Background

Unsupervised exercise intervention (UNSUP) appears to be a practical and beneficial strategy for older adults, although its feasibility and effectiveness compared to supervised exercise intervention (SUP) remains unknown. We aimed to compare the safety, attendance/adherence rates, and effectiveness of SUP versus UNSUP on physical function and well-being outcomes in older adults.

Methods

A systematic search was conducted in PubMed, Web of Science, CINAHL, SPORTDiscus, and APA PsycINFO up to September 2022 for randomized controlled trials comparing SUP versus UNSUP in older adults (≥ 60 years). Safety and attendance/adherence rates were registered as indicators of feasibility, and meta-analyses were performed for physical function and well-being outcomes. Sub-analyses were performed for those studies that applied a similar intervention in both groups and for those studies where participants performed ≥ 66% of the sessions in the assigned condition.

Results

Thirty-four studies were included (n = 2830). No serious adverse events were reported, with similar attendance rates (81%) for both SUP and UNSUP. Compared with UNSUP, SUP induced significant higher benefits on knee extension strength (standardized mean difference (SMD) = 0.18, p = 0.002), sit-to-stand test (STS, SMD = 0.25, p = 0.050), timed-up-and-go test (TUG, SMD = 0.21, p = 0.035), usual gait speed (SMD = 0.29, p = 0.026), lean mass (mean difference = 1.05 kg, p < 0.001) and health-related quality of life (HRQoL, SMD = 0.21, p = 0.035), albeit only knee extension strength remained significant in sensitivity analyses. Sub-analyses revealed superior benefits of SUP on knee extension strength when only considering those studies that applied a similar intervention in both SUP and UNSUP groups. However, no significant benefits were found for the remaining outcomes. Beneficial effects of SUP over UNSUP were also observed for knee extension strength, STS, functional reach test, TUG, usual gait speed, lean mass, and HRQoL when separately analyzing those studies in which participants performed ≥ 66% of the sessions in the assigned condition.

Conclusions

Current evidence suggests that both SUP and UNSUP programs are safe and could exert benefits on physical function and HRQoL. However, despite being associated with similar attendance rates, SUP might offer some additional benefits, although further high-quality research (i.e., accounting for confounding factors such as presence of supervised sessions in UNSUP or vice versa, as well as equating the exercise dose) is necessary to confirm these findings.

PROSPERO Registration Number

CRD42022326420.

中文翻译：

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有监督与无监督运动对于改善老年人身体功能和健康结果：随机对照试验的系统回顾和荟萃分析

背景

无监督运动干预（UNSUP）似乎对老年人来说是一种实用且有益的策略，尽管其与监督运动干预（SUP）相比的可行性和有效性仍然未知。我们的目的是比较 SUP 与 UNSUP 对老年人身体功能和健康结果的安全性、出勤率/坚持率和有效性。

方法

截至 2022 年 9 月，我们在 PubMed、Web of Science、CINAHL、SPORTDiscus 和 APA PsycINFO 中进行了系统检索，以比较老年人（≥ 60 岁）中的 SUP 与 UNSUP 的随机对照试验。安全性和出勤率/依从率被记录为可行性指标，并对身体功能和健康结果进行荟萃分析。对在两组中应用类似干预的研究以及参与者在指定条件下完成 ≥ 66% 的训练的研究进行了亚组分析。

结果

纳入 34 项研究 ( n  = 2830)。没有报告严重不良事件，SUP 和 UNSUP 的出勤率相似 (81%)。与 UNSUP 相比，SUP 在膝关节伸展强度（标准化平均差 (SMD) = 0.18，p  = 0.002）、坐站测试（STS，SMD = 0.25，p  = 0.050）、计时上升方面带来显着更高的益处。 and-go 测试（TUG，SMD = 0.21，p  = 0.035），通常步态速度（SMD = 0.29，p  = 0.026），瘦体重（平均差 = 1.05 kg，p  < 0.001）和健康相关的生活质量（ HRQoL，SMD = 0.21，p  = 0.035），尽管在敏感性分析中只有膝关节伸展力量仍然显着。子分析显示，仅考虑那些在 SUP 和 UNSUP 组中应用类似干预措施的研究时，SUP 对膝关节伸展力量具有卓越的益处。然而，对于其余的结果没有发现显着的好处。在单独分析那些参与者在指定条件下完成 ≥ 66% 的训练的研究时，还观察到 SUP 相对于 UNSUP 在膝关节伸展力量、STS、功能伸展测试、TUG、通常步态速度、瘦体重和 HRQoL 方面的有益效果。

结论

目前的证据表明，SUP 和 UNSUP 计划都是安全的，并且可以对身体功能和 HRQoL 产生益处。然而，尽管出勤率相似，SUP 可能会带来一些额外的好处，尽管需要进一步的高质量研究（即考虑到混杂因素，例如 UNSUP 中是否存在受监督的课程，反之亦然，以及运动剂量相等）有必要证实这些发现。

普洛斯彼罗注册号

CRD42022326420。