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        體育鍛煉對(duì)老年人主觀幸福感干預(yù)效果的元分析

        2022-07-15 11:18:48陳子超
        四川體育科學(xué) 2022年4期
        關(guān)鍵詞:效應(yīng)老年人分析

        廖 宇,陳子超

        體育鍛煉對(duì)老年人主觀幸福感干預(yù)效果的元分析

        廖 宇,陳子超

        樂山師范學(xué)院,四川 樂山,614000。

        研究目的:利用元分析方法檢驗(yàn)體育鍛煉對(duì)老年人主觀幸福感影響,并對(duì)影響兩者關(guān)系的調(diào)節(jié)變量進(jìn)行分析,從而為老年人提高和改善主觀幸福感的最優(yōu)體育鍛煉方法提供科學(xué)依據(jù)。方法:通過Google scholar、PuBmed、PsycINFO等國(guó)外數(shù)據(jù)庫(kù)檢索文獻(xiàn),運(yùn)用state13.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)處理,采用隨機(jī)效應(yīng)模型進(jìn)行元分析,并對(duì)相關(guān)調(diào)節(jié)變量進(jìn)行檢驗(yàn)。結(jié)果:體育鍛煉干預(yù)對(duì)老年人主觀幸福感的提高和改善有較好的效果,對(duì)積極情緒干預(yù)效果達(dá)到中等效應(yīng)量SMD=0.57,P<0.001,對(duì)消極情緒干預(yù)效果方面產(chǎn)生了小效應(yīng)量SMD=-0.46,P<0.001,對(duì)認(rèn)知評(píng)價(jià)干預(yù)效果達(dá)到了中等效應(yīng)量SMD=0.59,P<0.001差異均具有統(tǒng)計(jì)學(xué)意義。結(jié)論:體育鍛煉對(duì)老年人主觀幸福感的提高和改善具有良好的效果,具體表現(xiàn)為積極情緒的產(chǎn)生與持續(xù)、消極情緒的改善與消失、認(rèn)知評(píng)價(jià)的改善與提高?;谠治鰯?shù)據(jù)結(jié)果建議:(1)在提高和保持老年人積極情緒方面,每周不少于3次,周期至少13周,每次30-40min的高強(qiáng)度鍛煉,效果更佳。(2)在改善和降低老年人消極情緒水平方面,每周不少于3次,周期控制在10-12周,每次30-40min的高強(qiáng)度鍛煉效果更佳。(3)在提高和改善老年人認(rèn)知評(píng)價(jià)方面,每周至少3次,鍛煉周期控制在10-12周,每次40-50min的低強(qiáng)度鍛煉效果更佳。

