运动干预对帕金森病冻结步态效果的Meta分析

doi:10.3969/j.issn.1006-9771.2025.07.005

Abstract

Abstract:

Objective To evaluate the effect of exercise on freezing of gait in Parkinson's disease.

Methods After constructing a PICO framework, randomized controlled trials (RCTs) about exercise for freezing of gait in Parkinson's disease were systematically retrieved from Web of Science, PubMed, Cochrane Library, Embase, CNKI, VIP and Wanfang Data, from the establishment of the databases to March, 2025. The PEDro scale was used to evaluate the quality of literature, Stata 17.0 was used for meta-analysis, and GRADE was used to assess the evidence quality.

Results A total of twelve RCTs involving 463 patients were included, with PEDro scale scores of five to eight. Exercise improved the scores of Freezing of Gait Questionnaire (FOGQ) (SMD = -0.61, 95%CI -0.85~-0.36, P< 0.001) and Unified Parkinson's Disease Rating Scale Ⅲ (UPDRSⅢ) (SMD = -0.84, 95%CI -1.27~-0.41, P< 0.001). Subgroup analysis revealed that the patients aged 59 to 68 years, the course of disease < six years, and male might get more benefit from exercise; exercise more than 30 minutes a time, more than three times a week, and lasting eight weeks or more might be better; and walking training alone might do less. GRADE was moderate for FOGQ, and low for UPDRSⅢ.

Conclusion Exercise may relieve freezing of gait in Parkinson's disease, especially for male, younger people and people with shorter course of disease. Long term exercise (more than eight weeks), long session duration (more than 30 minutes) and high frequencies (more than three times a week), and mulit-strategy were recommended.

Key words: Parkinson's disease, exercise, freezing of gait, meta-analysis

CLC Number:

R473.74

DU Wenqian, ZHANG Xu, CHEN Jiwei, WANG Xing, ZHU Kun. Effect of exercise on freezing of gait in Parkinson's disease: a meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(7): 781-789.

Figures/Tables 7

Table 1

Figure 1

Table 2

Table 3

Basic information of the included literatures"

纳入文献	n		性别(男/女)/n		年龄/岁		诊断标准	病程/年		运动方式		干预参数	结局指标	不良事件
纳入文献	T	C	T	C	T	C	诊断标准	T	C	T	C	干预参数	结局指标	不良事件
Hackney等^[28](2009)	T1：14 T2：17	17	T1：11/3 T2：11/6	12/5	T1：68.2±1.4 T2：66.8±2.4	66.5±2.8	Hoehn-Yahr 1~3	T1：9.2±1.5 T2：6.9±1.3	5.9±1.0	T1：华尔兹和狐步舞 T2：阿根廷探戈	B	每次60 min，每周2次，共13周	①	-
Allen等^[29](2010)	24	24	13/11	13/11	66±10	68±7	临床诊断	7±5	9±6	渐进性下肢力量和平衡	A	每次40~60 min，每周3次，共24周	①	关节疼痛
李学等^[30](2016)	T1：14 T2：14	14	T1：7/7 T2：8/6	8/6	T1：67.6±5.6 T2：64.0±5.9	65.6±6.1	临床诊断	T1：7.5±4.2 T2：6.8±4	7.3±3.7	T1：音乐联合运动 T2：行走	A	每次15 min，每周5次，共8周	①②	-
Santos等^[31](2017)	11	11	5/6	4/7	73.0±9.81	78.09±5.24	Hoehn-Yahr 1~3	10.7±4.14	10.9±3.2	平衡	A	每次23 min，每周2次，共6周	①	-
Carroll等^[32](2017)	10	8	7/3	5/3	69.68±3.44	72.5±8.93	临床诊断	7.55±7.74	9.28±8.26	水疗	A	每次45 min，每周2次，共6周	①	-
Hubble等^[33](2018)	11	11	7/4	8/3	67.5±5.8	63.3±4.9	Hoehn-Yahr 1.5~3	6.5±5.2	7±5	耐力和平衡	A	每次90 min，每周1次，共12周	①	-
Van Puymbroeck等^[34](2018)	15	12	10/5	7/5	65.53±6.09	70.5±4.44	Hoehn-Yahr 1.5~3	-		瑜伽	B	每周2次，共8周	①	-
Medijainen等^[35](2019)	12	12	5/7	5/7	71.1±4.2	69.9±5.1	Hoehn-Yahr	8.0±6.9	7.7±5.4	综合训练	B	每次60 min，每周2次，共10周	①	-
Gryfe等^[36](2022)	14	13	7/7	10/3	70.7±7.3	69.3±8.0	Hoehn-Yahr 1~4	-		综合训练	B	每次60 min，每周2次，共8周	①	跌倒
Li等^[37](2022)	T1：23 T2：23	24	T1：11/12 T2：12/11	11/13	T1：64.09±11.65 T2：65.0±8.72	61.58±10.7	Hoehn-Yahr 2~3	T1：3.6±0.95 T2：3.74±0.78	3.42±0.86	T1：音乐联合运动 T2：行走	A	每次30 min，每周5次，共4周	①②	-
Mehta等^[38](2024)	T1：20 T2：20	15	T1：12/8 T2：12/8	9/6	T1：59.45±9.37 T2：59.35±8.13	62.13±8.2	Hoehn-Yahr 1~2.5	T1：3.26±0.97 T2：3.26±0.97	3.1±0.9	T1：音乐联合运动 T2：PNF模拟舞蹈	B	每次60 min，每周5次，共12周	①	跌倒
Fang等^[39](2024)	32	28	18/14	15/13	66.8±7.56	67.14±7.35	Hoehn-Yahr 2~3	5.57±1.63	5.69±1.68	综合训练	A	每周2次，共12周	①②	-

