《中国康复理论与实践》

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (9): 993-1002.doi: 10.3969/j.issn.1006-9771.2022.09.001

• 专题 身体活动与运动康复 • 上一篇    下一篇

基于WHO-FICs架构智力残疾儿童青少年身体活动与运动康复的健康结局：系统综述的系统综述

刘辉1,2,3,杨剑4,5(),曹航6,贾绍辉1,2   

  1. 1.武汉体育学院健康科学学院,湖北武汉市 430079
    2.武汉体育学院运动训练监控湖北省重点实验室,湖北武汉市 430079
    3.武汉体育学院运动与健康创新发展研究中心,湖北武汉市 430079
    4.华东师范大学青少年健康评价与运动干预教育部重点实验室,上海市 200241
    5.华东师范大学体育与健康学院,上海市 200241
    6.武汉体育学院研究生院,湖北武汉市 430079
  • 收稿日期:2022-08-24 修回日期:2022-08-29 出版日期:2022-09-25 发布日期:2022-10-08
  • 通讯作者: 杨剑 E-mail:yangjianxz@sina.com
  • 作者简介:刘辉(1980-),男,汉族,湖北黄石市人,硕士,讲师,主要研究方向：青少年体质健康促进、适应性体育、ICF。|杨剑(1970-),男,汉族,江苏徐州市人,博士,教授,世界卫生组织国际分类家族合作中心专家委员,主要研究方向：儿童青少年体育与健康、儿童青少年健康、ICF、康复科学、健康心理学、锻炼心理学、康复心理学、残疾研究。
  • 基金资助:
    "十四五"湖北省高等学校优势特色学科(群)项目(2021-5);武汉体育学院中青年科研创新团队项目(21KT14);上海高校"立德树人"人文社会科学重点研究基地子项目(1100-41222-16057);青少年体育教育研究上海市社会科学创新研究基地子项目(11001-412321-17006);华东师范大学青少年运动促进健康研究院子项目

Physical activity and exercise rehabilitation for children with intellectual disabilitiy: a systematic review of systematic reviews

LIU Hui1,2,3,YANG Jian4,5(),CAO Hang6,JIA Shaohui1,2   

  1. 1. College of Health Science, Wuhan Sports University, Wuhan, Hubei 430079, China
    2. Hubei Key Laboratory of Exercise Training and Monitoring, Wuhan Sports University, Wuhan, Hubei 430079, China
    3. Research Center for Sports and Health Innovation and Development, Wuhan Sports University, Wuhan, Hubei 430079, China
    4. Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai 200241, China
    5. College of Physical Education and Health, East China Normal University, Shanghai 200241, China
    6. Graduate School, Wuhan Sports University, Wuhan, Hubei 430079, China
  • Received:2022-08-24 Revised:2022-08-29 Published:2022-09-25 Online:2022-10-08
  • Contact: YANG Jian E-mail:yangjianxz@sina.com
  • Supported by:
    14th Five-Year-Plan Advantageous and Characteristic Disciplines (Groups) of Colleges and Universities in Hubei(2021-5);Wuhan Sports University Young and Middle-Aged Scientific Research and Innovation Team Project(21KT14);Shanghai University "Strengthening Morality" Humanities and Social Sciences Key Research Base Sub-project(1100-41222-16057);Adolescents Physical Education Research Shanghai Social Science Innovation Research Base Sub-project(11001-412321-17006);East China Normal University Adolescents Sports and Health Promotion Research Institute Sub-project

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摘要：

目的 基于世界卫生组织国际分类家族(WHO-FICs)构建智力残疾儿童青少年参与身体活动和运动康复的健康和功能结局的研究架构,系统分析智力残疾儿童青少年的主要健康与功能障碍表现、参与身体活动的方案以及健康和功能结局。
方法 运用《国际疾病分类第十一次修订本》(ICD-11)和《国际功能、残疾和健康分类》(ICF),对智力残疾儿童青少年身体活动干预方案以及健康与功能结局进行系统分析,构建智力残疾儿童青少年健康与功能状况、身体活动干预方案以及健康与功能结局架构。检索Scopus、PubMed、Embase、Web of Science、中国知网、维普、万方数据,收集建库至2022年8月18日公开发表的智力残疾儿童青少年参与身体活动与运动康复的健康及功能结局的系统综述,进行系统综述。
结果 最终纳入系统综述8篇,来自5个国家,包括190项随机对照试验和7 011例参与者,研究领域主要涉及智力障碍、儿童神经病学、康复科学、残疾与健康、适应性体育、特殊教育等,发表时间集中在2018年至2022年。常见的健康状况主要有唐氏综合征、孤独症谱系障碍、脆性X综合征、Prade-Willi综合征、智力障碍、认知障碍;身体活动干预形式分为体适能类、技能类和活动类3类,活动频率每周1~5次,活动强度为中-高强度,持续时间1周~1.5年;健康结局体现在智力功能和适应性行为、身体活动、心理行为健康与社会适应、整体生活质量和福祉方面。
结论 基于WHO-FICs构建了智力残疾儿童青少年参与身体活动和运动康复的健康效果的理论架构。智力残疾儿童青少年主要功能障碍表现为智力功能和适应性行为、活动和心理健康、生活质量和福祉3个层面。其中智力功能和适应性行为层面涉及概念性技能、社交性技能和实践性技能,活动和参与层面表现为低体育活动参与度、久坐和肥胖,活动能力低,没有发展基本运动能力和身体素质。生活质量和福祉层面涉及情绪和情感、自尊、一般自我概念、幸福感、友谊、与他人的关系或社会成熟度、生活质量和福祉等。身体活动方式可以分为体适能类、技能类和运动项目类。主要健康和功能结局主要表现在三个领域：智力功能与适应性行为,活动和参与以及心理行为健康与社会适应、生活质量和福祉。在智力功能和适应性行为领域,主要健康结局涉及认知功能(执行功能、认知可塑性、工作记忆等)、心理功能(情绪自我控制、自我价值和自尊)。在活动和参与领域,主要健康结局涉及体适能(肌力和肌耐力、速度、灵敏性)和动作技能(基本动作技能、平衡、核心稳定性),提高体育活动参与度,促进其更好地适应与赋能(社交、亲社会行为等),达成健康目标(降低疾病风险、缓解焦虑和抑郁、肥胖管理)。在心理行为健康与社会适应、生活质量和福祉领域,参与身体活动与运动康复可以提升儿童青少年整体的生活质量和福祉。

