Álvarez-Bustos Alejandro, Coelho-Junior Helio José, Calvani Riccardo, Rodriguez-Mañas Leocadio, Tosato Matteo, Cesari Matteo, Cherubini Antonio, Cruz-Jentoft Alfonso J, Jónsson Pálmi V, Lattanzio Fabrizia, Maggio Marcello, Roller-Wirnsberger Regina, Rýznarová Ingrid, Schols Annemie M W J, Sieber Cornel C, Sinclair Alan J, Skalska Anna, Strandberg Timo, Tchalla Achille, Topinková Eva, Vellas Bruno, von Haehling Stephan, Landi Francesco, Marzetti Emanuele
Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain.
Department of Geriatrics, Orthopaedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy.
J Cachexia Sarcopenia Muscle. 2025 Jun;16(3):e13870. doi: 10.1002/jcsm.13870.
BACKGROUND: Preservation of mobility independence is a primary goal in older adults with physical frailty and sarcopenia (PF&S). Interventions based on the combination of physical activity (PA) and nutritional counselling have been indicated as strategies for the management of this condition, although their effectiveness is not confirmed in all investigations. A possible explanation for this uncertain scenario relies in the impact of the adherence to PA interventions. Hence, the present study investigated the impact of the adherence to PA sessions on the incidence of mobility disability in older adults with PF&S. METHODS: This is a secondary analysis of an evaluator blinded, randomised controlled trial, developed in 16 clinical sites across 11 European countries, from January 2016 to 31 October 2019. Participants were community-dwelling older adults (70+ years) with PF&S enrolled in the SPRINTT trial (NCT02582138). PF&S was operationalised as having a total score from 3 to 9 on the short physical performance battery (SPPB), low appendicular lean mass and ability to complete the 400-m walk test in < 15 min. Data from participants allocated to a multicomponent intervention (PA with technological support plus nutritional counselling) and a healthy ageing lifestyle education programme (control group) were analysed. Adherence to PA was assessed based on the number of weekly sessions attended. According to recommendations of the American College of Sports Medicine, adherence was categorised as below recommendations (< 2 sessions/week, BR), meeting recommendations (2-3 sessions/week, MR), and above recommendations (> 3 sessions/week, AR). The primary outcome was incident mobility disability, operationalised as incident inability to complete the 400-m walk test in < 15 min during up to 36 months of follow-up. RESULTS: Data of 1444 participants (mean age 79.3 years, 72.6% women) were analysed. In those with SPPB scores of 3-7, MR and AR groups had lower risk of mobility disability compared with controls [MR HR (95% CI): 0.57 (0.41-0.78), p = 0.001; AR HR (95% CI): 0.33 (0.23-0.46), p < 0.001] and BR groups [MR: HR (95% CI): 0.48 (0.34-0.69), p < 0.001; AR: HR (95% CI): 0.27 (0.18-0.38), p < 0.001] in a dose-dependent manner. In those with SPPB scores of 8 or 9, the BR group had a higher risk of mobility disability than controls. MR and AR groups had a lower risk of mobility disability than the BR group. CONCLUSIONS: In older adults with PF&S, adherence to PA recommendations is associated with lower incidence of mobility disability. This benefit depends on the degree of adherence as well as baseline physical performance. TRIAL REGISTRATION: ClinicalTrials.gov NCT02582138.
背景：保持行动能力独立是身体虚弱和肌肉减少症（PF&S）老年患者的首要目标。基于体育活动（PA）与营养咨询相结合的干预措施已被视为管理这种状况的策略，尽管其有效性在所有研究中尚未得到证实。这种不确定情况的一个可能解释在于坚持PA干预措施的影响。因此，本研究调查了坚持PA课程对PF&S老年患者行动能力残疾发生率的影响。 方法：这是一项对评估者进行盲法的随机对照试验的二次分析，该试验于2016年1月至2019年10月31日在11个欧洲国家的16个临床地点开展。参与者为参加SPRINTT试验（NCT02582138）的社区居住PF&S老年患者（70岁及以上）。PF&S的定义为短身体性能测试（SPPB）总分为3至9分、低四肢瘦体重以及能够在15分钟内完成400米步行测试。对分配到多组分干预组（有技术支持的PA加营养咨询）和健康老龄化生活方式教育项目组（对照组）的参与者的数据进行分析。根据每周参加课程的数量评估对PA的坚持情况。根据美国运动医学学院的建议，坚持情况分为低于建议水平（每周<2节课程，BR）、达到建议水平（每周2 - 3节课程，MR）和高于建议水平（每周>3节课程，AR）。主要结局是行动能力残疾事件，定义为在长达36个月的随访期间出现无法在15分钟内完成400米步行测试的情况。 结果：分析了1444名参与者的数据（平均年龄79.3岁，72.6%为女性）。在SPPB评分为3 - 7分的人群中，与对照组相比，MR组和AR组行动能力残疾风险较低[MR组风险比（95%置信区间）：0.57（0.41 - 0.78），p = 0.001；AR组风险比（95%置信区间）：0.33（0.23 - 0.46），p < 0.001]，与BR组相比也较低[MR组：风险比（95%置信区间）：0.48（0.34 - 0.69），p < 0.001；AR组：风险比（95%置信区间）：0.27（0.18 - 0.38），p < 0.001]，呈剂量依赖性。在SPPB评分为8或9分的人群中，BR组行动能力残疾风险高于对照组。MR组和AR组行动能力残疾风险低于BR组。 结论：在PF&S老年患者中，坚持PA建议与行动能力残疾发生率较低相关。这种益处取决于坚持程度以及基线身体性能。 试验注册：ClinicalTrials.gov NCT025821
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