#591：保持年龄增长中的功能能力——布伦丹·伊根博士

你好，欢迎收听Sigma营养广播。

Hello, and welcome to Sigma Nutrition Radio.

这是该播客的第591期。

This is episode 591 of the podcast.

我叫丹尼·莱农。

My name is Danny Lennon.

欢迎来到本节目。

You are very welcome to the show.

在本期节目中，我将与布伦丹·伊根博士对话，这是他第三次做客本播客。

And in this episode, I'm gonna be talking to doctor Brendan Egan on what will be his third episode of the podcast.

伊根博士是都柏林城市大学运动与运动生理学的副教授。

Doctor Egan is an associate professor of sport and exercise physiology at Dublin City University.

总的来说，他的研究关注不同人群在生命周期中骨骼肌的功能与适应性变化。

And in general, his research looks at skeletal muscle function and adaptations across the life course with a range of different populations.

他的研究团队已针对多种不同结果开展过人体试验，这些结果与一定程度的体能和认知表现、恢复及适应有关。

His research group has performed human trials on both acute and chronic interventions for a range of different outcomes that relate to some degree of performance, both physical and cognitive, looking at also recovery and adaptation.

特别是，他的团队在老年人运动干预方面做了非常出色的工作。

In particular, his group has done some really nice work looking at exercise interventions in older adults.

特别是，他们将提到一项对照试验，在为期十二周的时间里对一组老年人实施了非常出色的干预措施。

In particular, they were gonna mention a controlled trial that they actually doing a really nice intervention over a twelve week period with a group of older adults.

然后，他们进行了为期十二个月的随访，观察试验结束后发生的变化，并通过与参与者进行访谈收集了大量优质的定性数据，以了解他们在随访期间的体验。

And then they did a twelve month follow-up of seeing after the trial what had happened and using some really nice qualitative data collected through interviews with those participants to see some of their experiences in that follow-up period.

因此，我们不仅会深入探讨这些内容，还会广泛讨论身体功能、健康衰老等概念。

And so we're gonna get into that as well as more broadly the concepts of physical function, healthy aging, etcetera.

希望你们会非常喜欢这次对话。

And so, hopefully, you will really enjoy this conversation.

如果你是Sigma Nutrition高级订阅用户，你将能够获得一套详细的研读笔记，伴随本集内容，深入讲解节目中提到的所有内容，帮助你更深入地理解或复习即将收听的内容。

If you are a Sigma Nutrition premium subscriber, you will be able to get a set of detailed study notes to accompany this episode, which will go through everything that is mentioned throughout it in a bit more detail as a way for you to go a bit deeper or to revise over what you are about to listen to.

此外，你还将获得我们在本场访谈结束后播放的‘核心观点’环节。

And also in addition, you will get our key ideas segment that will play after this interview is over.

对于收听免费公开播客的听众，如果你希望从播客中获得更多信息，获取这些额外资源，并将播客作为学习工具，那就去看看Sigma Measures高级版吧。

For those of you listening on the free public feed of the podcast, if you're interested in getting more out of your podcast listing, getting those extra resources, and using your podcast listing as a learning tool, then check out Sigma Measures from Premium.

这是您获取所有资源的方式，也是直接支持本节目的途径。

It is the way you can get all those resources and is the direct way that you can support the show.

如果您考虑这么做，非常感谢。

And so if you do consider that, thank you very much.

我们非常感激。

It's very much appreciated.

好了，闲话少说，让我们开始我和布伦丹·伊根博士的对话吧。

So with that preamble out of the way, let's dive into this conversation between myself and doctor Brendan Egan.

布伦丹·伊根博士，欢迎再次做客本节目。

Doctor Brendan Egan, welcome back to the podcast.

很高兴您再次来到这里。

It's great to have you on here again.

很高兴回来。

Good to be back.

我最近在整理简历时才发现，您是我做过的第一个播客，谢谢您。

I was actually compiling a CV recently and realized you were the first podcast I ever did, So thanks for that.

是的。

Yeah.

真有趣。

It's funny.

我最近其实想查一下我们第一次做节目的时间。

I actually recently was looking to try and see when was the first one that we did.

我敢肯定至少是十年前了。

I'm pretty sure it was at least ten years ago.

我觉得，是的，应该是2016年左右吧。

I think, yeah, I think it was, like, 2016, maybe.

据我回忆，我们确实做过。

We did too as if I recall.

是的。

Yeah.

时光飞逝。

Times flies.

所以，重新回顾一下你的工作确实是久违了。

So certainly a long overdue revisit some of your work.

但在那之前，对于刚刚接触到你的人，你能向他们介绍一下你的研究兴趣和学术背景吗？这或许能为我们今天的讨论奠定基础。

But before we get to that, maybe for people who are just coming across you now, can you give them an introduction to your research interests and your academic background, something that might set the scene for us here?

是的。

Yeah.

我目前就职于都柏林城市大学。

So I'm based here at Dublin City University.

我是运动与运动生理学的副教授。

I'm associate professor in sport and exercise physiology.

从研究角度来看，我的职业生涯大致可以分为三个领域。

My career is probably in three buckets from a research point of view.

早期我做了大量关于分子运动科学方面的工作，这是一个广义的术语。

I did a lot of work early on in in molecular exercise science as a broad term.

之后我更多地转向了应用性干预研究，特别是针对老年人群，这也是我们今天要讨论的内容。

Moved then more into the area of applied interventions, particularly in older adults, which is what we're gonna talk about today.

而在过去的几年里，我们一直在研究外源性酮体补充剂在运动表现和恢复中的作用。

And then I suppose over the last number of years, we've been doing a lot of work with exogenous ketone supplements and the role in embedded performance and recovery.

你知道，这就是我所擅长的领域。

You know, so that's what I'm known for.

此外，我也多年来一直从事应用运动营养师的工作。

So working in the field as well as a as an applied sports nutritionist for many years as well.

所以我同时兼具学术和实践的双重身份。

So wearing both the academic and the practice hat.

正如我之前向你提到的，今天我们主要想探讨的是：如何在老龄化过程中保持功能能力。

And as I mentioned to you, nominally, I wanted to us to focus on today is this concept of how can we maintain functional capacity with age.

对于那些试图查阅这一领域文献的人来说，他们可能会看到诸如‘功能能力’或‘神经肌肉功能’这样的术语。

And certainly for people who maybe try and take a look at some of the literature in this area, they'll see terminology like that functional capacity or neuromuscular function.

你能为我们概述一下，应该如何理解这些术语吗？

Can you maybe give us an outline of how we should think about these terms?

什么是定义‘功能能力’这类概念的最佳方式？

What is the best way to maybe define things like functional capacity?

我们到底在谈论什么？

What are we actually talking about?

是的。

Yeah.

这从一开始就引入了一个重要的观点，那就是你所面对的受众。

Think that introduces an important point from the very outset, which is the audience that you're talking to.

因此，在研究层面，术语的使用和结果的测量方式固然重要，但对于普通人或实践者来说，这些结果指标的实际应用往往比定义它们更重要。

So in research terms, the terminology and how the outcomes are measured is obviously really important, but to the layperson or equally to practitioners, it turns out to be more about the practicalities of some of these outcome measures rather than defining them.

我之所以这么说，是因为你会看到像‘功能能力’、‘功能适应性’这样的术语，例如世界卫生组织在健康老龄化定义中就使用了这类词汇。

So the reason I say that is that you see terms like functional capacity, functional ability, for example, is in the World Health Organization's definition of healthy aging.

神经肌肉功能可以通过多种方式来测量。

Neuromuscular function can be measured lots of different ways.

