太极运动对中老年人群骨密度影响的Meta分析
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摘要
背景:已有部分临床研究表明太极运动可提高中老年人群的骨密度,但是证据等级不高,仍缺乏对这些文献论据的系统评估。目的:系统评价太极运动对中老年人群骨密度的影响,为临床上预防和治疗中老年人群骨质疏松提供更为有效的临床指导,也为运动处方的制定提供循证医学的参考。方法:通过系统检索万方数据库、中国知网、中国生物医学文献数据库、Cochrane Library和PubMed、Embase数据库,对太极运动对中老年人群骨密度影响的临床随机对照试验(RCTs)和临床对照试验(CCTs)进行收集分析,检索时间由该数据库建库至2018年9月,RCTs采用Cochrane风险评价表对文献进行评价,CCTs采用法国外科医师Slim等制定的临床干预研究的质量评价工具进行评价,提取文献资料后使用RevMan 5.3软件和State13.0软件对数据进行分析。结果与结论:太极运动可以显著改善中老年人群的腰椎[MD=0.09, 95%CI (0.06,0.12),P <0.000 01]、股骨颈[MD=0.09,95%CI(0.06,0.13),P<0.00001]、股骨大转子[MD=0.06,95%CI(0.03,0.10),P <0.000 01]、Ward’s三角区[MD=0.07,95%CI (0.06,0.09),P <0.000 2]等部位骨密度。同时对跟骨骨密度测定分析,发现太极运动可以显著提高中老年人群的超声振幅衰减(BUA)值和骨超声传播速度(SOS)值等跟骨骨密度指标(P <0.05)。结果表明,太极运动可以显著改善中老年人群不同部位的骨密度,对中老年人群的骨质疏松有较好的预防和治疗作用。
BACKGROUND: Tai Chi has been shown to improve the bone mineral density of the middle-aged and elderly patients, and the quality is poor, so a systematic assessment is required. OBJECTIVE: To evaluate the effect of Tai Chi on bone mineral density in the middle-aged and elderly, thereby providing accurate and reliable reference for the prevention and treatment of osteoporosis, and providing the reference of evidence-based medicine for making exercise prescription. METHODS: Databases of WanFang, CNKI, CBM, Cochrane Library, PubMed and Embase were searched from inception to September 2018 to identify the randomized controlled trials or clinical controlled trials concerning the effect of Tai Chi on bone mineral density in the middle-aged and elderly. The quality of the included randomized controlled trials and clinical controlled trials was evaluated by Cochrane system and criteria made by Slim. RevMan 5.3 software and State 13.0 software were used for meta-analysis. RESULTS AND CONCLUSION: Tai Chi could significantly improve the bone mineral density of the lumbar vertebrae [MD=0.09, 95%CI(0.06, 0.12), P < 0.000 01], femoral neck [MD=0.09, 95%CI(0.06, 0.13), P < 0.000 01], large trochanter [MD=0.06, 95%CI(0.03, 0.10), P < 0.000 01] and Ward's triangle [MD=0.07, 95%CI(0.06, 0.09), P < 0.000 2] in the middle-aged and elderly. At the same time, Tai Chi could significantly increase the bone mineral density of calcaneus, such as speed of sound and broadband ultrasound attenuation(P < 0.05). These results indicate that Tai Chi can significantly improve the bone mineral density in the middle-aged and elderly patients, and possesses the good roles in the prevention and treatment of middle-aged and elderly osteoporosis.
BACKGROUND: Tai Chi has been shown to improve the bone mineral density of the middle-aged and elderly patients, and the quality is poor, so a systematic assessment is required. OBJECTIVE: To evaluate the effect of Tai Chi on bone mineral density in the middle-aged and elderly, thereby providing accurate and reliable reference for the prevention and treatment of osteoporosis, and providing the reference of evidence-based medicine for making exercise prescription. METHODS: Databases of WanFang, CNKI, CBM, Cochrane Library, PubMed and Embase were searched from inception to September 2018 to identify the randomized controlled trials or clinical controlled trials concerning the effect of Tai Chi on bone mineral density in the middle-aged and elderly. The quality of the included randomized controlled trials and clinical controlled trials was evaluated by Cochrane system and criteria made by Slim. RevMan 5.3 software and State 13.0 software were used for meta-analysis. RESULTS AND CONCLUSION: Tai Chi could significantly improve the bone mineral density of the lumbar vertebrae [MD=0.09, 95%CI(0.06, 0.12), P < 0.000 01], femoral neck [MD=0.09, 95%CI(0.06, 0.13), P < 0.000 01], large trochanter [MD=0.06, 95%CI(0.03, 0.10), P < 0.000 01] and Ward's triangle [MD=0.07, 95%CI(0.06, 0.09), P < 0.000 2] in the middle-aged and elderly. At the same time, Tai Chi could significantly increase the bone mineral density of calcaneus, such as speed of sound and broadband ultrasound attenuation(P < 0.05). These results indicate that Tai Chi can significantly improve the bone mineral density in the middle-aged and elderly patients, and possesses the good roles in the prevention and treatment of middle-aged and elderly osteoporosis.
