通过简易肌力测试预测社区老年人群身体肌肉含量的模型

目的通过测量社区老年人身体肌肉含量和不同部位的肌力,建立以单独或联合肌力水平为基础的肌肉含量预测模型。方法2019年9~12月在社区招募老年居民140例,分别进行握力、30 s肱二头肌弯举、30 s连续坐立测试和基于Micro FET3手持测力仪测定的股四头肌与腘绳肌最大等长肌力测试,并使用日本TANITA体成分仪测定身体肌肉含量,分析上述肌力指标与肌肉含量的相关性,并建立回归预测模型。结果所有肌力检测指标(握力、30 s肱二头肌弯举测试、30 s连续坐立测试、股四头肌与腘绳肌最大等长肌力)均与身体肌肉含量呈正相关(r=0.207~0.720,P<0.001)。在各肌力测试指标单独预测肌肉含量的多元回归分析中,除30 s连续坐立测试外,其余指标模型均具有统计学意义(r2=0.702~0.761,P<0.001)。多项肌力测试结果联合预测肌肉含量回归方程(r2=0.786,P<0.001)的预测因子包括性别、BMI、非优势手握力、30 s连续坐立测试和股四头肌最大等长肌力。结论身体不同部位简易肌力测试的结果均与身体肌肉含量呈正相关。除30 s连续坐立测试外,每一单项肌力水平均可建立拟合优度较好的肌肉含量预测模型,多项肌力指标联合预测模型效果稍优于单独指标,但优势差别较小。这些结果为评估社区老年人肌肉质量提供了简易的筛查方法,可为后续检查及治疗提供参考依据。     

电针穴位刺激对膝骨性关节炎患者的疗效观察

目的探讨电针穴位刺激对轻中度膝关节骨性关节炎的治疗效果,为今后膝关节骨性关节炎保守治疗提供一定的临床基础。方法选取2019年1月至2020年1月来自国家体育总局运动医学研究所体育医院运动创伤骨科和康复科的轻中度膝关节骨性关节炎患者,随机分为对照组(常规康复训练)和试验组(电针穴位刺激加常规康复训练),2个月后行Lequesne评分和等速肌力测试,比较两组治疗效果。结果治疗2个月后,两组Lequesne评分无统计学差异(P>0.05);等速肌力测试中,两组相对峰力矩(60°/s和240°/s)和耐力比较,电针穴位刺激加常规康复训练组均较单纯行康复治疗组效果好,治疗后60°/s的伸屈肌群PT/TW:试验组屈肌(1.33±0.21),伸肌(2.55±0.41);240°/s伸屈肌群PT/TW:试验组屈肌(0.96±0.11),伸肌(1.41±0.41);伸屈肌群耐力(ER):试验组屈肌(0.77±0.09),伸肌(0.82±0.11),与对照组相比存在统计学差异(P<0.01)。结论电针穴位刺激联合康复训练能够很好地恢复膝关节功能,并能恢复膝关节肌肉力量,是一种针对轻中度骨性关节炎有效的治疗方式。     

等速肌力训练对脑卒中后上肢功能障碍患者上肢运动功能的影响

目的:研究等速肌力训练对脑卒中患者上肢运动功能的影响。方法:2016年1月-2017年10月于我院治疗的90例脑卒中后上肢功能障碍患者被随机均分为常规康复组和联合训练组(在常规康复组基础上接受等速肌力训练),两组均治疗4周。观察比较两组治疗前后Fugl-Meyer运动功能量表(FMA)评分、改良Ashworth量表(MAS)评分、改良Barthel指数(MBI)评分及以角速度60°/s、120°/s伸屈时肘伸肌、肘屈肌峰力矩(PT)、总功(TW)、平均功率(AP)。结果:与治疗前比较,治疗后两组FMA评分、MBI评分、以角速度60°/s、120°/s伸屈时肘伸肌及肘屈肌PT、TW、AP均显著升高(P均=0.001),治疗后两组MAS评分无显著差异(P均>0.05)。与常规康复组比较,联合训练组治疗后FMA评分[(49.28±6.73)分比(56.79±6.24)分]、MBI评分[(59.92±9.33)分比(70.14±9.39)分]、以角速度60°/s、120°/s伸屈时肘伸肌:PT[60°/s(17.25±3.66)N·m比(21.48±4.21)N·m,120°/s(10.74±3.80)N·m比(15.69±4.21)N·m]、TW[60°/s(165.74±20.51)J比(194.67±23.55)J,120°/s(209.67±25.28)J比(258.76±26.72)J]、AP[60°/s(11.28±3.35)W比(15.42±4.14)W,120°/s(11.58±3.65)W比(17.83±3.74)W]升高更显著(P均=0.001),以角速度60°/s、120°/s伸屈时肘屈肌:PT、TW、AP均无显著差异(P均>0.05)。结论:等速肌力训练可显著促进脑卒中后上肢功能障碍患者上肢运动功能的恢复,提高日常生活活动能力。     

