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Cognitive Effect of Repetitive Transcranial Magnetic Stimulation with Cognitive Training: Long-Term Mitigation Neurodegenerative Effects of Mild Alzheimer's Disease 重复经颅磁刺激与认知训练的认知效果:长期缓解轻度阿尔茨海默病的神经退行性影响
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2020-05-01 DOI: 10.6890/IJGE.202005_14(2).0009
Juyoun Lee, E. Sohn, E. Oh, C. Song, S. Jeong, A. Lee
Background: Despite several studies having reported on the cognitive effects of repetitive transcranial magnetic stimulation (rTMS) in Alzheimer's disease (AD), no studies, to date have addressed the long-term effects of rTMS with cognitive training (CT). This study was aimed to investigate the long-term effects of rTMS-CT in mild AD. Methods: Patients with mild AD (Mini-mental Status Examination [MMSE] score of 21-26), diagnosed based on the diagnostic and statistical manual of mental disorders-IV, were recruited and randomly allocated to two groups, treatment and sham, in a 2:1 ratio. We matched the acetylcholinesterase inhibitor (AChEI)-only group to the treatment group to comparing the long-term effect of rTMS-CT. Treatment group was treated for 6 weeks with high-frequency (10 Hz) rTMS-CT, whereas the other group received 6 weeks of the sham management. These groups underwent neuropsychological tests at baseline, immediately after rTMS-CT, and 6 weeks after the last rTMS-CT. Data of AChEI-only and treatment groups were analyzed changes of cognitive scores (MMSE, and clinical dementia rating-sum of boxes scales) over 3 years. Results: Among the 44 enrolled mild AD (mean age, 72.5 years; females, 36.4%), the rTMS-CT group (n = 30) showed improvement on the ADAS-Cog score for 12 weeks compared with the sham group (n = 14). The rTMS-CT group showed slower rates of neurodegeneration than those in the AChEI-only group (n = 60) during the 3 years of follow-up. Conclusions: Compared to the administration of AChEI only, the use of rTMS-CT might be a useful supplementary interventional strategy in mild AD for long-term mitigation of neurodegeneration.
背景:尽管有几项研究报道了重复经颅磁刺激(rTMS)对阿尔茨海默病(AD)的认知影响,但迄今为止还没有研究涉及rTMS与认知训练(CT)的长期影响。本研究旨在探讨rTMS-CT对轻度AD的长期影响。方法:招募根据《精神障碍诊断与统计手册- iv》诊断的轻度AD患者(Mini-mental Status Examination [MMSE]评分21-26分),按2:1的比例随机分为治疗组和假手术组。我们将乙酰胆碱酯酶抑制剂(AChEI)组与治疗组进行对比,比较rTMS-CT的长期效果。治疗组采用高频(10 Hz) rTMS-CT治疗6周,另一组采用假治疗6周。这些组在基线、rTMS-CT后立即和最后一次rTMS-CT后6周进行神经心理测试。分析单纯治疗组和治疗组3年内认知评分(MMSE)和临床痴呆评分-盒量表总和的变化。结果:44例轻度AD患者(平均年龄72.5岁;rTMS-CT组(n = 30)与假手术组(n = 14)相比,ADAS-Cog评分在12周内有所改善。在3年的随访中,rTMS-CT组显示神经退行性变的发生率低于仅使用achei组(n = 60)。结论:与单纯使用乙酰胆碱酯酶抑制剂相比,使用rTMS-CT可能是一种有用的辅助干预策略,可以长期缓解轻度AD的神经变性。
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引用次数: 1
Impact of Immediate Treatment Within Four Days on Prognosis in Severe Traumatic Brain Injury Patients Without Vasospasm 无血管痉挛的重型颅脑外伤患者4天内立即治疗对预后的影响
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2020-05-01 DOI: 10.6890/IJGE.202005_14(2).0011
J. Lin, Cheng-Chia Tsai, T. Tsai, Yu-Jen Chen