我认为大多数人对‘肌肉减少症’这个术语都很熟悉，它指的是随着年龄增长，肌肉质量和力量达到某个阈值时的诊断。

And I think most people will be familiar with terms like sarcopenia then as this diagnosis of a threshold on muscle mass and strength as well as we age.

我之所以说这些，是因为单独定义其中任何一个概念其实都很困难，只能说在每一个这类结果下，我们都拥有多种不同的测量方式。

So the reason I say all that is that it's actually quite hard to define any one of those individually, except to say that we've got multiple different measures under each one of those outcomes.

因此，通常功能能力或功能性与日常生活活动相关，其中一些涉及身体能力，另一些则涉及心理能力的测量。

So typically functional capacity or functionability is related to things like activities of daily living, and some of that will be physical capacity and others will be measures of mental capability as well.

当你转向神经肌肉功能时，这通常是基于实验室的测量，我们稍后在讨论相关证据时会谈到一些其他指标。

And as you move into then neuromuscular function, that's typically more lab based by its nature, and we'll probably talk about some of the other measures as we talk about the evidence around that.

当你进入老年阶段时，所使用的定义和阈值，比如肌肉减少症，会包括坐立测试、握力、步行测试、100米步行测试，以及简短体能测试组合等。

And then as you move into sort of older age, the definitions that are used, the cutoffs, for example, with sarcopenia will be things like sit to stand tests, grip strength, walking tests, 100 meter walk test, for example, is another one, short physical performance, battery.

我之所以说这些，是因为市面上有太多不同的测量指标，很难给出一个切实有用的明确定义。

So I say all of this because there's just so many different outcomes that are out there that it's actually hard to put a firm definition on it that's useful.

而且，我想这引出了我们稍后会多次提到的一点：当我们关注特定结果时。

And, well, I suppose that speaks to something we'll mention a few times is when we're looking at specific outcomes.

通常，我们可能会侧重于力量和肌肉质量的重要性，这一点我们当然会讨论，它们确实非常重要。

Oftentimes, we can maybe have a focus on the importance of strength and muscle mass, which we'll certainly talk about, which are very important.

但我认为，你刚才提到的那些与日常生活相关的指标，其中一部分确实涉及绝对力量水平或肌肉质量的维持，但同时也包括协调性，以及神经对肌肉的调控等其他方面。

But I think some of these outcomes like you just mentioned that are important for aspects of daily living, a part of that is going to be absolute levels of strength or the maintenance of muscle mass, but there's also these other aspects related to coordination or that kind of communication neurally to the muscle as well amongst these other outcomes you mentioned.

对吧？

Right?

所以我认为这样表述很好，因为我认为我们之所以如此关注肌肉质量和肌肉力量，是因为它们在实验室中相对最容易测量。

So I think that's a good way to frame it because I think the reason why we've ended up with this major focus on muscle mass and muscle strength is because they tend to be the ones that are easiest to measure in the lab.

并不是说其他测试难以测量，但它们通常对运动干预也相当敏感。

Not to say that the other tests aren't easy to measure, but they tend to also be quite sensitive to exercise interventions.

因此，这可能与该领域研究人员的背景有关，他们往往专注于力量训练干预以及力量、功率和肌肉尺寸的相关结果，但这忽略了平衡能力。

And so it might be the background of the researchers who work in the field that they tend to focus on strength training interventions and outcomes around strength, power, muscle size, but that neglects the balance component.

我的研究也属于这一类，我们关注的是力量和肌肉质量的结果，尽管我们知道平衡能力是跌倒的强有力预测因子，而跌倒会导致骨折，这正是肌肉质量和功能丧失的下游影响——增加了跌倒、骨折及相关疾病的风险。

And my work would be included in that is that we focused on the outcomes around strength and mass, even though we know that balance is a very strong predictor of falls, which lead into fractures, which is really the downstream effects of this loss of muscle mass and function is the risk associated with greater risk of falls and on fractures and associated illness.

所以，是的，从更广泛的角度思考力量和肌肉质量之外的概念确实很有用，但现实中，大量研究仍把这些结果作为主要指标。

So, yeah, it is it's useful to think about the broad concepts beyond, say, strength and mass, but in in reality, an awful lot of the studies tend to focus on those outcomes as the primary outcomes.

因此，尽管我们刚刚提到了一些细微差别，但如果暂时将这些内容综合起来，比如神经肌肉功能或功能能力等，人们经常听到的一点是，这些指标通常会随时间推移而下降，从而为潜在的负面结果埋下伏笔。

So notwithstanding that bit of nuance we've just mentioned, if we broadly, just for the moment, pull these things together and maybe let's say neuromuscular function or functional capacity, etcetera, one thing people will have heard time and time again is that typically we tend to see declines in these things over time and hence setting up the stage for potential negative outcomes.

你能为我们概述一下，是否存在一种典型的下降轨迹吗？

Can you maybe give us an outline of if there is such a thing, what is that kind of typical trajectory of those declines?

也许为了让人更直观地理解，你能举个例子，说明你提到的这些日常活动中，这种下降会如何体现？

And maybe to paint a picture for people, what would that what would be an example of that in terms of those daily activities that you've outlined?

这些变化中有哪些是所谓的典型情况？

What are some of these changes that might be, quote, unquote, typical?

是的。

Yeah.

我其实喜欢世界卫生组织对健康老龄化的定义，虽然别让我直接引用，但它的核心思想是，健康老龄化实际上是一个发展功能能力的过程，这主要涉及人生早期以及我们达到巅峰的阶段。

So I actually like the World Health Organization's definition of healthy aging because it actually, now don't get me to quote it, but effectively applied to the idea that there is a certain amount of healthy aging is actually in the process of developing functional ability, which essentially is talking about early life and the point at which we reach a peak.

然后它还提到，随着年龄增长，维持功能能力的重要性，这实际上有助于我们在老年时期保持良好的生活质量。

And then it refers to the idea of maintenance of functional ability as we age, and that effectively enables well-being into older age.

所以，当你这样理解这个定义时，背后有一种生命历程的视角，它指向我们的功能能力达到巅峰，而功能能力之下，依然是那些相同的要素：肌肉质量、肌肉功能和平衡能力。

So when you think about the definition that way, there's a kind of a life course perspective that goes alongside that, which speaks to something like a peak in our functional ability or, and again, underneath functional ability, you see the same things, muscle mass, muscle function, balance.

你知道，这些变量中的任何一个，都可能在人生早期达到峰值或得到积累。

You know, any one of these variables can reach a peak or can be accumulated early in life.

之后，正如你所说，这些能力会开始下降，我稍后会给出一些具体的数据来说明下降的轨迹。

And then after that, it's declined, as you mentioned, the trajectories of decline that I'll put some numbers on shortly.

但我之所以提到人生早期，是因为这个峰值通常被认为出现在35到40岁之间，具体时间取决于不同的衡量方式。

But the reason I bring up the early life piece is because that peak is typically said to occur somewhere around 35 to 40 years of age, depending on how you look at it.

但这个峰值在不同人身上表现得非常不同。

And that peak though looks very different for different people.

你和我都知道，有些人巅峰时期能深蹲自身体重的两到三倍，而另一些人却连从椅子上站起来都困难。

You and I will know plenty of people who can squat two or three times their body mass at the peak of their strength and others then who will struggle to get up and down out of a chair.

我们可能在谈论两个40岁的人，但他们的峰值状态却有着巨大的差异。

We could be talking about two 40 year old individuals, but it's an enormous range in terms of what that peak actually looks like.