老年人下肢肌力测量方法及其研究进展

正目前,我国已步入老龄社会[1],随着人口老龄化速度的加剧,老龄化所带来的公共健康问题也成为政府及研究学者所关注的热门问题。随着年龄的增长,老年人许多器官和系统逐渐退化[2],研究显示[3],从40岁开始肌力以每10年5%的速度退化,65岁以后下肢肌力每年下降1%～2%。老年人下肢肌肉力量与活动能力和姿势稳定性密切相关,下肢肌肉力量对维持身体姿势的稳定具有很重要的作用,肌肉力量薄弱导致人体姿势不稳,增加老年人发生跌倒的危险系数[2,4]。     

老年男性肌肉力量、身体成分与骨密度的关联性

目的通过对老年男性不同部位肌肉力量,身体成分、骨密度(BMD)的同步实验,探讨它们之间的确切关联,旨在为老年男性骨质疏松(OP)预防干预提供参考。方法 60～79岁男性志愿受试者66名,进行握力、仰卧推举、负重屈肘、膝关节最大屈伸肌力、踝关节等长屈伸力、屈臂支撑时间等肌肉力量与耐力测试;同步使用GE双能X线骨密度仪进行全身、正位脊椎、双侧股骨颈BMD及体脂%、肌肉含量等身体成分测定。结果下肢最大肌力和肌肉耐力与全身BMD的相关度是0.604～0.711;握力与各部位BMD相关度为-0.60～0.162。下肢肌力与股骨颈BMD,背力、仰卧推举与脊柱BMD、负重屈肘除与上肢BMD表现了更高的相关度。结论加强下肢肌力练习是预防和改善老年人BMD水平的最重要手段;其中动力性的肌肉耐力练习将产生更有益的影响。肌力对BMD的影响有明显的部位特征,根据其自身各部位BMD水平进行针对性的力量练习可获得将更好的效果。老年男性去脂体重与BMD呈高度相关,通过肌力练习增加瘦体重,降低脂肪含量有利于预防OP。     

健身气功·易筋经锻炼对老年骨骼肌衰弱的延缓作用

目的探讨健身气功易筋经延缓老年骨骼肌衰弱的康复锻炼效果。方法将26例患者随机分为练功组和对照组各13例。练功组进行12 w运动干预,对照组维持原来的生活方式,采用等速测试指标分析健身气功易筋经延缓老年骨骼肌衰弱的康复锻炼效果。结果练功组与对照组在膝关节伸肌峰力矩(60°/s)、峰力矩/体重(60°/s)、平均功率(60°/s、180°/s)比较有明显提高(P0.05)。结论健身气功易筋经锻炼可以起到延缓老年骨骼肌增龄性衰弱的作用。     

社区老年人功能性体适能现状及与慢性病共病的相关性分析

目的 调查社区老年人功能性体适能水平,并分析功能性体适能水平与慢性病共病的关系。方法 于2020年3～6月招募社区老年人432例,通过慢性病共病调查表进行共病筛查,采用老年人体适能测试(SFT)方法进行功能性体适能测试。结果 与无共病的老人相比,慢性病共病老年人2 min踏步测试、肱二头肌屈举和30 s座椅站立次数均较少,“起立-步行”计时测试(TUGT)时间更长。随着慢性病数量增多,老年人2 min踏步测试和30 s座椅站立次数呈下降趋势,BMI和TUGT时间呈上升趋势。年龄(OR=1.058, 95%CI:1.021～1.097)、经济来源(OR=0.368, 95%CI:0.219～0.620)、肱二头肌屈举次数(OR=0.881, 95%CI:0.822～0.945)和肥胖(OR=2.361, 95%CI:1.096～5.084)是老年人慢性病共病的影响因素。结论 老年慢性病共病病人心肺耐力、肌肉力量和动态平衡能力均低于无慢性病共病者。年龄、经济来源、肥胖和上肢肌肉力量是老年人慢性病共病的影响因素。     

