Dual-Task Walking Capacity Mediates Tai Ji Quan Impact on Physical and Cognitive Function
Dual-Task Walking Capacity Mediates Tai Ji Quan Impact on Physical and Cognitive Function
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DOI：
10.1249/mss.0000000000002051
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发表时间：
2019-11-01
期刊：
影响因子：
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通讯作者：
Chou, Li-shan
中科院分区：
文献类型：
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作者：
Li, Fuzhong;Harmer, Peter;Chou, Li-shan
研究目的：有证据表明，运动训练可以改善老年人的活动能力和认知能力，减少福尔斯跌倒，但其潜在机制尚不清楚。本研究验证了这一假设，即双任务步行能力的变化介导了太极拳和多模式运动对社区老年人跌倒高危人群的体能、活动信心、整体认知和福尔斯的积极影响。方法我们对一项为期6个月的随机临床试验进行了二次分析，该试验比较了太极拳：运动以获得更好的平衡（TJQMBB）和多模式运动与拉伸运动，样本为670名70岁以上有福尔斯跌倒或活动能力受损史的成年人。在12个月随访时确定的远端结局指标为短期身体机能成套测验、特定活动平衡信心、蒙特利尔认知评估和福尔斯。假设解释干预效果的中介因素是双任务成本，通过计算从基线到干预结束从单任务步行到双任务步行的步态速度变化来估计。结果12个月时，与伸展运动相比，多模式运动显著改善了短期体能测试和活动平衡信心测试结果，并减少了福尔斯的次数（P < 0.05）。然而，它并没有降低双任务成本或介导远端结果的干预效果。相比之下，TJQMBB相对于多模式和伸展运动显著降低了双任务成本（P < 0.05），这反过来又导致了下肢体能、活动信心、整体认知功能的改善，以及随访期间福尔斯的减少（P < 0.05）。结论：太极拳训练增强了双任务步行能力，介导了跌倒高危老年人身体和认知结果的改善。
Purpose Emerging evidence indicates exercise training improves mobility and cognition and reduces falls in older adults, but underlying mechanisms are not well understood. This study tested the hypothesis that change in dual-task walking capacity mediates the positive effect of Tai Ji Quan and multimodal exercise on physical performance, activity confidence, global cognition, and falls among community-dwelling older adults at high risk of falling. Methods We conducted a secondary analysis of a 6-month randomized clinical trial comparing Tai Ji Quan: Moving for Better Balance (TJQMBB) and multimodal exercise to stretching exercise in a sample of 670 adults older than 70 yr who had a history of falls or impaired mobility. Distal outcome measures, ascertained at a 12-month follow-up, were the Short Physical Performance Battery, Activities-Specific Balance Confidence, Montreal Cognitive Assessment, and falls. The mediator hypothesized to account for the intervention effects was dual-task cost estimated by calculating changes in gait speed from single-task to dual-task walking from baseline to the end of intervention. Results At 12 months, compared with stretching exercise, multimodal exercise significantly improved Short Physical Performance Battery and Activities-Specific Balance Confidence outcomes and reduced the number of falls (P < 0.05). However, it did not lower dual-task cost or mediate the intervention effects on distal outcomes. In contrast, TJQMBB significantly reduced dual-task cost relative to multimodal and stretching exercises (P < 0.05) which in turn resulted in improvements in lower-extremity physical performance, activity confidence, global cognitive function, and reductions in falls (P < 0.05) during follow-up. Conclusions Enhanced dual-task walking capacity as a result of Tai Ji Quan training mediated improvements in physical and cognitive outcomes in older adults at high risk of falling.