无论如何，在那之后，通常所说的衰退率是：到65岁之前每十年下降3%到8%，65岁之后则每年下降1%，每十年下降10%。

Anyway, after that, then the sense of the peak, the declines that are typically quoted are something like three to 8% per decade up to the age of 65, and then one percent per year, 10% per decade after the age of 65.

这些就是我之前提到的数字。

They're the types of numbers that I mentioned.

但我认为一个重要的细微差别是，肌肉质量的流失与肌肉力量和爆发力的流失之间存在显著差异。

But I think an important nuance again is that there's a pretty big dissociation between the loss of muscle mass and the loss of muscle strength and power.

因此，人们常常用一个简化的说法：肌肉越大，力量就越强。

So one of the concepts that people often use as a shorthand is that bigger muscles mean stronger muscles.

这其实又回到了你关于神经肌肉功能的观点：那种一对一或近乎一对一的关系，并不总是成立。

And it kind of goes back to your point about neuromuscular function is that that kind of one to one or close relationship, that doesn't always actually hold true.

因此，我们看到的是，随着年龄增长，肌肉力量和功率的下降比肌肉质量的流失更为显著。

So what we end up seeing is that the loss of muscle strength and power is much more pronounced as we age than the loss of muscle mass.

因此，我应该从一开始就说明，我现在大量参与CPD工作，与物理治疗师、私人教练以及专门针对老年人训练的体能教练合作。

And as a result, and again, I should have said at the outset, I do an awful lot of work now with the CPD, with physiotherapists and personal trainers and S and C courses in particular around the training of older adults.

我们特别强调的一个观点是，对于老年人而言，通过训练干预来增加肌肉质量非常困难，而提升肌肉力量或功能则对常见的训练干预反应更明显。

And that's one of the messages that we really try to emphasize is that muscle mass is something that's very difficult to increase in terms of a training intervention in older adults, whereas improving muscle strength or muscle function is actually, it's much more responsive to the types of training interventions that we do.

所以，总的来说，我们的肌肉力量和功能在三四十岁左右达到峰值，最晚也不会超过四十岁出头，之后便进入下降阶段，虽然我们有大量广泛的数据，但有些人晚年仍能保持较好的功能，而另一些人则不然。

So I guess the broad point there is that there is a peak that occurs sometime in in our mid thirties and maybe early forties at the latest, and then there are trajectories of decline, and we have deep broad numbers that are stated, but some individuals will maintain their function throughout later life much better than others.

另一些群体则会出现更快速的衰退，也许我们可以谈谈造成这种差异的原因，比如之前提到的分解代谢危机模型。

And again, other groups will have these more rapid declines, and maybe we can talk about the the cause of that, the kind of catabolic crisis model that we might've talked about before.

但关于这一点，很多信息都来自横断面研究。

But there was just on that point, a lot of that information comes from cross sectional studies.

也就是说，你测量不同年龄段的大量人群，然后绘制他们的力量、肌肉质量或功能数据，从而得出一条趋势线。

So, you know, this idea that you measure lots of different people at different age points, and then you plot their strength or their mass or their function, and you plot this line that gives you your the trajectory.

有趣的是，最近有一篇论文基于多年的力量举数据，能够对个体进行纵向追踪。

What it's interesting that a paper came out relatively recently that modeled power lifting data over a large number of years and was able to follow people longitudinally.

实际上，关于纵向变化的文献，而不是横断面研究设计，是相当缺乏的。

So there's actually a shortage, I would say, of literature around longitudinal changes as opposed to cross sectional type story designs.

但有趣的是，在力量举数据集中，那些进行最大力量训练的人，其能力下降的速度明显要慢得多。

But what was interesting in power lifting data set is that the rate of decline was obviously far, far less in those individuals who were training for max strength.

我不确定他们的峰值是否也可能出现在更晚的年龄。

Not sure if the peak was probably occurring later in life as well.

他们的峰值不是在35岁，而是在40多岁期间。

The peak wasn't at 35, it was somewhere into the forties.

几年前我和大卫·里克斯合作制作了一张幻灯片，你可能熟悉他作为力量举运动员的身份。

And there's a slide that I created a few years ago with David Ricks, who you're probably familiar with as a power lifter.

是的。

Mhmm.

如果你追踪他来自公开数据库的表现数据，他的力量举成绩峰值实际上出现在50多岁。

And if you track his performance from the publicly available databases, his peak in terms of his power lifting scores were well into his fifties.

他并不是在30多岁时达到巅峰的。

He didn't reach his peak in his thirties.

我认为这一点说得有点啰嗦，但我的意思是，断言人们在三十五六岁或四十出头就达到巅峰、此后无能为力，这是不公平的。

And I think that's again, it's a point to be made a bit long winded, but my point is that it's not a fair to complete that people reach their peak in their mid thirties or early forties and nothing could be done about it.

有些人直到三四十岁仍在坚持锻炼、积累训练经验，他们的人生巅峰来得更晚，这非常好。

There are people who are engaging with exercise and building up their training history into their thirties and forties, and they're reaching their peak much later in life, that's great.

这是一个很好的观点。

That's that's a good message.

你的三四十岁之后并非一路下滑。

That's not all downhill from your from your thirties.

说起来这可能是在讲我自己，但这也是我们投身这项研究的部分原因。

You know, that's probably just me talking about myself here, but part of the reason we're in this research.

我觉得你刚才说的非常重要，也许我可以复述一下，确保我理解准确。

I I think what you said there is incredibly important, and maybe to recap some of that to make sure I have it accurate.

其中一个关键点是，如果我们从终点倒推，想象一个人在晚年时的状态，该如何安排才能实现最佳结果呢？

One of those important points was if we were to imagine, okay, starting from the endpoint and working back, have someone in later in life, how would we set up to have say best outcomes here?

你

You

你知道，显然其中一个方面是你提到的发展阶段，如果我们能达到更高的峰值，这就能为后续的衰退提供更多的缓冲空间。

know, obviously, one part is that the developmental part that you mentioned that ideally, if we can get to a higher peak, that kind of gives a bit more buffer room with these declines.

话虽如此，一旦一个人达到了峰值，无论这个峰值出现在何时，都有许多因素会影响衰退的陡峭程度。

That said, once someone has that peak, wherever that is, there's many things that can influence the steepness of that decline.

因此，我们显然希望让衰退尽可能平缓，而这些因素正是关键所在。

So obviously we want to have that the least steep as possible where some of this stuff comes in.

你提到的另一个方面是，我们可以根据不同实际结果来 differently 思考这个问题。

The other aspect you mentioned was that we can then think about this differently depending on that actual outcome.

在这里，力量对某些干预措施的反应更明显，或者比肌肉质量本身更可预测，甚至可能更重要。

Here, strength being much more responsive to some of those interventions or maybe more predictable to an intervention, let's say, than actual muscle mass per se, and perhaps even more important.

我认为各种运动领域的人士都能认同这一点：他们不一定想增加大量肌肉，而是希望在保持体重级别不变的同时变得更强大。

And I think people within various sports can acknowledge this that where they don't necessarily want to gain a lot of muscle, stay within a weight category but do want to get stronger.

然后，我们就可以考虑个体层面的反应差异。

And then so then we can have this individual level of response.

因此，表面上可以说，大约35到40岁是峰值出现的年龄段，但在个体层面上，这个时间点可能差异很大，我想这也与一个人的训练基础有关——如果某人从15岁就开始进行力量训练，那么他可能就在那个阶段达到峰值。

So nominally, can say, okay, roughly this 35 to 40 might be where a peak occurs, but on an individual level that can vary quite differently and I guess that also relates to maybe someone's baseline level of training right so if someone has been training in strength from the age of 15 yeah maybe they're going to reach a peak at that particular point.

