运动干预对帕金森病患者呼吸功能效果的Meta分析

doi:10.3969/j.issn.1006-9771.2025.11.007

摘要/Abstract

摘要：

目的系统评价运动干预对帕金森病患者呼吸功能和咳嗽能力、吞咽能力的影响，并比较不同运动干预类型的效果。

方法构建PICO架构，检索Web of Science、PubMed、Cochrane Library、Embase、中国知网、万方数据库、维普和中国生物医学文献数据库，纳入关于运动干预帕金森病患者呼吸功能的随机对照试验(RCT)，检索时限为建库至2025年7月25日。采用Cochrane手册5.1.0推荐的RCT偏倚风险评价工具和PEDro量表评估文献质量，采用Revman 5.3绘制偏倚风险图，采用Stata 17.0进行Meta分析。

结果最终纳入11篇RCT，涉及471例患者。PEDro量表评分5~8分。运动干预可以有效改善帕金森病患者的用力肺活量(FVC) (MD = 0.42, 95%CI 0.27~0.58, P < 0.001)、第1秒用力呼气容积(MD = 0.32, 95%CI 0.24~0.39, P < 0.001)、慢肺活量(MD = 0.80, 95%CI 0.68~0.93, P < 0.001)、最大吸气压力(MD = 11.53, 95%CI 7.45~15.60, P < 0.001)、最大呼气压力(MEP) (MD = 16.75, 95%CI 11.90~21.60, P < 0.001)、峰值呼气流量(MD = 55.77, 95%CI 49.87~61.66, P < 0.001)。呼吸肌训练(RMT)可以有效改善反射性咳嗽峰值流量(MD = 3.51, 95%CI 2.40~4.61, P < 0.001)、自主咳嗽峰值流量(MD = 3.09, 95%CI 2.12~4.06, P < 0.001)。亚组分析显示，在改善MEP方面，RMT优于非通气特异性运动(NVS) (P < 0.05)；在改善FVC方面，NVS优于RMT (P < 0.05)。

结论运动干预能有效改善帕金森病患者的呼吸功能，NVS在改善肺功能方面效果更好，RMT可以改善咳嗽能力，且在改善呼吸肌力方面效果更明显。

关键词: 帕金森病, 运动, 呼吸功能, Meta分析

Abstract:

Objective To systematically evaluate the effect of exercise interventions on respiratory function, cough ability and swallowing function in patients with Parkinson's disease, and to compare the efficacy of different types of exercise interventions.

Methods After constructing a PICO framework, randomized controlled trials (RCT) investigating the effects of exercise on respiratory function in Parkinson's disease were retrieved from Web of Science, PubMed, Cochrane Library, Embase, CNKI, Wanfang Data, VIP and CBM databases from the establishment of the databases to July 25th, 2025. The risk of bias was assessed using the Cochrane Risk of Bias tool 5.1.0 and PEDro scale. RevMan 5.3 was used to create risk of bias graphs, and Stata 17.0 was used for meta-analysis.

Results A total of eleven RCT involving 471 patients were included, with PEDro scale score of five to eight. Exercise interventions significantly improved forced vital capacity (FVC) (MD = 0.42, 95%CI 0.27 to 0.58, P < 0.001), forced expiratory volume in first second (MD = 0.32, 95%CI 0.24 to 0.39, P< 0.001), slow vital capacity (MD = 0.80, 95%CI 0.68 to 0.93, P < 0.001), maximal inspiratory pressure (MD = 11.53, 95%CI 7.45 to 15.60, P < 0.001), maximal expiratory pressure (MEP) (MD = 16.75, 95%CI 11.90 to 21.60, P < 0.001), and peak expiratory flow (MD = 55.77, 95%CI 49.87 to 61.66, P < 0.001) in patients with Parkinson's disease. Respiratory muscle training (RMT) significantly improved reflex peak cough flow (MD = 3.51, 95% CI 2.40 to 4.61, P < 0.001) and voluntary peak cough flow (MD = 3.09, 95% CI 2.12 to 4.06, P < 0.001). Subgroup analysis revealed that RMT was superior to non-ventilatory specific exercise (NVS) in improving MEP (P < 0.05), whereas NVS was superior to RMT in improving FVC (P < 0.05).