Table 3

Table 4

Table 5

Table 6

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纳入文献	明确的纳入与排除标准	随机分配	分配隐藏	基线相似	研究对象施盲	治疗师施盲	结果评估施盲	退出率<15%	意向治疗分析	组间统计结果分析	点测量和差异值	总分
Hackney等^[28](2009)	√	√		√			√			√	√	5
Allen等^[29](2010)	√	√	√	√			√	√	√	√	√	8
李学等^[30](2016)	√	√		√				√	√	√	√	6
Santos等^[31](2017)	√	√		√		√		√		√	√	6
Carroll等^[32](2017)	√	√	√	√	√			√	√	√	√	8
Hubble等^[33](2018)	√	√	√	√			√	√	√	√	√	8
Van Puymbroeck等^[34](2018)	√	√	√	√			√	√		√	√	7
Medijainen等^[35](2019)	√	√		√			√	√	√	√	√	7
Gryfe等^[36](2022)	√	√	√	√				√	√	√	√	7
Li等^[37](2022)	√	√	√	√			√	√		√	√	7
Mehta等^[38](2024)	√	√	√	√			√			√	√	6
Fang等^[39](2024)	√	√		√				√	√	√	√	6

结局指标	纳入研究数/n	异质性检验		Meta分析		效应模型
结局指标	纳入研究数/n	P值	I²值	SMD (95%CI)	P值	效应模型
FOGQ	12^[28-39]	0.02	47.55%	-0.61(-0.85~-0.36)	< 0.001	随机
UPDRSⅢ	3^[30,37,39]	0.06	54.93%	-0.84(-1.27~-0.41)	< 0.001	随机

亚组		纳入研究数/n	异质性检验		Meta分析
亚组		纳入研究数/n	P值	I²值	Z值	SMD (95%CI)	P值
年龄	59~68岁	7^{[28-30,33,37-39]}	< 0.001	55.82%	-5.91	-0.76(-1.02~-0.51)	< 0.001
年龄	69~78岁	4^{[31-32,35-36]}	0.90	0.00	-1.56	-0.33(-0.74~0.08)	0.12
性别	男性较多	9^{[28-30,32-34,36,38-39]}	< 0.001	56.99%	-4.85	-0.70(-0.99~-0.42)	< 0.001
性别	女性较多	2^[31,35]	0.58	0.00	-1.44	-0.44(-1.04~0.16)	0.15
病程	≤ 6年	3^[37-39]	< 0.001	67.60%	-4.93	-0.97(-1.35~-0.58)	< 0.001
病程	> 6年	7^[28-33,35]	0.70	0.00	-3.12	-0.41(-0.66~-0.15)	< 0.001
干预周期	≤ 8周	6^{[30-32,34,36-37]}	0.52	5.95%	-4.72	-0.50 (-0.71~0.29)	< 0.001
干预周期	> 8周	6^{[28-29,33,35,38-39]}	< 0.001	68.06%	-4.26	-0.89(-1.30~-0.48)	< 0.001
单次干预时间	≤ 30 min	4^[30-32,37]	0.49	8.34%	-4.77	-0.56(-0.79~-0.33)	< 0.001
单次干预时间	> 30 min	6^{[28-29,33,35-36,38]}	< 0.001	68.90%	-3.01	-0.73(-1.20~-0.25)	0.01
干预频次	每周≤ 3次	9^{[28-29,31-36,39]}	0.03	50.40%	-3.59	-0.56(-0.87~-0.25)	0.01
干预频次	每周> 3次	3^[30,37-38]	0.02	52.92%	-4.81	-0.78(-1.09~-0.46)	< 0.001
运动方式	音乐联合运动	3^[30,37-38]	0.26	2.55%	-7.30	-1.09(-1.38~-0.80)	< 0.001
	行走训练	2^[30,37]	< 0.001	0.00	-1.89	-0.31(-0.63~0.01)	0.06
	综合训练	3^[35-36,39]	0.06	59.50%	-3.13	-0.82(-1.34~-0.31)	< 0.001

结局指标	纳入研究数/n	证据质量					证据等级
结局指标	纳入研究数/n	研究的局限性	不一致性	间接性	不精确性	发表偏倚	证据等级
FOGQ	12^[28-39]	不严重	不严重	不严重	不严重	严重	中级
UPDRSⅢ	3^[30,37,39]	严重	不严重	不严重	不严重	严重	低级

Effect of exercise on freezing of gait in Parkinson's disease: a meta-analysis

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