Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon.
Aggregate Analytics Inc, Fircrest, Washington.
Arch Phys Med Rehabil. 2021 Dec;102(12):2464-2481.e33. doi: 10.1016/j.apmr.2021.10.002. Epub 2021 Oct 13.
To understand the benefits and harms of physical activity in people who may require a wheelchair with a focus on people with multiple sclerosis (MS), cerebral palsy (CP), and spinal cord injury (SCI).
Searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO, Cochrane CENTRAL, and Embase (January 2008 through November 2020).
Randomized controlled trials, nonrandomized trials, and cohort studies of observed physical activity (at least 10 sessions on 10 days) in participants with MS, CP, and SCI.
We conducted dual data abstraction, quality assessment, and strength of evidence. Measures of physical functioning are reported individually where sufficient data exist and grouped as "function" where data are scant.
No studies provided evidence for prevention of cardiovascular conditions, development of diabetes, or obesity. Among 168 included studies, 44% enrolled participants with MS (38% CP, 18% SCI). Studies in MS found walking ability may be improved with treadmill training and multimodal exercises; function may be improved with treadmill, balance exercises, and motion gaming; balance is likely improved with balance exercises and may be improved with aquatic exercises, robot-assisted gait training (RAGT), motion gaming, and multimodal exercises; activities of daily living (ADL), female sexual function, and spasticity may be improved with aquatic therapy; sleep may be improved with aerobic exercises and aerobic fitness with multimodal exercises. In CP, balance may be improved with hippotherapy and motion gaming; function may be improved with cycling, treadmill, and hippotherapy. In SCI, ADL may be improved with RAGT.
Depending on population and type of exercise, physical activity was associated with improvements in walking, function, balance, depression, sleep, ADL, spasticity, female sexual function, and aerobic capacity. Few harms of physical activity were reported in studies. Future studies are needed to address evidence gaps and to confirm findings.
了解对可能需要轮椅的人群进行身体活动的益处和危害，重点关注多发性硬化症（MS）、脑瘫（CP）和脊髓损伤（SCI）患者。
在 MEDLINE、护理与健康相关学科累积索引、PsycINFO、Cochrane 中心对照试验数据库和 Embase 数据库（2008 年 1 月至 2020 年 11 月）中进行了检索。
针对 MS、CP 和 SCI 患者进行的至少 10 次/10 天的随机对照试验、非随机试验和队列研究。
我们进行了双重数据提取、质量评估和证据强度评估。如果存在足够的数据，则单独报告身体机能的测量结果；如果数据稀少，则将其归类为“功能”。
没有研究提供预防心血管疾病、糖尿病或肥胖的证据。在纳入的 168 项研究中，44%的研究纳入了 MS 患者（38%的 CP 和 18%的 SCI）。MS 研究发现，跑步机训练和多模态运动可能改善行走能力；功能可能通过跑步机、平衡训练和运动游戏得到改善；平衡可能通过平衡训练得到改善，也可能通过水上运动、机器人辅助步态训练（RAGT）、运动游戏和多模态运动得到改善；日常生活活动（ADL）、女性性功能和痉挛可能通过水疗得到改善；睡眠可能通过有氧运动得到改善，而有氧运动能力可能通过多模态运动得到改善。在 CP 中，骑马疗法可能改善平衡；运动游戏和自行车、跑步机训练可能改善功能。在 SCI 中，RAGT 可能改善 ADL。
根据人群和运动类型，身体活动与步行、功能、平衡、抑郁、睡眠、ADL、痉挛、女性性功能和有氧能力的改善有关。研究中报告的身体活动的危害很少。需要进一步的研究来解决证据空白并证实这些发现。
