运动干预对多发性硬化患者疲劳症状影响的Meta分析

doi:10.3969/j.issn.1006-9771.2022.05.012

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (5): 568-577.doi: 10.3969/j.issn.1006-9771.2022.05.012

运动干预对多发性硬化患者疲劳症状影响的Meta分析

徐振¹,王一迪²,张月³,温宇红^4,⁵()

1.南开大学体育部,天津市 300071
2.北京体育大学中国游泳运动学院,北京市 100084
3.上海交通大学体育系,上海市 200240
4.北京体育大学体育休闲与旅游学院,北京市 100084
5.北京体育大学运动与体质健康教育部重点实验室,北京市 100084

收稿日期:2021-12-09 修回日期:2022-02-07 出版日期:2022-05-25 发布日期:2022-06-10
通讯作者: 温宇红 E-mail:wyhswim@126.com
作者简介:徐振(1997-),男,汉族,黑龙江哈尔滨市人,硕士,助教,主要研究方向：运动与健康促进
基金资助:
国家重点研发计划项目(2020YFC2006700)

Effects of exercise intervention on fatigue for patients with multiple sclerosis: a meta-analysis

XU Zhen¹,WANG Yidi²,ZHANG Yue³,WEN Yuhong^4,⁵()

1. Department of Physical Education, Nankai University, Tianjin 300071, China
2. China Swimming College, Beijing Sport University, Beijing 100084, China
3. Department of Physical Education, Shanghai Jiao Tong University, Shanghai 200240, China
4. School of Recreational Sports and Tourism, Beijing Sport University, Beijing 100084, China
5. Key Laboratory of Sports and Physical Health of the Ministry of Education, Beijing Sport University, Beijing 100084, China

Received:2021-12-09 Revised:2022-02-07 Published:2022-05-25 Online:2022-06-10
Contact: WEN Yuhong E-mail:wyhswim@126.com
Supported by:
National Key Research and Development Program(2020YFC2006700)

摘要/Abstract

摘要：

目的评价运动干预对多发性硬化(MS)患者疲劳症状的影响及其安全性。方法计算机检索PubMed、Cochrane Central Register of Controlled Trails、Web of Science、中国知网和万方数据库,收集从建库至2021年6月发表的关于运动干预对MS疲劳影响的随机对照试验。由两名研究人员进行文献检索与筛选,并独立对纳入文献进行质量评价。采用Stata 16.0软件进行Meta分析。结果共纳入41项随机对照试验,共2 155例患者。与对照组相比,运动干预能显著改善试验组疲劳症状(SMD = -0.59, 95%CI -0.73~-0.44, P < 0.001);随访期间试验组与对照组无显著性差异(SMD = -0.07,95%CI -0.26~0.12, P = 0.47)。运动干预未增加复发风险(RR = 0.67, 95%CI 0.45~1.00, P = 0.06)。结论运动干预能够有效减轻MS疲劳症状,且未造成MS复发率的升高。

关键词: 多发性硬化, 运动, 疲劳, Meta分析

Abstract:

Objective To evaluate the effect and safety of exercise intervention on fatigue for patients with multiple sclerosis (MS). Methods Randomized controlled trials (RCT) about effect of exercise intervention on MS fatigue were retrieved from the databases of PubMed, Cochrane Central Register of Controlled Trails, Web of Science, CNKI and Wanfang Data from establishment to June, 2021. Two researchers independently screened the literature, extracted the data and assessed the quality of eligible studies. Meta-analysis was performed with Stata 16.0. Results A total of 41 RCT with 2 155 patients were included. Compared with control group, exercise intervention might improve the MS fatigue at the end of intervention in exercise group (SMD = -0.59, 95%CI -0.73 to -0.44, P < 0.001). There was no significant difference between the exercise group and the control group in follow-up period (SMD = -0.07, 95%CI -0.26 to 0.12, P = 0.47). Exercise intervention did not increase the recurrence of MS (RR = 0.67, 95%CI 0.45 to 1.00, P = 0.06). Conclusion Exercise intervention can effectively relieve the fatigue of MS without increasing the recurrence of MS.