        體育鍛煉;老年人;主觀幸福感;元分析

        近年來(lái),隨著人們生活條件的改善和社會(huì)醫(yī)療保障體系的完善,人口壽命不斷提高,老年人口的數(shù)量持續(xù)增長(zhǎng),也加劇了世界老齡化的發(fā)展[1-2]。據(jù)聯(lián)合國(guó)報(bào)道指出,預(yù)計(jì)2050年65歲以上老年人將占世界人口的1/6,老齡化進(jìn)程進(jìn)一步加速。因此老年人的身心健康,社會(huì)福祉,生活質(zhì)量備受社會(huì)關(guān)注,然而老年人經(jīng)常受身體疾病以及社會(huì)的孤立和家庭的孤獨(dú),使其生活質(zhì)量產(chǎn)生負(fù)面的影響[3]。因此研究老年人主觀幸福感,對(duì)提高老年人生活質(zhì)量和心理健康水平有重要的現(xiàn)實(shí)意義[4]。體育鍛煉是以身體練習(xí)和運(yùn)動(dòng)負(fù)荷為手段,以健身健美、娛樂休閑、保健康復(fù)、心理智能鍛煉活動(dòng)為內(nèi)容,為增強(qiáng)體質(zhì)、增進(jìn)身心健康為目的,提高和保持機(jī)體能力而進(jìn)行的一類體育運(yùn)動(dòng)[5]。主觀幸福感能夠反映個(gè)體的心理健康狀況,它是評(píng)價(jià)者根據(jù)自定的某些標(biāo)準(zhǔn)對(duì)自身生活質(zhì)量所做的整體性評(píng)價(jià),是對(duì)客觀現(xiàn)實(shí)的主觀反映,是影響老年人生活質(zhì)量的關(guān)鍵因素[6]。本文通過查閱文獻(xiàn)發(fā)現(xiàn),體育鍛煉能夠提高主觀幸福感。例如Lok等人(2017)研究發(fā)現(xiàn),在進(jìn)行了10周的體育鍛煉后,能夠明顯改善老年人的生活質(zhì)量和減少抑郁癥狀[7]。Antunes等人對(duì)46名60-75歲的久坐老人進(jìn)行實(shí)驗(yàn)研究,發(fā)現(xiàn)參與為期6個(gè)月的健身計(jì)劃實(shí)驗(yàn)的老人,抑郁、焦慮評(píng)分顯著下降,生活質(zhì)量明顯改善,而對(duì)照組無(wú)明顯變化[8]。在以往的元分析中也有研究采用了主觀幸福感的多維結(jié)構(gòu);如:Netz等(2005)元分析發(fā)現(xiàn)身體活動(dòng)能夠提高老年人主觀幸福感,但納入的研究數(shù)據(jù)僅僅是非臨床疾病的老年人,Ginis等(2010)元分析發(fā)現(xiàn)身體活動(dòng)與主觀幸福感成顯著的正相關(guān)關(guān)系,但納入的研究數(shù)據(jù)來(lái)自于脊椎損傷臨床患者和相關(guān)調(diào)查研究[9]。因此本文,在已有研究的基礎(chǔ)上,對(duì)“體育鍛煉對(duì)老年人主觀幸福感影響”這一問題,利用元分析的方法,對(duì)近年的實(shí)證研究結(jié)果進(jìn)行綜合計(jì)算得出結(jié)論,從而克服傳統(tǒng)研究的不足,綜合各項(xiàng)研究成果,使結(jié)論具有普遍性和主客觀兼顧性[10]。本文以近年國(guó)外學(xué)者的實(shí)證研究結(jié)果進(jìn)行元分析,并總結(jié)干預(yù)效果最佳的現(xiàn)有證據(jù)。關(guān)于主觀幸福感的結(jié)構(gòu),國(guó)內(nèi)外學(xué)者普遍都認(rèn)同由積極情緒、消極情緒和認(rèn)知評(píng)價(jià)三個(gè)不同維度組成,然而三個(gè)維度相對(duì)獨(dú)立,其影響因素并不相同,個(gè)人積極情感上升并非預(yù)示出他的消極情感下降,反之亦然[11]。文中主觀幸福感各個(gè)維度具體指標(biāo):積極情緒(積極情感、精力、活力、康樂);消極情緒(消極情感,抑郁、焦慮);認(rèn)知評(píng)價(jià)(生活滿意感、身體滿意感、工作滿意感)。為了使檢驗(yàn)數(shù)據(jù)更加準(zhǔn)確,本文將主觀幸福感三個(gè)維度指標(biāo)進(jìn)行單獨(dú)的檢驗(yàn)。

        1 研究方法

        1.1 文獻(xiàn)獲取及篩選

        1.1.1 檢索范圍與方式 文獻(xiàn)采用Google scholar、PuBmed、PsycINFO數(shù)據(jù)庫(kù),以相關(guān)主題文獻(xiàn)(2009年-2019年)進(jìn)行檢索。體育鍛煉的關(guān)鍵詞包括:sport、、Physical activity、fitness、training、exercise、Tai-chi、yoga;主觀幸福感關(guān)鍵詞包括:subjective well-being、quality of life、mood、life satisfaction、happiness、affect、anxiety、depression、energy、vigor;老年人關(guān)鍵詞包括:older people、older adults、old man、old woman、aged。

        1.1.2 文獻(xiàn)獲取 (1)研究類型:隨機(jī)對(duì)照實(shí)驗(yàn)設(shè)計(jì);(2)研究對(duì)象:老年人≥60歲;(3)干預(yù)方式:干預(yù)組至少參與一項(xiàng)體育鍛煉項(xiàng)目;(4)結(jié)局指標(biāo):至少包含一項(xiàng)主觀幸福感指標(biāo)。

        1.1.3 檢索結(jié)果 經(jīng)初步檢索,英文文獻(xiàn)共獲得2119篇相關(guān)文獻(xiàn),整理后得到相關(guān)研究外文文獻(xiàn)230篇,排除相關(guān)綜述文獻(xiàn)和調(diào)查文獻(xiàn)134篇,非隨機(jī)對(duì)照實(shí)驗(yàn)文獻(xiàn)10篇,無(wú)實(shí)驗(yàn)數(shù)據(jù)20篇,最終有26篇文獻(xiàn)納入元分析中。如圖1所示:

