传统太极功法干预对改善骨密度流失疗效及安全性的系统评价
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摘要
背景:当前针对患者骨健康/骨密度相关疾患结局指标的影响,传统太极功法干预仍然存在较大的争议,亟待作进一步探讨。目的:系统评价传统太极功法干预对改善骨密度流失的临床疗效与安全性。方法:通过计算机对中国知网CNKI、万方、维普VIP和中国生物医学文献数据库、以及国外数据库PubMed、MEDLINE、EMbase、CochraneLibrary等进行全面检索;配合对大学图书馆的馆藏期刊进行手工检索,检索时间截于2019年1月;系统搜集传统太极功法(包括太极拳、太极推手、太极柔力球等)干预对骨健康/骨密度相关疾患结局指标影响的随机对照研究(RCT)文献。参考Cochrane系统评价方法进行文献筛选、资料提取以及方法学质量评价;并采用Rev Man 5.3软件进行Meta分析。结果与结论:共纳入14篇文献(16个RCT研究),Meta分析结果表明:接受传统太极功法干预后,脊柱腰椎L_(2-4)骨密度(SMD=0.40,95%CI[0.16,0.65],P=0.001)、以及股骨颈骨密度(SMD=0.75,95%CI [0.27,1.24],P=0.002)改善方面均优于对照组;然而在Ward's三角骨密度(SMD=0.50,95%CI[-0.10,1.10],P=0.10)、股骨干骨密度(SMD=0.16,95%CI[-0.11,0.44],P=0.25)、股骨近端转子骨密度(SMD=0.54,95%CI[-0.01,1.09],P=0.05)、以及桡骨远端1/3处骨密度(SMD=0.20,95%CI[-0.26,0.66],P=0.040)与对照组比较,组间差异无统计学意义;且传统太极功法干预尚未发现严重不良事件。当前证据发现,传统太极功法干预在特定人群(例如老年人、骨质疏松人群、围绝经期与绝经后妇女)脊柱腰椎、股骨颈等部位的骨密度流失改善方面疗效明确,不良反应较少。鉴于纳入文献数量偏少以及研究本身局限性,有待开展高质量的、设计严谨的临床试验予以进一步验证。
BACKGROUND: There is no consensus on the effectiveness and safety of Tai Chi of traditional body refreshment for patients concerning bone mineral density loss, which needs further investigation.OBJECTIVE: To assess the effectiveness and safety of Tai Chi of traditional body refreshment for improving bone mineral density loss.METHODS: Databases including CNKI, WanFang, VIP, CBM, PubMed, MEDLINE, EMbase and Cochrane Library were searched by computer for randomized controlled trials involving Tai Chi of traditional body refreshment(including Tai Ji Quan, Tai Chi push hand, Tai Chi softball, et al.) on the effect of bone health/bone mineral density published before January 2019. The related periodicals were also manually retrieved. Literature screening, data extraction and methodological quality were conducted based on the Cochrane methods. Meta-analysis was performed on RevMan 5.3 software.RESULTS AND CONCLUSION: Fourteen articles including 16 randomized controlled trials were included. Meta-analyses results found that:Tai Chi of traditional body refreshment was superior to the control group in improving bone mineral density of L_(2-4)(SMD=0.40, 95%CI[0.16,0.65], P=0.001), and femoral neck(SMD=0.75, 95%CI [0.27, 1.24], P=0.002). Furthermore, no significant differences were observed between groups in bone mineral density of Ward's triangle(SMD=0.50, 95%CI[-0.10, 1.10], P=0.10), femoral shaft(SMD=0.16, 95%CI [-0.11, 0.44],P=0.25), proximal femoral trochanter(SMD=0.54, 95%CI [-0.01, 1.09], P=0.05), and 1/3 distal radius(SMD=0.20, 95%CI [-0.26, 0.66],P=0.040). No seriously adverse events were reported. Current evidence suggest that Tai Chi of traditional body refreshment shows additive benefits for the improvement of bone mineral density loss of lumbar spine and femoral neck in specific populations(such as elderly,osteoporosis groups, perimenopausal and postmenopausal women). In view of the study of small number and itself limitations, further clinical trials with high quality and rigorous design are needed for further verification.
