*Graduate Department of Rehabilitation Science, Faculty of Medicine, University of Toronto †Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada ‡Department of Physical Medicine and Rehabilitation, Harvard University, Cambridge, MA Departments of §Physical Therapy ∥Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Med Care. 2014 Mar;52(3):216-26. doi: 10.1097/MLR.0000000000000065.
Chronic diseases are the leading cause of death and disability worldwide. Preliminary evidence suggests that community-based exercise (CBE) improves functional capacity (FC) and health-related quality of life (HRQL).
To describe the structure and delivery of CBE programs for chronic disease populations and compare their impact on FC and HRQL to standard care.
Randomized trials examining CBE programs for individuals with stroke, chronic obstructive pulmonary disease, osteoarthritis, diabetes, and cardiovascular disease were identified. Quality was assessed using the Cochrane risk of bias tool. Meta-analyses were conducted using Review Manager 5.1. The protocol was registered on PROSPERO (CRD42012002786).
Sixteen studies (2198 individuals, mean age 66.8±4.9 y) were included to describe program structures, which were comparable in their design and components, irrespective of the chronic disease. Aerobic exercise and resistance training were the primary interventions in 85% of studies. Nine studies were included in the meta-analysis. The weighted mean difference for FC, evaluated using the 6-minute walk test, was 41.7 m (95% confidence interval [CI], 20.5-62.8). The standardized mean difference for all FC measures was 0.18 (95% CI, 0.05-0.3). The standardized mean difference for the physical component of HRQL measures was 0.21 (95% CI, 0.05-0.4) and 0.38 (95% CI, 0.04-0.7) for the total score.
CBE programs across chronic disease populations have similar structures. These programs appear superior to standard care with respect to optimizing FC and HRQL in individuals with osteoarthritis; however, the effect beyond this population is unknown. Long-term sustainability of these programs remains to be established.
慢性病是全球范围内导致死亡和残疾的主要原因。初步证据表明，基于社区的运动（CBE）可改善功能能力（FC）和健康相关生活质量（HRQL）。
描述针对慢性病患者的 CBE 计划的结构和实施，并将其对 FC 和 HRQL 的影响与标准护理进行比较。
确定了针对患有中风、慢性阻塞性肺疾病、骨关节炎、糖尿病和心血管疾病的个体的 CBE 计划的随机试验。使用 Cochrane 偏倚风险工具评估质量。使用 Review Manager 5.1 进行荟萃分析。该方案在 PROSPERO（CRD42012002786）上进行了注册。
纳入了 16 项研究（2198 名参与者，平均年龄 66.8±4.9 岁）来描述计划结构，这些结构在设计和组成方面具有可比性，无论慢性病的类型如何。有氧运动和抗阻训练是 85%研究中的主要干预措施。9 项研究纳入了荟萃分析。使用 6 分钟步行测试评估 FC 的加权平均差异为 41.7 m（95%置信区间 [CI]，20.5-62.8）。所有 FC 测量的标准化均数差为 0.18（95% CI，0.05-0.3）。HRQL 测量的物理成分的标准化均数差为 0.21（95% CI，0.05-0.4），总分的标准化均数差为 0.38（95% CI，0.04-0.7）。
针对慢性病患者的 CBE 计划具有相似的结构。这些计划在改善骨关节炎患者的 FC 和 HRQL 方面似乎优于标准护理，但对于该人群以外的效果尚不清楚。这些计划的长期可持续性仍有待确定。
