Tai chi and postural stability in patients with Parkinson's disease.
Tai chi and postural stability in patients with Parkinson's disease.
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DOI：
10.1056/nejmoa1107911
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发表时间：
2012-02-09
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影响因子：
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通讯作者：
Batya SS
中科院分区：
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作者：
Li F;Harmer P;Fitzgerald K;Eckstrom E;Stock R;Galver J;Maddalozzo G;Batya SS
帕金森病患者的平衡能力严重受损，导致功能能力下降，跌倒的风险增加。虽然医疗保健提供者经常鼓励锻炼，但很少有项目被证明是有效的。我们进行了一项随机对照试验，以确定量身定制的太极拳计划是否可以改善特发性帕金森病患者的姿势控制。我们将195名Hoehn和Yahr分期量表（范围从1到5，更高的阶段表示更严重的疾病）上的1至4期疾病患者随机分配到三组之一：太极拳，阻力训练或拉伸。患者每周参加两次60分钟的运动，持续24周。主要结局是稳定性极限试验（最大偏移和方向控制;范围，0 - 100%）中较基线的变化。次要结果包括步态和力量的测量，功能性伸展和定时起身测试的评分，统一帕金森病评定量表的运动评分和福尔斯次数。太极组在最大行程方面的表现始终优于阻力训练组和拉伸组（较基线变化的组间差异，5.55个百分点; 95%置信区间[CI]，1.12 - 9.97;和11.98个百分点; 95%CI，分别为7.21至16.74）和定向控制（10.45个百分点; 95%CI，3.89至17.00;和11.38个百分点; 95%CI，5.50至17.27）。太极组在所有次要结果方面的表现也优于拉伸组，并且在步幅和功能伸展方面优于阻力训练组。与伸展运动相比，太极拳降低了福尔斯的发生率，但与阻力训练相比则不然。太极拳训练的效果在干预后3个月保持不变。未观察到严重不良事件。太极拳训练似乎可以减少轻度至中度帕金森病患者的平衡障碍，并具有改善功能能力和减少福尔斯的额外益处。（由国家神经疾病和中风研究所资助; ClinicalTrials.gov编号，NCT 00611481。
Patients with Parkinson's disease have substantially impaired balance, leading to diminished functional ability and an increased risk of falling. Although exercise is routinely encouraged by health care providers, few programs have been proven effective. We conducted a randomized, controlled trial to determine whether a tailored tai chi program could improve postural control in patients with idiopathic Parkinson's disease. We randomly assigned 195 patients with stage 1 to 4 disease on the Hoehn and Yahr staging scale (which ranges from 1 to 5, with higher stages indicating more severe disease) to one of three groups: tai chi, resistance training, or stretching. The patients participated in 60-minute exercise sessions twice weekly for 24 weeks. The primary outcomes were changes from baseline in the limits-of-stability test (maximum excursion and directional control; range, 0 to 100%). Secondary outcomes included measures of gait and strength, scores on functional-reach and timed up-and-go tests, motor scores on the Unified Parkinson's Disease Rating Scale, and number of falls. The tai chi group performed consistently better than the resistance-training and stretching groups in maximum excursion (between-group difference in the change from baseline, 5.55 percentage points; 95% confidence interval [CI], 1.12 to 9.97; and 11.98 percentage points; 95% CI, 7.21 to 16.74, respectively) and in directional control (10.45 percentage points; 95% CI, 3.89 to 17.00; and 11.38 percentage points; 95% CI, 5.50 to 17.27, respectively). The tai chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach. Tai chi lowered the incidence of falls as compared with stretching but not as compared with resistance training. The effects of tai chi training were maintained at 3 months after the intervention. No serious adverse events were observed. Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson's disease, with additional benefits of improved functional capacity and reduced falls. (Funded by the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov number, NCT00611481.)