血流限制训练对老年肌少症患者肌力及躯体功能的影响^*

Effects of Blood Flow Restriction Training on Muscle Strength and Physical Function in Older Adults With Sarcopenia

摘要

目的 探讨血流限制训练对住院老年肌少症患者肌肉力量、躯体功能、功能性移动能力及日常生活活动能力的影响，并比较其与传统抗阻训练的差异，为临床制定康复策略提供科学依据。方法 本研究采用随机对照试验设计，共纳入40例经临床诊断为肌少症的住院老年患者，按1∶1比例通过计算机生成随机分配序列分为试验组和对照组，各20例。试验组进行血流限制训练，对照组进行抗阻训练，干预持续12周，每周3次。分别于干预前、第4周及第12周对受试者进行评估。主要结局指标为肌肉力量，用优势手握力评估。次要结局指标包括躯体功能、功能性移动能力和日常生活活动能力，分别用简易体能状况量表（short physical performance battery, SPPB）、6 m步速和计时起立-行走测试（timed up and go test, TUG）以及改良的Barthel指数（modified barthel index, MBI）进行测量。结果 研究期间无失访，无不良事件发生。干预4周后，两组主要结局指标握力均较基线提升（均P<0.001），试验组握力〔（24.35±5.43） kg〕高于对照组〔（20.96±5.25） kg〕，但两组间差异无统计学意义（P=0.051）；在次要结局指标方面，试验组在SPPB评分和MBI评分方面均明显优于对照组（均P<0.05），TUG测试和6 m步速差异尤为明显（P<0.01）。干预12周后，主要结局指标握力在组间差异上具有统计学意义〔试验组（25.25±5.34） kg，对照组（21.66±5.26） kg，P=0.039〕。在次要结局指标方面，试验组在SPPB评分、6 m步速、TUG测试时间和MBI评分方面均明显优于对照组（均P<0.01）。结论 血流限制训练能够明显改善住院老年肌少症患者的肌力、提高老年人躯体功能、功能性移动能力及日常生活活动能力，其效果优于抗阻训练。

Abstract

Objective To investigate the effects of blood flow restriction (BFR) training on muscle strength, physical function, functional mobility, and activities of daily living (ADL) in hospitalized older adults with sarcopenia, and to compare its efficacy with that of traditional resistance training (RT), thereby providing a research basis for the development of clinical rehabilitation strategies. Methods In this randomized controlled trial, 40 hospitalized older adults clinically diagnosed with sarcopenia were enrolled. By using a computer-generated randomization sequence, the participants were randomly assigned at a 1∶1 ratio to an experimental group (n = 20) receiving BFR training or a control group (n = 20) receiving RT. Both groups underwent a 12-week supervised program, with training sessions conducted 3 times per week. Outcome measures were assessed at baseline, 4 weeks, and 12 weeks. The primary outcome measure was muscle strength, assessed by dominant-hand grip strength. Secondary outcomes included physical function assessed with the Short Physical Performance Battery (SPPB), functional mobility assessed by the 6-meter (6-m) gait speed and the Timed Up and Go (TUG) test, and ADL assessed with the Modified Barthel Index (MBI). Results No participants were lost to follow-up, and no adverse events were reported. After 4 weeks of intervention, grip strength improved significantly in both groups compared with the baseline data (allP < 0.001), with the BFR group demonstrating higher grip strength than the RT group ([24.35 ± 5.43] kg vs [20.96 ± 5.25] kg), although the between-group difference was not statistically significant ( P = 0.051). Regarding secondary outcomes, the BFR group showed significant improvements in SPPB and MBI scores compared with the RT group (all P < 0.05), with the most pronounced differences in TUG performance and 6-m gait speed ( P < 0.01). After 12 weeks of intervention, grip strength was significantly higher in the BFR group than that in the RT group ([25.25 ± 5.34] kg vs. [21.66 ± 5.19] kg; P = 0.039). Moreover, the BFR group demonstrated significantly better outcomes in SPPB score, 6-m gait speed, TUG time, and MBI score than the RT group did (all P < 0.01). Conclusion BFR training significantly improves muscle strength, physical function, functional mobility, and ADL in hospitalized older adults with sarcopenia, showing superior efficacy compared with conventional RT.

关键词

血流限制训练 / 肌少症 / 肌肉力量 / 老年患者

Key words

Blood flow restriction training / Sarcopenia / Muscle strength / Elderly patient

参考文献

[1] Cruz-Jentoft A J, Sayer A A . Sarcopenia[J]. Lancet, 2019, 393(10191): 2636-2646. DOI: 10.1016/s0140-6736(19)31138-9.

[2] Fanny P R, Viktoria B, Stuart R G, et al. Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta-analysis [J]. J Cachexia Sarcopenia Muscle, 2021, 13(1). DOI: 10.1002/jcsm.12783.

[3] Chen L K, Hsiao F Y, Akishita M, et al. A focus shift from sarcopenia to muscle health in the Asian Working Group for Sarcopenia 2025 Consensus Update[J]. Nat Aging, 2025, 5(11): 2164-75. DOI: 10.1038/s43587-025-01004-y.

