轻度认知障碍和痴呆症中的身体活动和锻炼：干预和观察研究的伞式综述。

Physical Activity and Exercise in Mild Cognitive Impairment and Dementia: An Umbrella Review of Intervention and Observational Studies.

机构信息

Primary Care Department Azienda USL Toscana Sud Est, Grosseto, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.

Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany; Department of Geriatric Rehabilitation, Robert-Bosch Hospital, Stuttgart, Germany.

出版信息

J Am Med Dir Assoc. 2020 Oct;21(10):1415-1422.e6. doi: 10.1016/j.jamda.2020.08.031.

DOI:10.1016/j.jamda.2020.08.031

PMID:32981668

Abstract

OBJECTIVES

The aim of this umbrella review was to determine the effect of physical activity/exercise on improving cognitive and noncognitive outcomes in people with MCI (mild cognitive impairment) and dementia.

DESIGN

Umbrella review of systematic reviews (SR), with or without meta-analyses (MAs), of randomized controlled trials (RCTs) and observational studies.

SETTINGS AND PARTICIPANTS

People with MCI or dementia, confirmed through validated assessment measures. Any form of physical activity/exercise was included. As controls, we included participants not following any prespecified physical activity/exercise intervention or following the same standard protocol with the intervention group.

METHODS

The protocol was registered in PROSPERO (CDR 164197). Major databases were searched until December 31, 2019. The certainty of evidence of statistically significant outcomes was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. SRs' findings, without a formal MA, were reported descriptively.

RESULTS

Among 1160 articles initially evaluated, 27 SRs (all of RCTs, 9 without MA) for a total of 28,205 participants with MCI/dementia were included. In patients with MCI, mind-body intervention (standardized mean difference [SMD] = 0.36; 95% confidence intervals [CI] 0.20-0.52; low certainty) and mixed physical activity interventions (SMD = 0.30; 95% CI 0.11-0.49; moderate certainty) had a small effect on global cognition, whereas resistance training (SMD = 0.80; 95% CI 0.29-1.31; very low certainty) had a large effect on global cognition. In people affected by dementia, physical activity/exercise was effective in improving global cognition in Alzheimer disease (SMD = 1.10; 95% CI 0.65-1.64; very low certainty) and in all types of dementia (SMD = 0.48; 95% CI 0.22-0.74; low certainty). Finally, physical activity/exercise improved noncognitive outcomes in people with dementia including falls, and neuropsychiatric symptoms.

CONCLUSIONS AND IMPLICATIONS

Supported by very low-to-moderate certainty of evidence, physical activity/exercise has a positive effect on several cognitive and noncognitive outcomes in people with MCI and dementia, but RCTs, with low risk of bias/confounding, are still needed to confirm these relationships.

摘要

目的

本综述旨在确定身体活动/运动对改善轻度认知障碍（MCI）和痴呆患者认知和非认知结果的影响。

设计

系统评价的伞式审查（SR），包括或不包括随机对照试验（RCT）和观察性研究的荟萃分析（MA）。

设置和参与者

通过验证评估措施确认的 MCI 或痴呆患者。包括任何形式的身体活动/运动。作为对照组，我们纳入了未遵循任何特定身体活动/运动干预或遵循与干预组相同标准方案的参与者。

方法

该方案在 PROSPERO（CDR 164197）中进行了注册。主要数据库检索至 2019 年 12 月 31 日。使用推荐评估、制定和评估方法评估具有统计学意义的结果的证据确定性。未进行正式 MA 的 SR 结果以描述性方式报告。

结果

在最初评估的 1160 篇文章中，共纳入 27 项针对 MCI/痴呆患者共 28205 名参与者的 SR（均为 RCT，9 项无 MA）。在 MCI 患者中，身心干预（标准化均数差 [SMD] = 0.36；95%置信区间 [CI] 0.20-0.52；低确定性）和混合身体活动干预（SMD = 0.30；95%CI 0.11-0.49；中等确定性）对整体认知有较小的影响，而抗阻训练（SMD = 0.80；95%CI 0.29-1.31；极低确定性）对整体认知有较大的影响。在受痴呆影响的人群中，身体活动/运动可有效改善阿尔茨海默病（SMD = 1.10；95%CI 0.65-1.64；极低确定性）和所有类型痴呆（SMD = 0.48；95%CI 0.22-0.74；低确定性）患者的整体认知。最后，身体活动/运动改善了痴呆患者的非认知结果，包括跌倒和神经精神症状。