Hurkmans Emalie, van der Giesen Florus J, Vliet Vlieland Thea Pm, Schoones Jan, Van den Ende E C H M
Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, Leiden, Zuid-Holland, Netherlands, 2333 ZA.
Cochrane Database Syst Rev. 2009 Oct 7;2009(4):CD006853. doi: 10.1002/14651858.CD006853.pub2.
An up-to-date overview of the effectiveness and safety of dynamic exercise therapy (exercise therapy with a sufficient intensity, duration, and frequency to establish improvement in aerobic capacity and/or muscle strength) is lacking.
To assess the effectiveness and safety of short-term (< three months) and long-term (> three months) dynamic exercise therapy programs (aerobic capacity and/or muscle strength training), either land or water-based, for people with RA. To do this we updated a previous Cochrane review (van den Ende 1998) and made categories for the different forms of dynamic exercise programs.
A literature search (to December 2008) within various databases was performed in order to identify randomised controlled trials (RCTs).
RCTs that included an exercise program fulfilling the following criteria were selected: a) frequency at least twice weekly for > 20 minutes; b) duration > 6 weeks; c) aerobic exercise intensity > 55% of the maximum heart rate and/or muscle strengthening exercises starting at 30% to 50% of one repetition maximum; and d) performed under supervision. Moreover, the RCT included one or more of the following outcome measures: functional ability, aerobic capacity, muscle strength, pain, disease activity or radiological damage.
Two review authors independently selected eligible studies, rated the methodological quality, and extracted data. A qualitative analysis (best-evidence synthesis) was performed and, where appropriate, a quantitative data analysis (pooled effect sizes).
In total, eight studies were included in this updated review (two additional studies). Four of the eight studies fulfilled at least 8/10 methodological criteria. In this updated review four different dynamic exercise programs were found: (1) short-term, land-based aerobic capacity training, which results show moderate evidence for a positive effect on aerobic capacity (pooled effect size 0.99 (95% CI 0.29 to 1.68). (2) short-term, land-based aerobic capacity and muscle strength training, which results show moderate evidence for a positive effect on aerobic capacity and muscle strength (pooled effect size 0.47 (95% CI 0.01 to 0.93). (3) short-term, water-based aerobic capacity training, which results show limited evidence for a positive effect on functional ability and aerobic capacity. (4) long-term, land-based aerobic capacity and muscle strength training, which results show moderate evidence for a positive effect on aerobic capacity and muscle strength. With respect to safety, no deleterious effects were found in any of the included studies.
AUTHORS' CONCLUSIONS: Based on the evidence, aerobic capacity training combined with muscle strength training is recommended as routine practice in patients with RA.
目前缺乏关于动态运动疗法（具有足够强度、持续时间和频率以改善有氧能力和/或肌肉力量的运动疗法）有效性和安全性的最新综述。
评估短期（<3个月）和长期（>3个月）的动态运动疗法项目（有氧能力和/或肌肉力量训练，包括陆地或水上运动）对类风湿关节炎（RA）患者的有效性和安全性。为此，我们更新了之前的Cochrane综述（van den Ende 1998年），并对不同形式的动态运动项目进行了分类。
在多个数据库中进行了文献检索（截至2008年12月），以识别随机对照试验（RCT）。
入选的RCT需包含符合以下标准的运动项目：a）每周至少两次，每次>20分钟；b）持续时间>6周；c）有氧运动强度>最大心率的55%和/或肌肉强化运动从一次重复最大值的30%至50%开始；d）在监督下进行。此外，该RCT需包含以下一项或多项结局指标：功能能力、有氧能力、肌肉力量、疼痛、疾病活动度或放射学损伤。
两位综述作者独立选择符合条件的研究，评估方法学质量并提取数据。进行了定性分析（最佳证据综合），并在适当情况下进行了定量数据分析（合并效应量）。
本次更新综述共纳入八项研究（新增两项研究）。八项研究中有四项至少符合8/10项方法学标准。在本次更新综述中发现了四种不同的动态运动项目：（1）短期陆地有氧运动能力训练，其结果显示对有氧能力有积极影响的证据中等（合并效应量0.99（95%CI 0.29至1.68）。（2）短期陆地有氧运动能力和肌肉力量训练，其结果显示对有氧能力和肌肉力量有积极影响的证据中等（合并效应量0.47（95%CI 0.01至0.93）。（3）短期水上有氧运动能力训练，其结果显示对功能能力和有氧能力有积极影响的证据有限。（4）长期陆地有氧运动能力和肌肉力量训练，其结果显示对有氧能力和肌肉力量有积极影响的证据中等。关于安全性，纳入的任何研究均未发现有害影响。
基于现有证据，建议将有氧能力训练与肌肉力量训练结合作为RA患者的常规治疗方法。
