Impact of brief daily functional resistance training on lower extremity physical performance

摘要 老年人中最常见且未经治疗的健康问题之一是行动不便， 近五分之一（17.9%）的老年人。行动不便通常是第一个残疾发展， 增加了未来其他残疾和死亡的风险。虽然最有效的治疗方法 残疾人是运动的形式，特别是阻力训练（RT），他们很少使用，只有不到20% 符合RT指南的老年人，而行动不便的老年人更少。的核心问题 向老年人传播RT的好处是坚持。提高依从性的一个潜在机会 到RT，这还没有经过测试，是使RT程序更短。研究表明，大部分的好处， RT在每周的前几组中累积，符合效用递减定律。传统RT 针对老年人的节目，如银运动鞋提供的节目，通常是每周三次，每次45分钟， 只有不到5%的老年人免费参加这些方案。我们的定性研究表明， 老年人经常感觉45分钟的会话太具有挑战性（例如，“我不认为我有力量去做 45分钟”），75%的老年人更喜欢5分钟的RT而不是45分钟的RT， 假设它们同样有效。在2020年，我们开始设计一个简短的，基于家庭的RT计划， 将导致高水平的依从性和功能改善。我们称这个项目为FAST （功能性活动强度训练），为了克服其简短性，FAST增加了几个 标准行为改变技术（例如，反馈，提醒，自我监控）和一种新的目标形式- 设置，很少用于RT研究，参与者应该能够做的额外重复次数 在研究期间在FAST-1中，24名健康的老年人每人进行了30秒的下蹲和俯卧撑 一天，没有个人监督。在6个月的时间里，他们在73%的时间里进行了锻炼， 在深蹲和俯卧撑的表现上有很大的提高（科恩d > 1.0）。在FAST-2中，我们随机 分配了97名行动不便的老年人，并分配了30秒的椅子站立， 每天走上踏步机的人在81%的时间里完成了锻炼（每周5.7天）， 时间坐立测试（-2.8秒，Cohen’s d=0.53），30秒椅子站立测试（+4.2次重复，d=1.1）和 单腿站立试验（+3.7秒，d=0.40）与对照组。在这项多中心研究中，我们将随机分配 360名SPPB评分< 8至6个月每日FAST或延迟对照组的老年人。我们将测试 FAST对体能、行走能力、福尔斯和功能限制的影响。我们假设 FAST将改善这些措施，而不是控制，那些更大的依从性， 感知的努力将得到最大的改善。通过严格测试FAST，我们希望改变RT的范式 从“越多越好”到“人们会做什么才有效？”如果FAST被证明是上级的， 这项研究将测试FAST是否会导致更多的老年人接受RT，从而改善公众的健康。

ABSTRACT One of the most common, and untreated, health problems among older adults is mobility disability, observed in nearly one in five (17.9%) of older adults. Mobility disability is typically the first disability to develop and increases future risk for additional disabilities and death. Though the most effective treatments for mobility disability are forms of exercise, especially resistance training (RT), they are rarely used, with fewer than 20% of older adults meeting RT guidelines and even fewer among those with mobility disability. The core problem of disseminating the benefits of RT to older adults is adherence. One potential opportunity to enhance adherence to RT, which has not been tested, is to make RT programs shorter. Studies show that most of the benefits of RT accrue with the first few sets per week, consistent with the law of diminishing utility. While traditional RT programs for older adults, like those offered by Silver Sneakers, are typically 45 minutes three times weekly, fewer than 5% of older adults with free access to these programs participate. Our qualitative work shows that older adults often feel that 45 minute sessions are too challenging (e.g., “I don’t think I have the strength to do it for 45 minutes”) and 75% of older adults we surveyed preferred a 5 minute RT to a 45 minute RT option, assuming they were equally effective. In 2020, we set out to design a brief, home-based RT program that would lead to both high levels of adherence and functional improvement. We called the program FAST (Functional Activity Strength Training) and, to overcome its brevity, FAST was augmented with several standard behavior change techniques (e.g., feedback, reminders, self-monitoring) and a novel form of goal- setting, rarely used in RT studies, for the number of additional repetitions participants should be able to do during the study. In FAST-1, 24 healthy older adults were prescribed 30 seconds of squats and push-ups each day and given no personal supervision. Over 6 months, they performed the exercises on 73% of days and showed large increases in squat and push-up performance (Cohen’s d > 1.0). In FAST-2, we randomly assigned 97 older adults with mobility disability, and those assigned to 30 seconds each of chair stands and steps onto a stepper each day completed exercises on 81% of days (5.7 days per week) and improved their 5 time sit-to-stand test (-2.8 seconds, Cohen’s d=0.53), 30 second chair stand test (+4.2 repetitions, d=1.1) and One Leg Stand test (+3.7 seconds, d=0.40), versus controls. In this multicenter study, we will randomly assign 360 older adults with an SPPB score < 8 to 6 months of daily FAST or to a delayed control group. We will test the impact of FAST on physical performance, walking ability, falls and functional limitations. We hypothesize that FAST will improve these measures more than controls, and that those with greater adherence and perceived effort will improve the most. By rigorously testing FAST, we hope to change the paradigm of RT prescription from “More is better” to “What will people do that works?” and, if FAST proves superior, a future study will test whether FAST leads more older adults to do RT and, thereby, improve the public’s health.