运动对阿尔茨海默病患者认知及精神行为症状疗效的Meta分析

Meta-analysis of the effect of exercise on cognitive and psycho-behavioral symptoms in patients with Alzheimer disease

目的 通过Meta分析运动对阿尔茨海默病患者(Alzheimer disease, AD)认知及精神行为症状的干预疗效,并对比不同运动强度下的差异性。方法 检索PubMed、Cochrane Library、Web of Science、中国知网、中国生物医学文献数据库、万方及维普数据库的随机对照试验(randomized controlled trial, RCT),查找时间从以上资料库建立起至2021年3月。采用RevMan5.4.1软件进行Meta分析。结果 共纳入15项研究,1194例患者。结果显示,经运动干预后AD患者的认知[MMSE:MD=2.51,95%CI(1.05,3.97),P=0.0008;ADAS-Cog:MD=-2.73,95%CI(-5.39,-0.07),P=0.04]和精神行为症状[MD=-4.12,95%CI(-7.15,-1.10),P=0.008]得分均优于对照组。亚组分析显示,在简易精神状态评价量表评价下,中强度运动[MD=3.04,95%CI(1.68,4.39),P<0.0001]干预AD患者认知的效果显著优于中高强度联合运动[MD=0.04,95%CI(-0.99,1.06),P=0.94];在阿尔茨海默病评定量表-认知分量表评价下,中强度运动[MD=-4.38,95%CI(-7.05,-1.70),P=0.001]干预AD患者认知的效果显著优于中高强度联合运动[MD=0.33,95%CI(-1.54,2.20),P=0.73]。结论 运动可以减轻AD患者认知及精神行为症状,且中强度运动对AD患者认知功能有积极影响,中高强度联合运动对AD患者认知功能没有明显影响。由于运动处方制定具有多样性,因此有待未来作进一步高质量验证。

Objective Meta-analysis of the intervention efficacy of exercise on cognitive and psycho-behavioral symptoms in patients with Alzheimer disease(AD)and comparison of differences at different exercise intensities.Methods The PubMed,the Cochrane Library,Web of Science,CNKI,CBMdisc,Wanfang and VIP databases were searched by computer to find RCTs from the establishment of the databases to March 2021.Meta-analysis was executed on the extracted data using RevMan 5.4.1.Results 15 studies involving a total of 1194 patients were included.Meta-analysis showed that AD patients were superior to the control group in terms of the cognitive[mean difference(MD)=2.51,95%CI(1.05,3.97),P=0.0008;MD=-2.73,95%CI(-5.39,-0.07),P=0.04]and psychobehavioral symptom[MD=-4.12,95%CI(-7.15,-1.10),P=0.008]scores after motor intervention.The results of analysis showed that the effect of moderate intensity exercise[MD=3.04,95%CI(1.68,4.39),P<0.0001]on cognition in AD patients was significantly better than that of moderate to high intensity combined exercise[MD=0.04,95%CI(-0.99,1.06),P=0.94]under the evaluation of MMSE.The effect of moderate intensity exercise[MD=-4.38,95%CI(-7.05,-1.70),P=0.001]on cognition in AD patients was significantly better than that of moderate to high intensity combined exercise[MD=0.33,95%CI(-1.54,2.20),P=0.73]under the evaluation of ADAS-cog,and the differences were statistically significant(P<0.05).Conclusion Exercise can enhance the cognitive and psycho-behavioral symptoms of AD patients,and moderate-intensity exercise has a positive effect on the cognitive function of AD patients,and moderate-high intensity combined exercise has no significant effect on the cognitive function of AD patients.Due to the diversity of exercise prescription development,further high-quality validation is needed in the future.