如果一个人开始得晚一些，那么他还有更大的提升空间。

If someone starts later, then they have a bit more room to go up.

还有像大卫或里克这样的个体因素。

And then these individual factors like David or Rick.

所以所有这些都非常重要。

So all of that is incredibly important.

当谈到肌肉力量时，我想问的一件事是，现在越来越多的人意识到，肌肉力量与死亡率或各种发病率之间存在某种关联，正如您的研究很好地暗示的那样。

One thing that I did want to ask about when it does come to, let's say, muscle strength is that I think more and more people now are becoming aware that there is some relation between that and outcomes like mortality or various morbidities as your work has alluded to quite nicely.

刚才您提到，我们可能需要依赖大量流行病学研究来指导这一点。

Moment ago, you mentioned that we might rely on a lot of epidemiology to to inform this.

关于这些关联的流行病学数据，您能否为我们提供一些见解，看看这种关联有多一致？就我们观察到的效果或效应大小而言，平均来看实际表现如何？

In terms of that epidemiology we have with these associations, can you give us an insight into how consistent maybe that is And in terms of the effect or the magnitude of effect we're seeing, what does that actually on average end up looking like?

是的。

Yeah.

说实话，这种关联非常一致，并且体现在多种不同的身体功能指标上。

So to be honest, it's very consistent and they're across a lot of different measures of physical function.

所以，我通常会用两种方式来表示这种数据。

So typically, I would represent this kind of in two ways.

有一种研究是考察运动量与全因死亡率、心血管疾病死亡率等之间的关系。

There are the studies that look at the amount of exercise performed and then all cause mortality or cardiovascular disease mortality or what have you.

在这些研究中，指南——你的许多听众和你都知道——通常非常笼统，指出对于力量训练，我们每周只需进行两次力量锻炼。

And in in those, the guidelines, again, many of your listeners and you will be aware, is that they're fairly generic in that they say that for strength, we should just perform two sessions of strength exercise per week.

你知道，这就是基本的指南。

You know, that's the basic guidelines.

但它并没有进一步深入更多细节。

And it doesn't really get into much more detail than that.

但当你查看这些流行病学研究，观察人们是否达到了这些指南时，达到这些抗阻运动指南所带来的效果，与达到150分钟有氧运动所看到的文献趋势是相似的。

But when you look at these epidemiological studies and look at whether people achieve those guidelines or not, the effect of meeting those resistance exercise guidelines, they parallel the type of literature that's seen around making that one hundred and fifty minutes of aerobic exercise.

事实上，几年前英国生物银行的一项大型研究显示，如果人们达到有氧运动或力量训练指南，或者两者都做到，全因死亡率的降低幅度大致相当，且略有差异。

And indeed, a big story of the UK Biobank from a few years ago, they were able to show that if there was roughly equivalent reduction in all cause mortality and people met the aerobic or the strength training guidelines, or if they did both, there was a slightly altered effect.

因此，关于达到指南的流行病学研究，这种类型的数据，我认为是非常稳健和一致的。

So that type of literature where epidemiology of achieving the guidelines, again, that's fairly robust and consistent, I would say.

但另一种看待这个问题的方式，当然是从身体功能的角度出发。

The other way though, of course, to look at this is from a physical function point of view.

所以我回想起那种身体活动流行病学的研究。

So I recall that kind of physical activity epidemiology.

另一种看待方式是，在某一特定时间点，对个体在多个不同领域中的身体功能进行测量。

This other way of looking at it is you take individuals at a moment in time and you measure their physical function across any one of a number of domains.

我能想到的一些研究，是那些考察整体力量的，比如上肢和下肢力量的综合表现。

So studies I can think of are ones that have looked at total body strength, for example, so combination of upper body and lower limb strength.

然后将人群分为三组，例如，我发现最强的三分之一人群的全因死亡率大约是最弱的三分之一人群的一半。

Breaking the population up then into turtles, for example, I've been able to see that the all cause mortality is about half of that in the strongest one third of the population compared to the weakest one third population.

因此，整体力量对健康的影响非常显著。

So that's a very dramatic effect total body strength.

但这种剂量反应关系，同样让我们对我们所观察到的关系更有信心，因为类似的现象在平衡能力研究中也出现过。

But that kind of dose response, like that, again, would give us confidence in the type of relationships that we're seeing because that type of thing has been observed for balance studies as well, for example.

比如所谓的‘坐起测试’，即从地上站起来的能力，以及人们在此类功能表现上的不同水平。

So also around sitting rising tests, as it's called, being able to get off the ground and looking at people's different levels of functionability there.

你可以继续列举大量这类研究，它们普遍显示出非常相似的效果：那些在最高五分位数、四分位数或任何使用分组中的个体，其全因死亡率的保护或降低效果几乎呈现出一种剂量反应关系，相较于最低百分位数的人群而言。

And you can go on and on through numbers of these different studies, and they generally show very similar effects, which is that those that perform in the highest quintile or turretile or quartile, whichever is used, it's almost like a dose response in terms of what's called a protection or reduction in all cause mortality compared to those in the lowest percentiles.

正如我所说，一旦你有了剂量反应关系，一旦观察结果具有一致性，我们就可以相当有信心了。

And like I said, once you've got dose response, once you've got consistency in the observations, I think we would be reasonably confident.

而且，这种现象在许多不同的身体功能领域中都会出现。

And again, it's across many different domains of physical function that you tend to see this.

因此，总体信息基本上是：许多这些结果都与力量训练密切相关，尤其是力量训练，这正是我们逐渐认识到力量训练在老龄化过程中价值的原因。

So the message more or less becomes that many of these outcomes are related or influenced by strength training in particular, and that's how we then coalesce on this idea of the value of strength training as we age.

你提到了剂量反应关系，因此从这一点我们可以得出一个简短的结论：也许越多越好，随着你做得更多，你可能会获得渐进式的收益，但这并不一定是一条直线，至少我想要问的一点是，一些心血管研究显示，最大的收益或益处往往来自于那些从久坐不动状态转变为某种程度运动的人，而进一步增加运动量的收益则相对减少。

You've mentioned this dose response and so essentially from that we can take the idea that in short maybe more is better and then as you do more you might get incrementally more gains but it's not necessarily a linear line and at least one of the things I wanted to ask about is one thing that seems to come from some of the cardiovascular research is that biggest gain or benefit is gonna come from someone that goes from sedentary to some degree of exercise and increasing amounts less.

我们在这些与力量和肌肉相关的结果中是否也看到了类似的情况？

Do we see a similar picture with some of these strength and muscle related outcomes?

这是一个

It's a

很好的观点。

great point.

实际上，我需要回到刚才说的某一点。

And, actually, I need to to just go back on something I said there.

所以当我提到身体功能的剂量反应时，我们实际上指的是最高表现者与最低表现者之间的对比。

So when I say dose response in relation to physical function, what we're actually talking about in that case is the highest performers versus the lowest performers.

在这些研究中，我们并不清楚是什么样的训练强度导致了某人成为高表现者或低表现者。

And in those studies, we don't actually know what the extent of the training was that led to the person being a high performer or a low performer in one of those outcome variables.

因此，实际上，在力量训练领域，关于训练剂量反应与流行病学之间的信息，远少于有氧运动领域。

So the answer actually is that we have far, far less information about dose response of training in relation to epidemiology in the strength training domain than we do in the aerobic exercise domain.

