Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review
Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review
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DOI：
10.1016/j.jphys.2017.12.001
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发表时间：
2018-01-01
影响因子：
12.1
通讯作者：
Pang, Marco Y. C.
中科院分区：
文献类型：
--
作者：
Lam, Freddy M. H.;Huang, Mei-Zhen;Pang, Marco Y. C.
问题：体育锻炼是否能改善认知障碍和痴呆患者的身体功能和生活质量？哪些训练方案可以改善身体功能和生活质量？认知障碍和其他患者特征如何影响运动训练的结果？设计：随机试验的系统回顾和荟萃分析。对象：以轻度认知障碍或痴呆为主要诊断的人群。干预措施：体育锻炼。结局指标：力量、柔韧性、步态、平衡、移动性、步行耐力、双重任务能力、日常生活活动、生活质量和福尔斯。结果：纳入43项临床试验（n = 3988）。根据GRADE推荐、评估、发展和评价等级系统，荟萃分析显示了强有力的证据，支持使用监督运动训练来改善30秒坐立测试的结果（MD 2.1重复，95% CI 0.3 - 3.9），步长（MD 5 cm，95% CI 2 - 8），贝格平衡量表（MD 3.6分，95% CI 0.3 - 7.0），功能达到（3.9 cm，95% CI 2.2 - 5.5），定时启动测试（-1秒，95% CI -2至0），步行速度（0.13 m/s，95% CI 0.03至0.24），和6分钟步行试验（50 m，95% CI 18至81）。微弱的证据支持使用运动来改善柔韧性和Barthel指数表现。弱证据表明，非特异性运动并没有提高双任务能力或活动水平。强有力的证据表明，运动并没有改善这一人群的生活质量。运动对福尔斯跌倒的影响仍无定论。身体机能较差是对运动训练反应更好的决定因素，但认知表现没有影响。结论：有不同程度认知障碍的人可以从每天约60分钟的监督下多模式运动中受益，每周2至3天，以改善身体功能。(c)2017年澳大利亚物理治疗协会。由爱思唯尔公司出版
Question: Does physical exercise training improve physical function and quality of life in people with cognitive impairment and dementia? Which training protocols improve physical function and quality of life? How do cognitive impairment and other patient characteristics influence the outcomes of exercise training? Design: Systematic review with meta-analysis of randomised trials. Participants: People with mild cognitive impairment or dementia as the primary diagnosis. Intervention: Physical exercise. Outcome measures: Strength, flexibility, gait, balance, mobility, walking endurance, dual-task ability, activities of daily living, quality of life, and falls. Results: Forty-three clinical trials (n = 3988) were included. According to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system, the meta-analyses revealed strong evidence in support of using supervised exercise training to improve the results of 30-second sit-to-stand test (MD 2.1 repetitions, 95% CI 0.3 to 3.9), step length (MD 5 cm, 95% CI 2 to 8), Berg Balance Scale (MD 3.6 points, 95% CI 0.3 to 7.0), functional reach (3.9 cm, 95% CI 2.2 to 5.5), Timed Up and Go test (-1 second, 95% CI -2 to 0), walking speed (0.13 m/s, 95% CI 0.03 to 0.24), and 6-minute walk test (50 m, 95% CI 18 to 81) in individuals with mild cognitive impairment or dementia. Weak evidence supported the use of exercise in improving flexibility and Barthel Index performance. Weak evidence suggested that non-specific exercise did not improve dual-tasking ability or activity level. Strong evidence indicated that exercise did not improve quality of life in this population. The effect of exercise on falls remained inconclusive. Poorer physical function was a determinant of better response to exercise training, but cognitive performance did not have an impact. Conclusion: People with various levels of cognitive impairment can benefit from supervised multi-modal exercise for about 60 minutes a day, 2 to 3 days a week to improve physical function. (c) 2017 Australian Physiotherapy Association. Published by Elsevier B.V.