全身振动训练对老年女性骨密度的影响

目的探讨全身振动训练对老年女性骨密度的影响,为预防老年人骨质疏松提供理论依据。方法年龄、身高、体重相匹配的试验组(n=26)和对照组(n=26)进行X射线骨密度测试,试验组进行24周(每周3次,20分钟/次,频率20-35Hz、振幅3 mm)全身振动训练。结果试验组大转子(提高9.1%,P=0.042)、Ward’s三角区(提高16.9%,P=0.030)和腰椎L2-4(提高7.6%,P=0.039)骨密度显著增大,而左股骨颈骨密度无显著变化(P0.05)。结论全身振动训练改善了老年女性骨密度,建议作为预防老年人骨质疏松的一种非药物疗法。     

老年肌肉减少症与离心抗阻训练研究进展

老年肌肉减少症是随年龄增长而出现的骨骼肌量逐年衰减、肌肉功能逐年衰退的骨骼肌退行性疾病,正常人均可出现。患者的爆发力下降最为明显,平衡功能受损,因而频繁跌倒而致伤。抗阻训练是一种对抗老年肌肉减少症的有效干预方式,包括传统抗阻训练、爆发力抗阻训练和离心抗阻训练。近年来,离心抗阻训练在干预老年肌肉减少症的病理进程、预防和治疗运动损伤、提高老年人功能活动能力方面的作用凸显。通过适度拉长肌肉的离心训练不仅能够提高绝对肌力,还能够提高起动速度,增加爆发力的起动力量,继而提高爆发力。此外,离心训练还能增强制动力量,使机体能够快速有效地制动、减速、转向等,提高机体对运动的控制能力,有效地提高平衡能力,避免因运动控制不良导致的运动损伤,能够有效地预防跌倒,避免因跌倒所致的骨折等病症。但是,由于离心抗阻训练需要较高的技巧,目前仍未确立安全有效的训练方法和负荷强度等相关参数,因而仍期待更多的相关实验研究。本文综述了近年来研究者在离心抗阻训练与老年肌肉减少症方面相关的研究进展,以期为后续研究抛砖引玉。     

渐进性抗阻训练在女性绝经后骨质疏松症的辅助改善作用

目的在常规口服抗骨质疏松药物基础上,探讨渐进性抗阻训练在女性绝经后骨质疏松症(Postmenopausal osteoporosis,PMO)的辅助改善作用。方法自2015年10月~2016年10月,纳入PMO患者70例,采用随机数字表法分为研究组和对照组各35例。两组均予以常规口服碳酸钙D3+骨化三醇胶丸+阿仑膦酸钠片,在此基础上,对研究组患者给予渐进性抗阻训练。两组治疗6个月后,统一进行疗效观察。结果与治疗前相比,两组治疗6个月后的骨质疏松性疼痛VAS评分均显著降低,骨密度值均有显著变化,抗酒石酸酸性磷酸酶(TRACP)、I型原胶原分子N-端前肽(PINP)的水平均显著下降,差异均有统计学意义(P0.05);组间相比,研究组患者在疼痛、骨密度改善方面,以及TRACP水平的改善方面,均有更优秀的表现,组间差异有统计学意义(P0.05)。结论在口服抗骨质疏松药物基础上联合渐进性抗阻训练治疗PMO患者,可进一步降低骨质疏松性疼痛,降低TRACP水平,提升骨密度,具有临床参考价值。     

抗阻训练对烧伤患儿康复效果影响的研究进展

处于生长发育关键时期的儿童,受烧伤的直接或间接影响,其机体功能和生活质量都会大大降低。因此烧伤后的康复运动对烧伤患儿的救治至关重要。抗阻训练是患者进行康复运动的方式之一。本文综述了抗阻训练对烧伤患儿伤后康复的影响,总结了目前相关研究的优势和不足,为以后的研究提供了参考和思路,以期提高烧伤患儿的总体预后。     

