练肌肉有什么用？除了体型上的好处之外？ 第1页

一、主要的好处是活命，降低死亡率

可能有些同学会不解，难道人的死亡率不是100%？还有人可以不死？

其实，在相关科学研究中，死亡是有时间和对象限制的。比如我们找来100个中年人，追踪他们15年，15年内有X人死亡，以此计算死亡率。死亡率在很大程度上反映疾病状况、生存质量和干预手段的有效性。

2018年的一项大型元分析包含了37万多名参与者，平均随访9年，年龄18-75岁。主要发现包括：长期进行系统阻力训练可以降低21%全因死亡率、17%心血管疾病死亡率；如果搭配有氧运动进行可降低全因死亡率40%。

支持肌肉/力量与死亡率之间负相关性的证据堆积如山。

2008年的一项前瞻性队列研究，对8762名20至80岁男性[67]追踪了19年之久，发现肌肉力量与各种原因的死亡和癌症呈独立负相关，即使调整了其他混杂因素之后也是如此。年龄调整后，肌肉力量和心肺功能水平高的男性，死亡率比肌力水平最低的不健康男性死亡率低60%。并且，肌肉力量升高是长期训练的结果[68,69]，长期抗阻训练对死亡率将降低发挥了一定的保护作用。

2007年的流行病学研究调查了800名65岁以上老人[74]，发现握力较高男性死亡风险为低19%、心血管风险低27%、癌症死亡风险低19%，这些关联在进一步调整了纯肌肉量或体脂水平后仍具有统计学意义。

日本广岛成人健康研究（AHS）队列研究了35至74岁的4912人[75]，握力每增加5公斤，男性心脏病风险降低15%、中风风险降低10%、肺炎风险降低15%；即使经过20多年的随访，每增加5公斤握力仍然降低相对风险8%。

一项目美国研究包含了2488名65岁及以上的墨西哥裔美国男性和女性[76]，发现在控制了相关的危险因素后，握力是老年墨西哥裔美国人死亡的一个强有力的预测因素，握力<22.01 kg的男性和握力小于14 kg的女性5年后死亡的比例分别为38.2%和41.5%。

对82名老年女性患者的研究发现，最大握力是否达到5KG，是患者存活/死亡的最明确、最敏感分界线[70]；日本的一项对6259人的研究发现，跳跃能力/握力/仰卧起坐能力较低的男性具有面临较高的死亡风险[71]；

Metter等人在25年中搜集了1071名男性的数据，握力下降与死亡率增加有关[72]；一项对8116人的调查发现，握力/仰卧起坐/俯卧撑等肌肉力量指标可以加拿大人的死亡率[73]；

许多研究选择握力作为测试方式的原因是，它不需要太多的技巧，简单易行。如果选择其他运动来测试，则技巧可能会混淆测试数据。

二、肌肉训练降低死亡率的其中一种机制：对抗腹部肥胖/代谢综合征

数据表明，人类在25至65岁之间，内脏脂肪可增加300%以上[9]。

不同部位脂肪的生理效应截然不同[10]，腹部/内脏脂肪比总脂肪与代谢综合征的关联性更强、更容易引发健康问题[11,12,24,25,26,27,28,29,30,31,32,33,35,36,37,38,39]。

但如果脂肪分布在下半身或大腿，则相应风险降低[7,8,13,14,15,16,17,18,19,20,21,22,23]。作为印证，女性的雌激素水平比男性更高，由于雌激素具有减少内脏/腹部脂肪（“转移”到腿臀部）的作用[34]，因此女性的心血管疾病率[34,40,41,42,43]和2型糖尿病几率要低于男性，并且即便两性的身体脂肪总量大致相等时，也是如此[44,45]。

代谢综合征包含了哪些？

腹部肥胖、血糖/血脂/血压/低密度脂蛋白胆固醇升高、胰岛素抵抗、慢性炎症，乃至于糖尿病等。并不是胖就完了，代谢综合征其病情发展的终点是各类致命性疾病[78,79,80]，包括动脉粥样硬化[47]、心肌梗死[48,49,52]、冠心病[50,51,53]。

腹部肥胖还促进多种癌症发病率升高，包括乳腺癌[81]、结直肠癌[82,90,91,92]、子宫内膜癌[83]、食道癌[86]、肾癌[84]、肺癌[89]、胰腺癌[85]、甲状腺癌[87]和胆囊癌[88]等。

腰围越大，各类癌症几率相应升高。

练肌肉有助于抵抗腹部肥胖和代谢综合征。

因为从原理上说，骨骼肌是人体处理葡萄糖的主要器官[55]，在正常情况下它处理了人体大约80%的葡萄糖[56,57]。

骨骼肌是一个巨大的糖库，普通人的骨骼肌大概能容纳400g左右葡萄糖，或者是每kg肌肉12g左右的糖——如果肌肉量很大，或者长期进行大运动量，肌肉可容纳的糖甚至可以超过800g。

注意，葡萄糖一旦被运输进入骨骼肌，被成肌糖原[122]，就永远留在里面了。因为肌肉中没有相应的酶（葡萄糖-6-磷酸酶），所以肌糖原是无法分解成葡萄糖重新回到血液，不可能再被合成为身体其他部位的脂肪让我们发胖。

但随年龄增加身体老化，人类的骨骼肌逐渐萎缩，30岁后每10年萎缩3-8%[1,2]，70岁后每十年就有减少25%-40%[65,66]，这导致静息代谢率降低、葡萄糖摄取减少、脂质氧化能力降低[6]。

