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[BMJ最新论文]:太极与有氧锻炼对纤维肌痛的疗效:一项疗效比较随机对照试验
2018年04月02日 时讯速递, 进展交流 暂无评论

Research

Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial

Chenchen WangChristopher H SchmidRoger A Fielding, et al

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k851 (Published 21 March 2018)

Cite this as: BMJ 2018;360:k851

Abstract

Objectives 目的

To determine the effectiveness of tai chi interventions compared with aerobic exercise, a current core standard treatment in patients with fibromyalgia, and to test whether the effectiveness of tai chi depends on its dosage or duration.

确定太极与有氧锻炼(目前的核心标准治疗方式)对纤维肌痛患者的疗效,并验证太极的疗效是否与剂量及其持续时间相关。

Design 设计

Prospective, randomized, 52 week, single blind comparative effectiveness trial.

前瞻、随机、历时52周、单盲疗效比较试验

Setting 场景

Urban tertiary care academic hospital in the United States between March 2012 and September 2016.

2012年3月至2016年9月,美国城市三级医院

Participants 研究对象

226 adults with fibromyalgia (as defined by the American College of Rheumatology 1990 and 2010 criteria) were included in the intention to treat analyses: 151 were assigned to one of four tai chi groups and 75 to an aerobic exercise group.

226名纤维肌痛成年患者(根据美国风湿病学院1990和2010年标准)纳入意向治疗分析:151名被分至4个太极治疗组中的一组,75名患者被分至有氧锻炼组。

Interventions 干预措施

Participants were randomly assigned to either supervised aerobic exercise (24 weeks, twice weekly) or one of four classic Yang style supervised tai chi interventions (12 or 24 weeks, once or twice weekly). Participants were followed for 52 weeks. Adherence was rigorously encouraged in person and by telephone.

患者被随机分组,分别为监督下的有氧锻炼组(24周,每周2次),或监督下的杨氏太极拳组4个组中的任意一组(12或24周,每周1或2次)。患者随访期为52周。通过个人或电话促进依从性提高。

Main outcome measures 主要预后指标

The primary outcome was change in the revised fibromyalgia impact questionnaire (FIQR) scores at 24 weeks compared with baseline. Secondary outcomes included changes of scores in patient’s global assessment, anxiety, depression, self efficacy, coping strategies, physical functional performance, functional limitation, sleep, and health related quality of life.

主要预后指标为24周时FIQR(修订纤维肌痛影响问卷)评分较基线水平的变化。次要预后指标包括患者总体评估、焦虑、抑郁、自我效能、应对策略、身体功能状态、功能受限、睡眠及健康相关生活质量。

Results 结果

FIQR scores improved in all five treatment groups, but the combined tai chi groups improved statistically significantly more than the aerobic exercise group in FIQR scores at 24 weeks (difference between groups=5.5 points, 95% confidence interval 0.6 to 10.4, P=0.03) and several secondary outcomes (patient’s global assessment=0.9 points, 0.3 to 1.4, P=0.005; anxiety=1.2 points, 0.3 to 2.1, P=0.006; self efficacy=1.0 points, 0.5 to 1.6, P=0.0004; and coping strategies, 2.6 points, 0.8 to 4.3, P=0.005). Tai chi treatment compared with aerobic exercise administered with the same intensity and duration (24 weeks, twice weekly) had greater benefit (between group difference in FIQR scores=16.2 points, 8.7 to 23.6, P<0.001). The groups who received tai chi for 24 weeks showed greater improvements than those who received it for 12 weeks (difference in FIQR scores=9.6 points, 2.6 to 16.6, P=0.007). There was no significant increase in benefit for groups who received tai chi twice weekly compared with once weekly. Participants attended the tai chi training sessions more often than participants attended aerobic exercise. The effects of tai chi were consistent across all instructors. No serious adverse events related to the interventions were reported.

所有5组的患者FIQR评分均有改善,但4个太极治疗组综合而言,24周时FIQR评分改善较有氧锻炼组更为明显(组间差异5.5分,95%可信限0.6-10.4,p=0.03),部分次要预后终点也有显著改善(患者总体评估0.9分,0.3-1.4,p=0.005;焦虑1.2分,0.3-2.1,p=0.006;自我效能1.0分,0.5-1.6,p=0.0004;应对策略2.6分,0.8-4.3,p=0.005)。与有氧锻炼组相比,相同治疗强度及持续时间(24周,每周2次)的太极治疗组获益更多(FIQR组间差异16.2分,8.7-23.6,p<0.001)。与12周太极治疗组相比,24周太极治疗组患者改善更明显(FIQR评分差异9.6分,2.6-16.6,p=0.007)。与每周1次相比,每周2次太极治疗疗效并无显著差异。患者参加太极锻炼较有氧锻炼更为积极。所有指导老师辅导的太极治疗疗效一致。未报告与干预措施相关的严重不良事件。

Conclusion 结论

Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment, for a variety of outcomes for patients with fibromyalgia. Longer duration of tai chi showed greater improvement. This mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia.

与目前最常使用的非药物治疗有氧锻炼相比,太极的身心治疗可同样或更显著改善纤维肌痛患者的多种预后指标。较长时间的太极锻炼症状改善更为明显。这种身心治疗方式可以作为纤维肌痛的多学科治疗选择。

Trial registration 试验注册

ClinicalTrials.gov NCT01420640.

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