一项为期 1 年的随机对照试验，比较了身心锻炼（太极拳）与拉伸和塑形锻炼对认知功能的影响，参与者为有认知能力下降风险的中国老年人。

A 1-year randomized controlled trial comparing mind body exercise (Tai Chi) with stretching and toning exercise on cognitive function in older Chinese adults at risk of cognitive decline.

机构信息

Department of Psychiatry, the Chinese University of Hong Kong, Hong Kong.

出版信息

J Am Med Dir Assoc. 2012 Jul;13(6):568.e15-20. doi: 10.1016/j.jamda.2012.03.008. Epub 2012 May 11.

DOI:10.1016/j.jamda.2012.03.008

PMID:22579072

Abstract

OBJECTIVES

To compare the effectiveness of Chinese-style mind-body exercise (24 forms simplified Tai Chi) versus stretching and toning exercise in the maintenance of cognitive abilities in Chinese elders at risk of cognitive decline.

DESIGN

A 1-year single-blind cluster randomized controlled trial.

SETTINGS

Community centers and residential homes for elders in Hong Kong.

PARTICIPANTS

A total of 389 subjects at risk of cognitive decline (Clinical Dementia Rating, CDR 0.5 or amnestic-MCI) participated in an exercise intervention program.

INTERVENTION

A total of 171 subjects were trained with Tai Chi (Intervention [I]) and 218 were trained with stretching and toning exercise (Control [C]).

METHODS

Cognitive and functional performance were assessed at the baseline, and at 5, 9, and 12 months. Data were analyzed using multilevel mixed models. Primary outcomes included progression to clinical dementia as diagnosed by DSM-IV criteria, and change of cognitive and functional scores. Secondary outcomes included postural balance measured by the Berg Balance Scale neuropsychiatric and mood symptoms measured by the Neuropsychiatric Inventory, and Cornell Scale for Depression in Dementia.

RESULTS

At 1 year, 92 (54%) and 169 (78%) participants of the I and C groups completed the intervention. Multilevel logistic regression with completers-only analyses controlled for baseline differences in education revealed that the I group had a trend for lower risk of developing dementia at 1 year (odds ratio 0.21, 95% CI 0.05-0.92, P = .04). The I group had better preservation of CDR sum of boxes scores than the C group in both intention-to-treat (P = .04) and completers-only analyses (P = .004). In completers-only analyses, the I group had greater improvement in delay recall (P = .05) and Cornell Scale for Depression in Dementia scores (P = .02).

CONCLUSION

Regular exercise, especially mind-body exercise with integrated cognitive and motor coordination, may help with preservation of global ability in elders at risk of cognitive decline; however, logistics to promote long-term practice and optimize adherence needs to be revisited.

摘要

目的

比较中式身心锻炼（24 式简化太极拳）与拉伸和调身运动对认知能力下降风险的中国老年人认知能力的维持效果。

设计

为期 1 年的单盲群随机对照试验。

设置

香港社区中心和老年人养老院。

参与者

共有 389 名认知能力下降风险（临床痴呆评定量表，CDR 0.5 或遗忘型轻度认知障碍）的受试者参加了一项运动干预计划。

干预

共有 171 名受试者接受太极拳训练（干预组 [I]），218 名受试者接受拉伸和调身运动训练（对照组 [C]）。

方法

在基线、5、9 和 12 个月时评估认知和功能表现。使用多级混合模型分析数据。主要结局包括根据 DSM-IV 标准诊断为临床痴呆的进展，以及认知和功能评分的变化。次要结局包括由 Berg 平衡量表测量的姿势平衡、由神经精神病学量表测量的神经精神病学和情绪症状，以及由痴呆症康奈尔量表测量的抑郁。

结果

在 1 年时，I 组和 C 组分别有 92 名（54%）和 169 名（78%）参与者完成了干预。采用仅完成者分析的多层次逻辑回归控制了基线教育差异，结果显示 I 组在 1 年内发展为痴呆的风险较低（优势比 0.21，95%CI 0.05-0.92，P =.04）。在意向治疗（P =.04）和仅完成者分析（P =.004）中，I 组的 CDR 总分保持优于 C 组。在仅完成者分析中，I 组在延迟回忆（P =.05）和痴呆症康奈尔量表评分（P =.02）方面的改善更大。