以系統性回顧與網絡統合分析比較阻力訓練、 耐力訓練與全身震動系統於治療老年人肌少症之成效

Abstract

背景與目標：肌少症是因年齡增加導致的肌肉質量減少、肌肉力量衰退與身體活動功能限制的疾病。若特別針對肌少症的三項診斷指標：肌肉質量、肌力與身體活動功能表現，目前仍缺乏各種運動療效之間的比較文獻。本篇研究的目的即採用系統性回顧與網絡統合分析，比較阻力訓練、耐力訓練與全身震動系統於治療老年人肌少症之成效。 方法：收集並分析阻力訓練、耐力訓練與全身震動系統的隨機對照試驗，摘錄其中訓練前與訓練後之肌肉質量、肌力與身體活動功能之數據，對象為六十歲以上的老人。以廣義線性混合模型進行網絡統合分析，並以直接證據與間接證據呈現混合治療型比較之結果。 結果：共收錄31篇隨機對照試驗，1405名六十歲以上老人被收錄(年齡介於60歲與92歲)。肌力在阻力訓練組與無運動介入組之間達到顯著差異，經由阻力訓練後的肌力較無運動組別增加12.8公斤 (95% 信賴區間 8.54 至 17.0公斤)。身體活動功能則在阻力訓練組與無運動介入組、全身震動系統與無運動介入組達到顯著差異[平均值分別是2.63次 (95% 信賴區間 1.34 至 3.93次) 與2.07次 (95% 信賴區間 0.49至3.65次)]。但肌肉質量在各組的直接比較或間接比較皆無顯著差異。 結論：若使用肌少症的診斷指標來評估老人的運動效益，阻力訓練可顯著增加老人的肌力與身體活動功能，而全身震動系統可顯著改善老人的身體活動功能。但研究結果卻顯示三種運動介入方式無法顯著增加肌肉質量。

Background and Objectives: Sarcopenia is an age-related loss of muscle mass, muscle strength, and physical performance. Few studies have examined the relative benefits of resistance training, endurance training, and whole-body vibration through the simultaneous consideration of three diagnostic criteria: muscle mass, muscle strength, and physical performance. The purpose of this systemic review and network meta-analysis was to analyze the effects of resistance training, endurance training, and whole-body vibration on changes in muscle mass, muscle strength, and physical performance through the evaluation of lean body mass, leg extension strength, and chair-stand tests in elderly people. Methods: We combined evidence from all randomized controlled trials comparing resistance training, endurance training, and whole-body vibration with usual care among adults aged at least 60 years. The effects of exercises and usual care on muscle mass, muscle strength, and physical performance were examined. We performed a mixed treatment comparison by using generalized linear mixed models for the network meta-analysis. Results: Thirty-one randomized controlled trials involving 1405 participants were included (age range, 60–92 years). Muscle strength enhancement was greater for resistance training compared with usual care [12.8 (95% CI 8.54 to 17.0)]. Physical performance enhancement was greater for resistance training compared with usual care, and whole-body vibration was greater compared with usual care [2.63 (95% CI 1.34 to 3.93), and 2.07 (95% CI 0.49 to 3.65)]. No significant difference was observed regarding changes in lean body mass. Conclusion: Resistance training is beneficial for elderly people with outcome indicators of sarcopenia; specifically, it enhances muscle strength and physical performance. Resistance training and whole-body vibration were the two most effective exercise interventions in terms of physical performance. However, no statistically significant results were observed for resistance training, endurance training, and whole-body vibration concerning increases in muscle mass.