老年慢性心力衰竭合并衰弱患者运动干预方案构建及初步应用

doi:10.3969/j.issn.1003-9198.2026.09.011

摘要/Abstract

摘要： 目的构建老年CHF合并衰弱患者聚焦运动行为和运动内容的干预方案,并初步验证其效果。方法通过文献检索及专家函询构建运动干预方案,并对20例老年CHF合并衰弱患者开展单组前后对照研究,比较干预前、干预1个月及3个月患者衰弱水平、体能状态、生活质量、抑郁及运动自我效能的变化。结果构建的运动方案包括运动知识、运动自我效能及社会支持3个维度。纳入干预研究患者20例,平均年龄(71.16±6.94)岁,其中男性11例。干预1个月后,患者的衰弱得分、体能状况、抑郁、运动自我效能和生活质量较干预前差异均无统计学意义(P>0.05);干预3个月后,患者衰弱评分、体能状态及抑郁水平较干预前差异有统计学意义(P＜0.05)。干预期间,15例(75%)患者完成运动打卡,未发生运动相关不良事件,2例(10%)患者出院后3个月内发生再入院情况。结论本运动干预方案可提高患者运动认知,对改善衰弱、体能及抑郁状态具有一定作用,可为老年CHF合并衰弱患者的运动管理提供参考。

关键词: 老年人, 心力衰竭, 衰弱, 运动, 行为, 自我效能

Abstract: Objective To develop an intervention program focusing on exercise behavior and exercise content for elderly patients with chronic heart failure (CHF) and frailty, and to preliminarily verify its effectiveness. Methods An exercise intervention program was developed through evidence-based literature review and expert consultation. A single-group pre-post controlled study was conducted among 20 elderly CHF patients with frailty. The frailty level, physical function, quality of life, depression, and exercise self-efficacy before intervention and 1 month and 3 months after intervention were recorded and compared. Results The intervention program consisted of three dimensions—exercise knowledge, exercise self-efficacy, and social support. The 20 patients had a mean age of 71.16±6.94 years, and 11 cases were male. After 1 month of intervention, patients showed no significant improvements in frailty scores, physical function, depression, exercise self-efficacy, and quality of life (P>0.05). After 3 months of intervention, statistically significant differences were observed in patients’ frailty scores, physical function, and depression levels compared with those before the intervention (P<0.05). During the intervention period, 15 patients (75%) completed exercise logs, no exercise-related adverse events occurred, and 2 patients(10%) were rehospitalized within 3 months after discharge. Conclusions This intervention program can improve patients’ exercise awareness and may contribute to improvements in frailty status, physical function, and depression levels, thereby providing a reference for exercise management in elderly patients with CHF and frailty.

Key words: aged, heart failure, frailty, exercise, behaviour, self-efficacy

中图分类号:

R 592

刘思, 涂惠, 徐燕娟, 郭婷, 孙兴兰, 宋玉洁, 熊晓云. 老年慢性心力衰竭合并衰弱患者运动干预方案构建及初步应用[J]. 实用老年医学, 2026, 40(9): 918-923.

LIU Si, TU Hui, XU Yanjuan, GUO Ting, SUN Xinglan, SONG Yujie, XIONG Xiaoyun. Development and preliminary application of an exercise intervention program for elderly patients with chronic heart failure and frailty[J]. Practical Geriatrics, 2026, 40(9): 918-923.