[4] Jang J Y, Kim D, Kim N D. Pathogenesis, intervention, and current status of drug development for sarcopenia: a review [J]. Biomedicines, 2023, 11(6). DOI: 10.3390/biomedicines11061635.

[5] 郭秦, 张伊祎, 王玲, 等. 肌少症临床不良结局的研究进展[J]. 实用医院临床杂志, 2024, 21(4): 172-175. DOI: 10.3969/j.issn.1672-6170.2024.04.039.

[6] Guo Q, Zhang Y Y, Wang L, et al. Research progress on adverse clinical outcomes of sarcopenia[J]. Journal of Practical Hospital Clinical Medicine, 2024, 21(4): 172-175. DOI: 10.3969/j.issn.1672-6170.2024.04.039.

[7] 陈薪竹, 龙怀聪. 老年慢性阻塞性肺疾病合并肌少症干预治疗研究进展[J]. 实用医院临床杂志, 2025, 22(4): 201-205. DOI: 10.3969/j.issn.1672-6170.2025.04.040.

[8] Chen X Z, Long H C. Research progress on intervention treatment for sarcopenia in elderly patients with chronic obstructive pulmonary disease[J]. Journal of Practical Hospital Clinical Medicine, 2025, 22(4): 201-205. DOI: 10.3969/j.issn.1672-6170.2025.04.040.

[9] Shen Y, Shi Q, Nong K, et al. Exercise for sarcopenia in older people: a systematic review and network meta-analysis[J]. J Cachexia Sarcopenia Muscle, 2023, 14(3): 1199-1211. DOI: 10.1002/jcsm.13225.

[10] Yasuda T. Selected methods of resistance training for prevention and treatment of sarcopenia [J]. Cells, 2022, 11(9). DOI: 10.3390/cells11091389.

[11] Sasaki K I, Fukumoto Y. Sarcopenia as a comorbidity of cardiovascular disease[J]. J Cardiol, 2022, 79(5): 596-604. DOI: 10.1016/j.jjcc.2021.10.013.

[12] Yuan J, Wu L, Xue Z, et al. Application and progress of blood flow restriction training in improving muscle mass and strength in the elderly[J]. Front Physiol, 2023, 14: 1155314. DOI: 10.3389/fphys.2023.1155314.

[13] 刘晓辰, 张婷婷, 朱思佳, et al. 高龄脑卒中患者肌少症与认知障碍的关系研究[J]. 实用医院临床杂志, 2025, 22(6): 89-93. DOI: 10.3969/j.issn.1672-6170.2025.06.017.

[14] Liu X C, Zhang T T, Zhu S J, et al. Relationship between sarcopenia and cognitive impairment in elderly stroke patients[J]. Journal of Practical Hospital Clinical Medicine, 2025, 22(6): 89-93. DOI: 10.3969/j.issn.1672-6170.2025.06.017.

[15] Chen N, He X, Zhao G, et al. Efficacy of low-load resistance training combined with blood flow restriction vs. high-load resistance training on sarcopenia among community-dwelling older Chinese people: study protocol for a 3-arm randomized controlled trial[J]. Trials, 2021, 22(1): 518. DOI: 10.1186/s13063-021-05495-z.

[16] Chen L K, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment[J]. J Am Med Dir Assoc, 2020, 21(3): 300-7.e2. DOI: 10.1016/j.jamda.2019.12.012.

[17] 中华医学会老年医学分会, 国家老年疾病临床医学研究中心(湘雅医院). 中国肌肉减少症诊疗指南(2024版)[J]. 中华医学杂志, 2025, 105(3): 181-203. DOI: 10.3760/cma.j.cn112137-20240724-0170.

[18] Geriatrics Branch of Chinese Medical Association, National Clinical Research Center for Geriatric Diseases (Xiangya Hospital). Chinese Guidelines for Diagnosis and Treatment of Sarcopenia (2024 Edition)[J]. Chinese Medical Journal, 2025, 105(3): 181-203. DOI: 10.3760/cma.j.cn112137-20240724-0170.

[19] 潘晨岚, 杨蕾, 李晓宁, 等. 老年人抗阻运动负荷制定方法的研究进展[J]. 护理研究, 2024, 38(23): 4282-4288. DOI: 10.12102/j.issn.1009-6493.2024.23.025.

[20] Pan C L, Yang L, Li X N, et al. Research progress on methods for determining resistance exercise load in the elderly[J]. Journal of Nursing Research, 2024, 38(23): 4282-4288. DOI: 10.12102/j.issn.1009-6493.2024.23.025.

[21] Parkington T, Maden-Wilkinson T, Klonizakis M, et al. Comparative perceptual, affective, and cardiovascular responses between resistance exercise with and without blood flow restriction in older adults [J]. Int J Environ Res Public Health, 2022, 19(23). DOI: 10.3390/ijerph192316000.

