运动结合认知训练对健康儿童执行功能影响的系统综述

Effect of exercise combined cognitive training on executive function in healthy children:A systematic review

背景儿童的执行功能(EFs)对其未来的身体和心理健康发展至关重要,运动是提高儿童EFs的经济有效方式。有研究显示,涉及较高认知参与度的运动即运动结合认知训练(ECT),对儿童EFs的提升效果更显著,但目前已有的相关研究结论并不一致。目的系统评价ECT对EFs的干预效果。设计系统综述。方法系统检索PubMed、Web of Science、Cochrane、Embase、Google Scholar和中国知网数据库,检索时间为建库至2023年10月17日。文献纳入标准:(1)RCT或NRCT;(2)研究对象为健康儿童;(3)试验组的干预措施为ECT,干预方案同时包含运动组件和至少1个明确的认知任务组件;(4)对照组的干预措施为除认知参与外的任何运动方式或传统体育课(PE);(5)运动干预的持续时间>6周;(6)结局指标至少包括1项EFs的相关评估;(7)文献语言为中文或英文。采用2010版物理治疗证据数据库(PEDro)量表进行文献偏倚风险评估。提取或计算每项结局指标干预前后的变化比[(后测-前测)/前测×100%]。通过差异有统计学意义(P<0.05)的结果在所有纳入文献中的占比来评估该指标的整体效应大小,>2/3认为干预策略有显著性效果。主要结局指标EFs指标在干预前后的变化比。结果纳入9篇英文文献,RCT 7篇,NRCT 2篇,研究对象均为学龄期儿童,研究场所为学校7篇,体育中心和课后托管中心各1篇。ECT组干预措施:2篇为战术策略相关体育游戏,7篇为根据信号和变化规则完成动作;4篇设有氧运动(AE)为对照组,8篇设PE为对照组;干预周期为6~40周,干预频率为每周1~10次,单次运动时间为10~150 min。PEDro量表评分:5分3篇,6分5篇,7分1篇。数据整合结果显示,经ECT干预后,EFs中的工作记忆(8/8篇)、抑制控制(7/8篇)和认知灵活性(4/5篇)均得以改善,改善程度分别为1.9%~33.9%、2.9%~15.1%和2.5%~20.3%。ECT组工作记忆的改善较PE组更显著,组间有效性为71.4%(5/7篇);ECT组认知灵活性的改善较AE组和PE组均更显著,组间有效性分别为100%(2/2篇)和75%(3/4篇);ECT组抑制控制的改善与AE组和PE组相比不显著。结论ECT对学龄期健康儿童的EFs有明显的改善效果,其对认知灵活性的改善优于AE和PE,对工作记忆的改善优于PE,对抑制控制的改善与AE和PE相当。

Background Executive functions(EFs)are crucial for the physical and psychological development of children,and exercise is a cost-effective method to enhance EFs in children.Studies have shown that exercise combined with cognitive training(ECT),which involves higher cognitive engagement,may have a more significant effect on children's EFs.However,existing research conclusions are inconsistent.Objective To systematically analyzed the intervention effect of ECT on EFs in children.Design Systematic review.Methods A systematic search was conducted on PubMed,Web of Science,Cochrane,Embase,Google Scholar,and China National Knowledge Infrastructure(CNKI)databases from the inception to October 17,2023.Inclusion criteria were:randomized controlled trials(RCT)or non-randomized controlled trials(NRCT);healthy child participants;ECT intervention with both exercise and at least one explicit cognitive task component for the experimental group;any form of exercise other than cognitive engagement or traditional physical education(PE)for the control group;intervention duration longer than 6 weeks;at least one EF-related assessment outcome;articles in Chinese or English.Risk of bias was assessed using the 2010 Physiotherapy Evidence Database(PEDro)scale.The percentage change in each outcome measure before and after the intervention[(post-test-pre-test)/pre-test×100%]was extracted or calculated,with a P-value<0.05 indicating significant results.The overall effect size of the indicator was evaluated by the proportion of significant results in all included literature,with>2/3 indicating a significant effect of the intervention strategy.Main outcome measures Percentage change in EF indicators before and after the intervention.Results Nine English articles were included.There were 7 RCTs and 2 NRCTs,all involving school-aged children,with 7 studies conducted in schools,one in a sports center and one in an after-school care center.ECT interventions included tactical strategy-related sports games in 2 articles,and actions completed based on signals and changing rules in 7 articles.Four articles had aerobic exercise(AE)control groups,and 8 had PE control groups.The intervention lasted from 6 to 40 weeks with 1 to 10 times per week and 10 to 150 minutes for single exercise.PEDro scale scores were 5 in 3 articles,6 in 5 articles and 7 in 1 article.Data integration showed improvement in working memory(8/8 articles),inhibitory control(7/8 articles),and cognitive flexibility(4/5 articles)after ECT intervention,with improvement ranges of+1.9%to+33.9%,+2.9%to+15.1%,and+2.5%to+20.3%,respectively.The improvement in working memory in the ECT group was more significant than that in PE group,with an effectiveness of 71.4%(5/7 articles).Improvement in cognitive flexibility were more significant in the ECT group compared to both AE and PE groups,with effectiveness of 100%(2/2 articles)and 75%(3/4 articles),respectively.The improvement in inhibitory control in the ECT group was not significant when compared with AE and PE groups.Conclusions ECT significantly improves EFs in school-aged healthy children,with a greater enhancement in cognitive flexibility compared to AE and PE,an improvement in working memory superior to PE,and equivalent improvement in inhibitory control when compared to AE and PE.