不同运动方式对维持性血液透析患者骨密度的影响

目的探讨维持性血液透析患者骨质疏松危险因素及不同运动方式干预后骨密度的变化。方法选取血液透析中心236例维持性血液透析患者并收集相关临床资料,将患者按照是否合并骨质疏松分为两组,对骨质疏松发生的危险因素进行单因素分析,对经单因素分析有显著差异的危险因素作二元Logistic回归分析;然后从中选取108例研究对象按年龄、性别随机分为4组:对照组(A组)、有氧运动联合抗阻运动组(B组)、有氧运动组(C组)及抗阻运动组(D组),每组各27例,研究观察24周,分别在干预前及24周末比较4组的骨密度。结果骨质疏松组女性比例、年龄、透析月龄、血磷、甲状旁腺素水平均高于非骨质疏松组(P0.05),血红蛋白低于非骨质疏松组(P0.05),性别、年龄、PTH是维持性血液透析患者骨质疏松的危险因素(P0.05)。A组、B组、C组、D组在运动干预前骨密度两两比较差异无统计学意义(P0.05);运动干预24周后,与A组相比较,B组、C组、D组骨密度差异均有统计学意义(P0.05); B组、D组骨密度在运动24周末较运动前比较差异有统计学意义(P0.05)。结论性别、年龄、PTH是维持性血液透析患者骨质疏松的危险因素。有氧联合抗阻运动改善骨密度方面效果更理想,而抗阻运动优于有氧运动;坚持长久持续的康复运动更能有效地改善血液透析患者的骨质疏松问题。     

青年女性腰椎骨密度与体脂分布的相关性

目的研究女性骨密度峰值阶段腰椎骨密度与体脂分布的相关性,探讨青年女性瘦身与老年骨质疏松症发生的关系。方法纳入一组25～35岁的女性志愿者,采集每位志愿者的一般信息(身高、体重、腰围、臀围),计算体质量指数(body mass index,BMI)和腰臀比(waist-hip ratio,WHR)。依据BMI将其分为两组,瘦型(BMI21.4)和胖型(BMI≥21.4)。利用Midways pro定量CT(QCT)分析系统,测量脐水平腹内脂肪面积(visceral fat area,VFA)、腹壁脂肪面积(subcutaneous fat area,SFA)、腰椎2～4的骨密度(bone mineral density,BMD),计算腹脂比(VF/SF)及腰椎平均BMD(vBMD)。两组间体脂参数、vBMD的差异比较采用独立样本t检验,vBMD与体脂参数的相关性采用Pearson相关性检验。结果纳入共计95名志愿者,其中瘦型43名,胖型52名。两组间VFA、SFA比较差异具有统计学意义,P值分别为0.01、0.003;两组间腰臀比、VF/SF、vBMD比较差异没有统计学意义;青年女性腰椎vBMD与VF/SF呈显著性相关(r=0.381,P=0.034)。结论女性腰椎峰值骨密度与BMI、腰围、臀围、VFA、SFA不具有相关性,与腹脂比(VF/SF)显著相关。青年女性科学瘦身不会降低机体骨密度储备。     

老年女性下肢关节等速肌力与骨密度的相关性研究

目的探讨老年女性膝、踝关节不同角速度等速肌力与骨密度的相关性,为针对性力量训练改善骨密度提供理论依据。方法采用Iso Med 2000等速肌力测试仪对42例健康老年女性,进行优势侧60°/s(5次)和180°/s(20次)膝、踝关节屈伸测试。肌肉峰力矩与优势侧股骨近端BMD进行主成分分析相关性。结果 1)与股骨颈BMD呈显著正相关肌力指标:膝关节伸肌绝对力、爆发力和肌耐力(r=0.572,r=0.662,r=0.691)。踝关节伸肌绝对力、爆发力和屈、伸肌耐力(r=0.429,r=0.667,r=0.617,r=0.509);2)与大转子BMD呈显著正相关肌力指标:膝关节屈肌爆发力和屈、伸肌耐力(r=0.522,r=0.526,r=0.525),踝关节伸肌爆发力和屈肌耐力(r=0.576,r=0.601);3)与Ward’s三角区呈显著相关肌力指标:膝关节伸肌绝对力(r=0.536),踝关节屈肌耐力(r=0.612)。结论加强老年女性大腿前群肌和小腿后群肌绝对力和爆发力,同时注重膝关节伸和踝关节屈耐力练习有利于提高股骨近端BMD。     