引文
[1]张崇蝉,琚向峰.中老年人骨量减少和骨质疏松症患病状况探究[J].实用中西医结合临床,2017,17(8):69-71.
[2]姚鑫,罗琳,洪邦辉,等.太极拳运动对老年男性骨质疏松患者锻炼情绪及骨密度和生理指标的影响[J].贵州师范大学学报(自然科学版),2016,34(3):32-36.
[3]董宏,孟良,王荣辉.体育锻炼对中老年人群骨密度影响的meta分析[J].北京体育大学学报,2016,39(3):58-65.
[4]Zhao R,Zhang M,Zhang Q.The Effectiveness of Combined Exercise Interventions for Preventing Postmenopausal Bone Loss:A Systematic Review and Meta-analysis.J Orthop Sports Phys Ther,2017;47(4):241-251.
[5]Wayne PM,Kiel DP,Buring JE,et al.Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women:a pilot pragmatic,randomized trial.BMC Complement Altern Med.2012;12:7.
[6]孙威,王疆娜,杨春荣,等.太极拳和快走练习对老年女性骨密度和骨代谢影响的跟踪研究[J].中国骨质疏松杂志,2017,23(8):1034-1040.
[7]李静雅,程亮.48周不同频率太极拳练习对老年女性骨密度的影响[J].中国骨质疏松杂志,2017,23(10):1309-1312.
[8]徐飞.24式简化太极拳对绝经后女性骨密度的影响[J].实用中医药杂志,2017,33(12):1428-1429.
[9]吴凤云,石霞萍,陈健英.太极拳运动预防老年女性骨质疏松性骨折的效果观察[J].现代医院,2016,16(11):1708-1711.
[10]叶超群,王崇伟,王广云,等.太极拳对中老年女性健康状况的影响[J].中华保健医学杂志,2016,18(6):494-495.
[11]李庆.太极拳、快步走与瑜伽对绝经后妇女下肢运动能力的影响[J].中国老年学杂志,2016,36(10):2457-2459.
[12]单鑫,康靖汶.太极拳辅助治疗绝经后骨质疏松症的效果[J].中华现代护理杂志,2015,21(31):3729-3731.
[13]李天乐.太极拳练习对男性中老年体成分和睾酮及骨密度影响的研究[D].宁波:宁波大学,2015.
[14]赵梦影,李宁,范超,等.太极推手锻炼配合营养干预对原发性骨质疏松症患者康复的影响[J].辽宁体育科技,2015,37(3):44-46.
[15]Wang H,Yu B,Chen W,et al.Simplified Tai Chi Resistance Training versus Traditional Tai Chi in Slowing Bone Loss in Postmenopausal Women.Evid Based Complement Alternat Med.2015;2015:379451.
[16]杜新星,张明军,苟波,等.太极柔力球运动对围绝经期女性雌激素及骨代谢指标的影响[J].西安体育学院学报,2014,31(4):459-463.
[17]刘长江,刘刚.规律性太极拳锻炼对退休知识女性血脂、瘦素水平及骨密度的影响[J].辽宁体育科技,2014,36(3):55-58.
[18]朱燕,陈姝艳,吴云鹏,等.太极拳运动对女性原发性骨质疏松症患者腰背肌力的影响[J].中国骨质疏松杂志,2014,20(1):45-48.
[19]Song Q H,Zhang Q H,Xu R M,et al.Effect of Tai-chi exercise on lower limb muscle strength,bone mineral density and balance function of elderly women.Int J Clin Exp Med.2014;7(6):1569-1576.
[20]许建文,尹利军,韦家鼎,等.社区骨质疏松高危人群预防胸腰椎骨折的干预研究[J].中国骨质疏松杂志,2013,19(11):1180-1183.
[21]郁嫣嫣,祁奇,余波,等.太极拳锻炼对绝经后女性骨密度的影响[J].中国康复理论与实践,2012,18(2):155-157.
[22]刘建国,周直模.太极拳和交谊舞对中老年人骨密度及柔韧性的对比研究[J].湖北体育科技,2012,31(3):325-326.
[23]Qian G,Xue K,Tang L,et al.Mitigation of oxidative damage by green tea polyphenols and Tai Chi exercise in postmenopausal women with osteopenia.PLoS One.2012;7(10):e48090.
[24]Shen CL,Chyu MC,Yeh JK,et al.Effect of green tea and Tai Chi on bone health in postmenopausal osteopenic women:a6-month randomized placebo-controlled trial.Osteoporos Int.2012;23(5):1541-1552.
