传统健身功法对绝经后妇女骨密度的影响：一项随机对照试验的网络荟萃分析。

UNLABELLED: We aimed to evaluate the clinical efficacy of five traditional Chinese fitness exercises (Baduanjin, Taijiquan, Wuqinxi, Yijinjing, and Liuzijue), as well as their efficacy when combined with drug therapy, in the treatment of decreased bone mineral density in postmenopausal women. METHODS: This study strictly followed the evaluation guidelines of PRISMA and followed the "PICOS" principle outlined in the Cochrane Handbook. We performed a systematic search on Web of Science, Springer Link, Scopus, EMBASE, EBSCO, PubMed, the Cochrane Library, CNKI, Wanfang, CBMdisc, and the VIP Database, and we targeted RCTs studying the effect of TCE on BMD in postmenopausal women published prior to September 2023. The quality of the literature and the risk of bias of the included studies were assessed according to ROB2 and GRADE criteria, and data analysis was performed using Stata 14. RESULTS: A total of 33 RCTs (3658 post-menopausal women) were included. Network meta-analysis showed that Taiji (SMD=0.72, 95% CI: 0.22, 1.21, P<0.01) and Yijinjing (SMD=0.51, 95% CI: 0.03, 0.99, P<0.05) were significantly superior to conventional rehabilitation in lumbar BMD. In terms of improvement of femoral neck BMD, Baduanjin (SMD=1.63, 95% CI: -3.58, 6.85, P<0.001) and Taiji (SMD=0.46, 95% CI: 0.14, 0.79, P<0.05) had statistically different outcomes to conventional rehabilitation. Regarding Ward's triangle BMD, Taiji (SMD= 0.32, 95% CI: 0.14, 0.50, P< 0.05) had statistically different outcomes to conventional rehabilitation. The results of the SUCRA probability ranking showed that Baduanjin + drug interventions achieved the most significant improvement in lumbar BMD (SUCRA=83.6%) and femoral neck BMD (SUCRA=90.2%). Taiji + drug interventions most effectively improved Ward's triangle BMD (SUCRA=86.0%). In terms of traditional Chinese fitness exercises alone, Taiji was the most effective in improving lumbar BMD (SUCRA=64.4%) and Ward's triangle BMD (SUCRA=46.8%), and Baduanjin was the most effective in treating femoral neck BMD (SUCRA=89.9%). CONCLUSION: Traditional Chinese fitness exercises can significantly improve the BMD levels of postmenopausal women. Taiji, Yijinjing, and Baduanjin combined with medication showed better intervention effects overall. However, due to the limitations of the number of studies and sample sizes of individual interventions, definitive conclusions need to be verified by more high-quality studies.

目的：评估五套传统中医健身功法（八段锦、太极拳、五禽戏、易筋经、六字诀）以及其与药物联合治疗绝经后女性骨密度降低的临床疗效。

方法：本研究严格遵循 PRISMA 评价指南，并遵循 Cochrane 手册中概述的“PICOS”原则。我们在 Web of Science、Springer Link、Scopus、EMBASE、EBSCO、PubMed、Cochrane 图书馆、中国知网、万方、CBMdisc 和 VIP 数据库中进行了系统检索，检索了截至 2023 年 9 月发表的关于 TCE 对绝经后妇女 BMD 影响的 RCTs。根据 ROB2 和 GRADE 标准评估文献质量和纳入研究的偏倚风险，并使用 Stata 14 进行数据分析。

结果：共纳入 33 项 RCT（3658 名绝经后女性）。网络荟萃分析显示，太极拳（SMD=0.72，95%CI：0.22，1.21，P<0.01）和易筋经（SMD=0.51，95%CI：0.03，0.99，P<0.05）在腰椎 BMD 方面明显优于常规康复。在股骨颈 BMD 改善方面，八段锦（SMD=1.63，95%CI：-3.58，6.85，P<0.001）和太极拳（SMD=0.46，95%CI：0.14，0.79，P<0.05）与常规康复相比有统计学差异。在 Ward 三角区 BMD 方面，太极拳（SMD=0.32，95%CI：0.14，0.50，P<0.05）与常规康复有统计学差异。SUCRA 概率排名结果显示，八段锦+药物干预在腰椎 BMD（SUCRA=83.6%）和股骨颈 BMD（SUCRA=90.2%）方面的改善效果最为显著。太极拳+药物干预在改善 Ward 三角区 BMD 方面最为有效（SUCRA=86.0%）。仅从中医健身功法来看，太极拳在改善腰椎 BMD（SUCRA=64.4%）和 Ward 三角区 BMD（SUCRA=46.8%）方面最为有效，而八段锦在治疗股骨颈 BMD 方面最为有效（SUCRA=89.9%）。

结论：中医健身功法可显著提高绝经后女性的 BMD 水平。太极拳、易筋经和八段锦联合用药整体干预效果更好。但由于研究数量和个体干预样本量的限制，还需要更多高质量的研究来验证明确的结论。