新编五禽戏练习对老年女性平衡能力和骨密度的影响

目的探讨有规律的五禽戏练习对老年女性平衡能力和骨密度(bone mineral density, BMD)的影响,为运动健身预防老年人跌倒、提升骨密度提供依据。方法根据年龄、身高、体重的情况分为实验组(n=36)和对照组(n=35),进行静态、动态平衡能力测试,腰椎以及优势侧股骨近端BMD测试。实验组进行为期24周(4次/周,70 min/次)的新编五禽戏练习。结果 24周实验组相比对照组:①静态平衡的左右方向开、闭眼压力中心移动距离显著缩短12.3%和13.1%(P0.05),左右方向闭眼压力中心移动速度显著降低12.9%(P0.05),开、闭眼单脚站立时间显著增加32.5%和49.4%(P0.01)。动态平衡的左右方向移动速度显著降低21.8%(P0.01)。静态和动态前后方向各项指标无统计学意义(P0.05);②腰椎L_(2～4)(增加6.8%)、大转子、Ward三角和股骨颈BMD虽不同程度增加但无显著变化(P0.05)。结论 24周五禽戏练习显著提高了老年女性左右方向静态和动态平衡能力,但前后方向变化不明显;对腰椎和股骨近端BMD改善不明显,可能延缓因增龄引起的BMD下降。     

高频全身振动训练及停练后对老年女性骨密度的影响

目的探讨24周高频全身振动训练及停练8周后对老年女性骨密度(BMD)的影响,为预防老年人骨质疏松症提供依据。方法 61名60~70岁健康老年女性随机分成振动组(30例)和对照组(31例)。采用美国Power-Plate振动仪进行24周(3次/周,20分钟/次,频率20~35Hz,振幅3 mm)的无负重全身振动训练。测试0周、24周和32周所有受试者股骨近端BMD。结果 1)24周后振动组大转子和Ward’s三角区BMD显著增大(P0.05),且显著大于对照组(P0.05);2)与0周相比,停练8周后振动组大转子BMD显著增大(P0.05)且显著大于对照组(P0.05)。结论高频全身振动训练能改善老年女性股骨近端BMD,但对股骨颈BMD影响不明显,停练8周后对大转子BMD提高仍起到维持作用。     

加压结合抗阻训练对糖耐量减低人群骨密度、胰岛素敏感性、肌力、激素分泌影响研究

目的探讨加压结合抗阻训练对糖耐量减低人群骨密度、胰岛素敏感性、肌力、激素代谢的影响,为推广改善胰岛素敏感性和骨健康的新运动处方提供参考。方法招募90名糖耐量减低人群,在实验前2周对所有受试者进行前测,前测内容包括腿部深蹲和腿举1RM测试、胰岛素敏感性、糖耐量测试、骨密度、骨代谢指标、腿部肌肉量、等速肌力测试、生长激素、血睾酮。所有受试者前测完成后进行随机分为对照组(C组)、加压搭配抗阻训练组(KR组)、抗阻训练组(R组),每组30人。分组完成后,按各组训练方案进行为期36周,每周5次的训练干预,36周训练干预结束后的3 d内进行后测,后测项目与前测一致。利用SPSS统计软件对所有指标进行独立样本t检验和单因素方差分析。结果糖耐量试验后2 h血糖(oral glucose tolerance test 2 h,OGTT-2 h)、胰岛素抵抗指数(homeostasis model assessment insulin resistance, HOMA-IR)、尿羟脯氨酸(hydroxyproline,HOP)、血浆抗酒石酸酸性磷酸酶(tartrate resistant acid phosphatase,TRACP)、尿脱氧吡啶喏啉(deoxypyridinoline,DPD),KR组和R组的后测结果均显著低于前测和C组(P0.05),KR组后测结果显著低于R组(P0.05)。股骨颈骨密度、Wards三角骨密度、大转子骨密度,KR组和R组的后测结果均显著高于前测和C组(P0.05)。下肢肌肉量和下肢肌力,KR组和R组的后测结果均显著高于前测和C组(P0.05),KR组后测结果显著高于R组(P0.05)。结论糖耐量减低人群进行加压结合抗阻训练能提高糖耐量,改善胰岛素敏感性,同时增加其骨密度,降低骨吸收作用,增加下肢肌力和肌肉量。加压造成的静脉池效应诱发的生长激素、IGF-1、睾酮的分泌量增加是造成上述现象的主要影响因素。     