例如，如果你查看一些身体活动的流行病学研究，无论是自我报告的日志、IPAQ问卷，还是加速度计数据，你都可以获得关于分钟数、MET小时数等不同变量的剂量反应数据。

So for example, if you look at some of the physical activity epidemiology, whether it's self report diaries or whether it's IPAC questionnaires, whether it's accelerometer data, you can get dose response data for the number of minutes or number of med hours or all of these different variables.

这在有氧运动指南中非常普遍，相关研究也十分丰富。

And that's very common across the aerobic exercise guidelines and plenty, plenty of studies around that.

但正如我所说，当你查看力量训练的文献时，由于推荐意见过于笼统，仅要求每周两次或更多，我们很少看到基于训练次数（如一次、两次、三次、四次）的文献分析。

But like I said, when you look at the strength training literature, because the recommendation is so generic to be two sessions or more a week, we don't tend to see literature being passed out on the basis of, do they do one session, two sessions, three sessions, four sessions?

因为再次强调，这与有氧运动指南中以分钟数衡量的方式并不完全相同。

Because again, within that, it's not quite like measuring minutes as we would do with physical activity guidelines.

我们实际上需要思考所进行的运动类型。

We actually need to be thinking about the type of exercise that's being performed.

而且，这些训练持续多长时间？当我们谈论力量训练时，文献中大量相关信息是缺失的。

And, again, for how long are those sessions and when we talk about strength training, a lot of that is missing from the literature.

我之前提到的英国生物银行的一项研究中，他们将参与者分为进行健身房力量训练和进行自重力量训练两类。

One of those studies from the UK Biobank that I did mention, though, they had they split people out into whether they did gym based strength training or whether they did their own body weight based strength training.

有趣的是，这一点也是我经常向从业者传达的信息：无论人们进行自重训练还是健身房训练，在降低风险方面似乎没有差异。

And the interesting thing there, which again is a message I often give to practitioners is that there doesn't seem to be any difference in terms of risk reduction, whether people do body weight based exercise or gym based.

现在我经常遇到这样的问题：对于自重训练，它怎么可能和健身房训练有相同的效果呢？

Now I often get then a question will come up with like, oh, for your body weight exercise, that surely can't have the same effect of as gym work.

但答案是，这实际上取决于参与者及其所处的具体情况。

But the answer is it really does depend on the participant and the situation that they're in.

这可能是我们接下来要探讨的内容，但当我们思考力量训练在老年人群中的作用时，其中一部分是预防性的，旨在维持肌肉健康，而有时则是康复性的。

And this is probably something we're going to get into, but when we think about the role of strength training in older adults in particular, some of it is preventative in terms of maintenance of muscle health, but sometimes it's rehabilitative in nature.

这两者在所需运动剂量方面是不同的概念。

And those are different concepts in terms of the dose of exercise as needed.

同样地，再次强调，那些与年轻成年人合作的从业者都知道，要实现肌肉肥大所需的训练量，与实现力量或爆发力效果所需的训练量之间存在显著差异。

And equally, again, practitioners who work with younger adults will know that there's quite a difference between the amount of work that's needed to produce muscle hypertrophy versus the amount of work that's needed to have a strength or power effect.

因此，这种细微差别在运动限制的文献中有时很难传达。

And so that kind of nuance, it's sometimes hard to get across on the exercise restriction literature.

正如我所说，这种差异有时很难厘清，因为目前我们还没有进行过这类表观遗传流行病学研究。

And as I said, it's sometimes hard to parse out because we just don't have those types of epigenetic epidemiological studies done at this moment in time.

是的。

Yeah.

我的意思是，这是一个非常好的观点，也许我应该在我的前一个观点中加入更多细微差别，因为正如你所指出的，真正的益处来自于运动带来的适应性变化，而不是一个人锻炼的分钟数甚至次数。

I mean, that's such a great point, and maybe I should have put a bit more nuance on my previous point because really, as you noted there, it's the benefit is coming from the adaptations we're deriving from the exercise necessarily the number of minutes or even the number of sessions that someone is doing.

现在，面向公众的一般性指导方针可能不得不使用这些非常笼统的表述。

Now a general guideline for the public has to be maybe given in those very vague terms.

但正如你已经指出的，如果一个人每周进行两次训练，根据这些训练的具体内容，肌肉层面的适应性可能会非常不同。

But as you've already outlined, if someone does two sessions per week, that could be a very different type of adaptation at the level of the muscle, depending on what those sessions looks like.

这些训练是否以适合该个体的适当强度进行，等等？

Are they done at the appropriate intensity, etcetera for that person?

而且这个人想要获得什么样的适应性呢？

And even what adaptation is that person trying to get?

是为了康复吗？

Is it rehabilitative?

不是吗？

Not?

所以，我刚刚突然想到这一点。

And so, I think this, it just came to me.

在一些心血管研究中也有类似的平行情况，比如实际的体能水平或心肺耐力显然比一个人锻炼的分钟数更具预测性。

There's parallels in some of the cardiovascular work where you see things like actual fitness levels or cardiorespiratory fitness is obviously more predictive than necessarily the number of minutes someone does something.

没错。

Exactly.

因此，我们预计在力量训练中也会看到类似情况：关键不在于你做了多少次训练、多少分钟，而在于是否进行了足够适当的训练量以实现真正的适应性？

And so presumably, we're gonna see something there with this strength training that it's not the number of sessions you do, the number of minutes, but is that an appropriate amount of work to derive an actual adaptation?

而这种适应性才为我们带来健康益处。

And the adaptation is what gives us the health benefit.

是的。

Yep.

但挑战在于，我们如何在这些研究中捕捉这一点，因为正如我所说，在有氧运动中，通过问卷和加速度计数据提取分钟数和强度要容易得多，而阻力训练则不然。

But the challenge is going to be how do we capture that in the in these studies because, like I said, it's a lot easier to pull out minutes and intensity from questionnaires and from accelerometer data in the case of aerobic exercise as compared to resistance exercise.

例如，如果我们考虑一些人进行的训练——我们稍后可能会讨论一些这些训练方案——特别是老年人中，低负荷抗阻训练正在兴起。

So for example, if we take someone who's doing, and probably we'll talk about some of these prescriptions, but there's a movement in older adults in particular around low load resistance exercise training.

还有一些像‘运动小憩’这样的方法，涉及大量自重训练和弹力带训练。

There's things like exercise snacking, which involves a lot of body weight and resisted band type work.

还有更经典的训练方式，一些指南中称之为力量训练，即稍重一点的举重。

And then there's the more classic, they call it power training in some of these position statements, just slightly heavier lifting.

但关于最大重复次数百分比的内容，你在文献中随处可见。

But the percentage of one RM stuff, you'll see it all over the literature.

当你与该领域的任何从业者交谈时，他们从不测量老年人的最大重复次数百分比，因为这属于学术界的一种做法，我们需要一些锚点来描述运动强度。

When you speak to any practitioner in the field, they never measure percentage of one RM, for example, in older adults, because it's one of those academic things where it's got a value and we have to be able to use anchors in some way to describe exercise intensity.

但当你开始以30%的一次最大重复量进行20次重复时，这种做法会让为个人或从业者提供训练建议变得极其复杂。

But when you start then working at 30% of one RM for 20 reps, like that, it just becomes very complicated to try and give people recommendations, either as individuals who are following a program or as practitioners who are trying to implement that.

所以我只是在想，我们是否能达到这样一个状态：能够以足够的精细度捕捉力量训练的各个环节，从而明确时间、持续性、频率、重复次数和组数。

So I just wonder whether we're gonna get to a state where we're able to capture strength training sessions in enough of a degree of granularity that would allow us to say time and retention, frequency, number of reps, number of sets.

