Li Fuzhong, Harmer Peter, Liu Yu, Eckstrom Elizabeth, Fitzgerald Kathleen, Stock Ronald, Chou Li-Shan
Oregon Research Institute, Eugene, Oregon, USA.
Mov Disord. 2014 Apr;29(4):539-45. doi: 10.1002/mds.25787. Epub 2013 Dec 29.
A previous randomized, controlled trial of tai chi showed improvements in objectively measured balance and other motor-related outcomes in patients with Parkinson's disease. This study evaluated whether patient-reported outcomes could be improved through exercise interventions and whether improvements were associated with clinical outcomes and exercise adherence. In a secondary analysis of the tai chi trial, patient-reported and clinical outcomes and exercise adherence measures were compared between tai chi and resistance training and between tai chi and stretching exercise. Patient-reported outcome measures were perceptions of health-related benefits resulting from participation, assessed by the Parkinson's Disease Questionnaire (PDQ-8) and Vitality Plus Scale (VPS). Clinical outcome measures included motor symptoms, assessed by a modified Unified Parkinson's Disease Rating Scale-Motor Examination (UPDRS-ME) and a 50-foot speed walk. Information on continuing exercise after the structured interventions were terminated was obtained at a 3-month postintervention follow-up. Tai chi participants reported significantly better improvement in the PDQ-8 (-5.77 points, P = 0.014) than did resistance training participants and in PDQ-8 (-9.56 points, P < 0.001) and VPS (2.80 points, P = 0.003) than did stretching participants. For tai chi, patient-reported improvement in the PDQ-8 and VPS was significantly correlated with their clinical outcomes of UPDRS-ME and a 50-foot walk, but these correlations were not statistically different from those shown for resistance training or stretching. However, patient-reported outcomes from tai chi training were associated with greater probability of continued exercise behavior than were either clinical outcomes or patient-reported outcomes from resistance training or stretching. Tai chi improved patient-reported perceptions of health-related benefits, which were found to be associated with a greater probability of exercise adherence. The findings indicate the potential of patient perceptions to drive exercise behavior after structured exercise programs are completed and the value of strengthening such perceptions in any behavioral intervention.
先前一项太极拳的随机对照试验表明，帕金森病患者经客观测量的平衡能力及其他与运动相关的指标有所改善。本研究评估了运动干预是否能改善患者报告的结局，以及这些改善是否与临床结局和运动依从性相关。在对太极拳试验的二次分析中，比较了太极拳组与抗阻训练组以及太极拳组与伸展运动组之间患者报告的结局、临床结局和运动依从性指标。患者报告的结局指标是通过帕金森病问卷（PDQ - 8）和活力增强量表（VPS）评估的参与运动后对与健康相关益处的感知。临床结局指标包括运动症状，通过改良的统一帕金森病评定量表 - 运动检查（UPDRS - ME）和50英尺速度步行进行评估。在结构化干预结束后的3个月随访中获取了关于干预终止后继续运动的信息。太极拳组参与者报告的PDQ - 8改善程度（-5.77分，P = 0.014）显著优于抗阻训练组参与者，PDQ - 8改善程度（-9.56分，P < 0.001）和VPS改善程度（2.80分，P = 0.003）显著优于伸展运动组参与者。对于太极拳组，患者报告的PDQ - 8和VPS改善与UPDRS - ME和50英尺步行的临床结局显著相关，但这些相关性与抗阻训练或伸展运动组显示的相关性无统计学差异。然而，与抗阻训练或伸展运动的临床结局或患者报告的结局相比，太极拳训练的患者报告结局与持续运动行为的可能性更高相关。太极拳改善了患者报告的对与健康相关益处的感知，且发现这与更高的运动依从性可能性相关。研究结果表明，在结构化运动计划完成后，患者的感知有推动运动行为的潜力，以及在任何行为干预中强化这种感知的价值。
