运动训练联合β-羟基-β-甲基丁酸补充对老年衰弱患者躯体功能的影响^*

Effects of Exercise Training Combined With β-Hydroxy-β-Methylbutyrate Supplementation on Physical Function in Older Adults With Frailty

摘要

目的 评估在多组分运动训练基础上，联合β-羟基-β-甲基丁酸（β-hydroxy-β-methylbutyrate, HMB）补充对老年衰弱患者躯体功能、肌肉质量及营养状态的额外疗效。方法 采用随机、双盲、安慰剂对照试验设计，将2023年3月-2025年3月就诊于四川大学华西医院的136例老年衰弱患者按1∶1随机分为干预组（n=68）和对照组（n=68）。干预组在运动训练基础上联合HMB钙盐补充（3 g/d，口服），对照组在接受同等运动方案的基础上服用麦芽糊精安慰剂，干预周期12周。分别于基线、干预4周及12周评估各指标。主要结局指标为简易体能状况量表（the Short Physical Performance Battery, SPPB）评分，次要结局指标包括六分钟步行试验（the 6-minute walk test, 6 MWT）、握力、改良Barthel指数（modified Barthel index, MBI）、计时起立-行走测试（timed up-and-go test, TUGT）、四肢骨骼肌指数（appendicular skeletal muscle index, ASMI）及血清白蛋白水平。结果 广义估计方程显示，SPPB总分具有显著的时间效应（Wald χ²=235.867，P<0.001）、组间效应（Waldχ²=8.148，P=0.004）和交互效应（Wald χ²=13.846，P<0.001），表明干预组整体躯体功能改善幅度明显优于对照组。干预4周时，干预组SPPB总分、平衡功能评分、6 MWT、MBI及血清白蛋白水平优于对照组，差异有统计学意义（P<0.05）；干预12周时，上述指标组间差异进一步扩大，干预组仍优于对照组（P<0.05）。此外，干预12周时，干预组步态评分及ASMI亦优于对照组（P<0.05），TUGT在12周时干预组低于对照组（P<0.05），但广义估计方程整体分析组间效应差异无统计学意义（P>0.05）。两组椅子起立评分及握力在各时间点差异均无统计学意义（P>0.05）。结论 在常规多组分运动训练基础上，联合HMB补充（3 g/d，持续12周）可进一步改善老年衰弱患者的躯体功能、肌肉质量和营养状态，为老年衰弱的非药物干预提供了新的循证依据。

Abstract

Objective To evaluate the additional effects of β-hydroxy-β-methylbutyrate (HMB) supplementation combined with multicomponent exercise training on physical function, muscle mass, and nutritional status in older adults with frailty. Methods A randomized, double-blind, placebo-controlled trial was conducted. A total of 136 older adults with frailty admitted to West China Hospital, Sichuan University between March 2023 and March 2025 were enrolled and randomly assigned at a ratio of 1∶1 to an intervention group (n = 68) and a control group (n = 68). Participants in the intervention group received oral calcium HMB supplementation at 3 g/d in addition to exercise training, while those in the control group received maltodextrin placebo on top of the same exercise program. The intervention lasted 12 weeks. Assessments were performed at baseline and after 4 and 12 weeks. The primary outcome measure was the Short Physical Performance Battery (SPPB) score. Secondary outcome measures included the 6-minute walk test (6 MWT), handgrip strength, modified Barthel index (MBI), timed up-and-go test (TUGT), appendicular skeletal muscle index (ASMI), and serum albumin level. Results Generalized estimating equation analysis showed that SPPB total score had significant time effect (Wald χ² = 235.867, P < 0.001), group effect (Wald χ² = 8.148, P = 0.004), and interaction effect (Wald χ² = 13.846, P < 0.001), indicating greater overall improvement in physical function in the intervention group than that in the control group. After 4 weeks, the intervention group showed significantly better total SPPB score, balance score, 6MWT performance, MBI score, and serum albumin level than the control group did (all P < 0.05). These between-group differences further increased after 12 weeks, with the intervention group continuing to outperform the control group (all P < 0.05). Additionally, at week 12, the intervention group showed significantly better results than the control group did in gait score and ASMI ( P < 0.05). Although TUGT was lower in the intervention group than that in the control group at week 12 in the single-timepoint comparison ( P < 0.05), the generalized estimating equation analysis showed no significant group effect ( P > 0.05). No significant differences were found between the two groups in chair stand test score or handgrip strength at any time point ( P > 0.05). Conclusion Among older adults with frailty, HMB supplementation (3 g/day for 12 weeks) in addition to conventional multicomponent exercise training further improves physical function, muscle mass, and nutritional status. The findings provide new evidence-based support for nonpharmacological intervention for frailty in older adults.

关键词

β-羟基-β-甲基丁酸 / 运动训练 / 老年人 / 衰弱 / 功能状态

Key words

β-hydroxy-β-methylbutyrate / Exercise training / Older adults / Frailty / Functional status

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基金资助

*四川省科技厅项目(2024JDKP0099)