Conclusion Exercise interventions can effectively improve respiratory function in patients with Parkinson's disease. NVS shows better efficacy in improving pulmonary function, while RMT can enhance cough ability, with more significant effect on respiratory muscle strength.

Key words: Parkinson's disease, exercise, respiratory function, meta-analysis

中图分类号:

R473.74

毛涛, 游茂林. 运动干预对帕金森病患者呼吸功能效果的Meta分析[J]. 《中国康复理论与实践》, 2025, 31(11): 1303-1313.

MAO Tao, YOU Maolin. Effect of exercise on respiratory function in Parkinson's disease: a meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(11): 1303-1313.

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纳入文献基本特征"

纳入文献	国家	受试者特征				干预方式	干预参数	结局指标
纳入文献	国家	n	性别(男/女)/n	年龄/岁	病程/年	干预方式	干预参数	结局指标
姜佳慧等^[23](2023)	中国	T:20 C:20	T:8/12 C:13/7	T:60.60±6.75 C:59.45±5.45	T:4.30±1.38 C:3.85±1.35	T:易筋经 C:常规治疗	每次30 min，每周5次，共8周	①
范杰诚等^[25](2021)	中国	T:30 C:30	T:21/9 C:22/8	T:65.35±4.12 C:66.22±3.67	T:4.62±1.31 C:4.74±1.47	T:腹式呼吸+吸气肌训练 C:常规康复训练	每周5次，共24周	①②③
王洁萍等^[24](2022)	中国	T:30 C:30	T:15/15 C:13/17	T:61.98±3.71 C:63.25±2.47	T:3.15±2.03 C:3.26±1.89	T:肢体协调训练 C:常规治疗	每次40 min，每周5次，共12周	①②④⑤⑥⑦
华玲等^[26](2023)	中国	T:24 C:24	T:11/13 C:14/10	T:73.33±7.49 C:71.67±8.82	T:5.96±3.66 C:5.83±4.57	T:吸气肌训练 C:常规康复训练	每周5次，共8周	⑤
厉坤鹏等^[27](2021)	中国	T:30 C:30	T:16/14 C:17/13	T:65.53±9.43 C:63.17±5.78	T:8.11±2.23 C:8.29±2.19	T:呼吸训练 C:常规康复	每周5次，共4周	①②
Yin等^[28](2025)	中国	T:25 C:26	T:12/13 C:12/14	T:58.80±8.61 C:58.15±7.09	T:6.05±3.07 C:6.15±4.47	T:六字诀 C:常规训练	每次30 min，每周5次，共12周	①②③⑤⑥⑦
Alves等^[29](2019)	巴西	T:12 C:16	— —	T:64.08±6.87 C:67.13±8.20	T:6.42±2.71 C:4.50±4.07	T:抗阻运动 C:常规治疗	每次30~40 min，每周2次，共16周	⑤⑥⑦
Reyes等^[30](2018)	智利	T1:10 T2:11 C:10	T1:7/3 T2:6/5 C:4/6	T1:70.40±6.81 T2:70.45±8.16 C:70.20±6.69	—	T1:呼气肌训练 T2:吸气肌训练 C:假呼气肌训练	每周6次，共2个月	①④⑤⑥⑧⑨
Sapienza等^[31](2011)^a	美国	T:30 C:30	T:25/5 C:22/8	T:66.73±8.90 C:68.50±10.31	—	T:呼气肌训练 C:假呼气肌训练	每次20 min，每周5次，共4周	①②③⑥⑦
Troche等^[32](2010)^a	美国	T:30 C:30	T:25/5 C:22/8	T:66.73±8.90 C:68.50±10.31	—	T:呼气肌训练 C:假呼气肌训练	每次20 min，每周5次，共4周	⑩
Reyes等^[33](2020)	智利	T1:11 T2:11 C:11	T1:6/5 T2:7/4 C:5/6	T1:65.81±7.35 T2:69.81±6.75 C:70.45±6.40	—	T1:呼气肌训练+空气叠加 T2:呼气肌训练 C:假呼气肌训练	每周6次，共2个月	④⑤⑥⑧⑨