BACKGROUND: There is no consensus on the effectiveness and safety of Tai Chi of traditional body refreshment for patients concerning bone mineral density loss, which needs further investigation.OBJECTIVE: To assess the effectiveness and safety of Tai Chi of traditional body refreshment for improving bone mineral density loss.METHODS: Databases including CNKI, WanFang, VIP, CBM, PubMed, MEDLINE, EMbase and Cochrane Library were searched by computer for randomized controlled trials involving Tai Chi of traditional body refreshment(including Tai Ji Quan, Tai Chi push hand, Tai Chi softball, et al.) on the effect of bone health/bone mineral density published before January 2019. The related periodicals were also manually retrieved. Literature screening, data extraction and methodological quality were conducted based on the Cochrane methods. Meta-analysis was performed on RevMan 5.3 software.RESULTS AND CONCLUSION: Fourteen articles including 16 randomized controlled trials were included. Meta-analyses results found that:Tai Chi of traditional body refreshment was superior to the control group in improving bone mineral density of L_(2-4)(SMD=0.40, 95%CI[0.16,0.65], P=0.001), and femoral neck(SMD=0.75, 95%CI [0.27, 1.24], P=0.002). Furthermore, no significant differences were observed between groups in bone mineral density of Ward's triangle(SMD=0.50, 95%CI[-0.10, 1.10], P=0.10), femoral shaft(SMD=0.16, 95%CI [-0.11, 0.44],P=0.25), proximal femoral trochanter(SMD=0.54, 95%CI [-0.01, 1.09], P=0.05), and 1/3 distal radius(SMD=0.20, 95%CI [-0.26, 0.66],P=0.040). No seriously adverse events were reported. Current evidence suggest that Tai Chi of traditional body refreshment shows additive benefits for the improvement of bone mineral density loss of lumbar spine and femoral neck in specific populations(such as elderly,osteoporosis groups, perimenopausal and postmenopausal women). In view of the study of small number and itself limitations, further clinical trials with high quality and rigorous design are needed for further verification.
引文
[1]刘晋元.太极拳治疗老年慢性病的国外研究进展[J].武术研究,2019,4(1):52-56.
[2]范仪铭,郭珈宜,张康乐,等.运动疗法治疗膝骨性关节炎的研究进展[J].中华中医药杂志,2017,32(12):5482-5485.
[3]宋婕,陆颖,李洁.近5年国内太极拳临床应用研究进展[J].中国中医药信息杂志,2018,25(8):137-140.
[4]张继瑶,叶涛,李宏玉,等.太极拳在疾病康复中的应用进展[J].中国康复,2018,33(5):422-424.
[5]李静雅,程亮.48周不同频率太极拳练习对老年女性骨密度的影响[J].中国骨质疏松杂志,2017,23(10):1309-1312.
[6]王建珠,程英武,张旻,等.太极拳国内外研究进展[J].辽宁中医杂志,2017,44(9):2001-2004.
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[9]王延涛,陈怡,潘美均,等.单侧与双侧椎弓根入路注入骨水泥治疗骨质疏松性椎体压缩骨折有效和安全性的Meta分析[J].中国组织工程研究,2019,23(10):1633-1640.
[10]林基勇,黄兰,梁凤珍,等.口服阿伦膦酸钠联合注射用骨肽治疗原发性骨质疏松症的Meta分析[J].中国组织工程研究,2019,23(12):1955-1960.
[11]Chan K,Qin L,Lau M,et al.A randomized,prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women.Arch Phys Med Rehabil.2004;85(5):717-722.
[12]杜新星,张明军,苟波,等.太极柔力球运动对围绝经期女性雌激素及骨代谢指标的影响[J].西安体育学院学报,2014,31(4):459-463.