Home-based resistance training improves femoral bone mineral density in women on hormone therapy

This study tested whether moderate resistance training would improve femoral bone mineral density (BMD) in long-term users of hormone therapy with low BMD. The study was a 2-year randomized, controlled, trial (RCT) of moderate resistance training of either the lower extremity or the upper extremity. Eighty-five women participated in a 6-month observation period. The setting was center-based and home-based training. The participants were 189 women aged 59–78 years, with total femur T-scores from –0.8 to –2.8 and on hormone therapy (HT) for a minimum of 2 years (mean 11.8 years); 153 completed the trial. Lower extremity training used weight belts (mean 7.8 kg) in step-ups and chair rises; upper extremity training used elastic bands and dumbbells. Measurements were BMD and body composition [dual-energy X-ray absorptiometry (DXA)], bone turnover markers. Total femoral BMD showed a downward trend during the observation period: 0.35%±0.18% (P=0.14). The response to training was similar in the upper and lower groups in the primary outcomes. At 2 years, total femoral BMD increased 1.5% (95% CI 0.8%–2.2%) in the lower group and 1.8% (95% CI 1.1%–2.5%) in the upper group. Trochanter BMD increased 2.4% (95% CI 1.3%–3.5%) in the lower group and 2.5% (95% CI 1.4%–3.6%) in the upper group (for both analyses time effect P<0.001). At 1 year, a bone resorption marker (C-telopeptide) decreased 9% (P=0.04). Bone formation markers, bone-specific alkaline phosphatase, decreased 5% (P<0.001), and N-terminal type I procollagen peptide decreased 7% (P=0.01). Body composition (percent lean and percent body fat) was maintained in both groups. We concluded that long-term moderate resistance training reversed bone loss, decreased bone turnover, increased femur BMD, and maintained body composition. The similarity of response in upper and lower groups supports a systemic response rather than a site-specific response to moderate resistance training.     

Bone mineral density and total body bone mineral content in 18- to 22-year-old women

One hundred sixty-four (164) healthy, young Caucasian women enrolled as midshipmen at the United States Naval Academy with no known disease or bone injury were followed for 3.6 years. Change in bone mineral density (BMD) of the hip, lumbar spine and distal tibia, and total body bone mineral content (TBMC) was measured by dual energy X-ray absorptiometry (DXA). Bone mineral density and TBMC of these women were measured within 2 months (60 ± 4 days) of entering the Academy and annually. Over the study period, hip BMD increased 2.26% (P < 0.001), lumbar spine BMD increased 3.27% (P < 0.001) and distal tibia BMD increased 5.2% (P < 0.001). Total body bone mineral content showed a 5.25% (P < 0.001) increase during the study period. In this group of young women, gain in BMD and TBMC continued until age 22. These results suggest that bone mass may accrue in certain groups of women beyond age 22. The significance of this increase in bone mass during early adulthood on risk for osteoporotic fractures in later life and its impact on exercise-related bone injuries are unknown and warrant further examination.     

Effect of exercise training and detraining on bone mineral density in postmenopausal women with osteoporosis

