结构化抗阻训练联合个体化营养干预对老年肌少症患者肌肉质量、力量及躯体功能的影响：一项回顾性对照研究

Effects of Structured Resistance Training Combined with Individualized Nutritional Intervention on Muscle Mass, Strength, and Physical Function in Older Adults with Sarcopenia: A Retrospective Controlled Study

摘要: 目的：肌少症是一种与年龄相关的进行性骨骼肌疾病。运动与营养是两项可干预因素，但二者联合干预是否存在协同效应仍缺乏系统性验证。本研究旨在对比结构化抗阻训练、个体化营养治疗以及二者联合方案对老年肌少症患者四肢骨骼肌质量指数(ASMI)、肌肉力量及躯体功能的影响，为优化临床干预策略提供依据。方法：本回顾性研究纳入120例老年肌少症患者，将其随机分为对照组、运动组(抗阻训练，每周3次，持续6个月)、营养组(乳清蛋白40 g/d + 个体化能量目标)及联合组，每组各30例。于干预前后检测四肢骨骼肌质量指数、体脂率、握力、膝关节伸肌峰力矩、步速、简易躯体功能评估成套测试(SPPB)及计时起立行走试验(TUGT)。采用校正基线的协方差分析及Bonferroni事后检验进行组间比较。结果：干预6个月后，联合组四肢骨骼肌质量指数升高幅度(0.59 ± 0.22 kg/m²)显著高于运动组(0.23 kg/m²)与营养组(0.19 kg/m²)；体脂率下降幅度(−2.3%)亦优于单一干预组。联合组握力与膝关节伸肌峰力矩的提升效果显著优于各单一干预组(所有P < 0.05)。功能指标方面，仅联合组步速改善达到临床最小重要差异值(+0.23 m/s)；简易躯体功能评估成套测试得分升高2.9分(由7.7分升至10.6分)；计时起立行走试验及五次坐立试验的改善幅度约为单一干预组的2倍(所有P < 0.01)。对照组各项指标未见显著变化。结论：结构化抗阻训练与乳清蛋白补充均可独立改善老年肌少症患者部分结局指标，但运动联合营养方案可产生显著更优的协同获益。因此推荐将其作为肌少症首选核心干预方案，并在老年门诊、住院病房及社区健康管理场景中推广应用。

Abstract: Objective: Sarcopenia is an age-related progressive skeletal muscle disorder. Exercise and nutrition are two modifiable components, but whether their combination yields synergistic effects remains systematically unverified. This study aimed to compare the effects of structured resistance training, individualized nutritional therapy, and their combination on appendicular skeletal muscle mass index (ASMI), muscle strength, and physical function in older patients with sarcopenia, so as to provide evidence for optimizing clinical intervention strategies. Methods: This retrospective study enrolled 120 older patients with sarcopenia, who were randomly divided into a control group, an exercise group (resistance training, 3 times/week for 6 months), a nutrition group (whey protein 40 g/d plus individualized energy target), and a combined group, with 30 cases each. ASMI, body fat percentage, grip strength, knee extension peak torque, gait speed, Short Physical Performance Battery (SPPB), and Timed Up and Go Test (TUGT) were measured before and after intervention. ANCOVA with baseline adjustment and Bonferroni post-hoc test were used for comparisons. Results: After 6 months, the increase in ASMI in the combined group (0.59 ± 0.22 kg/m²) was significantly greater than that in the exercise group (0.23) and nutrition group (0.19); the decrease in body fat percentage (−2.3%) was also superior to that in the single-intervention groups. The gains in grip strength and knee extension peak torque in the combined group were significantly better than those in the single-intervention groups (all P < 0.05). In terms of function, only the combined group exceeded the minimal clinically important difference for gait speed (+0.23 m/s), with a 2.9-point increase in SPPB (from 7.7 to 10.6), and improvements in TUGT and five-times sit-to-stand time were approximately twice those of the single-intervention groups (all P < 0.01). No significant changes were observed in the control group. Conclusion: Both structured resistance training and whey protein supplementation can independently improve certain outcomes in older patients with sarcopenia, but the combined exercise-plus-nutrition regimen demonstrated significantly superior synergistic benefits. Therefore, it is recommended as the preferred core intervention strategy for sarcopenia and should be promoted in geriatric outpatient clinics, inpatient wards, and community health management settings.