不同运动对改善帕金森病患者步态表现的影响：一项系统评价和网状Meta分析
Effects of different exercises on improving gait performance in patients with Parkinson's disease: a systematic review and network meta-analysis.
作者信息
Li Ying, Huang Jieling, Wang Jinguo, Cheng Yue
机构信息
College of Sports Science, Jishou University, Jishou, China.
Faculty of Health Sciences and Physical Education, Macao Polytechnic University, Macao, Macao SAR, China.
出版信息
Front Aging Neurosci. 2025 Feb 26;17:1496112. doi: 10.3389/fnagi.2025.1496112. eCollection 2025.
OBJECTIVE
Gait disorder represents a characteristic symptom of Parkinson's disease (PD), and exercise has been established as an effective intervention for gait management in PD. However, the relative efficacy of various exercise types in improving gait among PD patients remains unclear. This study aimed to compare the effectiveness of different movement-based interventions in enhancing gait for individuals with PD through a network meta-analysis.
METHODS
A comprehensive search was conducted across multiple databases, including PubMed, Cochrane Library, Embase, Web of Science, and CNKI. The methodological quality of included studies was evaluated using the Cochrane Bias risk tool. Data was extracted from these studies to compare the efficacy of 29 distinct exercise interventions on gait performance in patients with PD.
RESULTS
The analysis encompassed 68 randomized controlled trials (RCTs), involving a total of 3,114 participants. The results of the network meta-analysis showed that DE is higher than CON (SMD, 2.11; 95% CI 1.07 to 3.15), WE (SMD, 2.16; 95% CI 0.90 to 3.43), HE (SMD, 2.19; 95% CI 0.95 to 3.44), OE (SMD, 2.66; 95% CI 1.16 to 4.16), TR (SMD, 2.62; 95% CI 1.45 to 3.79) to better improve Gait velocity in patients with Parkinson's disease. DE is superior to CON (SMD, 2.08; 95% CI 0.04 to 4.13) in improving Step length. FAE is superior to CON (SMD, 1.01; 95% CI 0.04 to 1.98), BDJ (SMD, 1.20; 95% CI 0.15 to 2.25), RAGT (SMD, 1.29; 95% CI 0.07 to 2.52), DE (SMD, 1.57; 95% CI 0.36 to 2.77), TR (SMD, 1.62; 95% CI 0.48 to 2.76), OE (1.76, 95% CI 0.57 to 2.94) in improving Gait velocity. RAGT is superior to CT (MD, 2.02; 95% CI 0.41 to 3.63), TR (MD, 2.51; 95% CI 1.17 to 3.84), AE (MD, 2.66; 95% CI 0.45 to 4.88), BDJ (MD, 2.77; 95% CI 0.93 to 4.61), CON (MD, 2.83; 95% CI 1.30 to 4.36), DTT (MD, 12.84; 95% CI 10.05 to 15.63) in improving 6MWT.
CONCLUSION
Our study found that DE improved gait speed and step length in patients with Parkinson's disease better than other forms of exercise. FAE and RAGT were more effective than other exercises in improving step length and 6MWT in patients with Parkinson's disease.
目的
步态障碍是帕金森病（PD）的一个典型症状，运动已被确认为PD步态管理的有效干预措施。然而，各种运动类型在改善PD患者步态方面的相对疗效仍不明确。本研究旨在通过网络荟萃分析比较不同基于运动的干预措施对PD患者步态的改善效果。
方法
在多个数据库中进行了全面检索，包括PubMed、Cochrane图书馆、Embase、科学网和中国知网。使用Cochrane偏倚风险工具评估纳入研究的方法学质量。从这些研究中提取数据，以比较29种不同运动干预措施对PD患者步态表现的疗效。
结果
该分析涵盖了68项随机对照试验（RCT），共涉及3114名参与者。网络荟萃分析结果显示，在改善帕金森病患者的步速方面，动态平衡训练（DE）优于常规治疗（CON）（标准化均数差[SMD]，2.11；95%置信区间[CI] 1.07至3.15）、步行训练（WE）（SMD，2.16；95% CI 0.90至3.43）、手部运动训练（HE）（SMD，2.19；95% CI 0.95至3.44）、本体感觉训练（OE）（SMD，2.66；95% CI 1.16至4.16）、太极拳（TR）（SMD，2.62；95% CI 1.45至3.79）。在改善步长方面，DE优于CON（SMD，2.08；95% CI 0.04至4.13）。功能性动作评估（FAE）在改善步速方面优于CON（SMD，1.01；95% CI 0.04至1.98）、桥式运动训练（BDJ）（SMD，1.20；95% CI 0.15至2.25）、机器人辅助步态训练（RAGT）（SMD，1.29；95% CI 0.07至2.52）、DE（SMD，1.57；95% CI 0.36至2.77）、TR（SMD，1.62；95% CI 0.48至2.76）、OE（1.76，95% CI 0.57至2.94）。在改善6分钟步行试验（6MWT）方面，RAGT优于常规训练（CT）（平均差[MD]，2.02；95% CI 0.41至3.63）、TR（MD，2.51；95% CI 1.17至3.84）、主动运动训练（AE）（MD，2.66；95% CI 0.45至4.88）、BDJ（MD，2.77；95% CI 0.93至4.61）、CON（MD，2.83；95% CI 1.30至4.36）、双任务训练（DTT）（MD，12.84；95% CI 10.05至15.63）。
结论
我们的研究发现，在改善帕金森病患者的步态速度和步长方面，DE优于其他形式的运动。在改善帕金森病患者的步长和6MWT方面，FAE和RAGT比其他运动更有效。
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