Background and objectives: Traumatic brain injury (TBI) is associated with high mortality rate and long-term disability. Application of the Brain Trauma Foundation's "Guidelines for the management of severe traumatic brain injury" would reduce the prevalence of morbidity and mortality. However, the prevalence of some predictors of TBI have not been studied well with respect to the guidelines, for example, vasospasm. This study evaluated the correlation between the prognostic factors and outcome in patients without vasospasm. Materials and Methods: All patients were treated as per the aforementioned guidelines. Ten patients were prospectively recruited and nine were examined by computed tomography angiography (CTA). The cerebral perfusion pressure (CPP) was measured before and on the fourth postoperative day and was maintained at ≥ 60 mmHg. The results of Glasgow outcome scale (GOS) and Glasgow coma scale (GCS) were collected after four weeks, three months, one year, and two years after admission. Results: There was no vasospasm noted in any of the assessed patients. Current results showed that the elderly (≥ 65 years) had poor GOS (5/6, 83.3%), whereas the younger group had better GOS (3/3, 100%) (p < 0.05). Lower GCS was associated with lower GOS. The subgroup with GCS ≤ 6 (p < 0.05) had a lower GOS. We also observed a better outcome when GCS was higher than 9 (≥ 10) (5/5, 100%) on the fourth postoperative day (p < 0.05). Conclusions: The use of CTA to evaluate vasospasm could be a reference while following the guidelines to manage patients with severe TBI. Aggressive treatment within the first four days could help in obtaining better brain resuscitation in severe TBI patients.
背景与目的:外伤性脑损伤(TBI)具有高死亡率和长期残疾。应用脑外伤基金会的“严重创伤性脑损伤管理指南”将降低发病率和死亡率。然而,一些预测创伤性脑损伤的流行率还没有根据指南进行很好的研究,例如血管痉挛。本研究评估无血管痉挛患者预后因素与预后的相关性。材料和方法:所有患者均按照上述指南进行治疗。前瞻性招募10例患者,其中9例通过计算机断层血管造影(CTA)检查。术后第4天测定脑灌注压(CPP),维持在≥60 mmHg。分别于入院后4周、3个月、1年、2年收集格拉斯哥预后评分(GOS)和格拉斯哥昏迷评分(GCS)。结果:所有患者均未出现血管痉挛。目前的结果显示,老年人(≥65岁)GOS较差(5/6,83.3%),而年轻人GOS较好(3/3,100%)(p < 0.05)。GCS越低,GOS越低。GCS≤6亚组GOS较低(p < 0.05)。术后第4天GCS≥9(≥10)(5/ 5,100%)时预后较好(p < 0.05)。结论:应用CTA评估血管痉挛可作为指导重症TBI患者治疗的参考。在头4天内进行积极的治疗可以帮助重症TBI患者获得更好的脑复苏。
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引用次数: 1
How Do We Identify Older Adults at Risk of Dependency? Objective or Subjective Measures 我们如何识别有依赖风险的老年人?客观或主观测量
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2020-05-01 DOI: 10.6890/IJGE.202005_14(2).EC
H. Tseng
world, the population of numerous countries continues to cross the threshold of different stages of aging: becoming firstly an aging society, then aged society, and finally, a super-aged society. Taiwan, for instance, is estimated to become a super-aged society in 2026. This aging tendency leads to the rising importance of cultivating a generation of robust elderlies, i.e., a healthy old population, for it will enable elder people to contribute their unique talent, which further ensures the rate of senior social engagement. Therefore, investing in health for frail old adults is a critical issue. The purpose of clinical care for frail people is to prevent disability and further improve their overall life quality. To achieve this aim, an objective multidisciplinary Comprehensive Geriatric Assessment (CGA) is applied. CGA includes the assessment of cognitive, mood, comorbidities, polypharmacy, falls, functional status of daily activities, nutritional and social support. As known, Geriatrics is a medical field that requires professionals to conduct a holistic assessment on elderlies, and