Key words: multiple sclerosis, exercise, fatigue, meta-analysis

中图分类号:

R744.5

徐振,王一迪,张月,温宇红. 运动干预对多发性硬化患者疲劳症状影响的Meta分析[J]. 《中国康复理论与实践》, 2022, 28(5): 568-577.

XU Zhen,WANG Yidi,ZHANG Yue,WEN Yuhong. Effects of exercise intervention on fatigue for patients with multiple sclerosis: a meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(5): 568-577.

图/表 4

图1

表1

纳入研究的基本特征"

纳入研究	受试者特征				干预方案	持续时间/周	随访时间	结局指标	PEDro分	检验效能
纳入研究	n	性别(男/女)/n	年龄/岁	MS分型(EDSS)	干预方案	持续时间/周	随访时间	结局指标	PEDro分	检验效能
Ahmadi等^[32] (2013)	E1:10 E2:11 C:10	E1:0/10 E2:0/11 C:0/10	E1:36.8±9.2 E2:32.3±8.7 C:36.7±9.3	NR (1~4)	E1:有氧运动,30 min E2:其他(瑜伽),60~70 min 每周3次	8	NR	FSS	6	99%
Bahmani等^[33] (2019)	E1:26 E2:24 C:21	E1:0/26 E2:0/24 C:0/21	E1:37.9±8.7 E2:39.2±8.7 C:37.9±9.9	NR (< 6)	E1:有氧运动 E2:其他(协调) 30~45 min,每周3次	8	NR	FSS	8	55%
Brichetto等^[55] (2013)	E:18 C:18	E1:8/10 C:6/12	E1:40.7±11.5 C:43.2±10.6	NR (≤ 6)	其他(视频游戏) 60 min,每周3次	12	NR	MFIS	7	83%
Briken等^[24] (2014)	E1:10 E2:11 E3:11 C:10	E1:5/5 E2:4/7 E3:5/6 C:4/6	E1:49.1±8.5 E2:50.9±9.2 E3:48.8±6.8 C:50.4±7.6	SP/PP (4~6)	不同形式的有氧运动(上肢;划船;骑行) 15~45 min,每周2~3次	8~10	NR	MFIS	6	14%
Burschka等^[56] (2014)	E:15 C:17	E:5/10 C:5/12	E:42.6±9.4 C:43.6±8.0	RR/SP (< 5)	其他(太极) 90 min,每周1次	24	NR	FSMC	4	96%
Cakt等^[38] (2010)	E1:14 E2:10 C:9	E1:5/9 E2:2/8 C:3/6	E1: 36.4±10.5 E2: 43.0±10.2 C: 35.5±10.9	RR/SP (≤ 6)	不同形式的抗阻运动(功率自行车;居家徒手训练),30 min,每周2次	8	NR	FSS	6	6%
Callesen等^[35] (2020)	E1:23 E2:28 C:20	E1:7/16 E2:5/23 C:4/16	51~56	RR/SP/ PP (2~6.5)	E1:抗阻运动 E2:任务导向训练 60 min,每周2次	10	NR	MFIS	8	94%
Carter等^[39] (2014)	E:60 C:60	E:17/43 C:17/43	E:45.7±9.1 C:46.0±8.4	RR/SP/ PP (1~6.5)	混合运动 60 min,每周3次	12	6月	MFIS	8	63%
Castro-Sanchez等^[57](2012)	E:36 C:37	E:10/26 C:13/24	E:46.0±9.9 C:50±12.3	SP/PP (≤ 7.5)	其他(水中运动) 60 min,每周2次	20	10周	FSS	8	26%
Dalgas等^[36] (2010)	E:15 C:16	E:5/10 C:6/10	E:47.7±10.4 C:49.1±8.4	RR (3~5.5)	抗阻运动,每周2次	12	12周	FSS	6	13%
Dodd等^[37] (2011)	E:36 C:35	E:10/26 C:9/26	E:47.7±10.8 C:50.4±9.6	RR (NR)	抗阻运动 45 min,每周2次	10	12周	MFIS	8	34%
Eftekhari等^[58] (2018)	E:13 C:12	E:0/13 C:0/12	E:34.5±7.3 C:31.4±8.9	RR (2~6)	其他(普拉提) 50~60 min,每周3次	8	NR	MFIS	5	73%
