【原】#护理：结构化肢体运动计划对轻度认知障碍老年人一般认知功能的影响及其中介机制：一项随机对照试验

Nursing小班长 2022-03-29

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【推荐理由】

关注中介模型数据处理。本文献的局限性主要有一些结果是基于面对面访谈的自我报告(PSQI，GDS)，调解模式需要使用客观测量来进一步检验。本研究的中介模型表明，所包含的中介变量并不能解释所有可能的方差，因此其他潜在变量也可能起到中介作用，如疲劳、自我效能、压力等。

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Wang L, Wu B, Tao H, Chai N, Zhao X, Zhen X, Zhou X. Effects and mediating mechanisms of a structured limbs-exercise program on general cognitive function in older adults with mild cognitive impairment: A randomized controlled trial. Int J Nurs Stud. 2020 Oct; 110:103706.

结构化肢体运动计划对轻度认知障碍老年人一般认知功能的影响及其中介机制：一项随机对照试验

Background 研究背景

Exercise is known to prevent cognitive decline. Sleep quality and depression symptoms, which are associated with processing speed, are considered as common mediators in the exercise-cognition putative model. However, these mediating mechanisms have not been empirically tested in an intervention study.

众所周知，锻炼可以防止认知能力下降。睡眠质量和抑郁症状与加工速度有关，在运动认知假设模型中被认为是共同的中介因子。然而，这些中介机制还没有在干预研究中得到实证检验。

Objective 研究目的

The aim of this study was to evaluate the effects of a structured limbs-exercise program on general cognitive function, and to test the mediating effects and mediating pathways of depressive symptoms, sleep quality and processing speed in the relationship of exercise-induced cognitive benefits.

本研究的目的是评估结构化肢体锻炼计划对一般认知功能的影响，并验证抑郁症状、睡眠质量和加工速度在运动诱发认知益处关系中的中介作用和中介途径。

Design 研究设计

This study was an assessor-blinded, randomized, controlled trial, for which a total of 111 older adults with mild cognitive impairment were recruited from Chifeng, China from June 2018 to October 2019.

本研究为随机、盲法、对照研究，于2018年6月至2019年10月从中国赤峰市招募111名轻度认知障碍老年人为研究对象。

Participants and Setting 研究对象

Community-dwelling older adults with mild cognitive impairment living in an urban area in Chifeng, China.

赤峰市城区轻度认知障碍社区老年人。

Method 研究方法

Participants (N=116) were randomly allocated to one of the two arms: (1) a 24-week structured limbs-exercise program (3 supervised limb exercise sessions /week, 60 min /session for the first 12 weeks and 3 unsupervised practice sessions /week, 60 min /session for the following 12 weeks) or (2) health promotion classes alone. Measures of depressive symptoms, sleep quality, processing speed, and general cognitive function were collected at baseline, 12-week, and 24-week. Multivariate analysis of variance and structural equation modeling was used to test the effectiveness and mechanisms of structured limbs-exercise-induced cognitive improvement respectively.

受试者(N=116)被随机分配到两组中的一组：(1)24周的结构化肢体锻炼计划(3次/周，前12周60min/次；3次/周，60min/次，接下来的12周)或(2)单独的健康促进课。在基线、12周和24周收集抑郁症状、睡眠质量、处理速度和一般认知功能的测量结果。采用多元方差分析和结构方程模型分别检验结构化肢体运动对认知改善的有效性和机制。

Results 研究结果

The structured limbs-exercise program was beneficial for maintaining general cognitive function at 12 weeks (mean difference = 1.20, 95% CI [0.354, 2.054], p = 0.006) and at 24 weeks (mean difference = 1.59, 95% CI [0.722, 2.458], p = 0.001) in the intervention group. The results from the goodness-of-fit indices of structural equation modeling show as following: (1) The effect of structured limbs-exercise program on cognitive function was partially mediated by depressive symptoms, sleep quality, and processing speed, with 69.22% of joint mediation proportion; (2) Relative to the combined Z values of depressive symptoms and processing speed, sleep quality was more strongly related to cognitive function in the structured limbs-exercise program (Z= 9.294, p<0.01); (3) Processing speed was affected by depressive symptoms, sleep quality, and in turn, yielding a significant effect on cognitive function; and (4) Five potential mediating pathways for improvement in general cognitive function in the structured limbs-exercise intervention were identified.

干预组在12周(平均差值=1.2，95%CI[0.354，2.054]，p=0.006)和24周(平均差值=1.5，95%CI[0.722，2.458]，p=0.001)均有利于维持一般认知功能。结构方程模型拟合优度指数的结果表明：(1)结构化肢体运动方案对认知功能的影响部分受抑郁症状、睡眠质量和加工速度的影响，其联合中介比例为69.22%；(2)相对于抑郁症状和加工速度的综合Z值，结构化肢体运动方案的睡眠质量与认知功能的相关性更强(Z=9.294，p<0.01)；(3)加工速度受抑郁症状、睡眠质量的影响，依次受抑郁症状、睡眠质量和加工速度的影响；(4)在结构化肢体运动干预中，确定了改善一般认知功能的五条可能的中介途径。

Conclusions 研究结论

This study demonstrates a positive effect of the structured limbs-exercise program on maintaining general cognitive function for older adults with mild cognitive impairment. It illustrates pathways between an exercise program and cognitive function. This study was one of the first to show that processing speed is a key mediator for the impact of an exercise program on general cognitive function. It also presents joint mediating effects of depressive symptoms and sleep quality on cognitive function. This study provides strong clinical implications for nursing practice. Nurses can play an important role in designing and implementing individualized intervention to maintain or improve cognitive function for older adults. Nurses are able to evaluate individual-related abnormal problems based on the assessment of depressive symptoms, sleep quality and processing speed, and select an optimal intervention pathway and objectives of intervention to conduct path-oriented intervention.52 This approach can strengthen the effectiveness of an exercise intervention.

这项研究证明了结构化肢体锻炼计划对维持轻度认知障碍老年人的一般认知功能有积极作用。它说明了锻炼计划和认知功能之间的途径。这项研究是第一批表明处理速度是锻炼计划对一般认知功能影响的关键中介因素之一。它还显示了抑郁症状和睡眠质量对认知功能的联合调节作用。本研究对护理实践具有较强的临床指导意义。护士可以在设计和实施个性化干预以维持或改善老年人的认知功能方面发挥重要作用。护士可以根据抑郁症状、睡眠质量和处理速度的评估来评估个体相关的异常问题，并选择最优的干预路径和干预目标进行路径定向干预。这种方法可以增强运动干预的有效性。