a team to intervene in older adults at risk of dependency accordingly. The hope is that the early interventions and health investment made by the medical teams can collectively and effectively reduce the elderlies’ chance of disability, timely reversing their frailty. However, even though objective measures such as CGA can give reliable assessment results to assist medical professionals in identifying older adults who are at risk of dependency, the process of conducting a CGA is rather time-consuming and requires a great deal of professionalism as well as work, causing it to lack efficiency. Compared to objective measures such as the aforementioned CGA or Physical Performance Battery (PPB), subjective measures such as the “Self-Reported screening tool for older adults at risk of Dependency (SRD)” has become a pleasant alternative due to insufficient resources to conduct objective measures. With SRD, patients can reflect on their life experience and answer the health assessment questionnaire with the help of their caregivers, and report back to the medical professionals their health condition. In this case, considering the amount of time and labor saved, adopting SRD for assessment will undoubtfully boost the efficiency of the process to identify frail elderlies. Besides, Tanaka et al. present the effectiveness of two questions from a 25-question self-reported SRD that could predict the objective measures of PPB on the physical function among old adults. Since one of the major causes for elderlies to reduce to dependency is falls, the two questions are, therefore, “Have you experienced a fall in the past year?” and “Do you feel anxious about falling while walking?” Nevertheless, if necessary, medical professionals are free to apply other self-reported questionnaires with appropriate questions to identify older adults at risk of dependency. It is of utmost significance
在世界范围内,许多国家的人口不断跨越老龄化的不同阶段:先进入老龄化社会,再进入老年社会,最后进入超老龄化社会。例如,据估计,台湾将在2026年成为一个超老龄化社会。这种老龄化趋势使得培养一代健壮的老年人,即健康的老年人口变得越来越重要,因为这将使老年人贡献他们独特的才能,从而进一步保证老年人的社会参与率。因此,投资于体弱多病的老年人的健康是一个关键问题。临床护理弱者的目的是预防残疾,进一步提高整体生活质量。为了实现这一目标,应用了客观的多学科综合老年评估(CGA)。CGA包括对认知、情绪、合并症、多种药物、跌倒、日常活动功能状态、营养和社会支持的评估。众所周知,老年病学是一个医学领域,需要专业人员对老年人进行全面评估,并需要一个团队对有依赖风险的老年人进行相应的干预。希望医疗团队的早期干预和健康投资能够共同有效地减少老年人的残疾机会,及时扭转他们的脆弱性。然而,尽管诸如CGA之类的客观措施可以提供可靠的评估结果,以协助医疗专业人员识别有依赖风险的老年人,但进行CGA的过程相当耗时,需要大量的专业知识和工作,导致效率低下。与上述CGA或Physical Performance Battery (PPB)等客观测量方法相比,“老年人依赖风险自我报告筛查工具(SRD)”等主观测量方法由于进行客观测量的资源不足,已成为一种令人愉快的替代方法。通过SRD,患者可以在照顾者的帮助下反思自己的生活经历并回答健康评估问卷,并向医疗专业人员报告自己的健康状况。在这种情况下,考虑到节省的时间和人力,采用SRD进行评估无疑会提高识别体弱老年人过程的效率。此外,Tanaka等人提出了25题自我报告SRD中的两个问题的有效性,这些问题可以预测PPB对老年人身体功能的客观测量。由于老年人减少依赖的主要原因之一是跌倒,因此这两个问题是,“你在过去一年中经历过跌倒吗?”和“你会因为走路时摔倒而感到焦虑吗?”然而,如有必要,医疗专业人员可以自由地使用其他自述问卷,其中包含适当的问题,以确定有依赖风险的老年人。构建一种可行的、及时有效的方法来应对急剧增长的老年人口统计具有重要意义。与客观措施相比,主观措施节省了时间和人力,从而更满意地回应了在超老龄化社会中投资健康和防止老年人依赖的呼吁。
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引用次数: 0
Lived Experiences in the Illness Trajectory for Elderly Patients with Ovarian Cancer in Taiwan: A Phenomenological Study 台湾老年卵巢癌患者患病轨迹之生活经验:现象学研究
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2020-02-01 DOI: 10.6890/IJGE.202002_14(1).0013
Li-Yun Tsai, Shu-chen Lee, Chen-Yuan Hsu, Jung-Mei Tsai, Shiow-Luan Tsay