Escudero-Uribe等^[40](2017)	E:30 C:18	E:11/19 C:4/14	E:43.1±10.2 C:43.0±9.3	RR (≤ 4.5)	混合运动 60~100 min,每周2次	12	NR	FSS	6	69%
Feys等^[52] (2017)	E:21 C:21	E:1/20 C:3/18	E:36.6±8.5 C:44.4±8.5	NR (NR)	任务导向训练(跑步5 km) 每周3次	12	NR	FSMC	5	19%
Garrett等^[49] (2013)	E1:63 E2:67 E3:63 C:49	E1:13/50 E2:22/45 E3:19/44 C:6/43	E1:51.7±10 E2:50.3±10 E3:49.6±10 C:48.8±11	RR/SP/ PP (NR)	E1/E2：混合运动 E3:其他(瑜伽) 60 min,每周3次	10	NR	MFIS	8	12%
Geddes等^[53] (2009)	E:8 C:4	E:2/6 C:1/3	E:40~64 C:22~50	RR/PP (≤ 6)	任务导向训练 20~30 min,每周3次	12	NR	FSS	5	5%
Heine等^[25] (2017)	E:43 C:46	E:11/32 C:13/33	E:43.1±9.8 C:48.2±9.2	RR/SP/ PP(≤ 6)	有氧运动 30 min,每周3次	16	10周	FSS	8	7%
Hebert等^[31] (2011)	E1:12 E2:13 C:13	E1:3/9 E2:2/11 C:2/11	E1: 46.8±10 E2: 42.6±10 C: 50.2±9.2	RR/SP (NR)	E1:其他(前庭),55 min E2:有氧运动,30 min 每周2次	6	4周	MFIS	8	51%
Hogan等^[34] (2014)	E1:48 E2:35 E3:13 C:15	E1:18/30 E2:15/20 E3:5/8 C:2/13	E1:57±10 E2:52±11 E3:58±8 C:49±6	RR/SP/ PP (NR)	E1/E2:抗阻运动, E3:其他(瑜伽) 60 min,每周1次	10	NR	MFIS	7	27%
Kalron等^[59] (2017)	E:22 C:23	E:8/14 C:8/15	E:42.9±7.2 C:44.4±6.6	RR (3~6)	其他(普拉提) 30 min,每周1次	12	NR	MFIS	7	6%
Kooshiar等^[60] (2015)	E:18 C:19	E:0/18 C:0/19	29.2±7.9	RR/SP (1~5.5)	其他(水中运动) 45 min,每周3次	8	NR	MFIS	5	51%
Learmonth等^[41] (2012)	E:20 C:12	E:5/15 C:4/8	E:51.4±8.0 C:51.8±8.0	NR (5~6.5)	混合运动 45~60 min,每周2次	12	NR	FSS	7	73%
Learmonth等^[42] (2017)	E:29 C:28	E:1/28 C:1/27	E:48.7±10.4 C:48.2±9.1	RR/SP (NR)	混合运动,每周2次	16	NR	FSS	6	52%
Mostert等^[27](2002)	E:13 C:13	E:3/10 C:2/11	E:45.2±8.6 C:43.9±13.9	RR/SP/ PR (1~6.5)	有氧运动 30 min,每周5次	4	NR	FSS	5	12%
Negahban等^[43] (2013)	E1:12 E2:12 C:12	E1:2/10 E2:2/10 C:2/10	E1:36.7±6.7 E2:36.7±7.6 C:36.8±8.7	RR/SP (2~6)	E1/E2:混合运动 30 min,每周3次	5	NR	FSS	7	49%
Oken等^[30] (2004)	E1:15 E2:22 C:20	E1:2/13 E2:2/20 C:0/20	E1:48.8±10.4 E2:49.8±7.4 C:48.4±9.8	NR (≤ 6)	E1:其他(瑜伽),90 min E2:有氧运动,60 min 每周1次	24	NR	POMS	6	79%
Ozdogar等^[50] (2020)	E1:21 E2:19 C:20	E1:5/16 E2:6/13 C:5/15	E1:39.2±8.6 E2:43.6±10.5 C:37.9±12.4	RR/SP (≤ 5)	E1:其他(视频游戏) E2:混合运动 45 min,每周1次	8	NR	MFIS	6	35%
Ozkul等^[44] (2018)	E:18 C:18	E:4/14 C:4/14	E:34.5±12.8 C:34.0±8.7	RR (< 5)	混合运动 90 min,每周3次	8	NR	FSS	6	99%