城市中老年女性踝关节力量的年龄变化特征

目的 探讨城市中老年女性踝关节力量的衰退特征.方法 实验于2005年3～5月在上海体育学院体质测试中心完成测试.150名受试者按年龄分为3组:40～49岁组、50～59岁组、60～69岁组,每组50名.所有受试者在Contrex肌力测试系统上进行踝关节60°/s的等速肌力测试.观察运动女性踝关节肌力的衰退特征.结果 受试者的踝关节屈肌最大力矩/kg、屈肌最大功率/kg与年龄呈显著负相关(r=-0.449,-0.451,P=0.002);踝关节伸肌最大力矩/屈肌最大力矩与年龄呈正相关(r=0.516,P=0.00).结论 在50～59岁期间,踝关节屈肌力量随年龄增大而迅速衰退,在60～69岁期间衰退趋于平缓;在60～69岁期间,踝关节伸、屈肌衰退明显不平衡,屈肌快于伸肌.     

Biodex等速系统测试老年人膝关节屈伸肌力可靠性的初步研究

目的确定Biodex等速系统测试老年人膝关节伸肌和屈肌等速向心肌肉功能的可靠性。方法使用Biodex System 3型多关节等速系统在2个测试日对20名老年人（年龄71±6岁）的双下肢进行等速向心肌力测试。结果除了屈肌的作功疲劳度值,伸肌和屈肌两次测试的峰力矩、单次最大作功和平均功率值差异均有统计学意义（P〉0．05）。伸肌和屈肌两次重复测试的相关系数在0．40～0．96之间,除屈肌的作功疲劳度值的P值〉O．05,其余各指标的P值均〈0．05,具有相关关系。结论采用Biodex等速系统对老年人膝关节伸肌和屈肌进行的肌肉功能的重复测试之间具有较好的可靠性。同时提示,有必要加强测试程序的标准化、测试前的热身和熟练程序。     

下肢肌力/体重与老年人行走能力的相关性

目的探讨下肢肌力与体重的比值对老年人行走能力的影响。方法筛选70～79周岁的健康老年男性90例,逐一对其下肢肌力、体重及行走能力等指标进行检测,观察下肢肌力、体重及其比值与行走能力的相关性。结果下肢肌力越大行走能力普遍较好,但正相关性不明显(P0.05);体重越大行走能力越差,但相关性也不明显(P0.05);而下肢肌力与体重的比值与行走能力呈密切相关性,比值指数越大行走能力越好(P0.05)。结论老年人锻炼下肢肌力固然重要,而控制体重也是提高行走能力、预防跌倒发生的重要手段。     

The relationship of age and leg strength in the step test with stipulated tempo in the elderly

This study aimed to examine age differences in the step test with stipulated tempo, a test of dynamic balance ability in the elderly. One hundred eighty-nine healthy elderly people (96 men and 93 women) executed the step test for 20 s twice, with adjustments of the metronome (40 bpm, 60 bpm and 120 bpm). The knee extension strength of both legs was each measured twice. Evaluation parameters included the time difference between metronome sound and the time when each foot hit the ground, two-leg support time, and one-leg support time. The time difference and two-leg support time were significantly longer in the order of 40 bpm, 60 bpm, and 120 bpm tempos, and one-leg support time was shorter in the 40 bpm tempo than the 60 bpm and 120 bpm tempos. A significant age difference was found in the 40 bpm or 60 bpm tempo, and the former two parameters were longer in the older groups and the one-leg support time was shorter. Three evaluation parameters showed significant relationships with knee extension strength. In conclusion, because the step test with a slow tempo (40 bpm or 60 bpm) requires longer one-leg support time, it is effective for the evaluation of dynamic balance ability and leg strength of the elderly.     

