不同方式运动对慢性阻塞性肺疾病患者肺功能及生存质量影响的Meta分析

Meta-analysis of the Effects of Different Types of Exercise on Pulmonary Function and Quality of Fife in COPD Patients

目的:评价有氧运动、抗阻运动、瑜伽、传统健身功法4种不同运动对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者的影响,从肺功能、6 min步行实验(6 minutes walk test,6MWT)、生存质量3方面,分析比较不同运动方式对慢性阻塞性肺疾病患者肺功能及生存质量的改善效果,有针对性的在慢性阻塞性肺疾病的预防和管理方面提供合理建议和科学依据。方法:建立纳入和排除标准,通过检索PubMed、Web of Science、Embase、Cochrane Library、中国知网(CNKI)、万方等文献数据库,收集运动对慢性阻塞性肺疾病干预的随机对照试验(randomized controlled trial,RCT),运用Revman5.3软件和Stata16.0软件对所纳入文献的结局指标进行分析。结果:共纳入23篇文献,包括1440例受试者,其中实验组719人,对照组721人。Meta分析结果显示,与对照组相比,运动锻炼能够提高COPD患者第1 s用力呼吸容积(forced expiratory volume in the first second,FEV1)(SMD=0.51,95%CI:0.19,0.83,P=0.002)、用力肺活量(forced vital capacity,FVC)(SMD=0.78,95%CI:0.08,1.47,P=0.03)、第1 s用力呼气容积与用力肺活量比值FEV1/FVC(SMD=0.51,95%CI:0.18,1.10,P=0.007)和第1 s用力呼气容积占预计值百分比FEV1/%(SMD=0.35,95%CI:0.10,0.60,P=0.006),延长了6 min步行距离6MWT(SMD=0.49,95%CI:0.33,0.65,P≤0.0001),降低患者呼吸困难指数,提高了生存质量(SMD=-0.59,95%CI:-0.87,-0.31,P≤0.0001)。传统健身功法和有氧运动对COPD患者肺功能、6MWT及生存质量的改善效果更好,抗阻运动和瑜伽虽然在6 min步行距离的加长和生存质量的提高方面效果显著,但在与慢性阻塞性肺疾病最密切相关的肺功能方面的改善效果并不明显。结论:有氧运动、抗阻运动、瑜伽和传统健身功法都对慢性阻塞性肺疾病有一定的预防和改善效果,对肺功能、6MWT及生存质量有明显的改善作用,且传统健身功法和有氧运动的改善效果更全面。

Objective:The paper evaluated the effects of aerobic exercise,resistance training,yoga and traditional fitness on patients with chronic obstructive pulmonary disease(COPD).From three aspects of lung function,6 MWT and quality of life,the paper analyzed and compared the improvement effects of different exercise modes on pulmonary function and quality of life of COPD patients,so as to prevent and improve COPD Management provides reasonable suggestions and scientific basis.Methods:The inclusion and exclusion criteria were established.By searching PubMed,Web of Science,Embase,Cochrane Library,CNKI,Wanfang Data and other databases,the RCT of exercise intervention on chronic obstructive pulmonary disease was collected.Revman 5.3 and Stata 16.0 software were used to analyze the outcome indicators of the literature.Results:A total of 23 articles were included,including 1440 subjects.719 were in the experimental group and 721 were in the control group.The results of meta analysis showed that exercise could improve FEV1(SMD=0.51,95%CI:0.19,0.83,P=0.002),FVC(SMD=0.78,95%CI:0.08,1.47,P=0.03),FEV1/FVC(SMD=0.51,95%CI:0.18,1.10,P=0.007)and forced expiratory volume in the first second accounted for FEV1/%(SMD=0.35,95%CI:0.10,0.60,P=0.006),and prolonged 6 min walking distance(SMD=0.49,95%CI:0.33,0.65,P≤0.0001),and reduced dyspnea index,and improved quality of life(SMD=-0.59,95%CI:-0.87,0.31,P≤0.0001).Traditional physical exercise and aerobic exercise have better effect on the improvement of lung function,6 MWT and quality of life of COPD patients.Resistance exercise and yoga have good effect on the lengthening of 6 min walking distance and the improvement of quality of life,but the effect on lung function which is closely related to chronic obstructive pulmonary disease is not obvious.Conclusion:Aerobic exercise,resistance training,yoga and traditional fitness exercises all have certain prevention and improvement effects on chronic obstructive pulmonary disease,and have obvious improvement effects on lung function,6 WMT and quality of life,and the improvement effects of traditional fitness and aerobic exercise are more comprehensive.