Efficacy of resistance exercises in rheumatoid arthritis: meta-analysis of randomized controlled trials
Efficacy of resistance exercises in rheumatoid arthritis: meta-analysis of randomized controlled trials
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DOI：
10.1093/rheumatology/ker330
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发表时间：
2012-03-01
期刊：
影响因子：
5.5
通讯作者：
Gaudin, Philippe
中科院分区：
文献类型：
--
作者：
Baillet, Athan;Vaillant, Mathieu;Gaudin, Philippe
Objective.评价抗阻运动对类风湿关节炎患者的疗效。使用截至2009年11月的Pubmed、Embase和科克伦数据库以及过去3年在流变学科学会议上提交的摘要进行了系统性文献检索。随机对照试验（RCT）比较抗阻运动为基础的治疗与不抗阻运动的干预措施治疗类风湿关节炎患者。研究的结果是HAQ干预后残疾，步行速度评估的功能能力，视觉模拟量表（VAS）上的疼痛，关节计数，等长，等速和握力。通过加权平均差（WMD）评估疗效，通过相对危险度（RR）评估耐受性。采用方差倒数模型对数据进行合并，并进行异质性检验。10项RCT，包括547例患者，符合研究入选标准。平均值（S.D.）Jadad评分为2.3（0.6）。抗阻训练显著提高了等速肌力（WMD = 23.7%，P < 0.001）、等长肌力（WMD = 35.8%，P < 0.001）、握力（WMD = 26.4%，P < 0.001）和HAQ（WMD =-0.22，P < 0.001）。运动对50英尺步行试验（WMD =-1.90s，P < 0.001）和ESR（WMD =-5.17，P = 0.005）也有积极影响。两组患者[RR = 0.95，95%置信区间（CI）0.61，1.48]和不良事件（RR = 1.08，95% CI 0.72，1.63）分布均衡。患者和运动特征不影响结果。亚组分析显示，高强度项目的疗效更高。抗阻运动在RA中是安全的，大多数结局的改善具有统计学意义，可能与RA残疾具有临床相关性。
Objective. To evaluate the efficacy of resistance exercises in RA patients.Methods. A systematic literature search was done using Pubmed, Embase and Cochrane databases through November 2009 and in abstracts presented at rheumatology scientific meetings over the past 3 years. Randomized controlled trials (RCTs) comparing resistance exercise based therapy with interventions without resistance exercise for the treatment of RA patients were included. Outcomes studied were post-intervention disability on the HAQ, functional capacity assessed by walking speed, pain on the visual analogue scale (VAS), joint count, isometric, isokinetic and grip strength. Efficacy was assessed by weighted mean differences (WMDs) and tolerance was assessed by relative risk (RR). Data were pooled using the inverse of variance model, and heterogeneity was tested.Results. Ten RCTs, including 547 patients, met the study inclusion criteria. The mean (S.D.) Jadad score was 2.3 (0.6). Resistance exercises significantly improved isokinetic strength (WMD = 23.7%, P < 0.001), isometric strength (WMD = 35.8%, P < 0.001), grip strength (WMD = 26.4%, P < 0.001) and HAQ (WMD = -0.22, P < 0.001). Exercise also had a positive impact on the 50-foot walking test (WMD = -1.90 s, P < 0.001) and ESR (WMD = -5.17, P = 0.005). Withdrawals [RR = 0.95, 95% confidence interval (CI) 0.61, 1.48] and adverse events (RR = 1.08, 95% CI 0.72, 1.63) were well balanced in both groups. Patient and exercise characteristics did not influence the results. Subgroup analysis revealed a trend towards higher efficacy associated with high-intensity programmes.Conclusion. Resistance exercise in RA is safe, and the improvement in most outcomes was statistically significant and possibly clinically relevant for RA disability.