Hanel Joshua, Owen Patrick J, Held Steffen, Tagliaferri Scott D, Miller Clint T, Donath Lars, Belavy Daniel L
Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, VIC, 3125, Australia.
German Sports University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany.
Sports Med. 2020 Dec;50(12):2193-2207. doi: 10.1007/s40279-020-01345-1.
Fear of pain and movement is an important factor in the development of hypervigilance and avoidance behaviours.
We examined the effectiveness of exercise training on improving fear-avoidance beliefs.
A systematic review (data sources: MEDLINE, CINAHL, SPORTDiscus, EMBASE, CENTRAL) and metaanalysis of randomised controlled/clinical trials of exercise training in adults versus relevant nonexercise comparators that quantified fear-avoidance was conducted.
After screening 4603 identified records, 17 (2014 participants) and 13 (1152 participants) studies were eligible for qualitative and quantitative synthesis, respectively. Pairwise meta-analysis showed exercise training was more effective than all non-exercise comparators (standardised mean difference (SMD) [95% CI] - 0.378 [- 0.623, - 0.133], P = 0.002, Grading of Recommendations Assessment, Development and Evaluation [GRADE]: very low) for reducing fear-avoidance. Exercise training was more effective than true control for reducing fear avoidance (- 0.407 [- 0.750, - 0.065], P = 0.020, GRADE: very low), however it was not more effective than other interventions (- 0.243 [- 0.614, 0.128], P = 0.199, GRADE: very low). In people with low back pain, exercise training was more effective than non-exercise comparator groups for reducing fear-avoidance (- 0.530 [- 0.755, - 0.304], P < 0.001, GRADE: very low). For individuals with neck pain, exercise training was not more effective than non-exercise comparator groups for reducing fear-avoidance (0.061 [- 0.360, 0.482], P = 0.777, GRADE: very low).
There is very low to low-quality evidence that exercise training is effective for reducing fear-avoidance, including in people with low back pain. Exercise training may be more effective than no intervention for reducing fear avoidance, but there is very low-quality evidence that non-exercise interventions are as effective as exercise for fear avoidance. Few studies with low risk of bias is a limitation.
PROSPERO Registration Number: CRD42019139678.
对疼痛和运动的恐惧是导致过度警觉和回避行为的一个重要因素。
我们研究了运动训练在改善恐惧回避信念方面的有效性。
进行了一项系统评价（数据来源：MEDLINE、CINAHL、SPORTDiscus、EMBASE、CENTRAL）以及对成人运动训练与相关非运动对照的随机对照/临床试验进行荟萃分析，这些研究对恐惧回避进行了量化。
在筛选出的4603条已识别记录中，分别有17项研究（2014名参与者）和13项研究（1152名参与者）符合定性和定量综合分析的条件。两两荟萃分析显示，运动训练在降低恐惧回避方面比所有非运动对照更有效（标准化均值差（SMD）[95%置信区间] -0.378 [-0.623, -0.133]，P = 0.002，推荐分级评估、制定与评价[GRADE]：极低）。运动训练在降低恐惧回避方面比真正的对照更有效（-0.407 [-0.750, -0.065]，P = 0.020，GRADE：极低），然而它并不比其他干预措施更有效（-0.243 [-0.614, +0.128]，P = 0.199，GRADE：极低）。在腰痛患者中，运动训练在降低恐惧回避方面比非运动对照组更有效（-0.530 [-0.755, -0.304]，P < 0.001，GRADE：极低）。对于颈部疼痛患者，运动训练在降低恐惧回避方面并不比非运动对照组更有效（0.061 [-0.360, 0.482]，P = 0.777，GRADE：极低）。
有极低到低质量的证据表明运动训练对降低恐惧回避有效，包括对腰痛患者。运动训练在降低恐惧回避方面可能比不进行干预更有效，但有极低质量的证据表明非运动干预在恐惧回避方面与运动训练一样有效。少数偏倚风险低的研究是一个局限性。
PROSPERO注册号：CRD42019139678。