换句话说，你可能会说，知道这些细节的实际价值可能不如业界的第五、第七最佳实践来得重要。

Like, it's probably you could argue that the practicality of knowing that might not be as valuable as just people in the field fifth, seventh best practice.

他们正在获取自己的数据。

They're getting their own data.

他们正在积累自己的经验。

They're getting their own experience.

他们与客户合作，并从这些实践中发现问题。

They're working with clients, and they're driving their problems from that.

是的。

Yeah.

我的意思是，关于百分之一RM的估算，这很有趣。

I mean, it's interesting of with those estimations of percentage of one RM.

显然，这些都只是估算，但我认为，任何研究过这个问题的人都会明白，要获得任何程度的准确性有多困难，尤其是像你提到的低负荷情况。

Obviously, they are estimations, but I think for anyone who's looked at this, just how difficult it would be to get any degree of accuracy, particularly, like you mentioned, as low loads.

我的意思是，甚至有关于力量运动员的数据。

I mean, there's even data on people who are strength athletes.

然后你让他们做，比如说，留有三次的余地，或者七分的RPE。

And then you put them and give them, like, say, three reps in reserve or say a seven RP.

即便如此，也很难做到。

And even at that, it's very difficult.

而且你给的强度越低，负荷越小，实际测量就越困难，是的。

And the further you give that and the lower the load, more difficult to actually measure Yeah.

那就是它的含义。

What that is.

而它如何对应到个人的一次最大重复百分比，几乎是盲猜。

And how that maps onto an individual's percentage of one RM is almost a shot in the dark.

而且，关于这一点，处方可以根据随着时间的适应情况来调整。

And look, the thing about this is that the prescription can be informed by the adaptation over time.

因此，从实践角度来看，我们经常给治疗师的建议是，训练有一些基本原理适用，其中之一就是超负荷，尤其是渐进式超负荷。

So the message we often give from a practical point of view to for the therapist is that there's basic principles of training that apply, and one of them is overload and progressive overload for that matter.

人们不应该连续数周都使用相同的重量或做相同的次数。

And someone shouldn't be lifting the same amount of weights or doing the same amount of reps for weeks and weeks on end.

一旦你逐步增加负荷、次数，或缩短休息时间，或者通过多种方式调整训练刺激，受训者在训练中就应该感到有挑战性。

Once you progressively add to their to the load or the reps or reduce the rest periods or lots of different ways to manipulate the training stimulus, but the person should be challenged in their training sessions.

有些人会说，哦，老年人不能举重物。

And that goes people say, oh, well, you can't push heavy weights on an old adult.

这取决于你所说的‘重’是什么意思。

Well, it depends on what you mean by heavy.

有时候这是相对的，我们甚至可以用‘剩余次数’这样的方法来指导老年人。

It's in sometimes it's relative, and we can use things like reps in reserve even with old rattles.

正如你所描述的，这并不完美，但一旦我们开始增加他们的负荷，让他们感到有挑战性，并接近力竭，尽管人们常常认为你不会让老年人做到力竭。

Again, as you've described there, it's not perfect, but once we're beginning to overload them and they find it challenging and they're approaching failure, even though, again, people often think they're sure you're not putting an old rattle to failure.

这一切都取决于动作的执行方式、安全性以及其他因素。

It all depends on the way that the exercise is performed and the safety around it and everything.

正如你所知，训练计划有太多不同的方式，有时语言表达会很困难，因为变量太多，容易让人困惑，但基本原则是存在的，那就是你需要以适当的方式给予挑战，并确保安全，但这些是否能整体上推动训练计划的进步呢？

So there's so many different ways to program as you well know that sometimes the language is difficult because there's so many variables and it becomes confusing for people, but the principles are generally there, which is that you just need to challenge them in an appropriate way and ensure it's safe, but will that progress overall into the programs?

是的。

Yeah.

我想再回过头来谈谈这一点。

And I do wanna revisit that.

但我觉得目前特别有启发性的是你已经发表过的多项研究，这些研究都围绕着一项最初的为期十二周的干预实验。

But one thing that I think is particularly instructive at this point is work that you've actually published across a number of publications at this point, but it relates to one original twelve week intervention.

之后你又做了几项很棒的后续研究，既有客观测量数据，也有非常出色的定性资料，我认为值得深入探讨。

And then you had some really nice follow-up work that had both objective measures and then some really nice qualitative data that I think is worth getting into.

首先，我们能不能先谈谈这项原始的干预实验？

First, can we maybe talk about the actual original intervention?

这是一项针对65岁以上人群的为期十二周的训练干预，如果我没记错的话。

This was this twelve week training intervention in people over the age of 65, if I'm correct.

你能给我们介绍一下这项干预的具体内容吗？以及你从这项原始研究中得出的主要结论有哪些？

Can you give us some of the details about what that intervention might have looked like and some of the kind of headline things that you took from the original intervention.

是的，这项研究我们大概是2016年或2017年开始的，当时詹姆斯·蒂蒙斯是正在参与的博士生。

Yeah, so we approached that work, I think probably starting about 2016 or '17, and James Timmons was the PhD student who was working around at the time.

他现在是都柏林大学的讲师。

He's now a lecturer in UCD.

当时我们注意到，运动指南建议同时达到有氧运动和抗阻运动，我们之前已经提到过。

And we had noted at the time, of course, that the exercise guidelines refer to achieving both the aerobic and the resistance exercise that we've mentioned already.

人们经常听到的说法是，这似乎需要投入大量的运动时间。

And thing you hear often from people is that, well, that seems like an awful lot of exercise to try and fit in.

难道我每天都得训练吗？

Like, do I have to be training every day?

实际的答案是否定的。

And the actual answer is no.

你只需要进行合并训练，也就是在同一次训练中同时进行有氧和抗阻运动，以提高时间效率。

You just engage in concurrent training, which is that you do both aerobic and resistance within the same session to be more time efficient.

当时我们使用的是一个名为米兰循环的循环训练模式，这是一种由智能卡驱动的运动训练循环。

Now we were working with a model at the time that involved this circuit style training called the Milan circle, and it was a smart card enabled exercise training circuit.

这项训练与位于都柏林南部的Medford积极健康诊所合作开展，该诊所是一家物理治疗机构。

It was done in conjunction with Medford Proactive Healthcare, which was a physiotherapy clinic in South Dublin.

我们真正关心的问题是，如果将运动时间匹配，那么只进行有氧运动、只进行力量训练，还是两者结合，会有什么不同。

And our question really was around if you time match exercise, whether you do aerobic only or whether you do resistance only or whether you do the two combined.

但时间匹配这一点至关重要，因为在我们所谓的联合训练组中，他们进行的有氧运动和力量训练量分别是其他两组的一半，最终意味着三组在每次训练中的总运动时间是相同的。

But the time match piece was critical because effectively in what we call the concurrent training group, they did the same amount sorry, they did half the amount of aerobic and half the amount of resistance exercise of the other two groups, which ultimately meant that all three groups were doing the same amount of exercise in terms of minutes for reach.

所以每周训练三次，持续十二周。

So it was three sessions a week for twelve weeks.

每次实际训练时间为二十四分钟。

It was twenty four minutes of active training time.

因此，我们可以进一步探讨运动处方的一些细节，但当时使用了多种不同的有氧训练设备。

So again, we could get into some of the nuance around the exercise prescription itself, but there were a number of different aerobic training devices.

也有多种不同的力量训练设备，我们每次训练都采用一分钟一组的方式。

There was a number of different strength training devices, and we used one minute sets on that.

所以我们以时间为基准，这涉及到‘张力时间’的概念，或许也值得讨论一下训练节奏。

So we base it on time, and this gets into the time under tension concept that might be worth talking about as well in tempo.