[13]毛红妮.太极拳锻炼结合补钙对绝经后女性骨密度的影响[J].中国康复医学杂志,2009,24(9):814-816.
[14]宋桦.太极拳锻炼对原发性骨质疏松症患者骨密度及骨代谢的影响[J].体育学刊,2008,15(11):106-108.
[15]Wang HR,Yu B,Chen WH,et al.Simplified Tai Chi resistance training versus traditional Tai Chi in slowing bone loss in postmenopausal women.Evid Based Complement Alternat Med.2015;2015:379451.
[16]Wayne PM,Kiel DP,Buring JE,et al.Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women:a pilot pragmatic,randomized trial.BMC Complement Altern Med.2012;12:7.
[17]Woo J,Hong A,Lau E,et al.A randomised controlled trial of Tai Chi and resistance exercise on bone health,muscle strength and balance in community-living elderly people.Age Ageing.2007;36(3):262-268.
[18]周勇.运动锻炼防治绝经女性腰椎L2-4骨质疏松的作用[J].中国运动医学杂志,2003,22(1):72-74.
[19]周勇.传统体育对绝经女性骨密度的影响[J].北京体育大学学报,2004,27(3):354-355.
[20]周先进,刘曹静,李靖.太极拳对高脂血症老年人骨密度影响变化趋势[J].福建体育科技,2014,33(2):39-42.
[21]周勇,李靖,陈一冰.运动锻炼防治绝经女性腰椎L2-4骨质疏松的作用[J].中国运动医学杂志,2005,24(1):106-108.
[22]包勤文,龚晨,申潇竹,等.太极运动对老年2型糖尿病患者骨质疏松的预防作用[J].中国老年学杂志,2016,36(13):3246-3248.
[23]Song R,Roberts BL,Lee EO,et al.A randomized study of the effects of t'ai chi on muscle strength,bone mineral density,and fear of falling in women with osteoarthritis.J Altern Complement Med.2010;16(3):227-233.
[24]徐飞.24式简化太极拳对绝经后女性骨密度的影响[J].实用中医药杂志,2017,33(12):1428-1429.
[25]曾令烽,刘军,潘建科,等.中医临床实践、循证医学及伦理学问题探讨[J].中华中医药杂志,2018,32(12):5265-5269.
[26]喻佳洁,李琰,陈雯雯,等.从循证医学到循证科学的必然趋势[J].中国循证医学杂志,2019,19(1):119-124.
[27]刘军,曾令烽,潘建科,等.中医骨伤科循证临床实践指南制定共性问题的专家共识[J].中华中医药杂志,2018,33(8):3228-3232.
[28]沈以昕,朱冬奇,牛文鑫.太极拳的平衡维持作用及其生物力学研究进展[J].医用生物力学,2018,33(4):372-377.
[29]范高胜,杨帅.浅析太极拳养生性与技击性的融合关系[J].中华武术(研究),2019,8(1):70-71.
[30]冯卫.健康中国背景下太极拳健身功效研究[J].广州体育学院学报,2019,39(1):87-90.
[2]范仪铭,郭珈宜,张康乐,等.运动疗法治疗膝骨性关节炎的研究进展[J].中华中医药杂志,2017,32(12):5482-5485.
[3]宋婕,陆颖,李洁.近5年国内太极拳临床应用研究进展[J].中国中医药信息杂志,2018,25(8):137-140.
[4]张继瑶,叶涛,李宏玉,等.太极拳在疾病康复中的应用进展[J].中国康复,2018,33(5):422-424.
[5]李静雅,程亮.48周不同频率太极拳练习对老年女性骨密度的影响[J].中国骨质疏松杂志,2017,23(10):1309-1312.
[6]王建珠,程英武,张旻,等.太极拳国内外研究进展[J].辽宁中医杂志,2017,44(9):2001-2004.
