运动疗法对哮喘儿童的可行性:一项荟萃分析
2023/08/28
摘要
背景：尽管大量研究已经证明了运动对哮喘患者的明显益处，但仍存在争议。本研究评估了持续运动类型对哮喘患者肺功能和生活质量的影响。
方法：检索2000年1月至2022年8月PubMed、EMBASE、Web of Science、Cochrane Library、中国知网(CNKI)、万方数据库。包括哮喘儿童运动干预的随机对照试验(RCTs)。结局指标为肺功能和哮喘相关生活质量。采用固定效应模型(I2≤50%)或随机效应模型(I2>50%)计算合并效应。绘制漏斗图量化发表偏倚，以P<0.05为差异有统计学意义。
结果：最终有15项研究符合入选标准。运动组较对照组明显改善哮喘患儿的肺功能(FEV1和FVC)。第1秒用力呼气量(MD = 2.12, 95%CI = 0.70, 3.53;P = 0.003;I2 = 15%);用力肺活量(MD = 2.78, 95%CI = 1.26, 4.31;P = 0.0004; I2 = 56%)。运动组免疫系统标志物IL-6和TNF-α明显降低。IL-6 (MD = -0.49,95%CI = -0.81,-0.17;P = 0.003; I2 = 0%);肿瘤坏死因子-α(MD = -0.54, 95%CI = -0.92， -0.15;P = 0.006; I2 = 0%)。运动组哮喘患儿的生活质量(PAQLQ)显著改善。PAQLQ-总评分(MD = 1.06, 95%CI = 0.46, 1.66;P = 0.006; I2= 94%);PAQLQ-情绪 (MD = 0.91, 95%CI = 0.76, 1.06;p < 0.00001; I2= 90%) PAQLQ症状(MD = 0.87, 95%CI = 0.71, 1.02;0.00001 I2 = 95%);PAQLQ-活动(MD = 1.20, 95%CI = 0.58, 1.82;P = 0.00001; I2= 93%)。荟萃分析显示，运动组的身体成分有显著改善。BMI (MD = -2.42, 95% ci = -4.40, 0.44, p=0.02: I2= 85%)。
结论：meta分析显示运动干预对改善哮喘患儿肺功能指标(FEV1、FVC)、免疫系统(IL-6、TNF-α、Feno)、运动能力(6MWT)、身体成分(BMI)和生活质量(PAQLQ)的有效性。哮喘患儿应定期参加体育锻炼。
Feasibility of exercise therapy for children with asthma: a meta-analysis
L. Zhou and H. Xu
Abstract
BACKGROUND: Although numerous studies have demonstrated the clear benefits of exercise for people with asthma, controversy remains. This study evaluated the effects of sustained exercise types on lung function and quality of life in patients with asthma.
METHODS:We searched PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang database since January 2000 to August 2022. included randomized controlled trials (RCTs) of asthmatic children intervened with exercise. The outcomes were lung function and asthma-related quality of life. Fixed-effects model (I2≤50%) or random-effects model (I2>50%) was applied to calculate the pooled effects. Funnel plots were quantified to present publication bias, and a P value＜0.05 was statistically significant.
RESULTS: Eventually, 15 trials conformed to the selection criteria. The exercise group significantly improved lung function (FEV1 and FVC) in asthmatic children compared with the control group. Forced Expiratory Volume in 1 Second (MD = 2.12, 95%CI = 0.70, 3.53; p = 0.003; I2 = 15%); Forced Vital Capacity (MD = 2.78, 95%CI = 1.26, 4.31; p = 0.0004; I2 = 56%). The immune system markers IL-6 and TNF-α, were significantly reduced in the exercise group. Interleukin-6 (MD = -0.49, 95%CI = -0.81, -0.17; p = 0.003; I2 =0%); tumor necrosis factor-α (MD = -0.54, 95%CI = -0.92, -0.15; p = 0.006; I2 = 0%). That quality of life (PAQLQ) was significantly improved in children with asthma in the exercise group. PAQLQ-Total score (MD = 1.06, 95%CI = 0.46, 1.66; p = 0.006; I2 = 94%); PAQLQ-Emotional (MD = 0.91, 95%CI = 0.76, 1.06; p＜0.00001; I2 = 90%)PAQLQ-symptoms (MD = 0.87, 95%CI = 0.71, 1.02; p<0.00001 I2 = 95%); PAQLQ-activities (MD = 1.20, 95%CI = 0.58, 1.82; p = 0.00001; I2 = 93%). Meta-analysis showed significant improvements in body composition in the exercise group. BMI (MD = -2.42, 95%CI = -4.40, 0.44: p = 0.02: I2 = 85%).
CONCLUSIONS: This meta-analysis demonstrated the effectiveness of exercise in improving pulmonary function index (FEV1, FVC), immune system (IL-6, TNF-α, Feno), exercise ability (6MWT), body composition (BMI), and quality of life (PAQLQ) in asthmatic children. Asthmatic children should regularly participate in physical exercise.
