4 种运动干预措施在多发性硬化症中的比较效果：一项随机对照试验。随后进行 2 年的运动维持。
Comparative Effectiveness of 4 Exercise Interventions Followed by 2 Years of Exercise Maintenance in Multiple Sclerosis: A Randomized Controlled Trial.
机构信息
Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary; Department of Sport Biology, Institute of Sport Sciences and Physical Education, University of Pécs, Pécs, Hungary.
Departments of Epidemiology and Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
出版信息
Arch Phys Med Rehabil. 2022 Oct;103(10):1908-1916. doi: 10.1016/j.apmr.2022.04.012. Epub 2022 May 16.
OBJECTIVE
To determine the effects of exergaming (EXE) on quality of life (QOL), motor, and clinical symptoms in multiple sclerosis (MS). We compared the effects of EXE, balance (BAL), cycling (CYC), proprioceptive neuromuscular facilitation (PNF), and a standard care wait-listed control group on clinical and motor symptoms and quality of life (QOL) in people with MS (PwMS) and determined the effects of subsequent maintenance programs for 2 years in a hospital setting.
DESIGN
A randomized controlled trial, using before-after test design.
SETTING
University hospital setting.
PARTICIPANTS
Of 82 outpatients with MS, 70 were randomized (N=70), and 68 completed the study.
INTERVENTIONS
The initial high-intensity and high-frequency interventions consisted of 25 one-hour sessions over 5 weeks. After the 5-week-long initial intervention, the 2-year-long maintenance programs followed, consisting of 3 sessions per week, each for 1 hour.
MAIN OUTCOME MEASURES
The primary outcome: Multiple Sclerosis Impact Scale (MSIS-29).
SECONDARY OUTCOMES
Measures 5 aspects of health-related QOL (EuroQol 5-Dimension questionnaire), Beck Depression Inventory, 6-minute walk test (6MWT), Berg Balance Scale (BBS), Tinetti Assessment Tool (TAT), and static BAL (center of pressure).
RESULTS
MSIS-29 improved most in EXE (11 points), BAL (6), and CYC (6) (all P<.05). QOL improved most in EXE (3 points), CYC, and BAL (2) (all P<.05). TAT and BBS improved significantly (P<.05) but similarly (P>.05) in EXE, BAL, and CYC. 6MWT improved most in EXE (57m), BAL (32m), and CYC (19m) (all P<.001). Standing sway did not change. Maintenance programs further increased the initial exercise-induced gains, robustly in EXE.
CONCLUSIONS
A total of 25 sessions of EXE, BAL, CYC, and PNF, in this order, improved clinical and motor symptoms and QOL, and subsequent 2-year-long thrice weekly maintenance programs further slowed symptom worsening and improved QOL. EXE was the most and PNF was the least effective to improve clinical symptoms, motor function, and QOL in PwMS.
目的
确定运动游戏（EXE）对多发性硬化症（MS）患者生活质量（QOL）、运动和临床症状的影响。我们比较了 EXE、平衡（BAL）、骑行（CYC）、本体感觉神经肌肉促进法（PNF）和标准护理候补对照组对多发性硬化症患者（PwMS）的临床和运动症状以及生活质量（QOL）的影响，并确定了在医院环境中进行为期 2 年的后续维持计划的效果。
设计
一项随机对照试验，采用前后测试设计。
地点
大学医院。
参与者
82 名门诊多发性硬化症患者中，有 70 名随机分组（N=70），68 名完成了研究。
干预
最初的高强度和高频干预包括 5 周内的 25 次 1 小时的治疗。在为期 5 周的初始干预后，开始为期 2 年的维持计划，每周进行 3 次，每次 1 小时。
主要观察指标
主要结果：多发性硬化影响量表（MSIS-29）。
次要观察指标
衡量健康相关生活质量的 5 个方面（EuroQol 5-Dimension 问卷）、贝克抑郁量表、6 分钟步行测试（6MWT）、伯格平衡量表（BBS）、Tinetti 评估工具（TAT）和静态平衡（中心压力）。
结果
EXE（11 分）、BAL（6 分）和 CYC（6 分）（均 P<.05）在 MSIS-29 中改善最多。EXE（3 分）、CYC 和 BAL（2 分）（均 P<.05）在生活质量方面改善最多。TAT 和 BBS 显著改善（P<.05），但在 EXE、BAL 和 CYC 中相似（P>.05）。EXE（57m）、BAL（32m）和 CYC（19m）的 6MWT 改善最多（均 P<.001）。站立摇摆没有改变。维持计划进一步增加了初始运动引起的收益，在 EXE 中尤为明显。
结论
总共 25 次 EXE、BAL、CYC 和 PNF 治疗，按此顺序进行，改善了临床和运动症状以及生活质量，随后 2 年的每周 3 次维持治疗进一步减缓了症状恶化并改善了生活质量。EXE 是最有效的，PNF 是最无效的，可改善 PwMS 的临床症状、运动功能和生活质量。
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