        圖1 研究文獻(xiàn)篩選流程圖

        1.2 文獻(xiàn)質(zhì)量評(píng)估

        采用 Cochrane偏倚風(fēng)險(xiǎn)評(píng)價(jià)工具,并運(yùn)用Review Manager5.3對(duì)所納入的26篇RCT文獻(xiàn)進(jìn)行質(zhì)量評(píng)估。主要從以下幾個(gè)方面進(jìn)行評(píng)估:(1)選擇偏倚:是否采用隨機(jī)分配序列的方法;(2)分配方案隱藏:分配方案是否有效地隱藏;(3)盲法:是否對(duì)受試者或試驗(yàn)人員實(shí)施盲法;(4)結(jié)果數(shù)據(jù)的完整性:對(duì)于缺失的數(shù)據(jù)是否明確告知,是否采用意向性分析;(5)選擇性報(bào)告研究結(jié)果:有無(wú)選擇性報(bào)告結(jié)果;(6)其它偏倚來(lái)源:是否存在引起偏倚風(fēng)險(xiǎn)的其他因素[12]。對(duì)納入文獻(xiàn)的質(zhì)量評(píng)估結(jié)果可知(圖2),7篇達(dá)到了低度偏倚風(fēng)險(xiǎn),6篇達(dá)到了中度偏倚風(fēng)險(xiǎn),13篇達(dá)到了高度偏倚風(fēng)險(xiǎn)。

        1.3 數(shù)據(jù)編碼

        由兩名研究者對(duì)納入文獻(xiàn)進(jìn)行數(shù)據(jù)編碼,編碼內(nèi)容包括文獻(xiàn)來(lái)源、發(fā)表年份、樣本含量、性別、被試特征、年齡、干預(yù)方式、干預(yù)時(shí)間、實(shí)驗(yàn)設(shè)計(jì)、干預(yù)強(qiáng)度(干預(yù)強(qiáng)度的測(cè)量標(biāo)準(zhǔn)不同,本文選取最大攝氧量VO2 max、最高心率HR max和抗阻訓(xùn)練中RPE主觀強(qiáng)度分級(jí)表為標(biāo)準(zhǔn))、干預(yù)周期、干預(yù)頻率、量表類型等相關(guān)數(shù)據(jù)。如數(shù)據(jù)編碼出現(xiàn)不一致情況,由第三方成員對(duì)不一致數(shù)據(jù)進(jìn)行討論解決。

        1.4 數(shù)據(jù)整理

        圖2 納入研究質(zhì)量評(píng)估圖

        表1 納入研究基本特征表

        (續(xù)上表)

        注:E: experimental group; C:control group; SF-36:the MOS item short from health survey; WHO-5: Portuguese version of WHO-5; TDQ: Taiwanese Depression Questionnaire; MHI-18: Mental health status – the mental health inventory; LEIPAD :(Leiden-Padua)questionnaire;GDSSF-K:Geriatric Depression Scale Short Form Korea Version. GDS-15: Geriatric Depression Scale; HAD: Hospital Anxiety and Depression Scale; SLS:Satisfaction with Life scale; SF-12: Short Form-12 physical and mental sub-scales; WHOQOL-OLD: The WHO Quality of Life Instrument-Older Adults Module; CES-D: Cronbach’s alpha for the short Chinese version; DBI: Beck’s Depression Inventory. 表格中1Wanderley2015、2Wanderley2015表示作者采用了兩種干預(yù)方式,所以收集了2組數(shù)據(jù);1Tiia2018、2Tiia2018、3Tiia2018,作者采用了三種不同的訓(xùn)練強(qiáng)度,所以收集了3組數(shù)據(jù);1Uiku K2018、2Uiku K2018作者采用了兩種干預(yù)不同的強(qiáng)度,所以收集了2組數(shù)據(jù)1 Chaiya 2 Chaiya作者采用了兩種干預(yù)方式,所以收集了2組數(shù)據(jù)。

        2 研究結(jié)果

        2.1 研究特征

        本次元分析共納入26篇外文文獻(xiàn)(表1),1954名老年人被試,年齡范圍在60歲至90歲之間。在主觀幸福感測(cè)量工具方面有SF-36、LEIPAD 、WHO-5、MHI-18、GDSSF-K、GDS-15、HAD、SLS、SF-12、WHOQOL-OLD、CES-D、臺(tái)灣抑郁問卷(TDQ)12種問卷。研究主要在社區(qū)、養(yǎng)老機(jī)構(gòu)中選取被試者,被試?yán)夏耆松眢w狀況主要以健康和非健康者(抑郁患者、傷殘、常年患病、孤獨(dú)老人歸納為非健康組)。干預(yù)內(nèi)容主要有太極、健身氣功、瑜伽、有氧跑、固定自行車、體操、舞蹈、抗阻訓(xùn)練、有氧運(yùn)動(dòng)等訓(xùn)練方式,每次干預(yù)時(shí)間在30min—90min之間,干預(yù)頻率控制在2-5次每周,整個(gè)干預(yù)周期持續(xù)在6-36周不等。本次選取的文獻(xiàn)在研究設(shè)計(jì)方面均采用隨機(jī)對(duì)照實(shí)驗(yàn)設(shè)計(jì)。

