School of Acupuncture-Moxibustion and Tuina, Hebei University of Chinese Medicine, No. 3 Xingyuan Road, Luquan District, Shijiazhuang, Hebei Province, China.
Hebei Academy of Traditional Chinese Medicine, Shijiazhuang, China.
Osteoporos Int. 2023 Nov;34(11):1853-1866. doi: 10.1007/s00198-023-06830-7. Epub 2023 Jul 10.
PURPOSE: To critically evaluate systematic reviews (SRs) of the Tai Chi (TC) exercise on bone health and provide more recently available evidence. METHODS: SRs with or without meta-analysis (MA) of TC on bone health were comprehensively searched in eight electronic databases (PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database, and Chinese Scientific Journals Database) and in the international prospective register of systematic reviews of (PROSPERO) from initiation to March 2023. Descriptive analyses of SRs were performed, and reporting and methodological quality of the included SRs were evaluated using the updated version of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2). The certainty of the synthesized evidence was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS: Eighteen SRs, 15 with MAs, were included. Forty-nine RCTs and 16 NRSIs with 3956 and 1157 participants, respectively, were included in these SRs. The reporting quality of the included SRs ranged from high to low, but most received critically low AMSTAR-2 scores. Efficacy of TC on nine bone health biomarkers has been explored, covering bone mineral density (BMD) and serum biomarkers. The results showed that compare to non-intervention, perimenopausal and postmenopausal participants who practiced TC may benefit in BMD of the lumbar spine [MD = 0.04, 95% CI (0.02, 0.07)], and femoral neck [MD = 0.04, 95% CI (0.02, 0.06)], but not BMD of the femoral proximal trochanter [MD = 0.02, 95% CI (0.00, 0.03)], ward's triangle [MD = 0.02, 95% CI (-0.01, 0.04)], and femoral shaft [SMD = 0.16, 95% CI (-0.11, 0.44)]. Elders practicing TC may benefit in BMD of the femoral neck [SMD = 0.28, 95% CI (0.10, 0.45)], femoral proximal trochanter [SMD = 0.39, 95% CI (0.05, 0.73)], and ward's triangle [SMD = 0.21, 95% CI (0.05,0.37)], but may not in BMD of lumbar spine [SMD = 0.03, 95% CI (-0.22, 0.27)]. CONCLUSION: We have low certainty that for perimenopausal and postmenopausal women, compare to those with no exercise, TC could improve BMD of the lumbar spine, femoral neck. We also have low certainty that in elder population, TC practitioners may benefit in BMD of femoral neck, and Ward's triangle. REGISTRATION: PROSPERO (CRD42020173543).
目的:批判性评估太极拳(TC)锻炼对骨骼健康的系统评价(SRs),并提供最新的可用证据。
方法:从开始到 2023 年 3 月,在 8 个电子数据库(PubMed、EMBASE、Cochrane 图书馆、Web of Science、中国国家知识基础设施、万方数据库、中国生物医学文献数据库和中国科学期刊数据库)和国际前瞻性注册系统评价(PROSPERO)中全面搜索了 TC 对骨骼健康的系统评价(SRs),包括或不包括荟萃分析(MA)。对 SRs 进行描述性分析,并使用更新后的系统评价和荟萃分析报告标准(PRISMA)检查表和系统评价工具评估(AMSTAR-2)评估纳入 SRs 的报告和方法学质量。使用 Grading of Recommendations, Assessment, Development, and Evaluation(GRADE)方法评估综合证据的确定性。
结果:纳入了 18 篇 SRs,其中 15 篇有 MA。这些 SRs 共纳入了 49 项 RCTs 和 16 项 NRSIs,分别有 3956 名和 1157 名参与者。纳入 SRs 的报告质量从高到低不等,但大多数 AMSTAR-2 得分较低。已经探讨了 TC 对 9 种骨骼健康生物标志物的疗效,涵盖了骨密度(BMD)和血清生物标志物。结果表明,与非干预组相比,围绝经期和绝经后参与者练习 TC 可能有益于腰椎 [MD=0.04,95%置信区间(0.02,0.07)] 和股骨颈 [MD=0.04,95%置信区间(0.02,0.06)] 的 BMD,但股骨近端转子 [MD=0.02,95%置信区间(0.00,0.03)] 、Ward's 三角 [MD=0.02,95%置信区间(-0.01,0.04)] 和股骨干 [SMD=0.16,95%置信区间(-0.11,0.44)] 的 BMD 没有获益。练习 TC 的老年人可能有益于股骨颈 [SMD=0.28,95%置信区间(0.10,0.45)] 、股骨近端转子 [SMD=0.39,95%置信区间(0.05,0.73)] 和 Ward's 三角 [SMD=0.21,95%置信区间(0.05,0.37)] 的 BMD,但腰椎 [SMD=0.03,95%置信区间(-0.22,0.27)] 的 BMD 可能没有获益。
结论:我们有较低的确定性认为,对于围绝经期和绝经后妇女来说,与没有运动的妇女相比,TC 可以提高腰椎和股骨颈的 BMD。我们也有较低的确定性认为,在老年人群中,TC 练习者可能会受益于股骨颈和 Ward's 三角的 BMD。
注册:PROSPERO(CRD42020173543)。
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