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。行动不便通常是首先出现的残疾， 增加未来更多残疾和死亡的风险。尽管对行动不便最有效的治疗方法 残疾是运动的一种形式，特别是抵抗训练(RT)，它们很少使用，只有不到20% 在符合RT指南的老年人中，行动不便的人更少。的核心问题 向老年人传播RT的好处是坚持。提高遵从性的一个潜在机会 对尚未经过测试的RT来说，就是要使RT程序更短。研究表明，大多数的好处是 RT与每周的前几套相一致，符合效用递减规律。而传统的RT 为老年人提供的节目，比如银色运动鞋公司提供的节目，通常每周三次，每次45分钟， 只有不到5%的老年人可以免费参加这些计划。我们的定性工作表明 老年人经常觉得45分钟的训练太有挑战性了(例如，我认为我没有力气去做 接受调查的老年人中，75%的人更喜欢5分钟的RT而不是45分钟的RT选项， 假设它们都是同样有效的。在2020年，我们开始设计一个简短的、基于家庭的RT计划， 将导致高水平的遵守和功能改进。我们把这个项目称为FAST (功能活动力量训练)，为了克服其简洁性，FAST增加了几个 标准的行为改变技术(例如，反馈、提醒、自我监控)和一种新形式的目标-- 设置，在RT研究中很少使用，用于参与者应该能够进行的额外重复次数 在研究过程中。在FAST-1中，24名健康的老年人被要求每人做30秒的下蹲和俯卧撑 当天，没有给予任何个人监督。在6个月的时间里，他们有73%的时间进行锻炼， 在下蹲和俯卧撑方面表现出很大的提高(Cohen‘s d&gt；1.0)。在FAST-2中，我们随机 被分配了97名行动不便的老年人，那些被分配了30秒的椅子站立和 每天踏上踏板完成81%的锻炼(每周5.7天)，并提高他们的5 坐立测试时间(-2.8秒，Cohen‘s d=0.53)，30秒椅子站立测试(+4.2次，d=1.1)和 单腿站立试验(+3.7秒，d=0.40)，与对照组比较。在这项多中心研究中，我们将随机分配 360名有SPPB评分的老年人，每天禁食8至6个月或延迟对照组。我们将测试 禁食对体能、行走能力、跌倒和功能限制的影响。我们假设 这一速度将比控制措施更好地改善这些措施，而那些更严格遵守和 感觉到的努力将是最大的进步。通过严格的FAST测试，我们希望改变RT的范式 从“越多越好”到“人们会怎么做才管用？”而且，如果FAST被证明是优越的，那么未来 研究将测试FAST是否会导致更多的老年人进行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.