[7]Moher D,Liberati A,Tetzlaff J,et al.Preferred reporting items for systematic reviews and meta-analyses:the PRISMAstatement.Ann Intern Med.2009;151(4):264-268
[8]Higgins JPT,Green S.Cochrane handbook for systematic reviews of interventions version 5.1.0(updated March 2011):The Cochrane Collaboration;2011(www.cochrane-handbook.org,Access 2019,March 17th)
[9]王延涛,陈怡,潘美均,等.单侧与双侧椎弓根入路注入骨水泥治疗骨质疏松性椎体压缩骨折有效和安全性的Meta分析[J].中国组织工程研究,2019,23(10):1633-1640.
[10]林基勇,黄兰,梁凤珍,等.口服阿伦膦酸钠联合注射用骨肽治疗原发性骨质疏松症的Meta分析[J].中国组织工程研究,2019,23(12):1955-1960.
[11]Chan K,Qin L,Lau M,et al.A randomized,prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women.Arch Phys Med Rehabil.2004;85(5):717-722.
[12]杜新星,张明军,苟波,等.太极柔力球运动对围绝经期女性雌激素及骨代谢指标的影响[J].西安体育学院学报,2014,31(4):459-463.
[13]毛红妮.太极拳锻炼结合补钙对绝经后女性骨密度的影响[J].中国康复医学杂志,2009,24(9):814-816.
[14]宋桦.太极拳锻炼对原发性骨质疏松症患者骨密度及骨代谢的影响[J].体育学刊,2008,15(11):106-108.
[15]Wang HR,Yu B,Chen WH,et al.Simplified Tai Chi resistance training versus traditional Tai Chi in slowing bone loss in postmenopausal women.Evid Based Complement Alternat Med.2015;2015:379451.
[16]Wayne PM,Kiel DP,Buring JE,et al.Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women:a pilot pragmatic,randomized trial.BMC Complement Altern Med.2012;12:7.
[17]Woo J,Hong A,Lau E,et al.A randomised controlled trial of Tai Chi and resistance exercise on bone health,muscle strength and balance in community-living elderly people.Age Ageing.2007;36(3):262-268.
[18]周勇.运动锻炼防治绝经女性腰椎L2-4骨质疏松的作用[J].中国运动医学杂志,2003,22(1):72-74.
[19]周勇.传统体育对绝经女性骨密度的影响[J].北京体育大学学报,2004,27(3):354-355.
[20]周先进,刘曹静,李靖.太极拳对高脂血症老年人骨密度影响变化趋势[J].福建体育科技,2014,33(2):39-42.
[21]周勇,李靖,陈一冰.运动锻炼防治绝经女性腰椎L2-4骨质疏松的作用[J].中国运动医学杂志,2005,24(1):106-108.
[22]包勤文,龚晨,申潇竹,等.太极运动对老年2型糖尿病患者骨质疏松的预防作用[J].中国老年学杂志,2016,36(13):3246-3248.
[23]Song R,Roberts BL,Lee EO,et al.A randomized study of the effects of t'ai chi on muscle strength,bone mineral density,and fear of falling in women with osteoarthritis.J Altern Complement Med.2010;16(3):227-233.
[24]徐飞.24式简化太极拳对绝经后女性骨密度的影响[J].实用中医药杂志,2017,33(12):1428-1429.
[25]曾令烽,刘军,潘建科,等.中医临床实践、循证医学及伦理学问题探讨[J].中华中医药杂志,2018,32(12):5265-5269.
[26]喻佳洁,李琰,陈雯雯,等.从循证医学到循证科学的必然趋势[J].中国循证医学杂志,2019,19(1):119-124.
[27]刘军,曾令烽,潘建科,等.中医骨伤科循证临床实践指南制定共性问题的专家共识[J].中华中医药杂志,2018,33(8):3228-3232.
[28]沈以昕,朱冬奇,牛文鑫.太极拳的平衡维持作用及其生物力学研究进展[J].医用生物力学,2018,33(4):372-377.
[29]范高胜,杨帅.浅析太极拳养生性与技击性的融合关系[J].中华武术(研究),2019,8(1):70-71.
[30]冯卫.健康中国背景下太极拳健身功效研究[J].广州体育学院学报,2019,39(1):87-90.
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