高强度训练对改善膝骨关节炎患者膝关节屈曲力量及生活质量的影响：一项随机对照试验的系统评价与荟萃分析
Effect of high-intensity training on improving knee flexion strength and quality of life in patients with knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials.
作者信息
Zhai Bo, Wang Yu, Zhang Zhongliang, Wang Qiang
机构信息
Department of Joint Surgery, JINHUA Hospital of Traditional Chinese Medicine, Jinhua, Zhejiang, China.
Department of Trauma One, JINHUA Hospital of Traditional Chinese Medicine, Jinhua, Zhejiang, China.
出版信息
Front Physiol. 2025 Jun 27;16:1561697. doi: 10.3389/fphys.2025.1561697. eCollection 2025.
OBJECTIVES
Whether high-intensity exercise can effectively improve the symptoms and quality of life of patients with knee osteoarthritis has not been determined. This study updates the evidence on the efficacy of high-intensity training for patients with knee osteoarthritis by integrating all large-scale randomized controlled trials (RCTs).
METHODS
A systematic literature search was conducted in PubMed, Embase, Web of Science, and Cochrane through November 2024. Outcomes assessed included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 6-min walk test (6-MWT), knee flexion strength, knee extension strength, leg press strength, Knee Injury and Osteoarthritis Outcome Score (KOOS) (pain, symptoms, and QoL), stair climbing test, and timed-up-and-go (TUG). Standardized mean differences (SMD) with 95% confidence intervals (CI) were used to pool continuous variables. Sensitivity analysis was performed to assess result stability. Analyses were conducted using Review Manager 5.4 and STATA 15.1.
RESULTS
Nine RCTs with 1,540 patients were included. The average age of the patients ranged from 59.1 to 69 years. Meta-analysis showed significant improvements in knee flexion strength (SMD: 0.39; 95% CI: 0.08, 0.70), leg press strength (SMD: 0.47; 95% CI: 0.23, 0.70), KOOS symptoms (SMD: 0.18; 95% CI: 0.02, 0.35), and KOOS QoL (SMD: 0.29; 95% CI: 0.13, 0.45) in the high-intensity exercise group compared to the control. However, high-intensity exercise had no significant effect on WOMAC, 6-MWT, knee extension strength, KOOS pain, stair climbing, or TUG.
CONCLUSION
High-intensity exercise significantly improves knee flexion strength, leg press strength, and KOOS symptoms and QoL in knee osteoarthritis patients. Given the study's limitations, further large-scale, multicenter RCTs are needed to confirm the rehabilitation effects and potential influencing factors of high-intensity exercise.
SYSTEMATIC REVIEW REGISTRATION
目的
高强度运动能否有效改善膝关节骨关节炎患者的症状和生活质量尚未确定。本研究通过整合所有大规模随机对照试验（RCT），更新了关于高强度训练对膝关节骨关节炎患者疗效的证据。
方法
截至2024年11月，在PubMed、Embase、Web of Science和Cochrane中进行了系统的文献检索。评估的结果包括西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、6分钟步行试验（6-MWT）、膝关节屈曲力量、膝关节伸展力量、腿部推举力量、膝关节损伤和骨关节炎结局评分（KOOS）（疼痛、症状和生活质量）、爬楼梯试验和定时起立行走试验（TUG）。采用标准化均数差（SMD）及95%置信区间（CI）汇总连续变量。进行敏感性分析以评估结果的稳定性。使用Review Manager 5.4和STATA 15.1进行分析。
结果
纳入了9项RCT，共1540例患者。患者的平均年龄在59.1至69岁之间。荟萃分析显示，与对照组相比，高强度运动组的膝关节屈曲力量（SMD：0.39；95%CI：0.08，0.70）、腿部推举力量（SMD：0.47；95%CI：0.23，0.70）、KOOS症状（SMD：0.18；95%CI：0.02，0.35）和KOOS生活质量（SMD：0.29；95%CI：0.13，0.45）有显著改善。然而，高强度运动对WOMAC、6-MWT、膝关节伸展力量、KOOS疼痛、爬楼梯或TUG没有显著影响。
结论
高强度运动可显著改善膝关节骨关节炎患者的膝关节屈曲力量及腿部推举力量、KOOS症状和生活质量。鉴于本研究的局限性，需要进一步开展大规模、多中心RCT来证实高强度运动的康复效果及潜在影响因素。
系统评价注册
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