[25]邹军,林菲,张丽,等.长期太极拳运动对绝经后妇女骨密度和平衡能力的影响[J].中国康复理论与实践,2011,17(1):80-82.
[26]高元元,王志鹏,刘晓军.长期习练太极拳对老年女性骨健康状况与骨代谢的影响[J].北京体育大学学报,2010,33(9):60-62.
[27]李雯钦,黄秀凤,白满.太极拳运动对围绝经期妇女骨质疏松症患者生活质量的影响[J].齐鲁护理杂志,2010,16(11):16-17.
[28]王纯,杨泽宏,陈演.不同健身运动对中老年女性骨代谢水平的影响[J].生物医学工程学杂志,2009,26(6):1306-1310.
[29]毛红妮.太极拳锻炼结合补钙对绝经后女性骨密度的影响[J].中国康复医学杂志,2009,24(09):814-816.
[30]沈华.不同形式的健身运动和体成分对中老年女性骨密度的影响[J].成都体育学院学报,2008,34(12):71-74.
[31]宋桦.太极拳锻炼对原发性骨质疏松症患者骨密度及骨代谢的影响[J].体育学刊,2008,15(11):106-108.
[32]王洁.太极柔力球运动对绝经后妇女骨密度和骨代谢指标的影响[J].北京体育大学学报,2007,30(9):1226-1228.
[33]王玉昕,方港.长期坚持太极拳锻练对老年男性跟骨超声参数及雄性激素的影响[J].首都体育学院学报,2007,19(3):53-55.
[34]马学文,王伟卓.太极拳预防老年男性骨质丢失32例的临床研究[J].陕西中医,2006,27(10):1214-1215.
[35]周勇.传统体育对绝经女性骨密度的影响[J].北京体育大学学报,2004,23(3):354-355.
[36]Chan K,Qin L,Lau M,et al.A randomized,prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women.Arch Phys Med Rehabil,2004,85(5):717-722.
[37]龚敏,张素珍,王斌,等.长期太极拳练习对老年人骨密度的影响[J].中国临床康复,2003,7(15):2238-2239.
[38]Qin L,Au S,Choy W,et al.Regular Tai Chi Chuan exercise may retard bone loss in postmenopausal women:Acase-control study.Arch Phys Med Rehabil.2002;83(10):1355-1359.
[39]Slim K,Nini E,Forestier D,et al.Methodological index for non-randomized studies(minors):development and validation of a new instrument.ANZ J Surg.2003;73(9):712-716.
[40]孙静,庞小芬,巩云霞,等.血清性激素水平与老年男性骨代谢指标及骨密度的关系[J].内科理论与实践,2008,3(4):272-275.
[2]姚鑫,罗琳,洪邦辉,等.太极拳运动对老年男性骨质疏松患者锻炼情绪及骨密度和生理指标的影响[J].贵州师范大学学报(自然科学版),2016,34(3):32-36.
[3]董宏,孟良,王荣辉.体育锻炼对中老年人群骨密度影响的meta分析[J].北京体育大学学报,2016,39(3):58-65.
[4]Zhao R,Zhang M,Zhang Q.The Effectiveness of Combined Exercise Interventions for Preventing Postmenopausal Bone Loss:A Systematic Review and Meta-analysis.J Orthop Sports Phys Ther,2017;47(4):241-251.
[5]Wayne PM,Kiel DP,Buring JE,et al.Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women:a pilot pragmatic,randomized trial.BMC Complement Altern Med.2012;12:7.
[6]孙威,王疆娜,杨春荣,等.太极拳和快走练习对老年女性骨密度和骨代谢影响的跟踪研究[J].中国骨质疏松杂志,2017,23(8):1034-1040.
[7]李静雅,程亮.48周不同频率太极拳练习对老年女性骨密度的影响[J].中国骨质疏松杂志,2017,23(10):1309-1312.
[8]徐飞.24式简化太极拳对绝经后女性骨密度的影响[J].实用中医药杂志,2017,33(12):1428-1429.
[9]吴凤云,石霞萍,陈健英.太极拳运动预防老年女性骨质疏松性骨折的效果观察[J].现代医院,2016,16(11):1708-1711.
[10]叶超群,王崇伟,王广云,等.太极拳对中老年女性健康状况的影响[J].中华保健医学杂志,2016,18(6):494-495.
[11]李庆.太极拳、快步走与瑜伽对绝经后妇女下肢运动能力的影响[J].中国老年学杂志,2016,36(10):2457-2459.
[12]单鑫,康靖汶.太极拳辅助治疗绝经后骨质疏松症的效果[J].中华现代护理杂志,2015,21(31):3729-3731.
[13]李天乐.太极拳练习对男性中老年体成分和睾酮及骨密度影响的研究[D].宁波:宁波大学,2015.