已经证明，肌肉的胰岛素敏感性、肌肉摄取/利用/消耗血糖的能力（特别是在不依赖胰岛素的情况下），与代谢综合征[58,59,60,61,62]和2型糖尿病[63,64]密切相关。

2007年，美国心脏协会临床心脏病学委员会和营养、体育和代谢理事会发表了一份科学声明，引用了一项包括8570名年龄在20-75岁之间的男性进行的研究。

该声明支持持一切有、无心血管疾病/代谢综合征的人进行肌肉训练[93]，因为肌肉力量的发展可能会带来独立于心血管健康的、额外的好处；肌肉力量与代谢综合征患病率具有独立负相关关系。

肌肉训练与有氧训练带来的健康益处出在机制上的相似性，包括减少腹部脂肪[94]、降低血液甘油三酯[95]、降低高密度脂蛋白胆固醇[96]、血糖改善等[97]。

无氧运动/抗阻训练/高强度训练都对于减少腹部/内脏脂肪有好处。

Treuth等人观察到对14名健康老年妇女（平均年龄67岁）进行每周3次持续16周的训练后，她们的内脏脂肪从143减少到130cm²、同时力量和肌肉横截面积增加[98]，研究者认为这些变化对于预防与年龄相关的腹部脂肪增加、及由此带来的负面健康结果可能很重要。

一项目我国的研究，针对60名65-75岁的肥胖老人，发现单纯的力量训练能减少老人的内脏脂肪，增加他们的肌肉体积、握力[99]。

虽然单纯抗阻训练的减脂效果要低于有氧或混合训练，但也是不可忽视的一种促进健康的手段。而且力量训练组的老人具有更高的IGF-1水平，这可能导致他们的骨骼、韧带、关节更健康，代谢状态优化。

无氧运动/高强度运动在相同的能量消耗下，比有氧运动产生更大的腹部脂肪减少[98]。Blomster等人研究了11140名糖尿病患者，发现与不进行或轻度运动的患者相比，中度至剧烈运动的患者发生心血管事件的风险降低22%、微血管并发症少15%、全因死亡率降低17%。

所以不难理解为什么美国运动医学院推荐超重/肥胖者也进行抗阻训练[100]。

三、肌肉训练的更大意义体现在生命力薄弱、身体差的老年人身上

例如抑郁症，一种严重降低生活质量的疾病，许多抑郁症患者自杀[101,102,103,104]。体力活动可以可以提升身体活力，改善生活质量，对抗抑郁症[105,106,107,108]；抗阻训练也被证明有助于降低抑郁程度[109,110]。

老年人容易发生大脑功能衰退，许多大型研究表明肌肉力量和大脑功能具有密切关系，肌肉力量较强者的反应、逻辑、记忆、认知能力都更高[112,113,114,115,116]。肌肉力量强和大脑功能好两者之间并不只是单纯的同时发生，也有明确的因果关系。

Mavros等人设计了双盲/双假实验研究了100名55岁以上患有轻度认知障碍的老人[111]，在专业培训师的监督下，他们进行的为期6个月的渐进负荷力量训练（负荷为80-92%的大强度）。训练提高了老人的力量和认知能力，他们的阿茨海默认知表中的得分显著改善。特别值得一提的是，Mavros等人还研究并排出了肌肉力量与认知之间的反向因果关系，确认了是肌肉力量提高了认知水平。

这样的研究结论被一而再再而三的复制、被反复论证。

Roberta对65岁以上老人进行3个月的渐进力量训练，方案包括腿屈伸、腿弯举、卧推、划船、箭步蹲、拉伸、自重训练等，促进了他们神经功能和执行能力的改善[117]；

Carla等人对67名55-75岁的健康老年人进行16周的力量训练，在进行思维任务期间，他们大脑左前额叶皮层耗氧量下降，运动训练使大脑皮层激活时的脑氧合效率更高，认知表现（反应时间）得到改善[118]；

Lindsay等人对86名70至80岁的妇女进行了为期6个月的随机对照试验，发现每周两次的力量训练可以改善她们的注意力、选择性、联想记忆功能，而平衡和协调性训练则不能[119]；

Fia等人100名患有轻度认知障碍的老年人[121]，6个月的力量训练改善阿茨海默平分表48%、无阻力训练改善27%、认知训练则无改善只减轻了记忆力的下降。

Tsai等人从大学医院阿茨海默研究中心招募了66名患有认知障碍的老年人（60至80岁）进行实验，证实有氧/力量训练后他们的认知改善，反应时间缩短[120]。

在更宏观的层面上，Sarah等人对47个列队研究进行了元分析，得出体力活动与认知能力下降和痴呆呈显著的负相关关系。体力活动与认知障碍风险减少35%、痴呆风险14%有关；

这些内容我以前写过，就不详细铺开了。

如何看待我国老年人健身很少进行力量训练，而是采取快走等有氧耐力运动？

此外，肌肉训练防止摔倒骨折等。对于老年人来说，一次摔倒引发的骨折，结果可能是住院、卧床、丧失行动能力、健康状况恶化、乃至死亡，网传袁老就是在一次摔倒后身体状况急剧恶化的。

此外，就算没有骨折，长期力量训练也有助于减少受伤几率和降低伤情，因为负重可导致骨密度提高、韧带、肌腱、肌肉的韧性/弹性加强。

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