International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines
International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines
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DOI：
10.1007/s12603-021-1665-8
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发表时间：
2021-07-30
影响因子：
5.8
通讯作者：
Singh, M. Fiatarone
中科院分区：
文献类型：
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作者：
Izquierdo, Mikel;Merchant, R. A.;Singh, M. Fiatarone
人类老龄化过程是普遍的、普遍的和不可避免的。每一种生理功能都在不断地减弱。有两种不同的衰老表型，由生活经历和行为模式塑造，特别是有没有体育活动(PA)和有无有组织的锻炼(即久坐的生活方式)。衰老和久坐不动的生活方式与肌肉功能和心肺功能下降有关，导致日常活动和维持独立功能的能力受损。然而，在适当的运动/PA存在的情况下，这些肌肉和有氧能力随年龄增长的变化会大大减弱。此外，有组织的锻炼和全面的PA都发挥着重要的作用，可以预防许多慢性疾病，包括心血管疾病、中风、糖尿病、骨质疏松症和肥胖症；改善行动能力、心理健康和生活质量；以及降低死亡率等好处。值得注意的是，运动干预计划改善了虚弱(低体重、低强度、低机动性、低PA水平、低能量)和认知的特征，从而优化了衰老期间的功能能力。在这些病理情况下，运动被用作治疗剂，并遵循以下戒律：确定疾病的原因，然后以循证剂量使用药物来消除或缓解疾病。因此，PA/结构性运动的处方应以预期结果为基础(例如，初级预防、改善健康或功能状态或疾病治疗)，并像任何其他医疗治疗一样，进行个性化、调整和控制。此外，与其他治疗药物一样，运动表现出剂量反应效应，并可根据健康状况或医疗条件使用不同的方式、体积和/或强度进行个性化。重要的是，运动疗法往往同时针对几个生理系统，而不是像通常的药物治疗疾病方法那样，针对单一结果。对于一些疾病，运动是药物治疗(如抑郁症)的替代方法，因此有助于实现停用潜在不适当药物(PIMS)的目标。在其他情况下，目前还没有有效的药物治疗(如骨质疏松症或痴呆症)，在这些情况下，它可能在预防和治疗中发挥主要作用。因此，这一共识声明为在老年人中使用运动和PA促进健康和预防和治疗疾病提供了循证的理由。运动处方是根据在随机对照试验中研究的特定方式和剂量来讨论的，这些试验表明，运动处方在减缓衰老的生理变化、预防疾病和/或改善患有慢性病和残疾的老年人方面具有有效性。建议弥补当前文献中的空白，并优化运动/PA作为预防药物和治疗剂的使用。
The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.