Liu Xiaobo, Jiang Chengzhi, Fan Rong, Liu Tianyu, Li Yuxi, Zhong Dongling, Zhou Luxiang, Liu Tao, Li Juan, Jin Rongjiang
School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Department of Rehabilitation Medicine, Sichuan Science City Hospital, Mianyang, China.
Front Aging Neurosci. 2022 Sep 13;14:935326. doi: 10.3389/fnagi.2022.935326. eCollection 2022.
Tai Chi may be a promising exercise to prevent and control bone loss in postmenopausal women. This meta-analysis and trial sequential analysis aimed to evaluate the effect and safety of Tai Chi on bone health in postmenopausal women.
Seven databases were searched from their inceptions to 11 May 2022 to collect randomized controlled trials (RCTs) investigating the effect and safety of Tai Chi on bone health in postmenopausal women. Two independent reviewers identified the eligible studies, extracted data, and assessed the risk of bias of included studies using the revised Cochrane risk-of-bias tool for randomized trials. The primary outcome was the bone mineral density (BMD), and secondary outcomes included bone turnover markers and calcaneus quantitative ultrasound. Subgroup analyses were conducted based on the duration of Tai Chi. Sensitivity analyses and publication bias assessment were performed. RevMan software (version 5.4.1) and R software (version 3.6.1) were used for data synthesis. The certainty of evidence was rated with the Grading of recommendations assessment, development, and evaluation (GRADE) system. We also performed the trial sequential analysis to evaluate the reliability of the evidence.
A total of 25 reports involving 24 studies were included. Four studies were considered as high overall risk of bias, and the rest were some concerns. Among included studies, there were three comparisons including Tai Chi vs. non-intervention, Tai Chi vs. other exercises, and Tai Chi plus nutraceutical vs. nutraceutical. Compared with non-intervention, Tai Chi was more effective to improve BMD of lumbar spine (MD = 0.04, 95% CI 0.02 to 0.07, = 0%, low certainty), femoral neck (MD = 0.04, 95% CI 0.02 to 0.06, = 0%, low certainty), and trochanter (MD = 0.02, 95% CI 0.00 to 0.03, = 0%, very low certainty), but there was no significant difference in increasing the BMD of Ward's triangle (MD = 0.02, 95% CI -0.01 to 0.04, = 0%, very low certainty). Trial sequential analysis showed that the effect of Tai Chi vs. non-intervention on the BMD of lumbar spine and femoral neck was reliable, but the effect on the BMD of trochanter and Ward's triangle needed further verification. The subgroup analyses suggested that Tai Chi training for over 6 months had greater improvement in BMD of the lumbar spine, femoral neck, and trochanter than non-intervention. No significant differences were observed in the above outcomes of Tai Chi vs. other exercises, and Tai Chi plus nutraceutical vs. nutraceutical. There was insufficient evidence to support the effect of Tai Chi on bone turnover markers and calcaneus quantitative ultrasound. Few Tai Chi relevant adverse events occurred.
Tai Chi may be an optional and safe exercise for improving BMD loss in postmenopausal women, and practicing Tai Chi for more than 6 months may yield greater benefits. However, more rigorously designed RCTs are required to verify the benefits and to explore the optimal protocol of Tai Chi exercise for bone health.
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309148, identifier: CRD42022309148.
太极拳可能是预防和控制绝经后女性骨质流失的一种有前景的运动。本荟萃分析和试验序贯分析旨在评估太极拳对绝经后女性骨骼健康的效果和安全性。
检索了7个数据库自建库至2022年5月11日的数据，以收集调查太极拳对绝经后女性骨骼健康效果和安全性的随机对照试验（RCT）。两名独立评审员确定符合条件的研究，提取数据，并使用修订后的Cochrane随机试验偏倚风险工具评估纳入研究的偏倚风险。主要结局是骨密度（BMD），次要结局包括骨转换标志物和跟骨定量超声。根据太极拳练习时长进行亚组分析。进行敏感性分析和发表偏倚评估。使用RevMan软件（5.4.1版）和R软件（3.6.1版）进行数据合成。证据的确定性采用推荐分级评估、制定和评价（GRADE）系统进行评级。我们还进行了试验序贯分析以评估证据的可靠性。
共纳入25篇报告，涉及24项研究。4项研究被认为总体偏倚风险高，其余研究存在一些问题。在纳入的研究中，有三项比较，包括太极拳与无干预、太极拳与其他运动、太极拳加营养补充剂与营养补充剂。与无干预相比，太极拳在改善腰椎骨密度（MD = 0.04，95%CI 0.02至0.07，I² = 0%，低确定性）、股骨颈骨密度（MD = 0.04，95%CI 0.02至0.06，I² = 0%，低确定性）和大转子骨密度（MD = 0.02，95%CI 0.00至0.03，I² = 0%，极低确定性）方面更有效，但在增加Ward三角区骨密度方面无显著差异（MD = 0.02，95%CI -0.01至0.04，I² = 0%，极低确定性）。试验序贯分析表明，太极拳与无干预对腰椎和股骨颈骨密度的影响是可靠的，但对大转子和Ward三角区骨密度的影响需要进一步验证。亚组分析表明，太极拳训练6个月以上在改善腰椎、股骨颈和大转子骨密度方面比无干预更显著。太极拳与其他运动、太极拳加营养补充剂与营养补充剂在上述结局方面无显著差异。没有足够的证据支持太极拳对骨转换标志物和跟骨定量超声的影响。很少发生与太极拳相关的不良事件。
太极拳可能是改善绝经后女性骨密度流失的一种可选且安全的运动，练习太极拳6个月以上可能会带来更大益处。然而，需要更严格设计的随机对照试验来验证其益处，并探索太极拳运动促进骨骼健康的最佳方案。
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309148，标识符：CRD420223