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人群(Population)	干预(Intervention)	比较(Comparison)	结局(Outcome)
帕金森病患者	干预方式	与对照组比较	FVC、FEV₁、FEV₁/FVC、SVC、MIP、MEP、PEF、v-PCF、r-PCF、渗透误吸量表
	RMT	不同运动干预方式比较	FVC、FEV₁、FEV₁/FVC、SVC、MIP、MEP、PEF、v-PCF、r-PCF、渗透误吸量表
	NVS

纳入文献	纳入条件明确	随机分配	分配隐藏	基线指标相似	受试者设盲	评定者设盲	85%以上受试者完成试验	意向性治疗分析	组间统计结果比较	点测量和差异值	总分	质量
姜佳慧等^[23](2023)	√	√		√		√	√		√	√	6	高
范杰诚等^[25](2021)	√	√		√		√	√		√	√	6	高
王洁萍等^[24](2022)	√	√		√			√		√	√	5	中
华玲等^[26](2023)	√	√		√		√	√		√	√	6	高
厉坤鹏等^[27](2021)	√	√		√		√	√		√	√	6	高
Yin等^[28](2025)	√	√		√		√			√	√	5	中
Alves等^[29](2019)	√	√		√		√	√		√	√	6	高
Reyes等^[30](2018)	√	√	√	√	√				√	√	6	高
Sapienza等^[31](2011)	√	√		√	√	√	√		√	√	7	高
Troche等^[32](2010)	√	√		√	√	√	√	√	√	√	8	高
Reyes等^[33](2020)	√	√		√	√		√		√	√	6	高

结局指标	纳入研究数/n	异质性检验		效应模型	Meta分析
结局指标	纳入研究数/n	P值	I²值	效应模型	MD (95%CI)	P值
FVC	7	0.026	55.90%	随机	0.42(0.27~0.58)	< 0.001
FEV₁	5	0.501	0%	固定	0.32(0.24~0.39)	< 0.001
FEV₁/FVC	3	0.056	65.30%	随机	0.17(-3.35~3.70)	0.923
SVC	3	0.272	22.30%	固定	0.80(0.68~0.93)	< 0.001
MIP	6	0.892	0%	固定	11.53(7.45~15.60)	< 0.001
MEP	6	0.138	36.40%	固定	16.75(11.90~21.60)	< 0.001
PEF	4	0.781	0%	固定	55.77(49.87~61.66)	< 0.001
v-PCF	2	0.648	0%	固定	3.09(2.12~4.06)	< 0.001
r-PCF	2	0.305	17.30%	固定	3.51(2.40~4.61)	< 0.001

结局指标	运动类型	纳入研究数/n	异质性检验		Meta分析		组间效应量差异/P值
结局指标	运动类型	纳入研究数/n	I²值	P值	MD (95%CI)	P值	组间效应量差异/P值
FVC	NVS	3	45.10%	0.162	0.57(0.39~0.75)	< 0.001	0.013
	RMT	4	0%	0.705	0.30(0.18~0.42)	< 0.001	0.013
FEV₁	NVS	2	0%	0.691	0.34(0.26~0.43)	< 0.001	0.232
	RMT	3	0%	0.414	0.24(0.10~0.38)	0.001	0.232
FEV₁/FVC	NVS	1	—	—	-3.00(-6.89~0.89)	0.131	0.113
	RMT	2	64.0%	0.096	1.63(-2.57~5.83)	0.448	0.113
SVC	NVS	1	—	—	0.83(0.70~0.96)	< 0.001	0.103
	RMT	2	0%	0.478	0.42(-0.06~0.90)	0.084	0.103
MIP	NVS	3	14.30%	0.311	11.02(5.22~16.81)	< 0.001	0.843
	RMT	3	0%	0.967	11.94(4.83~19.06)	0.001	0.843
MEP	NVS	3	0%	0.855	13.52(8.19~18.84)	< 0.001	0.004
	RMT	3	0%	0.661	32.43(20.70~44.16)	< 0.001	0.004
PEF	NVS	3	0%	0.584	55.79(49.86~61.72)	< 0.001	0.932
	RMT	1	—	—	53.40(-1.10~107.90)	0.055	0.932