基于共享决策的心脏运动康复在老年衰弱前期患者中的应用效果研究

doi:10.3969/j.issn.1003-9198.2026.01.006

摘要/Abstract

摘要： 目的探讨基于共享决策的心脏运动康复在老年衰弱前期患者中的应用效果。方法选取华中科技大学同济医学院附属协和医院老年医学科2023年7月至2024年6月收治的100例老年衰弱前期患者,应用随机数表法分为对照组和干预组各50例。对照组予常规的疾病治疗及护理,指导患者进行有氧运动与抗阻运动。干预组在此基础上实施基于共享决策的心脏运动康复。比较2组患者运动依从性、躯体活动功能(SPPB)、衰弱评分(Fried衰弱表型量表)、心肺功能、运动能力、生活质量的差异。结果干预12周后干预组运动依从性、SPPB评分、衰弱评分、LVEF、VO₂AT、VO₂max、运动耐量、6MWD,以及生理健康及心理健康得分均优于对照组(P<0.05)。结论基于共享决策的心脏运动康复可以提高老年衰弱前期患者的运动依从性,进而提高躯体活动功能,缓解衰弱前期状态,改善心肺储备功能及运动耐量,提高生活质量。

关键词: 共享决策, 心脏运动康复, 衰弱前期, 运动依从性

Abstract: Objective To explore the application effect of cardiac exercise rehabilitation based on shared decision-making in elderly patients in the pre-frailty stage. Methods A total of 100 elderly patients in the pre-frailty stage admitted to Department of Geriatrics,Union Hospital,Tongji Medical College of Huazhong University of Science and Technology from July 2023 to June 2024 were selected and randomly divided into the control group and the intervention group using random number table method, with 50 cases in each group. The control group was given conventional treatment and nursing care for geriatric diseases, and the patients were instructed to perform aerobic exercise and resistance exercise.The intervention group received cardiac exercise rehabilitation based on shared decision-making additionally. The exercise compliance, physical activity function (Short Physical Performance Battery, SPPB), frailty score (Fried Phenotype), cardiopulmonary function , exercise capacity , and quality of life were compared between the two groups. Results After 12 weeks of intervention, the intervention group showed significantly better improvement in terms of exercise compliance, SPPB score, frailty score, LVEF, VO₂AT, VO₂max, exercise tolerance, 6MWD, and higher scores in both physical and mental health compared with the control group (P<0.05). Conclusions Cardiac exercise rehabilitation based on shared decision-making can improve exercise compliance in elderly patients in the pre-frailty stage, thereby enhancing physical activity function, alleviating the pre-frailty state, improving cardiopulmonary reserve and exercise tolerance, and enhancing quality of life.

Key words: shared decision-making, cardiac exercise rehabilitation, pre-frailty, exercise compliance

中图分类号:

R 592

胡莉萍, 沈颖, 李凌, 王朝晖. 基于共享决策的心脏运动康复在老年衰弱前期患者中的应用效果研究[J]. 实用老年医学, 2026, 40(1): 26-31.

HU Liping, SHEN Ying, LI Ling, WANG Zhaohui. Application effect of cardiac exercise rehabilitation based on shared decision-making in elderly patients with pre-frailty[J]. Practical Geriatrics, 2026, 40(1): 26-31.

