目的:系统地评估身心锻炼的效果(太极拳,瑜伽,和健康气功)对运动功能(UPDRS,定时向上,余额),抑郁症状,帕金森病患者(PD)的生活质量(QoL)。方法:通过计算机系统检索和手工检索,PubMed,WebofScience,科克伦图书馆,CNKI,万方数据库,使用了CQVIP。文章已检索到2019年6月30日发布日期。遵循Cochrane协作系统评估手册(5.1.0版),两名研究人员独立评估了每篇文章的质量和偏倚风险,包括22篇评价文章。这些研究中有86%(19/22)的Pedro质量评分为6分或更高,其中21项为随机对照试验,共1199名受试者;试验干预时间为4~24周.对照组的干预措施包括无干预对照组,安慰剂,等待名单,常规护理,和非体育控制。采用RevMan5.3统计软件对文献进行Meta分析,异质性分析采用Stata14.0软件。结果:(1)心身锻炼显著改善PD患者的运动功能,包括UPDRS(SMD=-0.61,p<0.001),TUG(SMD=-1.47,p<0.001)和平衡功能(SMD=0.79,p<0.001)。(2)身心锻炼对抑郁(SMD=-1.61,p=0.002)和QoL(SMD=0.66,p<0.001)也有显着影响。(3)指标中,UPDRS(I2=81%)和抑郁(I2=91%)具有更高的异质性;根据TUG(I2=29%)的单独联合效应大小的结果,余额(I2=16%)和生活质量(I2=35%),表明异质性较小;(4)对年龄限制和其他可能的混杂因素进行了荟萃回归分析,进一步亚组分析显示,UPDRS运动功能异质性的原因可能与PD患者的性别和病情严重程度有关;抑郁结局异质性。造成这种情况的原因可能是在实验中使用特定药物以及在试验中进行干预的持续时间。结论:(1)身心锻炼对运动功能有显著改善,抑郁症状,以及帕金森病患者的生活质量,可作为PD患者临床运动干预的有效方法。(2)未来PD患者的临床干预方案需要充分考虑性别等具体因素,疾病的严重程度,特定药物使用,和干预周期,有效控制异质性因素,使PD患者的临床运动干预计划具有客观性,科学,而且有效。
Purpose: To systematically evaluate the effects of mind-body exercises (Tai Chi, Yoga, and Health Qigong) on motor function (UPDRS, Timed-Up-and-Go, Balance), depressive symptoms, and quality of life (QoL) of Parkinson\'s patients (PD). Methods: Through computer system search and manual retrieval, PubMed, Web of Science, The Cochrane Library, CNKI, Wanfang Database, and CQVIP were used. Articles were retrieved up to the published date of June 30, 2019. Following the Cochrane Collaboration System Evaluation Manual (version 5.1.0), two researchers independently evaluated the quality and bias risk of each article, including 22 evaluated articles. The Pedro quality score of 6 points or more was found for 86% (19/22) of these studies, of which 21 were randomized controlled trials with a total of 1199 subjects; and the trial intervention time ranged from 4 to 24 weeks. Interventions in the control group included no-intervention controls, placebo, waiting-lists, routine care, and non-sports controls. Meta-analysis was performed on the literature using RevMan 5.3 statistical software, and heterogeneity analysis was performed using Stata 14.0 software. Results: (1) Mind-body exercises significantly improved motor function in PD patients, including UPDRS (SMD = -0.61, p < 0.001), TUG (SMD = -1.47, p < 0.001) and balance function (SMD = 0.79, p < 0.001). (2) Mind-body exercises also had significant effects on depression (SMD = -1.61, p = 0.002) and QoL (SMD = 0.66, p < 0.001). (3) Among the indicators, UPDRS (I2 = 81%) and depression (I2 = 91%) had higher heterogeneity; according to the results of the separate combined effect sizes of TUG(I2 = 29%), Balance(I2 = 16%) and QoL(I2 = 35%), it shows that the heterogeneity is small; (4) After meta-regression analysis of the age limit and other possible confounding factors, further subgroup analysis showed that the reason for the heterogeneity of UPDRS motor function may be related to the sex of PD patients and severity of the disease; the outcome of depression was heterogeneous. The reason for this may be the use of specific drugs in the experiment and the duration of intervention in the trial. Conclusion: (1) Mind-body exercises were found to have significant improvements in motor function, depressive symptoms, and quality of life in patients with Parkinson\'s disease, and can be used as an effective method for clinical exercise intervention in PD patients. (2) Future clinical intervention programs for PD patients need to fully consider specific factors such as gender, severity of disease, specific drug use, and intervention cycle to effectively control heterogeneity factors, so that the clinical exercise intervention program for PD patients is objective, scientific, and effective.