不同运动剂量干预对衰弱老年人健康状况的影响

目的探讨不同运动剂量干预对衰弱老年人肌力、体适能及睡眠状况的效果。方法招募符合纳入标准的衰弱老年人88例,随机将其分为对照组、小量中强度组、小量大强度组和大量大强度组,每组22例。对照组无任何针对性身体训练干预,3个干预组按设计方案进行相应的运动量和强度的下肢抗阻运动。分别在干预前、干预12周后评估老年人的下肢肌力、体适能及睡眠状况。结果对照组干预前后下肢肌力、体适能及睡眠状况差异均无统计学意义(P>0.05);小量中强度组、小量大强度组和大量大强度组干预前后各指标均有改善(P<0.05或P<0.01)。小量大强度组和大量大强度组的下肢肌力、6 min步行距离、30 s坐站次数、总睡眠时间均明显优于小量中强度组(P<0.01)。结论抗阻运动可以有效改善衰弱老年人的肌力、体适能和睡眠状况,运动量和运动强度都有利于衰弱老年人肌力、体适能、睡眠指标的改善,但是强度是影响上述健康指标的主要因素。     

An investigation of the association between grip strength and hip and knee joint moments in older adults

Grip strength is a predictor of health outcomes but with differing rates of age-related decline in muscle strength, it is unclear whether handgrip is a reliable indicator of lower limb moments. This study investigated the relationship between grip strength and lower extremity moments in community-dwelling older adults. Eighty-two healthy volunteers aged 60-82 years (mean age 73.2 years) performed maximal voluntary contractions of knee and hip extensors and flexors at three positions and at neutral position for hip abductors and adductors using a custom-built dynamometer. Grip strength was measured using an electronic Jamar dynamometer. The relative reduction in muscle strength of 80s age category compared to 60-year-olds ranged from 14% for grip strength to 27% for hip abductors. Peak torque of flexors and extensors of the knee and hip joints were significantly correlated with grip strength and Pearson's correlation coefficients ranged from 0.56 to 0.78 with the highest correlations observed between knee moments and grip strength. "Good" correlation was found but only 31-60% of the variation in grip strength could be related to changes in joint torques. Hence the assumption that grip strength is an indicator of strength in the lower limb would seem unjustified in the healthy older adult.     

Lower limb arterial disease: assessment of risk factors in an elderly population.

Doppler ultrasound measurement of ankle/brachial systolic blood pressure ratio was carried out in 295 elderly (mean 77.3, SEM +/- 0.3, range 68-92 years; males = 180) subjects. Of these, 49.8% (n = 147; males = 86) had evidence of lower limb arterial disease (ankle/brachial systolic blood pressure ratio less than 0.96). On multivariate analyses, excluding ischaemic heart disease as an independent variable, systolic blood pressure and current cigarette pack years were positively related to lower limb arterial disease while BMI and serum high density lipoprotein cholesterol were inversely related (multiple correlation coefficient = 0.277; P less than 0.0001). On including ischaemic heart disease as an independent variable, this was positively associated with lower limb arterial disease; the relationships of the other variables were similar except for a weaker (P = 0.055) relationship with serum high density lipoprotein cholesterol (multiple correlation coefficient = 0.296; P less than 0.0001). While the relationships demonstrated were relatively weak, the findings suggest that reversible risk factors are still relevant in the development of lower limb arterial disease in the elderly.     

Is hand-held dynamometry useful for the measurement of quadriceps strength in older people? A comparison with the gold standard Bodex dynamometry

BACKGROUND: The lower limb muscle strength is an important determinant of physical function in older people. However, measurement in clinical and epidemiological settings has been limited because of the requirement for large-scale equipment. A protocol using a novel, versatile hand-held dynamometer (HHD) has been developed to measure the quadriceps strength in a supine position. OBJECTIVE: The objective of this study was to assess the validity of this new methodology for measuring the lower limb muscle strength compared to the gold standard Biodex dynamometer. METHODS: The supine quadriceps strength was measured twice with each of the Biodex and the HHD in 20 men and women, aged 61-81 years, on their non-dominant leg. The agreement between the peak torques obtained by Biodex and HHD was analyzed. RESULTS: The mean peak Biodex and HHD results were 83.4 +/- (SD) 28.0 Nm and 68.9 +/- 19.6 Nm, respectively. The HHD undermeasured the quadriceps strength by an average of 14.5 Nm (95% CI 8.5, 20.6) compared to the Biodex, and this effect was most marked in the strongest participants. Nevertheless, there was a good correlation between the measures (r = 0.91, p < 0.0001). Classification of individuals into tertiles of muscle strength showed good agreement between the two methods (Kappa = 0.69, p < 0.0001). CONCLUSIONS: Our findings suggest that the HHD using a supine positioning offers a feasible, inexpensive, and portable test of quadriceps muscle strength for use in healthy older people. It underestimates the absolute quadriceps strength compared to the Biodex particularly in stronger people, but is a useful tool for ranking muscle strength of older people in epidemiological studies. It may also be of value for quick and objective assessment of physical function in the clinical setting.     

