《中国康复理论与实践》

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (12): 1412-1421.doi: 10.3969/j.issn.1006-9771.2021.12.006

• 专题 身体活动与健康及ICF应用 • 上一篇    下一篇

抑郁症患者运动干预的证据图谱

吴福霞1a,李艳飞1b,1c,1d,2,郑忠礼1b,1c,1d,2,3,魏志鹏1b,1c,1d,2,邱卓英4,5(),杨克虎1b,1c,1d,2()   

  1. 1.兰州大学,a.体育教研部,b.基础医学院,c.循证医学中心,d.循证社会科学研究中心,甘肃兰州市 730000
    2.甘肃省循证医学与临床转化重点实验室,甘肃兰州市730000
    3.甘肃省康复中心医院,甘肃兰州市730000
    4.中国康复研究中心/中国康复科学所,北京市 100068
    5.康复大学,山东青岛市 266071
  • 收稿日期:2021-11-29 出版日期:2021-12-25 发布日期:2021-12-29
  • 通讯作者: 邱卓英,杨克虎 E-mail:qiutiger@hotmail.com;kehuyangebm2006@126.com
  • 作者简介:吴福霞(1978-),女,汉族,甘肃兰州市人,硕士,讲师,主要研究方向：体育教学与训练;|李艳飞(1994-),男,汉族,甘肃天水市人,博士研究生,主要研究方向：循证卫生决策与证据转化。
  • 基金资助:
    国家社科基金重大项目(19ZDA142)

Exercise Intervention for Patients with Depression: An Evidence Mapping

WU Fu-xia1a,LI Yan-fei1b,1c,1d,2,ZHENG Zhong-li1b,1c,1d,2,3,WEI Zhi-peng1b,1c,1d,2,QIU Zhuo-ying4,5(),YANG Ke-hu1b,1c,1d,2()   

  1. 1. a. Sport Department; b. Evidence Based Medicine Center; c. School of Basic Medical Sciences; d. Evidence Based Social Science Research Center, Lanzhou University, Lanzhou, Gansu 730000, China
    2. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu 730000, China
    3. Rehabilitation Center Hospital of Gansu, Lanzhou, Gansu 730000, China
    4. China Rehabilitation Research Centre/China Rehabilitation Science Institute, Beijing 100068, China
    5. University of Health and Rehabilitation Science, Qingdao, Shandong 266071, China
  • Received:2021-11-29 Published:2021-12-25 Online:2021-12-29
  • Contact: QIU Zhuo-ying,YANG Ke-hu E-mail:qiutiger@hotmail.com;kehuyangebm2006@126.com
  • Supported by:
    National Social Science Fund of China(19ZDA142)

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摘要：

目的 通过证据图谱方法系统识别、描述和评价抑郁症患者运动干预相关研究证据。方法 计算机检索建库至2021年7月中国知网、万方数据、中国生物医学文献数据库、维普、Web of Science、EMBASE、Cochrane library和PubMed,获取抑郁症患者运动干预的随机对照试验和系统综述/Meta分析。采用Cochrane手册5.1.0推荐的偏倚风险评估工具和AMSTAR-2对纳入的研究进行质量评估。基于世界卫生组织国际健康分类家族(WHO-FICs)架构,建立证据图谱研究框架,利用EPPI软件和Microsoft Excel 2019工具进行数据提取和编码,采用气泡图综合呈现研究人群、干预类别、原始研究样本量及系统综述/Meta分析纳入研究数量、结论分类等信息。结果 最终纳入101篇随机对照试验和52篇系统综述/Meta分析。101篇随机对照试验中,共涉及3类干预策略,15种不同的干预措施,主要包括未特指的运动干预(28篇,27.72%)和瑜伽干预(19篇,18.81%)。主要研究结局包括b1.精神功能(92篇,91.09%)和d9.社区、社会和公民生活(19篇,18.81%)。3类干预策略中康复类占比最高,共计47篇(46.53%),主要研究人群为其他特指的抑郁症患者(19篇,40.42%),如重度抑郁症及老年抑郁症患者,46篇(97.87%)结论被归类为“有益”或“可能有益”。52篇系统综述/Meta分析中,共涉及9项干预措施,主要包括未特指的运动干预(17篇,32.69%)和瑜伽干预(12篇,23.08%)。主要研究结局包括b1.精神功能(41篇,78.85%)和不良反应(12篇,23.08%)。3类干预策略中治疗类占比最高,共计34篇(65.38%),其中,研究人群主要为其他特指的抑郁症患者(27篇,79.41%),如成年抑郁症和抑郁症孕产妇,28篇(82.35%)的研究结论被归类为“有益”或“可能有益”。同时,干预环境/背景主要为门诊和住院环境。结论 证据图谱结果显示运动干预策略主要聚焦于抑郁症患者的治疗和康复,主要研究患者的身体功能与结构(精神功能),且有效性显著。对于步行、自行车、气功、阻力训练和运动游戏干预的有效性,以及干预时间、干预的不良反应等方面,仍需未来高质量的研究进一步探讨。

