Tamin Tirza Z, Murdana Nyoman, Pitoyo Yupitri, Safitri Eka D
Departement of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Acta Med Indones. 2018 Oct;50(4):299-308.
obesity and osteoarthritis have strong inter-relationship with multi-factorial mechanism that caused pain and leads to decreased quality of life. Exercise has been identified as prevention and management against obesity and joint pain. This systematic review aims to assess the effect between exercises compared to diet group for chronic pain management, physical and mental function in obese patients with chronic musculoskeletal problem.
we performed a systematic search of Randomized Control Trial studies from Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EBSCO; SCIENCEDIRECT (Elsevier); SCOPUS, grey literature, trial registry, ongoing study for published studies, and from the ClinicalTrial.gov, thesis of rehabilitation medicine in RSCM, and proceeding books for unpublished studies that was last updated on November 2016. Risk of bias was assessed using Cochrane risk-of-bias tool and data were analyzed using Review Manager 2014.
one study showed no difference in pain reduction (assessed using VAS) between two groups. Two studies showed improvement in physical function measured using 6MWT in exercise group at 6 and 18 months with mean difference 28.12 [11.20, 45.04] and 26.21 [9.01, 43.41]. There was no significant effects observed for Mental and Physical Function based on SF-36 after 6 months (1 study) and 18 months (2 studies) observation, with mean difference 1.10 [-0.79, 2.99] and 0.08 [-1.53, 1.70] respectively for Mental Function score and -0.30 [-2.54, 1.94] and -0.36 [-2.30, 1.57] respectively for Physical Function score.
exercise can improve physical function objectively, but could not reduce pain in obese patients with chronic musculoskeletal problem subjectively.
肥胖与骨关节炎之间存在着密切的相互关系，其涉及多因素机制，可引发疼痛并导致生活质量下降。运动已被确认为预防和管理肥胖及关节疼痛的方法。本系统评价旨在评估运动组与饮食组相比，对患有慢性肌肉骨骼问题的肥胖患者进行慢性疼痛管理、身体和心理功能的影响。
我们对来自Cochrane对照试验中心注册库（CENTRAL）、MEDLINE、EBSCO、科学Direct（爱思唯尔）、SCOPUS的随机对照试验研究进行了系统检索，包括灰色文献、试验注册库、已发表研究的正在进行的研究，以及来自ClinicalTrial.gov、RSCM康复医学论文和2016年11月最后更新的未发表研究的会议书籍。使用Cochrane偏倚风险工具评估偏倚风险，并使用Review Manager 2014分析数据。
一项研究表明两组之间在疼痛减轻方面（使用视觉模拟评分法评估）没有差异。两项研究表明，运动组在6个月和18个月时使用6分钟步行试验测量的身体功能有所改善，平均差异分别为28.12 [11.20, 45.04]和26.21 [9.01, 43.41]。在6个月（1项研究）和18个月（2项研究）观察后基于SF-36的心理和身体功能未观察到显著影响，心理功能评分的平均差异分别为1.10 [-0.79, 2.99]和0.08 [-1.53, 1.70]，身体功能评分的平均差异分别为-0.30 [-2.54, 1.94]和-0.36 [-2.30, 1.57]。
运动可以客观地改善身体功能，但不能主观地减轻患有慢性肌肉骨骼问题的肥胖患者的疼痛。
