太极拳与其他运动降低老年人跌倒风险的Meta分析

doi:10.3969/j.issn.1006-9771.2022.10.007

摘要/Abstract

摘要：

目的系统评价太极拳练习对降低老年人跌倒发生率、提高平衡能力和减少跌倒恐惧感的效果是否优于其他运动干预。

方法检索PubMed、EMBASE、Web of Science、The Cochrane Library、中国知网、万方数据库和维普数据库中太极拳练习干预老年人跌倒相关的文献,检索时限均为建库至2021年9月。由两名研究者独立筛选文献、提取资料并评价文献质量后,采用Review Manager 5.3软件进行Meta分析。

结果共纳入12篇随机对照试验,包括1 345例健康老年人。太极拳练习后跌倒发生率低于其他运动干预(RR = 0.54, 95%CI 0.42~0.68, P < 0.001)。关于跌倒危险因素的相关指标,太极拳练习者单腿站立时间(MD = 9.57, 95%CI 6.19~ 12.94, P < 0.001)、功能性伸展距离(MD = 2.16, 95%CI 1.31~3.01, P < 0.001)均优于其他运动干预。而太极拳练习对跌倒恐惧感、计时“起立-行走”测试时间的改善与其他运动干预方式相比无显著性差异(P > 0.05)。

结论太极拳练习在降低老年人跌倒率、提高静态平衡能力方面比其他运动干预方式更有优势,但没有足够的证据表明太极拳练习更能减少跌倒恐惧感,提高动态平衡能力。

关键词: 太极拳, 跌倒, 老年人, 平衡, Meta分析

Abstract:

Objective To systematically evaluate whether Tai Chi exercise is more effective than other exercise interventions in reducing the incidence of falls, improving the balance ability and reducing the fear of falls in older adults.

Methods Literatures about Tai Chi exercise for older healthy adults in PubMed, EMBASE, Web of Science, the Cochrane Library, CNKI, Wanfang database and VIP database were searched from establishment to September, 2021. After literature screening, data extraction and literature quality evaluation independently were conducted by two investigators, meta-analyses were performed using Review Manager 5.3.

Results A total of twelve randomized controlled trials including 1 366 elderly patients were included in the analysis. Compared with other ecercise intervention, Tai Chi exercise reduced the rate of falls among older adults (RR = 0.54, 95%CI 0.42 to 0.68, P< 0.001). Tai Chi exercise was superior to other ecercise intervention in terms of single leg standing time (MD = 9.57, 95%CI 6.19 to 12.94, P< 0.001) and functional reach distance (MD = 2.16, 95%CI 1.31 to 3.01, P< 0.00001). However, there was no significant difference in the improvement of fear of falling, Timed 'Up and Go' Test between Tai Chi exercise and other ecercise intervention modalities (P> 0.05).

Conclusion Tai Chi exercise is more advantageous than other ecercise intervention modalities in reducing the rate of falls and improving static balance ability among older adults, however, there is insufficient evidence that Tai Chi exercise is more effective in reducing fear of falling and improving dynamic balance ability.

Key words: Tai Chi, accidental falls, aged, balance, meta-analysis

中图分类号:

R592

李欣欣,刘卉,马沐佳. 太极拳与其他运动降低老年人跌倒风险的Meta分析[J]. 《中国康复理论与实践》, 2022, 28(10): 1169-1177.

LI Xinxin,LIU Hui,MA Mujia. Reduction of risk of fall for aging adults participating in Tai Chi and other exercises: a meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(10): 1169-1177.