但关键是，训练计划是以分钟为单位设计的，并且其中也包含了一些渐进性和其他调整内容。

But the point was that it was based on a on a minutes type of programming, and, again, there was some progression and everything built into it.

但我这么说是为了提供背景，因为其中一个问题是关于适应的特异性，因为我们有三个不同的组在做略有不同的训练，同时我们也测量了多项功能性结果和身体成分指标。

But I say all that by way of background, because one of the questions was around the specificity of adaptation, because we had these three different groups that were doing slightly different things and we had a number of functional outcomes as well as body composition outcomes.

总体来看，综合训练组在我们所考察的各项指标上，表现与其它组相当，甚至更好。

And the kind of top line summary was that in most cases, the concurrent exercise training group was getting as good or better a response across the various different outcome measures that we looked at.

不过你可能会问，他们做的抗阻训练或有氧训练量只有其它组的一半，为什么还能获得同样的适应效果呢？

Now, again, you might say, but didn't they do half the amount of the resistance group or half the amount of the aerobic group, and they were still getting the same type of adaptation?

答案是肯定的，但这其实并不意外，因为当你回顾有关力量训练的研究时，会发现存在一个最小有效剂量。

The answer is yes, but that's actually not that unexpected because when you look at some of the literature again around strength outcomes, there is this minimal effective dose that seems to be there.

再次回顾我们这项研究中的训练方案，他们很可能恰好达到了这个最小有效剂量。

And again, based on kind of looking back at the prescription that we used in that study, they probably were getting the minimum effective dose.

而且在某些研究中，尤其是在老年人群中，增加训练量并不一定更好。

And again, in certain studies, particularly in older adults, adding more isn't better.

我知道我们之前说过，更多更好，但这也只在一定范围内成立。

Now, I know you and I sort were saying earlier, more is better, but that's up to a point as well.

因此，这项研究真正传达的信息是：在时间匹配的前提下，尤其是对老年人而言，进行综合训练能获得与单一训练方式相同的益处。

So the message that really came out of that study was that when it's time matched, particularly in older adults, you can get the same benefits from doing concurrent exercise training as doing one or the other.

当然，在力量训练的情况下，他们可能得不到有氧运动的好处。

And of course, in the case of resistance exercise, they're probably not getting the aerobic benefits.

以有氧益处为例，上肢力量在其中并没有得到改善。

In the case of the aerobic benefits, for example, upper body strength didn't improve there.

这就是特异性的例子。

So that's an example of specificity.

所以，是的，那是几年前的事了，我们现在回想起来，大概是在2018年发表的，当时这是一个相当新颖的发现，因为这种时间匹配的联合训练模式以前从未被做过。

So, yeah, so that was at the time, a good few years ago now at this stage, think we published in 2018, that but was a pretty novel finding at the time because that type of time matched concurrent exercise training type model hadn't been done before.

而且，是的，我认为在长期增加训练量时的一个前提是，个体是否能够适应这种增加。

And, yeah, I guess that caveat to the adding more training over time is the caveat of given that someone is able to adapt to that.

因此，在某些情况下，增加训练量可能导致个体无法充分恢复，从而无法有效适应，或者只是做了额外的训练，但并没有带来更大的益处，因为他们已经获得了显著的适应。

And so perceivably adding more in certain situations can lead to someone not being able to appropriately recover and therefore adapt or or essentially just doing an amount that wouldn't lead to any greater benefit if they've already got a significant adaptation.

这一点是众所周知的。

And that's well known.

这种现象在九十年代就已经确立了，就是你之前提到的曲线型剂量反应关系：最不活跃的人，如果每周只活动一小时，就能获得非常大的健康益处；而那些每周已经锻炼五小时的人，如果再增加一小时，获得的额外益处却非常有限。

That was established in the nineties, the curvilinear dose response curve, what you mentioned earlier, the person who's the least active and they just have an hour of activity, let's say, in their week, they get a very large response in terms of health benefits, whereas the person who's already doing five hours a week, if they add an extra hour of training, they're derived very little extra benefits in that context.

所以这大致就是我们所观察到的情况。

So that's more or what we're seeing.

谢谢。

Thank you.

是的。

Yeah.

我认为这印证了你之前提到的超负荷概念，这个概念有时也会被误解。

I think it speaks to your point earlier about the concept of overload, which, again is another one that sometimes just get misunderstood.

并不是说你可以强迫一个人不断增加重量，他们能举起更重的重量，是因为他们从之前的训练中获得了适应。

It's not that you can force someone just to keep putting more and more weight each Their ability to lift more is their adapt their adaptation that they've made from the previous training.

所以如果他们能举起更重的重量，这仅仅表明这是恢复的结果，而不是你强行施加给他们的。

And so if they can lift more, it's just showing you it's a consequence of that recovery as opposed to them you forcing it onto them.

因此，我们有了这个为期十二周的干预方案。

So with that, we have this kind of twelve week intervention.

你还有，正如我提到的，之后为期一年的随访，你们也对此发表了研究。

You also have, like I mentioned, this follow-up over that kind of next year and you published on that as well.

观察一些这些客观指标，我认为像力量这样的指标，还应包括认知功能的测量，以提供一些客观数据。

Looking at some of those objective markers, I think things like strength, but also either cognitive function measure in there as well to give us some of that objective data.

然后对其中一部分参与者进行访谈，以获得一些定性数据。

And then some of the interviews with a subset of those participants to give us some of that qualitative one.

对于力量、身体成分、认知功能等一些客观指标，在后续随访中，呈现出什么样的整体情况？

For some of those objective measures in terms of things like the strength, body composition, the cognitive function, with some of that follow-up, what was the kind of picture that was emerging?

是的。

Yeah.

实际上，我们在他们完成研究一年后对他们进行了跟踪。

So we followed them one year later, actually, from when they had finished the study.

当然，首先需要注意的是，在这项研究中，他们接受了为期十二周、每周三次的全程监督训练。

And the first thing, of course, to note was that in the study where they had been trained, they were fully supervised for twelve weeks for three sessions a week.

米兰小组的运作方式是，他们以小组形式进行训练。

And the way that the Milan circle worked is that they trained in small groups.

因此，实际上是为老年人提供了有监督的小团体个人训练，当然，他们也是与同龄人一起锻炼。

So effectively, they have supervised small group person training, want a better word, as older adults training with their peers, of course, as well.

所以一年后我们跟进时，他们仍然保持在70%左右。

So one year later when we followed them up, they were still around 70%.

他们仍然在进行有氧运动。

We're still doing the aerobic.

他们仍然符合有氧运动指南的要求。

They're still meeting the aerobic exercise guidelines.

但结果发现，只有五分之一的人仍在进行力量训练。

But it turned out that only one in five were still doing the strength training.

哇。

Wow.

尽管很多人谈到了他们从中获得的好处，说明他们现在明白了力量训练的重要性，以及因为参与这项研究，他们的整体健康状况感觉更好了，但他们实际上还是回到了旧习惯，或者没有像你预期的那样坚持力量训练，尽管他们对这些内容和训练体验都了如指掌。

So even though a lot of them talked about the benefits they had received, that they now knew the importance of strength training, I should say, and how they felt better in terms of overall wellness because of their their engagement in the research study, they actually gone back to old habits or they weren't engaging with strength training in the way that you might have expected despite knowing all of this around and the and the experience of training as well.

