体力活动对痴呆患者认知功能干预效果的Meta分析

目的:系统评价体力活动对痴呆患者认知功能的干预效果。方法:计算机检索PubMed、Web of Science、The Cochrane Library、EMbase、Medline、CBM、CNKI、VIP和Wan Fang Data数据库中有关体力活动对痴呆患者认知功能的随机对照试验(RCTs),检索时限均从各个数据库收录起始年限至2018年7月27日,使用PEDro量表进行方法学质量评价,采用Revman5.3软件进行Meta分析,采用Stata14.0软件进行发表偏倚检验。结果:共纳入24个RCT,包括1581例痴呆患者。Meta分析结果显示:体力活动对痴呆患者整体认知功能(MD=2.17,95%CI:1.50,2.84,P<0.00001)有积极的影响。亚组分析结果显示:体力活动对AD患者(MD=2.40,95%CI:1.58,3.23,P<0.00001)与合并AD患者(MD=1.45,95%CI:0.41,2.48,P=0.006)的整体认知功能优于对照组;有氧运动(MD=2.43,95%CI:1.63,3.23,P<0.00001)与混合运动(MD=1.48,95%CI:0.08,2.87,P=0.04)对痴呆患者整体认知功能优于对照组,但抗阻运动(MD=1.70,95%CI:-0.15,3.55,P=0.07)与太极拳运动(MD=0.92,95%CI:-2.98,4.82,P=0.64)与对照组差异无统计学意义;高频率体力活动(MD=1.64,95%CI:0.25,3.04,P=0.02)与低频率体力活动(MD=2.33,95%CI:1.57,3.09,P<0.00001)对痴呆患者的整体认知功能均优于对照组。不同认知领域Meta分析结果显示:体力活动对痴呆患者执行功能(SMD=0.08,95%CI:-0.05,0.20,P=0.22)、TMT-A与TMT-B(SMD=-0.05,95%CI:-0.26,0.16,P=0.63)和记忆功能(SMD=0.15,95%CI:-0.06,0.37,P=0.17)与对照组相比差异无统计学意义,只有注意力(SMD=0.18,95%CI:0.02,0.35,P=0.03)优于对照组。结论:体力活动干预对AD患者与合并AD患者的整体认知功能有积极影响,并且有氧与混合、高频率与低频率的体力活动干预对所有痴呆患者的整体认知功能同样有效,不同认知领域中只有注意力有改善效果。

Meta-analysis of the Effect of Physical Activity on Cognitive Function Intervention in Patients with Dementia

Objective:To systematically review the efficacy of physical activity on the cognitive function of patients with dementia.Methods:An electronically search was conducted in PubMed,Web of Science,the Cochrane Library,EMbase,Medline,CBM,CNKI,VIP,and Wan Fang Data databases from inception to July 27,2018 to collect randomized controlled trials(RCTs)on physical activity on the cognitive function of patients with dementia.Meta-analysis was performed by using Revman 5.3 software,and the methodological quality of the included studies was evaluated by using the PEDro scale.The potential publication bias were analyzed with Stata 14.0.Results:Twenty-four RCTs were included,involving 1581 patients with dementia.Meta-analysis showed that the overall effect of physical activity on cognitive function in patients with dementia was positive(MD=2.17,95%CI:1.50,2.84,P<0.00001).Subgroup analysis showed that the global cognitive function of physical activity in patients with AD(MD=2.40,95%CI:1.58,3.23,P<0.00001)and both AD and non-AD dementia patients(MD=1.45,95%CI:0.41,2.48,P=0.006)was better than that of the control group.The global cognitive function of aerobic exercise(MD=2.43,95%CI:1.63,3.23,P<0.00001)and combined exercise(MD=1.48,95%CI:0.08,2.87,P=0.04)in dementia patients was better than that of the control group.However,there was no significant difference between resistance exercise(MD=1.70,95%CI:-0.15,3.55,P=0.07)and Tai Ji(MD=0.92,95%CI:-2.98,4.82,P=0.64)compared with the control group.The high-frequency physical activity(MD=1.64,95%CI:0.25,3.04,P=0.02)and low-frequency physical activity(MD=2.33,95%CI:1.57,3.09,P<0.00001)were better than the control group in the global cognitive function of dementia patients.Meta-analysis results in different cognitive fields:physical activity had no statistically significant difference between executive function(SMD=0.08,95%CI:-0.05,0.20,P=0.22)and TMT-A and TMT-B(SMD=-0.05,95%CI:-0.26,0.16,P=0.63)and memory function(SMD=0.15,95%CI:-0.06,0.37,P=0.17)in dementia patients,and only attention(SMD=0.18,95%CI:0.02,0.35,P=0.03)was better than control group.Conclusion:Physical activity intervention has a positive impact on the global cognitive function in patients with AD and both AD and non-AD dementia patients,and physical activity interventions such as aerobic exercise and combined exercise,high frequency and low frequency are equally effective for the global cognitive function of all dementia patients.Physical activity only improves the attention in different cognitive areas.