参考文献

[1] 国家统计局.中华人民共和国2024年国民经济和社会发展统计公报[R/OL].(2025-02-28)[2025-03-30].http://www.stats.gov.cn/sj/zxfb/202502/t20250228_1958817.html.
[2] WANARATNA K, MUANGPAISAN W, KUPTNIRATSAIKUL V, et al. Prevalence and factors associated with frailty and cognitive frailty among community-dwelling elderly with knee osteoarthritis[J]. J Community Health, 2019, 44(3): 587-595.
[3] ARAKAWA MARTINS B, VISVANATHAN R, BARRIE H, et al.Frailty prevalence using Frailty Index, associated factors and level of agreement among frailty tools in a cohort of Japanese older adults[J].Arch Gerontol Geriatr, 2019, 84:103908.
[4] 秦丽, 梁珍珍, 葛立宾, 等. 社区老年衰弱综合征的影响因素研究[J]. 中国全科医学, 2020, 23(5): 598-603.
[5] SEZGIN D, LIEW A, O’DONOVANM R, et al. Pre-frailty as a multi-dimensional construct: a systematic review of definitions in the scientific literature[J]. Geriatr Nurs, 2020, 41(2): 139-146.
[6] CHITTRAKUL J, SIVIROJ P, SUNGKARAT S, et al. Multi-system physical exercise intervention for fall prevention and quality of life in pre-frail older adults: a randomized controlled trial[J]. Int J Environ Res Public Health, 2020, 17(9): 3102.
[7] OFORI-ASENSO R, LEE CHIN K, MAZIDI M,et al.Natural regression of frailty among community-dwelling older adults: a systematic review and Meta-analysis[J].Gerontologist, 2020, 60(4):286-298.
[8] VERONESE N, SIGEIRSDOTTIR K, EIRIKSDOTTIR G, et al.Frailty and risk of cardiovascular diseases in older persons: the age, gene/environment susceptibility-Reykjavik study[J]. Rejuvenation Res, 2017, 20(6):517-524.
[9] FAN J, YU C, GUO Y, et al. Frailty index and all-cause and cause-specific mortality in Chinese adults: a prospective cohort study[J]. Lancet Public Health, 2020, 5(12): e650-e660.
[10] FU C, WANG H, WEI Q, et al. Effects of rehabilitation exercise on coronary artery after percutaneous coronary intervention in patients with coronary heart disease: a systematic review and meta-analysis[J]. Disabil Rehabil, 2019, 41(24): 2881-2887.
[11] 王雅男,王晋,刘云,等.基于自我调节理论的八段锦锻炼模式在养老机构老年人中的应用效果[J].护理实践与研究,2022,19( 23) :3539-3544.
[12] FELDMAN D I, DUDUM R, BLUMENTHAL R S. Shared decision making. In: MARTINSS. Precision medicine in cardiovascular disease prevention[M]. Springer, 2021: 169-192.
[13] 中华医学会老年医学分会.老年人衰弱预防中国专家共识(2022)[J].中华老年医学杂志, 2022, 41(5):503-511.
[14] 白霞, 刘金成, 段维勋, 等. 共享决策管理的家庭心脏康复对冠状动脉旁路移植术术后患者运动依从性及康复效果影响[J]. 中国体外循环杂志, 2024, 22(5): 407-411.
[15] 杨存美, 胡亦新, 舒刚明, 等. 三种评估量表在门诊老年病人衰弱筛查中的应用研究[J]. 实用老年医学, 2022, 36(7): 688-692.
[16] 中华医学会老年医学分会.老年患者6分钟步行实验临床应用中国专家共识[J].中华老年医学杂志,2020, 39(11): 1241-1250.
[17] 王昕晔, 蒲昱廷, 汤勇. 长春市养老机构老年人抑郁程度、跌倒风险与生命质量相关性[J]. 中国老年学杂志, 2024, 44(14): 3569-3573.
[18] 邹杏坚, 陆艳霞, 陈晓华, 等. 共享决策干预对胃出血患者治疗决策满意度的影响研究[J]. 山西医药杂志, 2020, 49(8): 944-946.
[19] 陈春梅, 陈玉婷, 李胜男. 综合运动康复训练对住院老年衰弱患者衰弱、跌倒风险、平衡状态和疾病认知的干预效果研究[J]. 老年医学与保健, 2024, 30(3): 599-603.
[20] 周飞翔,龙柯宇,谢琳琳,等.老年人衰弱前期现状及影响因素的研究进展[J].军事护理,2023,40(8):64-66.
[21] PIGGOTTD A, BANDEEN-ROCHE K, MEHTAS H, et al. Frailty transitions, inflammation, and mortality among persons aging with HIV infection and injection drug use[J]. AIDS, 2020, 34(8): 1217-1225.
[22] 王红, 王青, 张建薇, 等. 多组分运动在稳定期老年慢性阻塞性肺疾病合并衰弱病人中的效果评价[J]. 实用老年医学, 2025, 39(3): 249-253.
[23] 龙杰, 刘俊荣. 基于患者视角的共享决策参与现况及策略研究[J]. 中国医学伦理学, 2021, 34(1): 75-80.