        2.2 體育鍛煉對(duì)老年人主觀幸福感各維度meta分析結(jié)果

        主觀幸福感各維度之間相對(duì)獨(dú)立,其影響因素也各不相同,為了使效應(yīng)檢驗(yàn)更加準(zhǔn)確,本文首先將主觀幸福感各維度進(jìn)行單獨(dú)檢驗(yàn)。納入26篇文獻(xiàn)中產(chǎn)生了67個(gè)效果量納入元分析中(表2)。

        2.2.1 體育鍛煉對(duì)老年人積極情緒影響meta分析 積極情緒方面:共有18項(xiàng)研究23個(gè)效果量納入到元分析中,檢驗(yàn)結(jié)果可知X2=107.56,P<0.05,I2=79.5%,差異具有統(tǒng)計(jì)學(xué)意義,研究間存在中度異質(zhì)性,檢驗(yàn)結(jié)果證明效果量不是來(lái)自同一總體,所以采用隨機(jī)效應(yīng)模型進(jìn)行檢驗(yàn)。合并效應(yīng)量SMD=0.57,95%的置信區(qū)間為(0.31,0.83),合并效應(yīng)量的檢驗(yàn)Z=4.38,P<0.001。根據(jù)分析結(jié)果表明,體育鍛煉干預(yù)組的老人與對(duì)照組相比,體育鍛煉干預(yù)組的老年人積極情緒得分明顯高于對(duì)照組的老年人,因此體育鍛煉能夠明顯的提高老年人的積極情緒。

        2.2.2 體育鍛煉對(duì)老年人消極情緒影響meta分析 消極情緒方面:共有15項(xiàng)研究20個(gè)效果量納入到元分析中,檢驗(yàn)結(jié)果可知X2=55.53,P<0.05,I2=65.8%,差異具有統(tǒng)計(jì)學(xué)意義,研究間存在中度異質(zhì)性,檢驗(yàn)結(jié)果證明效果量不是來(lái)自同一總體,所以采用隨機(jī)效應(yīng)模型進(jìn)行檢驗(yàn)。合并效應(yīng)量SMD=-0.46,95%的置信區(qū)間為(-0.67,-0.25),合并效應(yīng)量檢驗(yàn)Z=4.37,P<0.001。根據(jù)分析結(jié)果表明,體育鍛煉干預(yù)組的老人與對(duì)照組相比,體育鍛煉干預(yù)組的老年人消極情緒得分低于對(duì)照組的老年人,因此體育鍛煉能夠明顯的降低老年人的消極情緒。

        2.2.3 體育鍛煉對(duì)老年人認(rèn)知評(píng)價(jià)影響meta分析認(rèn)知評(píng)價(jià)方面:共有20項(xiàng)研究24個(gè)效果量納入到元分析中,檢驗(yàn)結(jié)果可知X2=201.04,P<0.05,I2=88.6%,差異具有統(tǒng)計(jì)學(xué)意義,研究間存在高度異質(zhì),檢驗(yàn)結(jié)果證明效果量不是來(lái)自同一總體,所以采用隨機(jī)效應(yīng)模型進(jìn)行檢驗(yàn)。合并效應(yīng)量SMD=0.59,95%的置信區(qū)間為(0.27,0.92),合并效應(yīng)量檢驗(yàn)Z=3.54,P<0.001。根據(jù)分析結(jié)果表明,體育鍛煉干預(yù)組的老人與對(duì)照組相比,體育鍛煉干預(yù)組的老年人認(rèn)知評(píng)價(jià)得分高于對(duì)照組的老年人,因此體育鍛煉能夠明顯的提高老年人的認(rèn)知評(píng)價(jià)。

        表2 體育鍛煉與老年人主觀幸福感各維度元分析一覽表

        2.3 調(diào)節(jié)效應(yīng)檢驗(yàn)