Background: Elderly patients with ovarian cancer have complex emotional responses to the cancer diagnosis and treatment such as worry about performing daily routines. As cancer treatment progress, these patients need support from family, community, and health care professionals to cope with physical and psychological symptoms and impairments. Methods: Giorgi's phenomenological methodology was employed to explore the essence for elderly patients' lived experiences amid the illness trajectory of ovarian cancer. Results: Fifteen interviews were conducted. Four themes and 10 subthemes emerged from the verbatim transcripts: (1) hopelessness regarding loss of health: treatment side effects exceed expectations, worries about loss of energy hindering the cancer battle, and interruption of daily activities and interpersonal relationships; (2) endeavoring to fight for life: optimism and difficulty in establishing a new perspective on life, and cooperation with prescribed treatment; (3) managing uncertainty: realizing the impermanence of life and seizing the moment, self-reflection on the meaning of life, and attempting to regain physical health; and (4) learning to face early death: perceiving the upcoming end of life, and seeking peace of mind for lasting love. Conclusion: The low cure rate of ovarian cancer forces elderly patients to face the possibility of death. Medical teams must provide urgent and long-term medical care and value the medical autonomy of elderly patients with ovarian cancer to offer timely professional opinions and adequate care. Medical professionals should help patients develop adjustment strategies and establish a support system by integrating social resources for the holistic well-being of the patient.
背景:老年卵巢癌患者对癌症诊断和治疗有复杂的情绪反应,如对日常生活的担忧。随着癌症治疗的进展,这些患者需要家庭、社区和卫生保健专业人员的支持,以应对身体和心理症状和损伤。方法:采用Giorgi现象学方法,探讨老年患者在卵巢癌病程中的生活体验本质。结果:共进行了15次访谈。从逐字记录中出现了4个主题和10个副主题:(1)对健康丧失的绝望:治疗副作用超出预期,对能量丧失的担忧阻碍了与癌症的斗争,以及日常活动和人际关系的中断;(2)努力为生命而战:乐观和难以建立新的人生观,并配合规定的治疗;(3)管理不确定性:意识到生命的无常,抓住当下,反思生命的意义,努力恢复身体健康;(4)学会面对早逝:感知即将到来的生命终结,为持久的爱寻求内心的平静。结论:卵巢癌的低治愈率使老年患者面临死亡的可能。医疗团队必须提供紧急和长期的医疗护理,重视老年卵巢癌患者的医疗自主权,提供及时的专业意见和充分的护理。医务人员应通过整合社会资源,帮助患者制定适应策略,建立支持系统,实现患者的整体福祉。
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引用次数: 1
Sarcopenia and Frailty in Elderly: Manifestations, Impacts on Diseases, and Management 老年人肌肉减少症和虚弱:表现、对疾病的影响和管理
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2020-02-01 DOI: 10.6890/IJGE.202002_14(1).0001
Wen-Chi Chao, Shen-Yung Wang
Aging population is frequently associated with a progressive function decline. Sarcopenia and frailty are common in elderly. Sarcopenia, defined by loss of muscle mass and strength and function, is a crucial driver for frailty. Sarcopenia can result from aging process, malnutrition, inactivity, and chronic diseases. Sarcopenia is highly prevalent in frail individuals. Frailty is a geriatric syndrome connected to adverse clinical outcomes. Frailty is associated with disability or increased mortality in elderly. Sarcopenia and frailty are prevalent in various diseases such as heart failure, chronic kidney disease, chronic obstructive pulmonary disease, and critical illness. Adequate nutritional support with higher protein ingestion in addition to exercise are crucial to improve physical performance in sarcopenic or frail elderly.