关键词: 智力残疾, 身体活动, 运动康复, 世界卫生组织国际分类家族, 系统综述

Abstract:

Objective To construct a research framework on the health and functional outcomes of children with intellectual disability participating in physical activities using World Health Organization Family of International Classifications (WHO-FICs), and systematically analyze the main health and functional impairment manifestations, interventions of physical activity, and health and functional outcomes of children and adolescents with intellectual disability.
Methods International Classification of Diseases, Eleventh Revision (ICD-11), and International Classification of Functioning, Disability and Health (ICF) were used to systematically analyze physical activity intervention programs for children and adolescents with intellectual disability, and health and functional outcomes, to develop a structure of health and functional status, physical activity intervention programs, and health and functional outcomes. Systematic reviews about physical activity, and health and functional outcomes of children and adolescents with intellectual disability were retrieved from Scopus, PubMed, Embase, Web of Science, CNKI, VIP and Wanfang Data, from establishment to August 18th, 2022, and a systematic review of systematic reviews was conducted.
Results Eight systematic reviews were finally included, from five countries, included a total of 190 randomized controlled trials and 7 011 participants, in the fields of intellectual disability, child neurology, rehabilitation sciences, disability and health, adaptive physical education, and special education, which mainly published from 2018 to 2022. The main common health conditions were Down syndrome, autism spectrum disorder, fragile X syndrome, Prader-Willi syndrome, intellectual disability and cognitive impairment. Physical activity interventions mainly involved physical fitness, skills, and activities, with the frequency of one to five times a week, moderate to high intensity, and duration of one week to 1.5 years. The health outcomes mainly involved in three aspects: intellectual function and adaptive behavior, physical activity, and psycho-behavioral health and social adaptation, overall quality of life and well-being.
Conclusion A conceptual framework for the health outcomes of physical activity and exercise rehabilitation for children and adolescents with intellectual disability has been constructed based on WHO-FICs. The main functioning of children and adolescents with intellectual disability are manifested at three levels: intellectual functioning and adaptive behavior, activity and participation, and mental health, quality of life and well-being, where limitations of intellectual functioning and adaptive behavior involve conceptual, social and practical skills; and low physical activity participation, sedentary and obesity, low mobility, and failure to develop basic motor skills and physical fitness at the level of activity and participation; for the quality of life and well-being, limitations involve mood and emotion, self-esteem, general self-concept, well-being, friendships, relationships with others or social maturity, and quality of life and well-being. Intervention programs of physical activity can be divided into physical fitness, skills and sports. The primary health and functional outcomes are synthesized in three main domains, namely intellectual functioning and adaptive behavior, activity and participation, and mental health, quality of life and well-being. In the intellectual functioning and adaptive behavior domain, the primary health outcomes involved cognitive functioning (executive functioning, cognitive plasticity, working memory, etc.) and psychological functioning (emotional self-control, self-worth, and self-esteem). In the activity and participation domain, physical activity contributes to the development of physical fitness (muscle strength and endurance, speed, agility) and motor skills (basic motor skills, balance, core stability), to increase the participation in physical activity, promote better adaptation and empowerment (socialization, prosocial behavior), and to achieve the health goals (reduction of disease risk, anxiety and depression, and management of obesity). In the domain of psycho-behavioral health and social adaptation, quality of life, and well-being, physical activity and exercise rehabilitation can improve overall quality of life and well-being.

Key words: intellectual disability, physical activity, exercise rehabilitation, World Health Organization Family of International Classifications, systematic review

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