        除了對(duì)主觀幸福感積極情緒、消極情緒和認(rèn)知評(píng)價(jià)這三個(gè)維度進(jìn)行單獨(dú)檢驗(yàn)外,本研究還將分別對(duì)主觀幸福感三個(gè)維度的調(diào)節(jié)變量進(jìn)行檢驗(yàn)。本研究選擇納入標(biāo)準(zhǔn)中的干預(yù)時(shí)間、干預(yù)強(qiáng)度、干預(yù)頻率、干預(yù)周期、干預(yù)方式、文獻(xiàn)質(zhì)量這6個(gè)調(diào)節(jié)變量進(jìn)行檢驗(yàn)(表3)

        表3 元分析的調(diào)節(jié)效應(yīng)量檢驗(yàn)一覽表

        (續(xù)上表)

        體育鍛煉影響老年人主觀幸福感meta分析的調(diào)節(jié)效應(yīng)檢驗(yàn)。(1)干預(yù)方式亞組分析結(jié)果得知,兩個(gè)組別上對(duì)積極情緒、消極情緒,認(rèn)知評(píng)價(jià)都產(chǎn)生了顯著效應(yīng),其中有氧運(yùn)動(dòng)結(jié)合抗阻訓(xùn)練對(duì)積極情緒、消極情緒產(chǎn)生了最大效應(yīng)量(積極情緒SMD=0.71、P=0.034,消極情緒SMD=-0.58、P=0.006),但有氧運(yùn)動(dòng)結(jié)合抗阻訓(xùn)練對(duì)認(rèn)知評(píng)價(jià)產(chǎn)生的效應(yīng)量最低,然而單純的有氧運(yùn)動(dòng)對(duì)認(rèn)知評(píng)價(jià)產(chǎn)生的效應(yīng)量最大(認(rèn)知評(píng)價(jià)SMD=0.69、P=0.039)。(2)干預(yù)強(qiáng)度亞組分析結(jié)果得知,三個(gè)組別對(duì)積極情緒均產(chǎn)生了顯著效應(yīng),高強(qiáng)度組產(chǎn)生的效應(yīng)量最大(SMD=0.6、P>0.001)。在消極情緒方面,高強(qiáng)度在三個(gè)組別中產(chǎn)生了顯著效應(yīng),且效應(yīng)量最大(SMD=-0.59、P<0.001)。在認(rèn)知評(píng)價(jià)方面,低強(qiáng)度在三個(gè)組別中產(chǎn)生的效應(yīng)量最大(SMD=-0.59、P>0.001)。(3)干預(yù)頻率亞組分析結(jié)果得知,在三個(gè)組別上對(duì)積極情緒、消極情緒,認(rèn)知評(píng)價(jià)均產(chǎn)生了顯著效應(yīng),干預(yù)頻率≥3次/周在積極情緒和認(rèn)知評(píng)價(jià)中產(chǎn)生的效應(yīng)量最大(積極情緒SMD=0.5、P<0.001,認(rèn)知評(píng)價(jià)SMD=0.68、P<0.001)。在消極情緒中,干預(yù)頻率≥3次/周產(chǎn)生了顯著效應(yīng),效應(yīng)量為(消極情緒SMD=-0.48、P<0.001)。(4)干預(yù)周期方面,本文設(shè)置了低于9周、10-12周和13周以上三個(gè)亞組,分析結(jié)果可知,>13周的干預(yù)周期對(duì)積極情緒產(chǎn)生了顯著效應(yīng)且效應(yīng)量最大(SMD=0.65、P<0.001),10-12周的干預(yù)周期對(duì)消極情緒產(chǎn)生了顯著效應(yīng),效應(yīng)量為(SMD=-0.39、P<0.001),在認(rèn)知評(píng)價(jià)中10-12周的干預(yù)產(chǎn)生了顯著效應(yīng),且效應(yīng)量為(SMD=1.27、P<0.001)。(5)干預(yù)時(shí)間方面,本文設(shè)置了<40min、40-50min和>50min三個(gè)亞組,分析結(jié)果可知,干預(yù)時(shí)間在<40min對(duì)積極情緒產(chǎn)生了顯著效應(yīng),效應(yīng)量為(SMD=0.44、P=0.001),干預(yù)時(shí)間在<40min對(duì)消極情緒產(chǎn)生了顯著效應(yīng),且效應(yīng)量最大(SMD=-0.83、P=0.023),40-50min對(duì)認(rèn)知評(píng)價(jià)產(chǎn)生了顯著效應(yīng),且效應(yīng)量最(SMD=1.27、P<0.001)。(6)文獻(xiàn)質(zhì)量方面,本文設(shè)置了低風(fēng)險(xiǎn)偏倚、中風(fēng)險(xiǎn)偏倚和高風(fēng)險(xiǎn)偏倚三個(gè)亞組,分析結(jié)果可知,中風(fēng)險(xiǎn)偏倚的文章在積極情緒中產(chǎn)生了顯著效應(yīng),且效應(yīng)量最大(SMD=0.6、P<0.001),低風(fēng)險(xiǎn)偏倚的文章在消極情緒和認(rèn)知評(píng)價(jià)中產(chǎn)生顯著效應(yīng),效應(yīng)量分別為(SMD=-0.77、P<0.001,SMD=1.06、P<0.001)。

