Yao Fang, Zhang Yang, Kuang Xiaohong, Zhou Qi, Huang Lihua, Peng Jiazhu, Hou Kun, Du Shizheng
Department of Nursing, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, Jiangsu, China.
School of Nursing, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China.
Evid Based Complement Alternat Med. 2021 Nov 15;2021:1068623. doi: 10.1155/2021/1068623. eCollection 2021.
PubMed, Embase, Cochrane Library, and three Chinese databases, namely, China National Knowledge Network, Wanfang, and China Biomedical Network, were searched from the time of their inceptions through August, 2021. We retrieved the studies on the application of TCE-based cardiac rehabilitation in patients with HF. Based on the standard evaluation methods of Cochrane Reviewer's Handbook 5.1.0, two authors independently assessed the risk of bias and evaluated the methodological quality of the studies included. The RevMan 5.3 software was used for further meta-analysis. Additionally, the GRADEpro GDT web version was used to assess the quality of the evidence in these studies.
Nine randomized controlled trials involving 721 patients were included in this analysis. The meta-analysis revealed that the TCE (experimental group) effectively improved the patient's motor function and endurance compared to walking or other activities (control group) (mean difference, MD = 68.23, 95% CI [54.55, 81.91]; < 0.00001). From each subgroup analysis, the exercising ability of the experimental group was higher than that of the control group. The quality of life's score in the experimental group was lower than that of the control group (MD = -9.51, 95%CI [-17.84, -1.18]; =0.03). The plasma B-type natriuretic peptide content in the experimental group was lower than that in the control group (MD = -59.77, 95%CI [-82.85, -36.7]; < 0.00001). The number of hospitalizations (MD = -0.83, 95%CI [-0.98, -0.68]; < 0.00001) and hospital costs in the experimental group (MD = -1.6, 95%CI [-1.89, -1.31]; < 0.00001) were lower than those in the control group. However, no significant differences were observed in the left ventricular ejection fraction and maximal oxygen consumption between the two groups (MD = 1.38, 95%CI [-3.08, 5.84] and =0.54; MD = -0.04, 95%CI [-1.62, 1.54] and =0.96, respectively). From the current analysis, TCE can be considered a relatively safe exercise method. According to the GRADE evaluation results on the evidence level, the studies included were of moderate quality, low quality, or very low quality.
Our systematic review showed that TCE had potential benefits in improving patients' cardiac function, motor function, and quality of life. Therefore, TCE might be an effective adjuvant therapy in patients with HF. However, given the inclusion of the low-quality elucidations, further rigorous studies are urgently needed to confirm these results.
检索了PubMed、Embase、Cochrane图书馆以及三个中文数据库，即中国知网、万方和中国生物医学文献数据库，检索时间从建库起至2021年8月。我们检索了关于基于太极拳运动的心脏康复在心力衰竭患者中的应用的研究。基于Cochrane系统评价员手册5.1.0的标准评估方法，两位作者独立评估偏倚风险并评价纳入研究的方法学质量。使用RevMan 5.3软件进行进一步的荟萃分析。此外，使用GRADEpro GDT网络版评估这些研究中的证据质量。
本分析纳入了9项涉及721例患者的随机对照试验。荟萃分析显示，与步行或其他活动（对照组）相比，太极拳运动（实验组）能有效改善患者的运动功能和耐力（平均差，MD = 68.23，95%可信区间[54.55, 81.91]；P < 0.00001）。从各亚组分析来看，实验组的运动能力高于对照组。实验组的生活质量评分低于对照组（MD = -9.51，95%可信区间[-17.84, -1.18]；P = 0.03）。实验组的血浆B型利钠肽含量低于对照组（MD = -59.77，95%可信区间[-82.85, -36.7]；P < 0.00001）。实验组的住院次数（MD = -0.83，95%可信区间[-0.98, -0.68]；P < 0.00001）和住院费用（MD = -1.6，95%可信区间[-1.89, -1.31]；P < 0.00001）均低于对照组。然而，两组之间的左心室射血分数和最大摄氧量未观察到显著差异（MD = 1.38，95%可信区间[-3.08, 5.84]，P = 0.54；MD = -0.04，95%可信区间[-1.62, 1.54]，P = 0.96）。从当前分析来看，太极拳运动可被认为是一种相对安全的运动方法。根据对证据水平的GRADE评估结果，纳入的研究质量为中等、低或极低。
我们的系统评价表明，太极拳运动在改善患者心脏功能、运动功能和生活质量方面具有潜在益处。因此，太极拳运动可能是心力衰竭患者有效的辅助治疗方法。然而，鉴于纳入了低质量的阐述，迫切需要进一步进行严谨的研究来证实这些结果。
