护理研究2025，Vol.39Issue(21)：3559-3566,8.DOI:10.12102/j.issn.1009-6493.2025.21.002
衰弱程度对社区衰弱老年人运动干预效果的影响:一项阶梯设计试验亚组分析
Impact of frailty level on the effectiveness of exercise interventions in community-dwelling older adults with(pre)frailty:a subgroup analysis of a stepped-wedge design trial
摘要
Abstract
Objective:To explore the impact of frailty level on the effectiveness of exercise interventions in community-dwelling older adults with(pre)frailty,and to provide a reference for developing stage-matched intervention strategies.Methods:A stepped-wedge design trial was conducted in three steps,involving 149(pre)frail older adults from six communities in Jinzhong city,Shanxi province.A 12-week exercise intervention was implemented,and multilevel models were used to analyze the immediate effects(at the end of the intervention)and sustained effects(12 and 24 weeks after the intervention)of baseline(pre)frailty level on the outcomes.Primary outcomes included frailty and frailty-related indicators(muscle mass,muscle strength,and physical performance).Secondary outcomes included physical health indicators(disability and fear of falling),mental health indicators(cognitive function and depressive symptom),and comprehensive social health indicators(social support and quality of life).Results:The exercise intervention was effective for most primary outcomes in the pre-frailty subgroup at baseline.Specifically,it reduced(pre)frailty scores(β=-0.640,-0.284,P<0.05),increased muscle mass(β=4.174,P=0.001)and grip strength(β=3.898,5.329,P<0.05),improved balance(β=0.204,0.236,P<0.05),and shortened the timed"Up&Go"test duration(β=-1.556,P=0.018).In the(pre)frailty subgroup at baseline,the intervention improved(pre)frailty(β=-1.163 to-1.100,P<0.001),muscle mass(β=2.413,5.049,P<0.05),grip strength(β=5.957,P=0.027),and 4-meter gait speed(β=0.439,P=0.042),but had no significant effects on short physical performance battery,balance,five-times sit-to-stand test,or timed"up&go"test(P>0.05).For secondary outcomes,the exercise intervention improved basic activities of daily living(β=1.809,P=0.022)and instrumental activities of daily living(β=2.612,P=0.004),enhanced social support(β=6.106-11.467,P<0.05),and improved the mental health domain of quality of life(β=5.007-10.966,P<0.05)in the pre-frailty subgroup.In the frailty subgroup,in addition to improving basic activities of daily living(β=1.688,2.424,P<0.05),instrumental activities of daily living(β=3.201,P=0.017),social support(β=7.421-16.094,P<0.01),and the mental health domain(β=11.103-16.726,P<0.05),it also alleviated depressive symptoms(β=-0.807--0.594,P<0.05)and enhanced the physical health domain of quality of life(β=8.923-17.129,P<0.05).Conclusions:Frailty level influences both the breadth and intensity of the effectiveness of exercise interventions in community-dwelling older adults with(pre)frailty.Future research should develop frailty-level-adapted interventions to promote precision nursing and enhance intervention efficacy.关键词
老年人/衰弱(前期)/运动干预/平衡能力/日常活动能力/生存质量/社会支持/阶梯设计试验Key words
the aged/(pre)frailty/exercise intervention/balance ability/activities of daily living/quality of life/social support/stepped-wedge trial引用本文复制引用
乔晓霞,朱瑞芳,周文蝶,王翠丽..衰弱程度对社区衰弱老年人运动干预效果的影响:一项阶梯设计试验亚组分析[J].护理研究,2025,39(21):3559-3566,8.基金项目
国家自然科学基金资助项目,编号:72404180,72274009 （）
山西省基础研究计划青年项目,编号:202303021222157 （）
山西医科大学校级博士基金项目,编号:XD2242 （）