[22] 彭娜, 苗笛, 王红, 等. 八段锦联合血流限制训练对老年肌少症的应用效果研究[J]. 中华保健医学杂志, 2024, 26(3): 332-335. DOI: 10.3969/j. issn.1674-3245.2024.03.019.

[23] Peng N, Miao D, Wang H, et al. Application effect of baduanjin combined with blood flow restriction training on elderly sarcopenia[J]. Chinese Journal of Health Care Medicine, 2024, 26(3): 332-335. DOI: 10.3969/j. issn.1674-3245.2024.03.019.

[24] 王鑫, 李诺, 梁诗雨, 等. 老年肌少症患者血流限制训练的最佳证据总结[J]. 中华护理杂志, 2024, 59(10): 1187-1194. DOI: 10.3761/j.issn.0254-1769.2024.10.005.

[25] Wang X, Li N, Liang S Y, et al. Summary of best evidence for blood flow restriction training in elderly patients with sarcopenia[J]. Chinese Journal of Nursing, 2024, 59(10): 1187-1194. DOI: 10.3761/j.issn.0254-1769.2024.10.005.

[26] Praetorius A. Blood flow restriction training (BFRT) in patients before and after total knee arthroplasty[J]. Orthopadie (Heidelb), 2024, 53(11): 853-857. DOI: 10.1007/s00132-024-04543-1.

[27] Piskin N E, Aktug Z B, Kara M, et al. The effect of blood flow restriction training on isokinetic strength muscle thickness and athletic performance[J]. J Musculoskelet Neuronal Interact, 2025, 25(2): 208-218. DOI: 10.22540/jmni-25-208.

[28] 梁玉祥, 王任杰, 蒋佼佼, 等. 奥塔戈运动对老年肌少症患者日常生活活动能力的影响[J]. 四川大学学报(医学版), 2025, 56(2): 543-548. DOI: 10.12182/20250360608.

[29] Liang Y X, Wang R J, Jiang J J, et al. Effect of Otago exercise on activities of daily living in elderly patients with sarcopenia[J]. Journal of Sichuan University (Medical Sciences), 2025, 56(2): 543-548. DOI: 10.12182/20250360608.

[30] Sinnott M J, Schneider N, Vanguri P. Effects of blood flow restriction training on the upper extremities: a scoping review[J/OL]. Cureus, 2025, 17(3): e79876. https://www.cureus.com/articles/322583-effects-of-blood-flow-restriction-training-on-the-upper-extremities-a-scoping-review#!/. DOI: 10.7759/cureus.79876.

[31] Zhang M, Song Y, Zhu J, et al. Effectiveness of low-load resistance training with blood flow restriction vs. conventional high-intensity resistance training in older people diagnosed with sarcopenia: a randomized controlled trial[J]. Sci Rep, 2024, 14(1): 28427. DOI: 10.1038/s41598-024-79506-9.

[32] Cahalin L P, Formiga M F, Anderson B, et al. A call to action for blood flow restriction training in older adults with or susceptible to sarcopenia: a systematic review and meta-analysis[J]. Front Physiol, 2022, 13: 924614. DOI: 10.3389/fphys.2022.924614.

[33] Zhang X Z, Xie W Q, Chen L, et al. Blood flow restriction training for the intervention of sarcopenia: current stage and future perspective[J]. Front Med (Lausanne), 2022, 9: 894996. DOI: 10.3389/fmed.2022.894996.

[34] 史雪珂, 冯晓东. 运动调控程序性细胞死亡在肌少症防治中的研究进展[J]. 中山大学学报(医学科学版), 2025, 46(5): 737-746. DOI: 10.13471/ j.cnki.j.sun.yat-sen.univ(med.sci).2025.0503.

[35] Shi X K, Feng X D. Research progress on exercise-regulated programmed cell death in the prevention and treatment of sarcopenia[J]. Journal Of Sun Yat-sen University (Medical Sciences), 2025, 46(5): 737-746. DOI: 10.13471/ j.cnki.j.sun.yat-sen.univ(med.sci).2025.0503.

[36] Zhao W, Ukawa S, Tsushita K, et al. Association of gait speed with mortality among the Japanese elderly in the New Integrated Suburban Seniority Investigation Project: a prospective cohort study[J]. Age Ageing, 2015, 44(1): 153-157. DOI: 10.1093/ageing/afu121.

[37] de Smet R, Brys A D H, Calders P, et al. Implementation of blood flow restriction training in the acute geriatric unit [J/OL]. Age Ageing, 2025, 54(10): afaf315. https://academic.oup.com/ageing/article/54/10/afaf315/ 8303973. DOI: 10.1093/ageing/afaf315.

[38] Middleton A, Fulk G D, Herter T M, et al. Self-selected and maximal walking speeds provide greater insight into fall status than walking speed reserve among community-dwelling older adults[J]. Am J Phys Med Rehabil, 2016, 95(7): 475-482. DOI: 10.1097/phm.0000000000000488.

基金资助

*四川省科技厅项目(2024JDKP0099)