[14]赵梦影,李宁,范超,等.太极推手锻炼配合营养干预对原发性骨质疏松症患者康复的影响[J].辽宁体育科技,2015,37(3):44-46.
[15]Wang H,Yu B,Chen W,et al.Simplified Tai Chi Resistance Training versus Traditional Tai Chi in Slowing Bone Loss in Postmenopausal Women.Evid Based Complement Alternat Med.2015;2015:379451.
[16]杜新星,张明军,苟波,等.太极柔力球运动对围绝经期女性雌激素及骨代谢指标的影响[J].西安体育学院学报,2014,31(4):459-463.
[17]刘长江,刘刚.规律性太极拳锻炼对退休知识女性血脂、瘦素水平及骨密度的影响[J].辽宁体育科技,2014,36(3):55-58.
[18]朱燕,陈姝艳,吴云鹏,等.太极拳运动对女性原发性骨质疏松症患者腰背肌力的影响[J].中国骨质疏松杂志,2014,20(1):45-48.
[19]Song Q H,Zhang Q H,Xu R M,et al.Effect of Tai-chi exercise on lower limb muscle strength,bone mineral density and balance function of elderly women.Int J Clin Exp Med.2014;7(6):1569-1576.
[20]许建文,尹利军,韦家鼎,等.社区骨质疏松高危人群预防胸腰椎骨折的干预研究[J].中国骨质疏松杂志,2013,19(11):1180-1183.
[21]郁嫣嫣,祁奇,余波,等.太极拳锻炼对绝经后女性骨密度的影响[J].中国康复理论与实践,2012,18(2):155-157.
[22]刘建国,周直模.太极拳和交谊舞对中老年人骨密度及柔韧性的对比研究[J].湖北体育科技,2012,31(3):325-326.
[23]Qian G,Xue K,Tang L,et al.Mitigation of oxidative damage by green tea polyphenols and Tai Chi exercise in postmenopausal women with osteopenia.PLoS One.2012;7(10):e48090.
[24]Shen CL,Chyu MC,Yeh JK,et al.Effect of green tea and Tai Chi on bone health in postmenopausal osteopenic women:a6-month randomized placebo-controlled trial.Osteoporos Int.2012;23(5):1541-1552.
[25]邹军,林菲,张丽,等.长期太极拳运动对绝经后妇女骨密度和平衡能力的影响[J].中国康复理论与实践,2011,17(1):80-82.
[26]高元元,王志鹏,刘晓军.长期习练太极拳对老年女性骨健康状况与骨代谢的影响[J].北京体育大学学报,2010,33(9):60-62.
[27]李雯钦,黄秀凤,白满.太极拳运动对围绝经期妇女骨质疏松症患者生活质量的影响[J].齐鲁护理杂志,2010,16(11):16-17.
[28]王纯,杨泽宏,陈演.不同健身运动对中老年女性骨代谢水平的影响[J].生物医学工程学杂志,2009,26(6):1306-1310.
[29]毛红妮.太极拳锻炼结合补钙对绝经后女性骨密度的影响[J].中国康复医学杂志,2009,24(09):814-816.
[30]沈华.不同形式的健身运动和体成分对中老年女性骨密度的影响[J].成都体育学院学报,2008,34(12):71-74.
[31]宋桦.太极拳锻炼对原发性骨质疏松症患者骨密度及骨代谢的影响[J].体育学刊,2008,15(11):106-108.
[32]王洁.太极柔力球运动对绝经后妇女骨密度和骨代谢指标的影响[J].北京体育大学学报,2007,30(9):1226-1228.
[33]王玉昕,方港.长期坚持太极拳锻练对老年男性跟骨超声参数及雄性激素的影响[J].首都体育学院学报,2007,19(3):53-55.
[34]马学文,王伟卓.太极拳预防老年男性骨质丢失32例的临床研究[J].陕西中医,2006,27(10):1214-1215.
[35]周勇.传统体育对绝经女性骨密度的影响[J].北京体育大学学报,2004,23(3):354-355.
[36]Chan K,Qin L,Lau M,et al.A randomized,prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women.Arch Phys Med Rehabil,2004,85(5):717-722.
[37]龚敏,张素珍,王斌,等.长期太极拳练习对老年人骨密度的影响[J].中国临床康复,2003,7(15):2238-2239.
[38]Qin L,Au S,Choy W,et al.Regular Tai Chi Chuan exercise may retard bone loss in postmenopausal women:Acase-control study.Arch Phys Med Rehabil.2002;83(10):1355-1359.
[39]Slim K,Nini E,Forestier D,et al.Methodological index for non-randomized studies(minors):development and validation of a new instrument.ANZ J Surg.2003;73(9):712-716.
[40]孙静,庞小芬,巩云霞,等.血清性激素水平与老年男性骨代谢指标及骨密度的关系[J].内科理论与实践,2008,3(4):272-275.
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