提供了依从性报告），由于这些研究中高依从性的标准不一致，无法辨别总体依从性和按干预类型的依从性。确定了四类干预输入：教育资源；运动设备及配件；监测和定制工具；以及激励策略。干预活动分为五类：确定干预计划；教育；定制；组织、监督、协助和激励；以及监测。虽然与肌肉减少症相关的指标通常被用作期望的结果，但对中间结果（即久坐时间和身体活动水平）和其他长期结果（即经济结果）的考虑较少。影响干预措施使用的背景因素包括参与者特征（即医疗状况和教育水平）和干预提供者特征（即可信度）。
这些发现促成了一个新颖的逻辑模型的开发，该模型详细说明了旨在管理长期护理机构中肌肉减少症的干预措施的基本组成部分，重点是解决久坐行为和缺乏身体活动的问题。未来长期护理机构中针对肌肉减少症的干预措施应充分关注久坐行为，通过改进教育、监测、定制和激励来提高对干预措施的依从性，并建立一套商定的标准结局指标。