We examined the effect of exercise training and detraining on bone mineral density (BMD) in postmenopausal women with osteoporosis. Thirty-five postmenopausal women with osteoporosis, aged 53–77 years, were randomly assigned to three groups: a control group (n = 20), a 2-year exercise training group (n = 8), and an 1-year exercise training plus 1-year detraining group (n = 7). Exercise training consisted of daily brisk walking and gymnastic training. Calcium lactate, 2.0 g, and 1α-hydroxyvitamin D₃, 1 μg were supplied daily to all subjects. No significant differences in initial lumbar BMD, measured by dual-energy X-ray absorptiometry (DXA) were found among the three groups. The mean percent change in BMD compared with the baseline was significantly higher at 1 and 2 years in the exercise training group and at 1 year in the detraining group than in the control group, and did not differ significantly at 2 years between the detraining and control groups. These findings indicate that our exercise training program led to a significant increase in lumbar BMD in postmenopausal women with osteoporosis compared with the control, but that the BMD reverted toward a level that was not significantly different from the control with detraining. Continued exercise training is needed to maintain the bone mass gained through exercise training. Received: May 6, 2000 / Accepted: October 6, 2000     

体育锻炼时长对苏南老年男性骨密度和平衡能力的影响

目的为了探讨每次锻炼时间长短对老年男性骨密度和平衡能力的关系。方法选取苏南地区200名60岁以上老年男性中每周锻炼3~4次的87名为研究对象,采用单光子吸收法(SPA)和平衡仪系统对其骨密度(BMD)和平衡能力(Fall Index)进行检测,结果采用SPSS17.0分析处理。结果 (1)对于老年男性来说,每周3~4次体育锻炼,每次锻炼时间控制在45 min~1.5 h,无论对延缓机体BMD的下降还是提高自身的平衡能力方面,都是最优的;(2)有跌倒史(骨折史)的老年男性平衡能力比无跌倒史的差,同时前者BMD也明显低于后者。结论有跌倒史老年男性更加容易跌倒并且更容易有骨折风险,在体育锻炼中要十分注意。切忌只关注曾经跌倒受伤、骨折部位而忽视其它身体部位的风险,定期检查。     

Effects of exercise on bone mineral density in calcium-replete postmenopausal women with and without hormone replacement therapy

Osteoporosis is a major public health concern. The combination of exercise, hormone replacement therapy, and calcium supplementation may have added benefits for improving bone mineral density compared to a single intervention. To test this notion, 320 healthy, non-smoking postmenopausal women, who did or did not use hormone replacement therapy (HRT), were randomized within groups to exercise or no exercise and followed for 12 months. All women received 800 mg calcium citrate supplements daily. Women who exercised performed supervised aerobic, weight-bearing and weight-lifting exercise, three times per week in community-based exercise facilities. Regional bone mineral density (BMD) was assessed by dual energy X-ray absorptiometry. Women who used HRT, calcium, and exercised increased femoral neck, trochanteric and lumbar spine bone mineral density by approximately 1–2%. Trochanteric BMD was also significantly increased by ~1.0% in women who exercised and used calcium without HRT compared to a negligible change in women who used HRT and did not exercise. The results demonstrate that regional BMD can be improved with aerobic, weight-bearing activity combined with weight lifting at clinically relevant sites in postmenopausal women. The response was significant at more sites in women who used HRT, suggesting a greater benefit with hormone replacement and exercise compared to HRT alone.     

Effect of resistance exercise on bone mineral density in premenopausal women

ObjectiveTo assess the effect of 9 months of strength training on total body and regional bone mineral density (BMD, g/cm²) in 58 premenopausal women aged 30–50 years.MethodsParticipants were randomized to either twice weekly supervised strength training for 15 weeks followed by 24 weeks of unsupervised training (treatment group) or control group. Height, weight, maximal muscular strength, nutrient intake and physical activity were assessed. Total body dual energy X-ray absorptiometry (DXA, Lunar Prodigy) scans were taken and analyzed for body composition (lean and fat mass), and BMD for total body and its sub-regions (spine, hip, arms and legs). All measurements were performed at baseline, 15 and 39 weeks. Analysis of covariance was used to assess group differences in BMD change adjusted for baseline BMD, weight, energy and calcium intake.ResultsAt baseline, the two groups had similar BMD and body size characteristics ( P < 0.05 for all), except that the treatment group had lower body weight (?7.1 kg), and higher energy (+259 kJ/d) and calcium (+232 mg/d) intake at baseline. Adjusted % change in BMD over 15 weeks (0.5% vs. 0.4%) or 39 weeks (0.9% vs. 1.2%) did not differ significantly between the exercise and control groups, respectively. The exercise group increased BMD at the spine and legs (1–2.2%), while there was no change in the controls, but differences between groups were not significant.ConclusionStrength training over 9 months did not lead to significantly greater change in total body or regional BMD in premenopausal women.     