Ozkul等^[45] (2020)	E1:13 E2:13 C:13	E1:4/9 E2:2/11 C:3/10	E1:29.0±11.8 E2:34.0±14.8 C:34.0±7.8	RR (< 6)	混合运动 40~50 min,每周2次	8	NR	FSS	7	97%
Petajan等^[29] (1996)	E:21 C:25	E:6/15 C:9/16	E:41.1±9.2 C:39.0±8.5	NR (≤ 6)	有氧运动 50 min,每周3次	15	NR	POMS	5	6%
Razazian等^[61] (2016)	E1:18 E2:18 C:18	E1:0/18 E2:0/18 C:0/18	E1:33.3±7.4 E2:35.4±6.9 C:33.1±6.6	RR/SP/ PR (≤ 6)	E1:其他(瑜伽) E2:其他(水中运动) 60 min,每周3次	8	NR	FSS	8	100%
Sangelaji等^[46] (2014)	E:39 C:22	E:15/24 C:7/15	E:33.0±7.7 C:32.0±6.3	RR (≤ 4)	混合运动 90 min,每周3次	10	NR	FSS	4	11%
Schulz等^[28] (2004)	E:15 C:13	E:4/11 C:5/8	E:39±9 C:40±11	RR/SP/ PP(< 5)	有氧运动 30 min,每周2次	8	NR	MFIS	5	38%
Skjerbaek等^[26] (2014)	E:6 C:5	3/8	E:62.0±5.9 C:55.2±8.2	SP/PP (6.5~8)	有氧运动 3×6 min,每周2~3次	4	NR	FSMC	7	5%
Straudi等^[54] (2014)	E:12 C:12	E:5/7 C:2/10	E:49.9±7.5 C:55.2±13.8	RR/SP/ PP (4~5.5)	任务导向训练 120 min(含休息),每周5次	2	12周	FSS	7	56%
Sutherland等^[23] (2001)	E:11 C:11	E:5/6 C:5/6	E:47.2±4.7 C:45.4±5.0	NR (≤ 5)	有氧运动 45 min,每周3次	10	NR	POMS	6	9%
Tarakci等^[47] (2013)	E:51 C:48	E:17/34 C:18/30	E:41.5±9.4 C:39.6±11.2	RR/SP/ PP (2~6.5)	混合运动 60 min,每周3次	12	NR	FSS	7	100%
van den Berg等^[22] (2006)	E:8 C:8	E:1/7 C:1/7	30~65	NR (NR)	有氧运动 30 min,每周3次	4	5周	FSS	6	5%
Yazgan等^[62] (2020)	E1:15 E2:12 C:15	E1:2/13 E2:0/12 C:2/13	E1:47.5±10.5 E2:43.1±8.7 C:40.7±8.8	RR/SP/ PP/PR (2.5~6)	E1/E2:其他(视频游戏) 60 min,每周2次	8	NR	FSS	6	15%
Young等^[51] (2019)	E1:27 E2:26 C-28	E1:5/22 E2:6/20 C:4/24	E1:49.7±9.4 E2:48.4±9.9 C:47.3±10.3	NR (≤ 6)	E1:混合运动 E2:其他(瑜伽) 60 min,每周3次	12	NR	PRO MIS	8	27%
朱琳等^[48](2011)	E:19 C:10	E:8/11 C:4/6	E:42.9±16.9 C:44.7±10.9	NR (NR)	混合运动 30 min,每周3次	4	NR	FSS	5	31%

表1

表2

图2

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结局指标	降级因素					证据质量
结局指标	偏倚风险	不一致性	间接性	不精确性	发表偏倚	证据质量
总体效应	0	-1	0	0	0	+++-中
有氧	0	0	0	0	0	++++高
抗阻	0	0	0	-1	0	+++-中
混合	0	-1	0	0	0	+++-中
任务导向	0	0	-1	-1	0	++--低
其他	0	-1	-1	0	0	++--低

运动干预对多发性硬化患者疲劳症状影响的Meta分析

Effects of exercise intervention on fatigue for patients with multiple sclerosis: a meta-analysis

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