        3 討論與分析

        通過對(duì)近10年國(guó)外的實(shí)驗(yàn)數(shù)據(jù)進(jìn)行元分析,發(fā)現(xiàn)體育鍛煉能夠明顯的提高和改善老年人的主觀幸福感,在具體維度上的表現(xiàn)為:積極情緒達(dá)到中等效應(yīng)量(SMD=0.57),消極情緒方面到產(chǎn)生了小效應(yīng)量(SMD=-0.46),在認(rèn)知評(píng)價(jià)方面也達(dá)到了中等效應(yīng)量(SMD=0.59)。此結(jié)果與Ginis等(2010)元分析的效應(yīng)量大小有差異[42],與 Wang X等(2015)元分析結(jié)果大小相近[43]。Ginis等(2010)在生活滿意感的效應(yīng)量為d=0.23,與抑郁的效應(yīng)量為d=0.22,Wang X等(2015)抑郁的效應(yīng)量為d=-0.41。與此前Netz等(2005)身體活動(dòng)對(duì)老年人心理健康元分析結(jié)果相比[44],本研究的效應(yīng)量均要高于Netz等(2005)研究的效應(yīng)量,具體來(lái)說(shuō)降低抑郁的效應(yīng)量d=0.29,提高積極情感的效應(yīng)量d=0.28,與自我效能感的效應(yīng)量d=0.38。本研究納入的老年人身體狀況包含了健康與非健康人群,通過這些數(shù)據(jù)得出結(jié)論更具有說(shuō)服力。

        在鍛煉方式方面,Reed和Ones(2006)研究發(fā)現(xiàn)短期的有氧運(yùn)動(dòng)能夠改善個(gè)體的積極情感[45],效應(yīng)量d=0.47,Reed和Buck(2009)研究發(fā)現(xiàn)長(zhǎng)期的有氧運(yùn)動(dòng)對(duì)于積極情感有顯著的影響[46],達(dá)到中等效應(yīng)量d=0.57,但兩項(xiàng)研究都缺乏來(lái)自抗阻訓(xùn)練的數(shù)據(jù)。Arent,等人(2000)研究表明在改善老年人情緒效果方面[47],抗阻訓(xùn)練優(yōu)于有氧訓(xùn)練。Ferrer等人(2011)元分析發(fā)現(xiàn)抗阻訓(xùn)練干預(yù)可以改善癌癥患者的生活質(zhì)量[48]。Rodrigo等(2016)研究發(fā)現(xiàn)抗阻訓(xùn)練能夠提高老年人的身體功能[49],同時(shí)改善了老年人的生活質(zhì)量。此次元分析發(fā)現(xiàn)有氧運(yùn)動(dòng)結(jié)合抗阻訓(xùn)練對(duì)于提高積極情緒和降低消極情緒的效果最佳,其次在認(rèn)知評(píng)價(jià)方面,單純的有氧運(yùn)動(dòng)干預(yù)效果更好。在體育鍛煉劑量方面,Rodrigo等(2016)建議在改善老年女性身體功能和提高生活質(zhì)量方面,個(gè)體需要每周參加2-3次每次鍛煉時(shí)間在50-70min的抗阻訓(xùn)練。Wang x(2015)元分析發(fā)現(xiàn)體育鍛煉干預(yù)周期控制在12周以內(nèi)對(duì)降低老年人抑郁水平的效果最好。Reed和Buck(2009)認(rèn)為,在提高積極情緒方面,建議至少參加10-12周的體育鍛煉,每次鍛煉時(shí)間控制在30-35min,每周3-5次的低強(qiáng)度鍛煉效果最佳。Arent等人(2000)元分析則建議,改善老年人情緒方面建議,每周不超過3次的低強(qiáng)度的體育鍛煉,鍛煉周期控制在6周以內(nèi)。本次元分析發(fā)現(xiàn)在提高老年人積極情緒方面,鍛煉周期至少大于13周,每周至少3次,每次不超過40min的高強(qiáng)度鍛煉效果最佳。在降低老年人消極情緒水平方面,鍛煉周期控制在10-12周,每周至少3次,每次不超過40min高強(qiáng)度鍛煉效果最佳。在提高老年人認(rèn)知評(píng)價(jià)方面,鍛煉周期控制在10-12周,每周至少3次,每次鍛煉時(shí)間控制在40-50min的低強(qiáng)度鍛煉效果最佳。