图/表 9

图1

表1

纳入文献的基本特征"

纳入研究	国家	组别	年龄/岁	n(女性)	干预措施	干预时间	干预频率	随访时间	结局指标
Son等^[2](2016)	韩国	对照组	71.5±3.6	24(24)	奥塔戈(平衡再训练和下肢力量训练)	12周	每次60 min,每周2次	6个月	SLS、TUG、FR
Son等^[2](2016)		试验组	72.8±4.7	21(21)	21式改良孙式太极拳	12周	每次60 min,每周2次	6个月	SLS、TUG、FR
Li等^[3](2004)	美国	对照组	77.4±4.95	131	拉伸控制训练	6个月	每次60 min,每周3次	6个月	跌倒发生
Li等^[3](2004)		试验组	77.4±4.95	125	杨式太极拳24式	6个月	每次60 min,每周3次	6个月	跌倒发生
Wolf等^[4](2003)	美国	对照组	76.3±75.1	64(49)	计算机平衡训练	15周	每次45 min,每周1次	4个月	跌倒发生
Wolf等^[4](2003)		试验组	76.9±74.8	72(58)	太极拳	15周	每次45 min,每周2次	4个月	跌倒发生
Kim等^[5](2020)	韩国	对照组	71.2±3.6	23(23)	跆拳道	12周	每次60 min,每周3次	12周	SLS、FR、TUG
Kim等^[5](2020)		试验组	70.4±4.5	23(23)	21式改良孙式太极拳	12周	每次60 min,每周2次	12周	SLS、FR、TUG
Li等^[12](2005)	美国	对照组	77.4±4.95	131	拉伸控制训练	6个月	每次60 min,每周3次	6个月	FES-I
Li等^[12](2005)		试验组	77.4±4.95	125	杨式太极拳24式	6个月	每次60 min,每周3次	6个月	FES-I
Yildirim等^[16](2016)	土耳其	对照组	64.4±7.5	30(26)	联合运动处方(步行、下肢肌肉力量和拉伸锻炼)	12周	每次60 min,每周3次	12周	TUG
Yildirim等^[16](2016)		试验组	62.9±6.5	30(27)	杨式太极拳12式	12周	每次60 min,每周3次	12周	TUG
Pluchino等^[18](2012)	美国	对照组1	76.00±7.74	14(9)	标准化平衡练习计划	8周	每次60 min,每周2次	8周	FES、FR、TUG、SLS
		对照组2	70.72±8.46	12(8)	Wii Fit游戏(瑜伽、力量训练、有氧运动和平衡游戏)	8周	每次60 min,每周2次	8周
		试验组	69.28±6.03	14(8)	孙式太极拳	8周	每次60 min,每周2次	8周
Ni等^[19](2014)	美国	对照组1	77.80±7.78	15(13)	标准平衡项目	12周	每次60 min,每周2次	3个月	SLS、FR
		对照组2	73.23±5.09	13(10)	瑜伽	12周	每次60 min,每周2次	3个月
		试验组	70.27±5.69	11(9)	陈式太极拳	12周	每次60 min,每周2次	3个月
Hwang等^[20](2016)	中国	对照组	72.7±8.1	175(151)	下肢训练(拉伸、肌肉强化和平衡训练)	6个月	每次60 min,每周1次	12个月	跌倒发生、FES-I
Hwang等^[20](2016)	中国	试验组	72.0±8.1	182(153)	杨式太极拳18式	6个月	每次60 min,每周1次	12个月	跌倒发生、FES-I
Zhao等^[21](2016)	中国	对照组	68.8±3.0	20(13)	平衡改善练习计划	16周	每次90 min,每周3次	24周	FES-I
Zhao等^[21](2016)		试验组	70.2±3.9	20(14)	杨式太极拳8式	16周	每次90 min,每周3次	24周	FES-I
Zhao等^[22](2017)	中国	对照组	68.8±3.0	20(13)	平衡改善练习计划	16周	每次90 min,每周3次	24周	TUG
Zhao等^[22](2017)		试验组	70.2±3.9	20(14)	杨式太极拳8式	16周	每次90 min,每周3次	24周	TUG
Li^[23](2021)	美国	对照组	76.20±6.3	15(12)	伸展控制训练	24周	每次60 min,每周3次	24周	跌倒发生、TUG
Li^[23](2021)		试验组	76.13±6.2	15(9)	太极拳	24周	每次60 min,每周3次	24周	跌倒发生、TUG

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