Measuring muscular strength of the lower limbs by hand-held dynamometer: a standard protocol

The aim of this study is to describe the reliability of measuring maximal strength of eight muscle groups of the lower limb by a hand-held dynamometer, according to a standard assessment protocol. The study population consisted of 26 patients (14 males and 12 females; age range 60-90 years) admitted to a geriatric hospital. Multiple assessments of muscle strength by two different examiners were compared to estimate test-retest and inter-rater reliability. The range of strength evaluated across the eight muscle groups was 2.1-29.8 Kg/force. Overall, short-term (same day) and long-term (one week apart) test-retest and inter-rater reliability were very high, with 60% of the intraclass correlation coefficient values above 0.8, and the majority above 0.7. No significant differences in strength were found comparing the left and the right side of each muscle group. Differences between values collected in the same subject by two different examiners, and by the same examiner at different points in time were similar, not influenced by the average strength of the muscle group, and significantly larger for long-term than for short-term comparisons. By using a standardized measurement protocol, reliable measurements of muscle strength can be obtained by a hand-held dynamometer in frail older persons.     

Test-retest reliability of hand-held dynamometry and functional tests in systemic lupus erythematosus

The aim of this study was to evaluate the test-retest reliability and determine the degree of measurement error of tests of isometric muscle strength and upper and lower limb function in women with systemic lupus erythematosus (SLE). Twelve women with SLE (age 39.8?±?10?years) were assessed on two occasions separated by a 7-10-day interval. Strength of six muscle groups was measured using a hand-held dynamometer; function was measured by the 30-s sit to stand test and the 30-s 1?kg arm lift. Relative reliability was estimated using the intraclass correlation coefficient (ICC), model 2,1 (ICC2,1). Absolute reliability was estimated using standard error measurement and the minimal detectable difference was calculated. All ICCs were greater than 0.87. Muscle strength would need to increase by between 18% and 39% in women with SLE to be 95% confident of detecting real changes. The functional tests demonstrated a systematic bias between trials. This study demonstrates that hand-held dynamometry in SLE can be performed with excellent reliability. Further work needs to be completed to determine the number of trials necessary for both the 30-s sit to stand and 30-s 1?kg arm lift to decrease the systematic bias.     

Physiological and psychological predictors of walking speed in older community-dwelling people

BACKGROUND: Six-metre walking speed (SMWS) is a commonly used test for measuring functional performance in older people. However, apart from lower limb strength, few studies have examined the range of physiological and psychological factors that influence performance in this test. OBJECTIVE: To investigate the relative contributions of a range of sensorimotor, balance and psychological factors to SMWS in a large sample of older people. METHODS: 668 community-dwelling people aged 75-98 years (mean age 80.1, SD = 4.4) underwent the SMWS test as well as quantitative tests of vision, peripheral sensation, strength, reaction time, balance, fear of falling, pain and vitality. RESULTS: Many physiological and psychological factors were significantly associated with SMWS in univariate analyses. Stepwise multiple regression analyses revealed that a composite lower limb strength measure (sum of knee extension, knee flexion and ankle dorsiflexion muscle strength scores), postural sway, leaning balance as assessed with the coordinated stability test, reaction time, edge contrast sensitivity, SF12 body pain and vitality scores and age were significant and independent predictors of SMWS. Of these measures, the combined lower limb strength measure had the highest beta weight indicating it was the most important variable in explaining the variance in SMWS. However, the other sensorimotor, balance and psychological measures each provided important independent information. The combined set of variables explained 40% of the variance in SMWS (multiple r = 0.63). CONCLUSIONS: The findings indicate that in community-dwelling older people, self-selected walking speed is influenced not only by lower limb strength but also by balance, reaction time, vision, pain and emotional well-being.