        研究表明體育鍛煉作為一種調(diào)節(jié)方式,能夠從生理和心理等方面作用于我們自身[50]。研究發(fā)現(xiàn)體育鍛煉的潛在作用機(jī)制是通過下丘腦-垂體-腎上腺(HPA)軸或糖皮質(zhì)激素循環(huán)調(diào)節(jié)應(yīng)激反應(yīng)[51-52]。體育鍛煉對(duì)刺激大腦一系列神經(jīng)生成起著很重要的,例如上調(diào)生長(zhǎng)因子,如腦源性神經(jīng)營(yíng)養(yǎng)因子,刺激神經(jīng)發(fā)生和血管生成從而減緩抑郁癥狀和提高心理健康水平[53-54]。通過體育鍛煉可刺激焦慮或壓力相關(guān)的大腦區(qū)域的神經(jīng)功能,可以幫助減少焦慮癥狀。例如,體育鍛煉已被證明能夠調(diào)節(jié)循環(huán)中的內(nèi)源性大麻素(如阿南達(dá)胺),后者可通過調(diào)節(jié)其他神經(jīng)遞質(zhì)(如多巴胺)產(chǎn)生抗焦慮作用[55]。在體育鍛煉中釋放的神經(jīng)化學(xué)因素如;阿片類和內(nèi)源性大麻素,它們能促進(jìn)人的愉悅感和幸福感,具有抗焦慮和鎮(zhèn)靜的作用[56]。研究發(fā)現(xiàn)體育鍛煉不僅可以提高老年人的神經(jīng)電生理指標(biāo),緩解生理功能的衰退,還可以調(diào)節(jié)老年人大腦中腦源性神經(jīng)營(yíng)養(yǎng)因子水平,改善和維持老年人的認(rèn)知功能[57]。同時(shí)體育鍛煉還有助于預(yù)防老年人心血管疾病,提高身體控制能力,改善平衡功能,降低慢性疾病發(fā)生率,同時(shí)身體鍛煉收益的積極情緒體驗(yàn)和建立良好的人際關(guān)系以及獲得更多的社會(huì)支持,從而全面的提高老年人的生活質(zhì)量[58-64]。整體來(lái)看,體育鍛煉能夠改善老年人的身體狀況、身體素質(zhì)、和運(yùn)動(dòng)能力進(jìn)而促進(jìn)神經(jīng)調(diào)節(jié)的發(fā)生收獲良好的情緒體驗(yàn),同時(shí)老年人可以借助體育鍛煉獲得更多的社會(huì)支持,改善老年人的認(rèn)知水平,增強(qiáng)自我效能感,進(jìn)一步提高老年人的生活滿意度和主觀幸福感[65]。

        值得注意的是本次元分析在干預(yù)強(qiáng)度方面與Reed和Buck(2009)的研究結(jié)論大有不同,本研究發(fā)現(xiàn)高強(qiáng)度運(yùn)動(dòng)對(duì)于改善老年人的積極情緒和消極情緒方面效果最為顯著。先前有研究證據(jù)表明,高強(qiáng)度的力量訓(xùn)練對(duì)于老年人積極情緒的影響有顯著的提高,并且也顯著降低了抑郁、焦慮、壓力等負(fù)面情緒的影響[66]。本次元分析高強(qiáng)度鍛煉組的獨(dú)立樣本數(shù)據(jù)僅來(lái)自4項(xiàng)研究,從少量的研究數(shù)據(jù)得出的結(jié)論可能具有偏差。本次元分析還對(duì)研究質(zhì)量進(jìn)行了調(diào)節(jié)效應(yīng)檢驗(yàn),研究發(fā)現(xiàn)不同文獻(xiàn)質(zhì)量組之間,體育鍛煉與主觀幸福感的效果量產(chǎn)生了顯著性差異,差異具有統(tǒng)計(jì)學(xué)意義P<0.001,文獻(xiàn)質(zhì)量越高,產(chǎn)生的效應(yīng)量越大。造成這一結(jié)果的原因可能有:(1)納入文獻(xiàn)質(zhì)量質(zhì)量評(píng)估方面僅采用了Revman5.3統(tǒng)計(jì)軟件進(jìn)行文獻(xiàn)質(zhì)量評(píng)估,單一的評(píng)價(jià)標(biāo)準(zhǔn)可能會(huì)使評(píng)價(jià)質(zhì)量發(fā)生偏差。(2)文獻(xiàn)研究設(shè)計(jì)的方法學(xué)部分,有關(guān)盲法的實(shí)施和分配隱藏的模糊,其次測(cè)量誤差和系統(tǒng)誤差也是影響meta分析結(jié)果的重要可能因素。