参考文献

[1] 穆光宗. 论关系之和谐存在决定健康长寿: “邬沧萍命题” 的意义开拓[J]. 华中师范大学学报(人文社会科学版), 2022, 61(5): 41-48.
[2] GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2018, 392(10159): 1789-1858.
[3] ZHONG C, WONG C, CHEUNG W, et al. Peri-discharge complex interventions for reducing 30-day hospital readmissions among heart failure patients: overview of systematic reviews and network meta-analysis[J]. Perspect Public Health, 2022, 142(5): 263-277.
[4] FRIED L P, TANGEN C M, WALSTON J, et al. Frailty in older adults: evidence for a phenotype[J]. J Gerontol A Biol Sci Med Sci, 2001, 56(3):M146-M156.
[5] DENT E, MARTIN F C, BERGMAN H, et al. Management of frailty: opportunities, challenges, and future directions[J]. Lancet, 2019, 394(10206): 1376-1386.
[6] KWOK C S, ZIEROTH S, VAN SPALL H G C, et al. The Hospital Frailty Risk Score and its association with in-hospital mortality, cost, length of stay and discharge location in patients with heart failure short running title: frailty and outcomes in heart failure[J]. Int J Cardiol, 2020, 300: 184-190.
[7] WANG X, ZHOU C, LI Y, et al. Prognostic value of frailty for older patients with heart failure: a systematic review and meta-analysis of prospective studies[J]. Biomed Res Int, 2018, 2018: 8739058.
[8] COLLARD R M, BOTER H, SCHOEVERS R A, et al. Prevalence of frailty in community-dwelling older persons: a systematic review[J]. J Am Geriatr Soc, 2012, 60(8): 1487-1492.
[9] YANG X, LUPÓN J, VIDÁN M T, et al. Impact of frailty on mortality and hospitalization in chronic heart failure: a systematic review and meta-analysis[J]. J Am Heart Assoc, 2018, 7(23): e008251.
[10] SILVA L G C, DA SILVA S L A, FREIRE J C G, et al. Exercise-based physiotherapeutic interventions in frailty syndrome: a systematic review and meta-analysis[J]. Physiother Res Int, 2024, 29(3): e2092.
[11] VAZQUEZ-GUAJARDO M, RIVAS D, DUQUE G. Exercise as a therapeutic tool in age-related frailty and cardiovascular disease: challenges and strategies[J]. Can J Cardiol, 2024, 40(8): 1458-1467.
[12] LEE J Y, PARK H A, MIN Y H. Transtheoretical model-based nursing intervention on lifestyle change: a review focused on intervention delivery methods[J]. Asian Nurs Res: Korean Soc Nurs Sci, 2015, 9(2): 158-167.
[13] HOFFMANN T C, GLASZIOU P P, BOUTRON I, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide[J]. BMJ, 2014, 348: g1687.
[14] HOOGEBOOM T J, OOSTING E, VRIEZEKOLK J E, et al. Therapeutic validity and effectiveness of preoperative exercise on functional recovery after joint replacement: a systematic review and meta-analysis[J]. PLoS One, 2012, 7(5): e38031.
[15] DODD S, CLARKE M, BECKER L, et al. A taxonomy has been developed for outcomes in medical research to help improve knowledge discovery[J]. J Clin Epidemiol, 2018, 96: 84-92.
[16] 田庄, 张抒扬. 《中国心力衰竭诊断和治疗指南2024》要点解读[J]. 协和医学杂志, 2024, 15(4): 801-806.
[17] DENT E, MORLEY J E, CRUZ-JENTOFT A J, et al. Physical frailty: ICFSR international clinical practice guidelines for identification and management[J]. J Nutr Health Aging, 2019, 23(9): 771-787.
[18] 中国康复医学会心血管病预防与康复专业委员会. 慢性心力衰竭心脏康复中国专家共识[J]. 中华内科杂志, 2020, 59(12): 942-952.
[19] 宋雨, 邢怡文, 刘盼, 等. 老年住院患者肌少症与心脏结构功能的关联性及影响因素分析[J]. 中华老年医学杂志, 2024, 43(12): 1556-1561.
[20] 王芳芳, 文杰, 张慧颖, 等. 精细化容量管理对慢性心力衰竭急性加重患者的影响[J]. 中国护理管理, 2024, 24(4): 588-592.
[21] RESNICK B, JENKINS L S. Testing the reliability and validity of the Self-Efficacy for Exercise scale[J]. Nurs Res, 2000, 49(3): 154-159.
[22] KATZAN I L, LAPIN B, GRIFFITH S, et al. Somatic symptoms have negligible impact on Patient Health Questionnaire-9 depression scale scores in neurological patients[J]. Eur J Neurol, 2021, 28(6): 1812-1819.
[23] LIU S, XIONG X Y, ZHANG M J, et al. Influencing factors of frailty in older patients with chronic heart failure: based on Bayesian network[J]. Asian Nurs Res: Korean Soc Nurs Sci, 2025, 19(2): 152-160.
[24] LIU S, XIONG X Y, GUO T, et al. Understanding frailty: a qualitative study of older heart failure patients’ frail experience and perceptions of healthcare professionals with frailty[J]. BMC Geriatr, 2024, 24(1): 1012.
[25] JAARSMA T, DASSEN T. The relationship of nursing theory and research: the state of the art[J]. J Adv Nurs, 1993, 18(5): 783-787.
[26] 伏思瑞, 邓小丽, 李玥璐, 等. 基于希望理论的肺康复训练对COPD患者希望水平及自我护理能力的影响[J]. 护理学杂志, 2024, 39(13): 111-115.
[27] SHERRINGTON C, TIEDEMANN A, FAIRHALL N, et al. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations[J]. N S W Public Health Bull, 2011, 22(3/4): 78-83.
[28] 李九红, 陈婷, 黄伶智, 等. 3种跌倒风险评估工具对养老机构中老年人跌倒风险的预测价值比较[J]. 护理研究, 2024, 38(13): 2296-2301.
[29] 刘聪, 王慧颖, 冀紫阳, 等. 运动疗法对轻中度抑郁症患者抑郁症状和睡眠质量及认知功能改善的效果分析[J]. 中华精神科杂志, 2024, 57(5): 298-304.
[30] 查宇喆, 赵彦, 郑玉婵, 等. 有氧联合抗阻运动的先后顺序对久坐女性血糖变异及疲劳消除的影响[J]. 中国体育科技, 2024, 60(4): 19-28.
[31] YANG W Y, XU Y, YE L, et al. Effects of Baduanjin exercise on quality-of-life and exercise capacity in patients with heart failure: a systematic review and meta-analysis[J]. Complement Ther Clin Pract, 2023, 50: 101675.
[32] 梁倩, 汪晓丽, 刘梦琪, 等. 多分运动护理干预在老年慢性心力衰竭合并衰弱患者中的应用[J]. 中华护理杂志, 2023, 58(23): 2821-2828.