School of Sports Science and Physical Education, Nanjing Normal University, Nanjing, China.
Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Henan University, 85 Minglun Rd, Shunhe District, Kaifeng City, 475001, China.
BMC Geriatr. 2023 Aug 28;23(1):522. doi: 10.1186/s12877-023-04239-9.
To compare, rank and evaluate the 24 exercise types that improve postural instability in patients with Parkinson's disease (PD).
We searched the data in PubMed, MEDLINE, Embase, PsycINFO, Cochrane library, and Web of Science from their inception date to January 23, 2023. Randomized controlled trials (RCTs) that aimed at determining the effectiveness of physical activity interventions on postural instability in adults with PD. This review focused on different balance outcome categories: (a) balance test batteries (BBS); (b) static steady-state balance (sSSB); (c) dynamic steady-state balance (dSSB); (d) proactive balance (PB); (e) reactive balance (RB).
Among 10,474 records, 199 studies (patients = 9523) were eligible for qualitative synthesis. The random-effects NMA model revealed that the following exercise training modalities had the highest p score of being best when compared with control group: body-weight support treadmill training (BWS_TT) for BBS (p score = 0.97; pooled standardised mean difference (95% CI): 1.56 (0.72 to 2.39)) and dSSB (1.00; 1.53 (1.07 to 2.00)), aquatic exercise (AQE) for sSSB (0.85; 0.94 (0.33 to 1.54)), Pilates for PB (0.95; 1.42 (0.59 to 2.26)). Balance and gait training with the external cue or attention (BGT_ECA) and robotic assisted gait balance (RA_GT) had similar superior effects in improving RB. The confidence in evidence was often low according to Confidence in Network Meta-Analysis.
There is low quality evidence that BWS_TT, AQE, Pilates, BGT_ECA and RA_GT are possibly the most effective treatments, pending outcome of interest, for adults with PD.
比较、排名和评估 24 种改善帕金森病（PD）患者姿势不稳定的运动类型。
我们检索了从建库至 2023 年 1 月 23 日期间 PubMed、MEDLINE、Embase、PsycINFO、Cochrane 图书馆和 Web of Science 中的数据。纳入旨在确定成人 PD 患者身体活动干预对姿势不稳定影响的随机对照试验（RCT）。本综述重点关注不同的平衡结果类别：（a）平衡测试组合（BBS）；（b）静态稳定平衡（sSSB）；（c）动态稳定平衡（dSSB）；（d）主动平衡（PB）；（e）反应性平衡（RB）。
在 10474 条记录中，有 199 项研究（患者=9523 人）符合定性综合分析的条件。随机效应 NMA 模型显示，与对照组相比，以下运动训练方式的最佳 p 评分最高：减重支持跑台训练（BWS_TT）对 BBS（p 评分=0.97；合并标准化均数差值（95%置信区间）：1.56（0.72 至 2.39））和 dSSB（1.00；1.53（1.07 至 2.00）），水上运动（AQE）对 sSSB（0.85；0.94（0.33 至 1.54）），普拉提对 PB（0.95；1.42（0.59 至 2.26））。带外部线索或注意力的平衡和步态训练（BGT_ECA）和机器人辅助步态平衡（RA_GT）在改善 RB 方面具有相似的优势。根据网络荟萃分析的可信度，证据的可信度往往较低。
低质量证据表明，BWS_TT、AQE、普拉提、BGT_ECA 和 RA_GT 可能是针对成人 PD 最有效的治疗方法（取决于关注的结果）。