人口老龄化往往与进行性功能衰退有关。肌肉减少症和虚弱在老年人中很常见。肌肉减少症是指肌肉质量、力量和功能的减少,它是导致身体虚弱的一个关键因素。肌肉减少症可由衰老过程、营养不良、缺乏运动和慢性疾病引起。肌肉减少症在身体虚弱的个体中非常普遍。虚弱是一种与不良临床结果相关的老年综合征。在老年人中,虚弱与残疾或死亡率增加有关。肌肉减少症和虚弱在各种疾病中都很普遍,如心力衰竭、慢性肾病、慢性阻塞性肺病和危重疾病。适当的营养支持和高蛋白质摄入,加上运动,对于改善肌肉减少症或体弱的老年人的身体表现至关重要。
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引用次数: 1
A Cross-sectional Assessment of Oral Health-related Quality of Life in Institutionalized Older People 机构老年人口腔健康相关生活质量的横断面评估
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2020-02-01 DOI: 10.6890/IJGE.202002_14(1).0015
Yao-Ming Cheng, S. Lan, S. Lan, Y. Hsieh
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引用次数: 0
Acute Dacryocystitis Complicated with Preseptal Cellulitis in Elderly 老年人急性泪囊炎并发隔膜前蜂窝织炎
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2020-02-01 DOI: 10.6890/IJGE.202002_14(1).0019
C. Hsieh, Wei-Jing Lee
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引用次数: 0
Acute Fatal Chest Pain: Spontaneous Massive Hemothorax in a Patient with Neurofibromatosis Type I 急性致死性胸痛:1型神经纤维瘤病患者自发性大量血胸
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2020-01-01 DOI: 10.6890/IJGE.202008_14(3).0019
K. Hsu, Wenqun Huang, Chin-Wang Hsu, Yi-Chung Yu
NF-1 is a genetic disorder with a rare incidence rate of approximately 1 in 3000. Arterial stenosis due to connective tissue dysplasia is a well-known vascular complication of NF-1, as well as aneurysms, which constitutes 3.6% of people diagnosed with this disease. Spontaneous hemothorax is one of the rare complications of NF-1. It is potentially fatal with a mortality rate as high as 36% and postoperative mortality of 33%. Massive and potentially fatal hemothorax caused by vascular complications is extremely uncommon. We present a rare case of massive hemothorax in a 62-year-old woman with NF-1 due to a spontaneous rupture of the right intercostal artery.
NF-1是一种罕见的遗传性疾病,发病率约为1 / 3000。结缔组织发育不良引起的动脉狭窄是NF-1的一种众所周知的血管并发症,以及动脉瘤,占诊断为该疾病的患者的3.6%。自发性血胸是NF-1的罕见并发症之一。它具有潜在的致命性,死亡率高达36%,术后死亡率为33%。由血管并发症引起的大量且可能致命的血胸极为罕见。我们提出一个罕见的病例大量血胸62岁妇女NF-1由于自发破裂的右肋间动脉。
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引用次数: 0
Which Japanese Older Adults are Least Likely to Enjoy Favorable Dietary Practices 哪些日本老年人最不可能享受良好的饮食习惯
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2019-12-01 DOI: 10.6890/IJGE.201912_13(4).0013
A. Ishida, Emiko Ishida
Background: With Japan becoming a super-aged society, extending healthy life expectancies resulting from favorable dietary practices in old age becomes an important policy agenda to curb the rapid increase in government healthcare expenditures. We clarify the comprehensive relationship between dietary practices among community-dwelling older adults and family structure. Methods: Individual data on dietary practices of older adults aged over 65 were obtained from the 2012 Survey of Attitudes toward Shokuiku (Food and Nutrition Education), which was conducted nationwide by the Cabinet Office of Japan in 2012. We applied ordered logistic regression for 483 valid respondents' data. Results: Among respondents separated by family composition and gender, dietary practices were found to be least favorable among single men. Although the majority of parameters regarding family composition were significant, no significant results were seen among single women, as compared to single men. Adjusting for possible covariates, it was found that irrespective of gender, single older adults living alone are less likely to (a) pursue well-balanced dietary habits, (b) follow a well-balanced diet, (c) attempt to enjoy eating meals, or (d) enjoy their meals. Besides family structure, subjective health status and knowledge regarding food significantly affect dietary practices among Japanese community-dwelling older adults. However, subjective economic status and place of residence were not significant predictors. Conclusion: Poor dietary habits can have significant consequences for single older adults, especially single old men, living alone.
