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

Abstract

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

CLC Number:

R744.5

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.

Figures/Tables 4

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%

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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

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

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