有氧运动在预防血管性认知障碍中的研究进展

doi:10.11817/j.issn.1673-9248.2022.05.002

血管性认知障碍（VCI）是第二常见的痴呆病因，现无针对其病理机制的特效药物，临床治疗以改善症状为主，效果有限。因此，VCI应着眼于预防，以从根本上减少病理损害的累积，避免认知障碍的发生。有氧运动预防认知障碍的效果目前已得到一定的证据支持，兼之与VCI的发病机制、危险因素关系紧密，逐渐成为研究热点。现就VCI与有氧运动的干预机制、危险因素以及预防作用进行综述。

关键词: 有氧运动, 血管性认知障碍, 预防

Vascular cognitive impairment (VCI) is the second most common type of dementia. As the pathogenesis of VCI remains unclear, there are no effective drugs for the pathological changes of VCI but only to improve symptoms. Hence, it is crucial to prevent and control VCI. There is a series of evidence supporting the effects of aerobic exercise on the prevention of VCI, as well as the association between aerobic exercise and the underlying mechanism and risk factors of VCI; aerobic exercise has received much attention. This review shed light on the correlation between aerobic exercise and VCI, and highlighted the effects of aerobic exercise on preventing cognitive decline.

Key words: Aerobic exercise, Vascular cognitive impairment, Prevention

图1 有氧运动预防血管性认知障碍的潜在机制

表1 有氧运动预防血管性认知障碍或痴呆的临床试验

文献来源	年份	国家	研究类型	研究人群	人数及性别	受试者年龄（岁， $x ¯$ ±s）	干预措施及时间	结局指标
Guadagni等^[15]	2020	加拿大	单臂前后对照研究	总体健康，55~80岁，总体认知功能正常^a	206 女：105	65.9±6.4	有氧运动：6个月；3 d/周，20~40 min，60%~70%最大心率	处理速度（SDMT符号数字转换测验），执行功能（Delis-Kaplan执行功能系统），言语记忆（Buschke选择性提醒测试），图形记忆（MCG复杂图形测验），流利度（Delis-Kaplan执行功能系统），注意力（听觉辅音三元测试）
Stern等^[51]	2019	美国	随机对照试验	总体健康，20~67岁，总体认知功能正常	E：66 女：47 C：66 女：46	E：41.56±12.30 C：39.33±14.46	E：有氧运动：26周；4 d/周，20~40 min，第1~2周：55%~65%最大心率，第3~4周：65%~75%最大心率，第5~26周：75%最大心率 C：拉伸运动	智力（韦氏成人阅读测试），执行功能（Groton迷宫学习测试），情景记忆（改良版雷氏听觉词语学习测试，连续配对联想学习），处理速度（韦氏数字符号测试，Groton追逐迷宫测试，辨识测试），语言能力（口述语意联想测试，动物命名测试），注意力（2和7测试），工作记忆（韦氏智力量表）
Tarumi等^[52]b	2022	美国	随机对照试验	总体健康，60~80岁，认知正常，久坐人群	E：36 女：27 C：37 女：28	E：69±6 C：68±5	E：有氧运动：1年；第1~10周：3 d/周，25~30 min，75%~85%最大心率，第11~25周：3~4 d/周，30 min，85%~90%最大心率，第26周后：4~5 d/周，30~40 min C：拉伸运动	逻辑推理能力，长期记忆及工作记忆，执行功能，处理速度
Zotcheva等^[53]	2022	挪威	随机对照试验	总体健康，1936年1月1日至1942年12月31日出生，无痴呆	E1：235 女：114 E2：216 女：97 C：494 女：239	E1：72.3±2.05 E2：72.4±2.08 C：72.2±2.02	E1：持续有氧运动：5年；2 d/周，50 min，70%峰值心率 E2：间歇有氧运动：5年；2 d/周，40 min，4 min 85%~95%峰值心率，3 min休息60%~70%峰值心率，4 min 85%~95%峰值心率 C：运动建议	总体认知功能：蒙特利尔认知评估量表

表1 有氧运动预防血管性认知障碍或痴呆的临床试验

文献来源	年份	国家	研究类型	研究人群	人数及性别	受试者年龄（岁， $x ¯$ ±s）	干预措施及时间	结局指标
Guadagni等^[15]	2020	加拿大	单臂前后对照研究	总体健康，55~80岁，总体认知功能正常^a	206 女：105	65.9±6.4	有氧运动：6个月；3 d/周，20~40 min，60%~70%最大心率	处理速度（SDMT符号数字转换测验），执行功能（Delis-Kaplan执行功能系统），言语记忆（Buschke选择性提醒测试），图形记忆（MCG复杂图形测验），流利度（Delis-Kaplan执行功能系统），注意力（听觉辅音三元测试）
Stern等^[51]	2019	美国	随机对照试验	总体健康，20~67岁，总体认知功能正常	E：66 女：47 C：66 女：46	E：41.56±12.30 C：39.33±14.46	E：有氧运动：26周；4 d/周，20~40 min，第1~2周：55%~65%最大心率，第3~4周：65%~75%最大心率，第5~26周：75%最大心率 C：拉伸运动	智力（韦氏成人阅读测试），执行功能（Groton迷宫学习测试），情景记忆（改良版雷氏听觉词语学习测试，连续配对联想学习），处理速度（韦氏数字符号测试，Groton追逐迷宫测试，辨识测试），语言能力（口述语意联想测试，动物命名测试），注意力（2和7测试），工作记忆（韦氏智力量表）
Tarumi等^[52]b	2022	美国	随机对照试验	总体健康，60~80岁，认知正常，久坐人群	E：36 女：27 C：37 女：28	E：69±6 C：68±5	E：有氧运动：1年；第1~10周：3 d/周，25~30 min，75%~85%最大心率，第11~25周：3~4 d/周，30 min，85%~90%最大心率，第26周后：4~5 d/周，30~40 min C：拉伸运动	逻辑推理能力，长期记忆及工作记忆，执行功能，处理速度
Zotcheva等^[53]	2022	挪威	随机对照试验	总体健康，1936年1月1日至1942年12月31日出生，无痴呆	E1：235 女：114 E2：216 女：97 C：494 女：239	E1：72.3±2.05 E2：72.4±2.08 C：72.2±2.02	E1：持续有氧运动：5年；2 d/周，50 min，70%峰值心率 E2：间歇有氧运动：5年；2 d/周，40 min，4 min 85%~95%峰值心率，3 min休息60%~70%峰值心率，4 min 85%~95%峰值心率 C：运动建议	总体认知功能：蒙特利尔认知评估量表

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Research advances on aerobic exercise in the prevention of vascular cognitive impairment

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Research advances on aerobic exercise in the prevention of vascular cognitive impairment