背景：尽管大量研究已经证明了运动对哮喘患者的明显益处，但仍存在争议。本研究评估了持续运动类型对哮喘患者肺功能和生活质量的影响。
方法：检索2000年1月至2022年8月PubMed、EMBASE、Web of Science、Cochrane Library、中国知网(CNKI)、万方数据库。包括哮喘儿童运动干预的随机对照试验(RCTs)。结局指标为肺功能和哮喘相关生活质量。采用固定效应模型(I2≤50%)或随机效应模型(I2>50%)计算合并效应。绘制漏斗图量化发表偏倚，以P<0.05为差异有统计学意义。
结果：最终有15项研究符合入选标准。运动组较对照组明显改善哮喘患儿的肺功能(FEV1和FVC)。第1秒用力呼气量(MD = 2.12, 95%CI = 0.70, 3.53;P = 0.003;I2 = 15%);用力肺活量(MD = 2.78, 95%CI = 1.26, 4.31;P = 0.0004; I2 = 56%)。运动组免疫系统标志物IL-6和TNF-α明显降低。IL-6 (MD = -0.49,95%CI = -0.81,-0.17;P = 0.003; I2 = 0%);肿瘤坏死因子-α(MD = -0.54, 95%CI = -0.92， -0.15;P = 0.006; I2 = 0%)。运动组哮喘患儿的生活质量(PAQLQ)显著改善。PAQLQ-总评分(MD = 1.06, 95%CI = 0.46, 1.66;P = 0.006; I2= 94%);PAQLQ-情绪 (MD = 0.91, 95%CI = 0.76, 1.06;p < 0.00001; I2= 90%) PAQLQ症状(MD = 0.87, 95%CI = 0.71, 1.02;0.00001 I2 = 95%);PAQLQ-活动(MD = 1.20, 95%CI = 0.58, 1.82;P = 0.00001; I2= 93%)。荟萃分析显示，运动组的身体成分有显著改善。BMI (MD = -2.42, 95% ci = -4.40, 0.44, p=0.02: I2= 85%)。
结论：meta分析显示运动干预对改善哮喘患儿肺功能指标(FEV1、FVC)、免疫系统(IL-6、TNF-α、Feno)、运动能力(6MWT)、身体成分(BMI)和生活质量(PAQLQ)的有效性。哮喘患儿应定期参加体育锻炼。
（中日友好医院呼吸与危重症医学科 李春晓 摘译 林江涛 审校）
（Front Cell Dev Biol 2023 Vol. 11 Pages 1192929 DOI: 10.3389/fcell.2023.1192929）
（Front Cell Dev Biol 2023 Vol. 11 Pages 1192929 DOI: 10.3389/fcell.2023.1192929）
Feasibility of exercise therapy for children with asthma: a meta-analysis
L. Zhou and H. Xu
Abstract
BACKGROUND: Although numerous studies have demonstrated the clear benefits of exercise for people with asthma, controversy remains. This study evaluated the effects of sustained exercise types on lung function and quality of life in patients with asthma.
METHODS:We searched PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang database since January 2000 to August 2022. included randomized controlled trials (RCTs) of asthmatic children intervened with exercise. The outcomes were lung function and asthma-related quality of life. Fixed-effects model (I2≤50%) or random-effects model (I2>50%) was applied to calculate the pooled effects. Funnel plots were quantified to present publication bias, and a P value＜0.05 was statistically significant.
RESULTS: Eventually, 15 trials conformed to the selection criteria. The exercise group significantly improved lung function (FEV1 and FVC) in asthmatic children compared with the control group. Forced Expiratory Volume in 1 Second (MD = 2.12, 95%CI = 0.70, 3.53; p = 0.003; I2 = 15%); Forced Vital Capacity (MD = 2.78, 95%CI = 1.26, 4.31; p = 0.0004; I2 = 56%). The immune system markers IL-6 and TNF-α, were significantly reduced in the exercise group. Interleukin-6 (MD = -0.49, 95%CI = -0.81, -0.17; p = 0.003; I2 =0%); tumor necrosis factor-α (MD = -0.54, 95%CI = -0.92, -0.15; p = 0.006; I2 = 0%). That quality of life (PAQLQ) was significantly improved in children with asthma in the exercise group. PAQLQ-Total score (MD = 1.06, 95%CI = 0.46, 1.66; p = 0.006; I2 = 94%); PAQLQ-Emotional (MD = 0.91, 95%CI = 0.76, 1.06; p＜0.00001; I2 = 90%)PAQLQ-symptoms (MD = 0.87, 95%CI = 0.71, 1.02; p<0.00001 I2 = 95%); PAQLQ-activities (MD = 1.20, 95%CI = 0.58, 1.82; p = 0.00001; I2 = 93%). Meta-analysis showed significant improvements in body composition in the exercise group. BMI (MD = -2.42, 95%CI = -4.40, 0.44: p = 0.02: I2 = 85%).
CONCLUSIONS: This meta-analysis demonstrated the effectiveness of exercise in improving pulmonary function index (FEV1, FVC), immune system (IL-6, TNF-α, Feno), exercise ability (6MWT), body composition (BMI), and quality of life (PAQLQ) in asthmatic children. Asthmatic children should regularly participate in physical exercise.
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难治性哮喘的特征概况:临床影响和对系统评估的反应
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比较支气管热成形术和生物制剂治疗重度哮喘:系统综述和网络荟萃分析