Effect of impact exercise on bone mineral density in elderly women with low BMD: a population-based randomized controlled 30-month intervention

Evidence of the effect of exercise on bone loss comes mainly from studies in voluntary postmenopausal women, and no population-based, long-term interventions have been performed. The purpose of this population-based, randomized, controlled trial was to determine the effect of long-term impact exercise on bone mass at various skeletal sites in elderly women with low bone mineral density (BMD) at the radius and hip. Participants ( n =160) were randomly assigned to 30 months either of supervised and home-based impact exercise training or of no intervention. The primary outcome measures were femoral neck, trochanter and total hip BMD, and the secondary outcomes were bone density measures at the radius and calcaneum. Outcomes were assessed at baseline, 12 months and 30 months using blinded operators. The analyses were performed on an intention-to-treat analysis. Mean femoral neck and trochanter BMD decreased in the control group [–1.1%, 95% confidence interval (CI) –0.1% to –2.1% and –1.6%, 95% CI –0.4% to –2.7%], while no change occurred in the exercise group. Mean trochanter BMC decreased more in the control group (–7.7%, 95% CI –9.7% to –5.6% vs. –2.9%, 95% CI –5.3 to –0.9). There were six falls that resulted in fractures in the exercise group and 16 in the control group during the 30-month intervention ( P =0.019). A significant bone loss occurred in both groups at the radius and calcaneum. In multivariate analysis, weight gain was associated with increased BMD and BMC at all femur sites both in the exercise group and in the pooled groups. In conclusion, impact exercise had no effect on BMD, while there was a positive effect on BMC at the trochanter. Exercise may prevent fall-related fractures in elderly women with low bone mass.There was no conflict of interest.     

妊娠妇女二维骨密度的变化及临床意义

目的：了解妊娠妇女二维骨密度变化的规律。方法：采用BH6012二维扫描SPA骨密度仪,测定了1052例早,中,晚期妊娠妇女和320例非妊娠健康育龄妇女的非优势前臂桡,尺骨超远端部位大面积二维扫描的骨矿含量变化。结果：妊娠妇女桡,尺骨骨密度（BMD）值均较非妊娠健康育龄妇女有显降低（P＜0．001）,且随妊娠时间的延长而降幅增大,早,中,晚期妊娠组之间比较亦有显性差异（P＜0．01）,结论：妊娠妇女存在不同程度的骨量减少和骨质疏松,二维骨密度测定对早期发现孕妇骨密度降低有一定的临床价值。     

晚孕妇女骨密度变化的研究

目的探讨晚孕妇女骨密度的变化。方法用单光子γ射线吸收法测定３０４例健康晚孕妇女桡骨远端１／１０点与中远端１／３点的骨密度,并与同年龄组的健康非孕妇女相比较。结果晚孕组骨密度均值低于非孕组,１／１０点Ⅰ度和Ⅱ度骨量减少发生率均高于１／３点。结论相当一部分晚孕妇女不同程度的存在骨量减少现象,骨密度测定对发现孕妇骨密度低有重要意义。     

绝经后运动人群与非运动人群骨密度的追踪调查研究

目的进一步探讨运动、年龄因素对绝经后女性骨的影响,为预防绝经后女性OP提供理论依据。方法对120名绝经后女性(运动组66人、非运动组54人)进行为期3年的追踪调查,采用美国Hologic QDR4500型双能X线吸收仪测试其BMC、BMD。结果两次测试中,运动组与非运动组腰椎、盆骨的BMD、BMC值具有显著性差异(P0.05);运动组双下肢BMC、BMD值和上肢优势侧BMD值不具有显著性差异。说明运动能减缓绝经后女性骨BMC的丢失,维持其BMD值;与胸椎相比,对腰椎和盆骨的"减缓"作用不显著。结论建议处于围绝经期和绝经后的女性进行运动时,注意左右上肢运动量和强度的平衡。