Applied Physiology and Nutrition Research Group, School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology, Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.
Research Institute for Sport and Exercise Sciences, Liverpool John Moores University.
Rheumatology (Oxford). 2021 Jul 1;60(7):3107-3120. doi: 10.1093/rheumatology/keab094.
To summarize existing evidence and quantify the effects of physical activity on vascular function and structure in autoimmune rheumatic diseases (ARDs).
Databases were searched (through March 2020) for clinical trials evaluating the effects of physical activity interventions on markers of micro- and macrovascular function and macrovascular structure in ARDs. Studies were combined using random effects meta-analysis, which was conducted using Hedges' g. Meta-analyses were performed on each of the following outcomes: microvascular function [i.e. skin blood flow or vascular conductance responses to acetylcholine (ACh) or sodium nitropusside (SNP) administration]; macrovascular function [i.e. brachial flow-mediated dilation (FMD%) or brachial responses to glyceryl trinitrate (GTN%); and macrovascular structure [i.e. aortic pulse wave velocity (PWV)].
Ten studies (11 trials) with a total of 355 participants were included in this review. Physical activity promoted significant improvements in microvascular [skin blood flow responses to ACh, g = 0.92 (95% CI 0.42, 1.42)] and macrovascular function [FMD%, g = 0.94 (95% CI 0.56, 1.02); GTN%, g = 0.53 (95% CI 0.09, 0.98)]. Conversely, there was no evidence for beneficial effects of physical activity on macrovascular structure [PWV, g = -0.41 (95% CI -1.13, 0.32)].
Overall, the available clinical trials demonstrated a beneficial effect of physical activity on markers of micro- and macrovascular function but not on macrovascular structure in patients with ARDs. The broad beneficial impact of physical activity across the vasculature identified in this review support its role as an effective non-pharmacological management strategy for patients with ARDs.
总结现有证据并量化身体活动对自身免疫性风湿病（ARDs）血管功能和结构的影响。
通过数据库搜索（截至 2020 年 3 月），评估身体活动干预对 ARD 患者微血管和大血管功能以及大血管结构标志物的影响的临床试验。使用随机效应荟萃分析对研究进行合并，使用 Hedges'g 进行分析。对以下每个结果进行荟萃分析：微血管功能[即乙酰胆碱（ACh）或硝酸钠（SNP）给药后的皮肤血流或血管传导率反应]；大血管功能[即肱动脉血流介导的扩张（FMD%）或肱动脉对甘油三酯的反应硝酸酯（GTN%）]；以及大血管结构[即主动脉脉搏波速度（PWV）]。
本综述共纳入 10 项研究（11 项试验），共 355 名参与者。身体活动显著改善了微血管[皮肤血流对 ACh 的反应，g=0.92（95%置信区间 0.42，1.42）]和大血管功能[FMD%，g=0.94（95%置信区间 0.56，1.02）；GTN%，g=0.53（95%置信区间 0.09，0.98）]。相反，身体活动对大血管结构[PWV，g=-0.41（95%置信区间-1.13，0.32）]没有有益影响。
总体而言，现有临床试验表明，身体活动对 ARD 患者微血管和大血管功能标志物有有益影响，但对大血管结构没有有益影响。本综述中确定的身体活动对血管系统的广泛有益影响支持其作为 ARD 患者有效非药物管理策略的作用。