背景:随着日本进入超老龄化社会,通过良好的老年饮食习惯延长健康预期寿命成为抑制政府医疗支出快速增长的重要政策议程。我们阐明了社区居住老年人饮食习惯与家庭结构之间的全面关系。方法:从2012年日本内阁府在全国范围内开展的《2012年食品与营养教育态度调查》中获取65岁以上老年人饮食习惯的个人数据。我们对483个有效被调查者的数据进行了有序逻辑回归。结果:在按家庭组成和性别分开的受访者中,单身男性的饮食习惯最不受欢迎。虽然关于家庭组成的大多数参数都很重要,但与单身男性相比,单身女性没有明显的结果。对可能的协变量进行调整后发现,无论性别如何,独居的单身老年人不太可能(a)追求均衡的饮食习惯,(b)遵循均衡的饮食,(c)尝试享受用餐,或(d)享受用餐。除了家庭结构外,主观健康状况和食物知识对日本社区老年人的饮食习惯也有显著影响。然而,主观经济地位和居住地并不是显著的预测因子。结论:不良的饮食习惯会对独居的单身老年人,尤其是单身老年男性产生重大影响。
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引用次数: 1
Promoting Physical Activity and Reducing Frailty of Middle-Aged and Older Adults in Community: The Effects of a Health Promotion Program Combining Smart Phone Learning and Exercise 促进社区中老年人的身体活动和减少虚弱:结合智能手机学习和锻炼的健康促进计划的效果
IF 0.3 4区 医学 Q4 Medicine Pub Date : 2019-12-01 DOI: 10.6890/IJGE.201912_13(4).0011
Shu-chen Lee, Jung-Mei Tsai, Li-Yun Tsai, Li-Jen Liang, Ching-Ping Wu
Background: To intervene the health and frailty of middle-aged and older adults lived in community is an important subject for health-related professions as society fostering healthy aging. Engaging in proper physical activity and adequate usage of smart phone are beneficial. This study explored the effects of a health promotion program on enhancing heath and reducing frailty of middle-aged and older adults. Methods: A quasi-experimental, two-group study design was conducted with purposive sampling of middle-aged and older adults from eight community care centers. The study period expanded from January to September, 2019. An intervention of smart phone learning and balance/flexibility exercise introduced to the experimental. A structural questionnaire used to collect pretest and posttest data: demographics; self-reported assessment of health, exercise, and frailty; measurement of handgrip and body mass. Descriptive and inferential statistical analyses were performed using SPSS 20.0. Results: Completed dataset consisted of 93 subjects: 39 in experimental and 54 control. For within-group comparison, exercise frequency improved significantly (p < .05) in the experimental group. For between-group comparison, exercise intensity and exercise duration improved significantly at posttest. Furthermore, frailty measuring by Study of Osteoporotic Fracture (SOF) index reduced significantly for both within- and between-group comparisons. Conclusion: The health promotion program combining smart phone learning of and the moderate exercise was effective to encourage physical activity and reduce frailty for middle-aged and older adults in community. The study could provide valuable information for future studies investigating healthy aging and frailty.
背景:干预社区中老年人的健康与衰弱是健康相关专业作为社会促进健康老龄化的重要课题。从事适当的体育活动和充分使用智能手机是有益的。本研究探讨健康促进计划对增进中老年人健康及减少虚弱的影响。方法:采用准实验、两组研究设计,对来自8个社区护理中心的中老年人进行有目的抽样。研究期从2019年1月延长至9月。用于收集测试前和测试后数据的结构性问卷:人口统计学;自我报告的健康、运动和虚弱评估;握力和体重的测量。采用SPSS 20.0进行描述性和推断性统计分析。结果:完整的数据集包括93名受试者,其中试验组39名,对照组54名。组内比较,实验组运动频率显著提高(p < 0.05)。组间比较,运动强度和运动时间在后测时显著提高。此外,通过研究骨质疏松性骨折(SOF)指数测量的脆弱性在组内和组间比较中均显著降低。结论:智能手机学习与适度运动相结合的健康促进项目对促进社区中老年人群的身体活动和减少虚弱是有效的。该研究可以为未来研究健康衰老和虚弱提供有价值的信息。
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引用次数: 4
期刊
International Journal of Gerontology
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