Zou Liye, Zhang Yanjie, Yang Lin, Loprinzi Paul D, Yeung Albert S, Kong Jian, Chen Kevin W, Song Wook, Xiao Tao, Li Hong
Lifestyle (Mind-Body Movement) Research Center, College of Sports Science, Shenzhen University, Shenzhen 518060, China.
Health and Exercise Science Laboratory, Institute of Sports Science, Seoul National University, Seoul 08826, Korea.
J Clin Med. 2019 May 8;8(5):628. doi: 10.3390/jcm8050628.
Chronic low back pain (CLBP) is a common health issue worldwide. Tai Chi, Qigong, and Yoga, as the most widely practiced mindful exercises, have promising effects for CLBP-specific symptoms.
We therefore conducted a comprehensive review investigating the effects of mindful exercises versus active and/or non-active controls while evaluating the safety and pain-related effects of mindful exercises in adults with CLBP.
We searched five databases (MEDLINE, EMBASE, SCOPUS, Web of Science, and Cochrane Library) from inception to February 2019. Two investigators independently selected 17 eligible randomized controlled trials (RCT) against inclusion and exclusion criteria, followed by data extraction and study quality assessment. Standardized mean difference (SMD) was used to determine the magnitude of mindful exercises versus controls on pain- and disease-specific outcome measures.
As compared to control groups, we observed significantly favorable effects of mindful exercises on reducing pain intensity ( = -0.37, 95% CI -0.5 to -0.23, < 0.001, = 45.9 %) and disability ( = -0.39, 95% CI -0.49 to -0.28, < 0.001, = 0 %). When compared with active control alone, mindful exercises showed significantly reduced pain intensity ( = -0.40, < 0.001). Furthermore, of the three mindful exercises, Tai Chi has a significantly superior effect on pain management (= -0.75, 95% CI -1.05 to -0.46, < 0.001), whereas Yoga-related adverse events were reported in five studies.
Findings of our systematic review suggest that mindful exercises (Tai Chi and Qigong) may be beneficial for CLBP symptomatic management. In particular, Tai Chi appears to have a superior effect in reducing pain intensity irrespective of non-control comparison or active control comparison (conventional exercises, core training, and physical therapy programs). Importantly, training in these mindful exercises should be implemented with certified instructors to ensure quality of movement and injury prevention.
慢性下腰痛（CLBP）是全球常见的健康问题。太极拳、气功和瑜伽作为练习最广泛的正念运动，对CLBP的特定症状有显著效果。
因此，我们进行了一项全面综述，研究正念运动与主动和/或非主动对照相比的效果，同时评估正念运动对成年CLBP患者的安全性和疼痛相关影响。
我们检索了从数据库建立至2019年2月的五个数据库（MEDLINE、EMBASE、SCOPUS、科学引文索引和Cochrane图书馆）。两名研究者根据纳入和排除标准独立筛选出17项符合条件的随机对照试验（RCT），随后进行数据提取和研究质量评估。标准化均数差（SMD）用于确定正念运动与对照在疼痛和疾病特定结局指标上的差异程度。
与对照组相比，我们观察到正念运动在减轻疼痛强度（SMD = -0.37，95%CI -0.5至 -0.23，P < 0.001，I² = 45.9%）和功能障碍（SMD = -0.39，95%CI -0.49至 -0.28，P < 0.001，I² = 0%）方面有显著的积极效果。与单独的主动对照相比，正念运动显示出疼痛强度显著降低（SMD = -0.40，P < 0.001）。此外，在这三种正念运动中，太极拳在疼痛管理方面有显著的优越效果（SMD = -0.75，95%CI -1.05至 -0.46，P < 0.001），而五项研究报告了与瑜伽相关的不良事件。
我们系统综述的结果表明，正念运动（太极拳和气功）可能对CLBP的症状管理有益。特别是，无论与非对照比较还是主动对照比较（传统运动、核心训练和物理治疗方案），太极拳在减轻疼痛强度方面似乎都有优越效果。重要的是，这些正念运动的训练应由认证教练实施，以确保动作质量和预防损伤。
