Kwok JoJo Yan Yan, Choi Kai Chow, Chan Helen Yue Lai
The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region.
The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region.
Complement Ther Med. 2016 Dec;29:121-131. doi: 10.1016/j.ctim.2016.09.016. Epub 2016 Sep 22.
The effects of mind-body exercises on individuals with chronic illnesses have attracted increasing attention. However, little effort had been made to systematically review the effects of these mind-body exercises on individuals with Parkinson's disease (PD). This review aimed to appraise the current evidence of the effects of mind-body exercises on the physiological and psychological outcomes for the PD population.
Systematic review and meta-analysis of randomized controlled trials.
Four English databases, namely, the EMBASE, Ovid Medline, Psych Info, and Cochrane Library, were searched on January 2016.
Studies involving participants with idiopathic PD were included if mind-body exercises were applied and compared with a non-exercise control to improve physiological and psychosocial well-being. The Effective Public Health Practice Project quality assessment tool was used for quality appraisal. RevMan 5.3 was employed to perform this meta-analysis. A subgroup analysis regarding the types and the dose of intervention was conducted to explore the sources of heterogeneity.
Ten studies met the inclusion criteria for quality appraisal. The overall methodological rating of these studies indicated that one study was strong; five studies were moderate; and four studies were weak. Nine articles comprising five Tai Chi, two yoga, and two dance studies were included in the meta-analysis. The results of this review showed that mind-body exercises had a large, significant beneficial effect in motor symptoms in terms of UPDRS III for people with mild to moderate PD [SMD=-0.91, 95% CI (-1.37, -0.45), p<0.05]. Significant subgroup differences were found among various types of mind-body exercises (p=0.001). Yoga demonstrated the largest and most significant beneficial effect in reducing UPDRS III scores [SMD=-2.35, 95% CI (-3.21, -1.50), p<0.01]. The pooled meta-analysis results showed that mind-body exercises had a large, significant effect in improving postural instability in terms of the Berg Balance Scale [SMD=1.48, 95% CI (0.91, 2.06), p<0.01] and Timed Up and Go test [SMD=-0.97, 95% CI (-1.46, -0.47), p<0.01] and moderate, significant effect in improving functional mobility in terms of the Six-minute Walk test [SMD=0.78, 95% CI (0.35, 1.21), p<0.05].
This review found that mind-body exercises demonstrated immediate moderate to large beneficial effects on motor symptoms, postural instability, and functional mobility among individuals with mild to moderate PD. However, the effects of mind-body exercises on psychosocial well-being had not been amply investigated, especially for yoga intervention. Future research should address the psychosocial effects of mind-body exercises on the PD population.
身心锻炼对慢性病患者的影响已引起越来越多的关注。然而，很少有人致力于系统回顾这些身心锻炼对帕金森病（PD）患者的影响。本综述旨在评估目前关于身心锻炼对PD患者生理和心理结局影响的证据。
对随机对照试验进行系统回顾和荟萃分析。
2016年1月检索了四个英文数据库，即EMBASE、Ovid Medline、Psych Info和Cochrane图书馆。
纳入涉及特发性PD患者的研究，这些研究应用了身心锻炼并与非锻炼对照组进行比较，以改善生理和心理社会健康状况。使用有效公共卫生实践项目质量评估工具进行质量评估。采用RevMan 5.3进行这项荟萃分析。进行了关于干预类型和剂量的亚组分析，以探讨异质性来源。
十项研究符合质量评估的纳入标准。这些研究的总体方法学评分表明，一项研究为强；五项研究为中等；四项研究为弱。荟萃分析纳入了九篇文章，包括五项太极拳、两项瑜伽和两项舞蹈研究。本综述结果表明，身心锻炼对轻度至中度PD患者的运动症状（根据统一帕金森病评定量表第三部分[UPDRS III]）有显著且很大的有益影响[标准化均数差（SMD）=-0.91，95%置信区间（CI）（-1.37，-0.45），p<0.05]。在各种类型的身心锻炼之间发现了显著的亚组差异（p=0.001）。瑜伽在降低UPDRS III评分方面显示出最大且最显著的有益影响[SMD=-2.35，95%CI（-3.21，-1.50），p<0.01]。汇总的荟萃分析结果表明，身心锻炼在伯格平衡量表[SMD=1.48，95%CI（0.91，2.06），p<0.01]和定时起立行走测试[SMD=-0.97，95%CI（-1.46，-0.47），p<0.01]方面对改善姿势不稳有显著且很大的影响，在六分钟步行测试[SMD=0.78，95%CI（0.35，1.21），p<0.05]方面对改善功能活动能力有中等且显著的影响。
本综述发现，身心锻炼对轻度至中度PD患者的运动症状、姿势不稳和功能活动能力有即时的中等至很大的有益影响。然而，身心锻炼对心理社会健康状况的影响尚未得到充分研究，尤其是瑜伽干预。未来的研究应关注身心锻炼对PD患者心理社会的影响。