        研究不足與展望。納入的研究中缺乏控制實(shí)驗(yàn)中的其他的干擾變量(生活環(huán)境、人口統(tǒng)計(jì)學(xué)變量),這些因素可能造成研究結(jié)果出現(xiàn)偏倚,未來(lái)在實(shí)證研究過程中應(yīng)盡量控制其他干擾變量影響,保證研究結(jié)果更可靠。研究在亞組分析中,一些調(diào)節(jié)分析的樣本較少,所得出的結(jié)論可能存在一定的偏差,未來(lái)研究中應(yīng)該納入更多的研究數(shù)據(jù)作為支撐條件,得出更加科學(xué)的結(jié)論。其次研究?jī)H納入了英文文獻(xiàn),沒有納入中文文獻(xiàn),且沒有對(duì)種族群體進(jìn)行亞組分析,未來(lái)研究可納入中文文獻(xiàn)并對(duì)種族群體的差異進(jìn)行探討。

        4 結(jié) 論

        體育鍛煉干預(yù)對(duì)老年人主觀幸福感有積極的影響,對(duì)積極情緒干預(yù)效果達(dá)到中等效應(yīng)量(SMD=0.57),對(duì)消極情緒干預(yù)效果方面產(chǎn)生了小效應(yīng)量(SMD=-0.46),對(duì)認(rèn)知評(píng)價(jià)干預(yù)效果達(dá)到了中等效應(yīng)量(SMD=0.59)。(1)基于元分析數(shù)據(jù)結(jié)果建議;在提高和保持老年人積極情緒方面,每周不少于3次,周期至少13周,每次30-40min的高強(qiáng)度鍛煉效果更佳。(2)在改善和降低老年人消極情緒水平方面,每周不少于3次,周期控制在10-12周,每次30-40min的高強(qiáng)度鍛煉效果更佳。(3)在提高和改善老年人認(rèn)知評(píng)價(jià)方面,每周至少3次,鍛煉周期控制在10-12周,每次40-50min的低強(qiáng)度鍛煉效果更佳。

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        Meta-analysis of the Effect of Physical Exercise on the Intervention of Subjective Well-being of the Elderly

        LIAO Yu, CHEN Zichao

        Leshan Normal University, Leshan Sichuan, 614000, China.

        Research purposes: Conditions use meta-analysis method to test the influence of physical exercise on subjective well-being of the elderly, and to analyze the regulatory variables affecting the relationship between the two, so as to provide scientific basis for the optimal physical exercise methods to improve and improve subjective well-being of the elderly. Methods: Literatures about the effects of physical exercise on subjective well-being of the elderly were retrieved from foreign databases, data was processed by state13.0 statistical software, meta-analysis was carried out by random effect model, and relevant regulatory variables were tested.Result: Physical exercise intervention had a good effect on the improvement of subjective well-being of the elderly. The effect of positive emotion intervention was moderate SMD = 0.57, P < 0.001. The effect of negative emotion intervention was moderate SMD = - 0.46, P < 0.001, and the effect of cognitive evaluation intervention was moderate. SMD = 0.59, P < 0.001, the difference was statistically significant. Conclusion: Physical exercise has a good effect on the improvement of subjective well-being of the elderly, including the generation and continuity of positive emotions, the improvement and disappearance of negative emotions, and the improvement and improvement of cognitive evaluation. Based on the results of meta-analysis, the following suggestions are made: (1) In terms of improving and maintaining the positive emotions of the elderly, high-intensity exercise for 30-40 minutes at least 13 weeks per week is more effective. (2) In terms of improving and reducing the negative emotional level of the elderly, no less than three times a week, the cycle is controlled in 10-12 weeks, each 30-40 minutes of high-intensity exercise is better. (3) In improving and improving the cognitive evaluation of the elderly, the exercise cycle should be controlled at least three times a week for 10-12 weeks, and the effect of low-intensity exercise for 40-50 minutes is better.

        Physical exercise; The elderly; Subjective well-being; Meta-analysis

        1007―6891(2022)04―0066―09

        10.13932/j.cnki.sctykx.2022.04.13

        2020-06-13

        2021-07-17

        陳子超(1980-)四川大學(xué),男,博士,教授,碩士生導(dǎo)師,研究方向:體育統(tǒng)計(jì)學(xué),體育心理學(xué)。

        G806

        A

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