因此，访谈的定性结果显然非常有启发性，也许我提前铺垫了背景，因为反馈的答案基本上是：他们喜欢和同伴一起训练，喜欢在小组中锻炼。

So the qualitative of the interviews were obviously very illuminating because maybe I've sort of preempted them, set the scene already because the answers that that came back were effectively that they enjoy training with their peers, and they enjoy training in small groups.

所以当他们被独自留在健身房时，尤其是那些他们描述为嘈杂、人们更关注追求极致健美的健身房。

So being left to their own devices to go to gyms, particularly what they described noisy gyms and people who were more concerned with being ultra fit.

你知道吗，研究中有一句引述是：天啊，我讨厌那些健身达人。

You know, one of the quotes that's in the study there is, God, I hate fit people.

他们提到了幽闭恐惧症。

They mentioned about claustrophobia.

他们提到了健身房的费用。

They mentioned about the cost of gyms.

所以作为领取养老金的老年人。

So as older adults who were one receiving a pension.

因此，当你看到所有这些阻碍老年人参与力量训练的障碍时，就会引出这样一个想法：一方面，我们可以为老年人打造专属健身房，让他们与同龄人一起训练，营造更强的社交氛围。

So when you begin to see all of these barriers to all adult engagement with strength training, it kind of points to this idea that either one level would be that we create bespoke gyms for older adults and they train with their peers and it's more of a social feeling to it.

或者另一种情况是，我们提供远程或在线运动干预方案，或者一些可以在家或他们更舒适的地方进行的锻炼方式。

Or the other scenario would be that we deliver either remote or online type of exercise interventions or things that can be done in the home or places that they're more comfortable doing the exercise.

对于这项研究，有多种解读方式，但正如我所说，主要结果是只有极少数人继续进行力量训练。

There's lots of ways to interpret the research there, but the main outcomes I said is that very few of them are continuing to do strength training.

关于你提到的结果问题，实际上我们在研究中测量到的所有改善指标，一年后都回到了基线水平，甚至更低。

And to your question about the outcomes then, effectively everything that we measured that had improved in the study had gone back to baseline or lower one year later.

所以这是同样的观点，老年人的衰退轨迹在数据中显然可见。

So this is the same idea, the trajectory of loss that are older adults, that was obviously evident within the data set.

但在某些情况下，他们的状况甚至比参加研究前更差。

But also in some cases, were worse off than they were prior to when they started the study.

因此，胸部推举和腿部推举力量的提升也出现了这种情况。

And so that was true of the improvements in chest press strength and in leg press strength.

你提到认知功能在这一年中也有所下降。

You mentioned cognitive function that had also declined over the course of the year.

体脂率上升了，瘦体重减少了。

Body fat had gone up, lean body mass had gone down.

真正有些奇怪的是，其他一些功能指标，比如坐立测试和步行速度，并没有变化。

What was actually kind of peculiar is that some of the other functional measures, so things like sit to stand test, walking speed, they haven't changed.

我不太确定这究竟是因为这些指标不够敏感，还是因为我们从短期训练干预中获得了如此大的益处，以至于十二个月后看到的只是回归基线。

And I wonder I, you know, I don't really have a a firm conclusion still on on that as to whether those measures didn't change because they're not as sensitive or whether we had just achieved such an a benefit of the short term training intervention that what we saw the twelve months later was just a kind of regression back to baseline.

但事实上，有些指标甚至比最初的状态更差，我认为这确实是因为缺乏力量训练的参与导致的衰退。

But, virtually, the fact that some things got worse than they were at best, and I do think that you were seeing decline due to a lack of engagement with strength training.

是的。

Yeah.

我想，你提到的关于老年人可能不愿去健身房的那些原因，在这种背景下完全是可以理解的——尤其是考虑到如今任何年龄段的人去商业健身房时的情况。

And I guess some of the things you outlined about that aversion to maybe going to a gym are completely understandable when we think of that context of especially in the context of older adults, you if go to a commercial gym now for anyone of any age

对。

Yeah.

刚开始时，这可能会让人望而却步，特别是现在一些商业健身房的氛围。

Initially starting that, that can be daunting and particularly how some commercial gyms are now.

当然，也有一些私人训练机构提供小团体训练，但费用是个巨大的障碍，这可能是仅次于单独私人教练最昂贵的选择。

There are, of course, personal training facilities that do that small group training, but cost is a huge factor there and is that is probably one of the most expensive things beyond individual personal training.

因此，理解这些障碍的存在并不难。

And so it's easy to understand how those barriers are there.

另一个我想知道的点，不确定在那些访谈中是否提到过，和你之前提到的内容相关：我们经常看到一些关于训练的误解或建议，其实并不完全正确。

One of the other things that I don't know if this was picked up in any of those interviews, related to something you mentioned earlier is that there's obviously a number of different maybe misconceptions or a piece of advice that we see quite regularly around training that maybe aren't actually totally correct.

比如，人们认为老年人举重时必须格外谨慎，只应该使用轻重量。

So for example, the idea that older adults need to be overly cautious with lifting weights, Maybe they should only do low loads.

他们不应该太拼命。

They shouldn't push too hard.

训练时应该始终远离力竭状态。

It should always be really far away from failure.

这类观念。

These types of concepts.

虽然这可能是出于谨慎，但有时我认为这会让人对运动本身产生恐惧。

And while maybe that's done out of caution, sometimes I think it can create fear of actually doing movement.

在你们的访谈中，有没有发现人们害怕做这些运动，尤其是独自一人时，害怕造成伤害，甚至觉得这种恐惧比什么都不做更严重？

Did you pick up anything where there might have been a fear of doing these things, particularly if they're going alone and doing it themselves, a fear of doing harm and almost seeing that as worse than a fear of doing nothing?

没有。

No.

你所描述的这些内容在文献中已有很好的阐述。

So so what you described there is is well described in the literature.

我们在研究中没有观察到这种情况，但我认为原因是我们采访的都是已经参与了十二周训练计划的人。

We didn't see it in our study, but I think the reason was because we were interviewing people who had already engaged with the twelve week training program.

嗯。

Mhmm.

所以他们确实被要求得很严格。

So they were and they've been pushed pretty hard.

詹姆斯显然一直在进行所有训练。

James James was obviously doing all the training.

他是个热情的人，不怕推动他们。

He's a enthusiastic guy and not afraid to push them.

所以我认为，他们已经体会到，作为老年人，进行中等强度的训练其实是安全的。

So they, I think, were they had the experience of knowing actually that it's okay to train for a decent intensity as an older adult.

但我理解你的观点，普遍的看法确实如此，而且再次跟物理治疗师交流时，这非常依赖于具体的患者或个体——比如，如果一个人刚从医院出院，卧床十天，康复目标是恢复平衡和基本运动模式，这和一位55岁停止打网球、现在只想进行力量训练的老年人截然不同。

But I take your point, the general perception, and it's true often speaking again to physiotherapists, it very much depends on the patient or the person of interest, because if again, it's someone who has been bed bound for ten days they're coming out of hospital and it's more of a rehabilitation program and looking to restore balance and just general movement patterns, that's very different to the older adult who, for example, stopped playing tennis at the age of 55 and just now wants to work on a bit of strength training.

而后者本身运动能力良好，可以承受更大强度的训练，或许还会一对一接受私人教练的指导。

And they're already good movers and they can be pushed a little bit harder, and maybe they do work one to one with personal trainer.

这个领域最大的挑战在于，我刚才描述的这种谱系——从资深运动员到完全卧床的人——可能都是65岁的人，但他们的背景却天差地别。

This is the the biggest challenge in this domain is that the spectrum of the what I described there effectively, the masters athletes down to the person who never leaves the bed, they could be two 65 year old individuals, and they're just so far apart in terms of their background.