关键词: 证据图谱, 系统综述, 随机对照试验, 运动干预, 抑郁症, 世界卫生组织国际健康分类家族

Abstract:

Objective To systematically identify, describe, and evaluate research evidence related to exercise intervention in patients with depression through the evidence mapping method. Methods Related studies on exercise intervention for patients with depression were searched in CNKI, Wanfang Data, CBM, VIP, Web of Science, EMBASE, Cochrane library, and PubMed from inception to July, 2021. The quality of the studies was assessed using the risk of bias (RoB) tool recommended by the Cochrane Handbook Version 5.1.0 and A Measurement Tool to Assess Systematic Review-2 (AMSTAR-2). Based on World Health Organization Family International Classifications (WHO-FICs) framework, an evidence mapping framework was established, using EPPI software and Microsoft Excel 2019 tools for data extraction and coding, and using bubble charts to comprehensively present the research population, intervention categories, original research sample size, and the number of studies included in the systematic review/meta-analysis, conclusion classification and other information. Results A total of 101 randomized controlled trials and 52 systematic reviews/meta-analyses were included. The randomized controlled trials involved three types of intervention strategies with 15 different interventions, mainly including unspecified exercise intervention (28, 27.72%) and yoga intervention (19, 18.81%). The main research outcomes included b1. Global mental functions (92, 91.09%) and d9. Community, social and civic life (19, 18.81%). Among the three types of intervention strategies, rehabilitation accounted for the highest proportion, with 47 studies in total, accounting for 46.53%. The main research population was patients with other specified depression (19, 40.42%), such as patients with major depression and elderly depression. Forty-six research conclusions (97.87%) were classified as "beneficial" or "probably beneficial". In 52 systematic reviews/meta-analyses, nine interventions were involved, mainly including unspecified exercise intervention (17, 32.69%) and yoga intervention (12, 23.08%). The main study outcomes included b1. Global mental functions (41, 78.85%) and adverse reactions (12, 23.08%). Among the three types of intervention strategies, the treatment type accounted for the highest proportion, with a total of 34 studies, accounting for 65.38%. The study population was mainly patients with other specific depression (27, 79.41%), such as adult depression and pregnant women with depression, 28 (82.35%) of the research conclusions were classified as "beneficial" or " probably beneficial". At the same time, the intervention environment/background was mainly outpatient and inpatient environment. Conclusion Exercise intervention may be beneficial for patients with depression. However, the effectiveness of walking, cycling, Qigong, resistance training, and sports game interventions, the optimal intervention duration or intensity, and the adverse effects of the intervention, still need to be further explored by high-quality study in the future.

Key words: evidence mapping, systematic review, randomized controlled trial, exercise intervention, depression, World Health Organization Family International Classifications

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