근관절건강학회지 (Journal of muscle and joint health)

  • 제26권2호
  • /
  • Pages.141-154
  • /
  • 2019
  • /
  • 1975-9398(pISSN)
  • /
  • 2288-789X(eISSN)
대한근관절건강학회 (Korean Society of Muscle and Joint Health)
권호 표지
DOI QR코드

DOI QR Code

강직성 척추염 환자의 폐기능에 미치는 운동효과에 대한 메타분석

A Meta-analysis for the Effects of Exercise on Pulmonary Function in Patients with Ankylosing Spondylitis

  • 투고 : 2019.06.17
  • 심사 : 2019.07.25
  • 발행 : 2019.08.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: This study aimed to analyze the effects of exercise on pulmonary function in patients with ankylosing spondylitis (AS). Methods: Randomized controlled trials (RCTs) were identified by searching MEDLINE, EMBASE, CENTRAL, and CINAHL (through Jan 2019). Three reviewers independently retrieved articles, extracted data, and assessed methodological quality using the Cochrane's Risk of Bias for randomized studies. Results: Fourteen studies met the inclusion criteria with a total of 729 participants. CE (SMD 0.58, 95% CI 0.41~0.75, p<.001) and $VO_2peak$ (SMD 0.56, 95% CI 0.24~0.88, p=.001) had a significant effect on the most exercise interventions. As a secondary variable, BASFI (SMD -0.53, 95% CI -0.70~-0.37, p<.001), BASMI (SMD -0.75, 95% CI -0.92~-0.58, p<.001) showed an effect size of more than medium. However, PFT and QoL did not produce a significant results. Conclusion: Pulmonary involvement is common in patients with AS and might have disturbed functionality and exercise modality. Exercise can be an effective intervention to improve pulmonary function in patients with AS. More attention is needed to improve the chest and spinal mobility to maintain the appropriate pulmonary function. It is also necessary to consider how to construct a patient-tailored exercise program to increase performance, accuracy and safety of exercise.

키워드

DGGJBW_2019_v26n2_141_f0001.png 이미지

Figure 1. Flow diagram of the study selection process.

DGGJBW_2019_v26n2_141_f0002.png 이미지

Figure 2. Assessment risk of bias in included studies.

DGGJBW_2019_v26n2_141_f0005.png 이미지

Figure 3. Forest plots of the effects of exercise program; primary outcomes.

DGGJBW_2019_v26n2_141_f0006.png 이미지

Figure 4. Forest plots of the effects of exercise program; secondary outcomes.

Table 1. Characteristics of Included Studies

DGGJBW_2019_v26n2_141_t0001.png 이미지

참고문헌

  1. Aytekin, E., Caglar, N. S., Ozgonenel, L., Tutun, S., Demiryontar, D. Y., & Demir, S. E. (2011). Home-based exercise therapy in patients with ankylosing spondylitis: Effects on pain, mobility, disease activity, quality of life, and respiratory functions. Clinical Rheumatology, 31(1), 91-97. https://doi.org/10.1007/s10067-011-1791-5
  2. Berdal, G., Halvorsen, S., van der Heijde, D., Mowe, M., & Dagfinrud, H. (2012). Restrictive pulmonary function is more prevalent in patients with ankylosing spondylitis than in matched population controls and is associated with impaired spinal mobility: A comparative study. Arthritis Research & Therapy, 14(1), R19. https://doi.org/10.1186/ar3699
  3. Brambila-Tapia, A. J. L., Rocha-Munoz, A. D., Gonzalez-Lopez, L., Vazquez-Del-Mercado, M., Salazar-Paramo, M., Davalos-Rodriguez, I. P., et al. (2013). Pulmonary function in ankylosing spondylitis: Association with clinical variables. Rheumatology International, 33(9), 2351-2358. https://doi.org/10.1007/s00296-013-2723-2
  4. Braun, J., & Sieper, J. (2007). Ankylosing spondylitis. Lancet, 369(9570), 1379-1390. https://doi.org10.1016/S0140-6736(07)60635-7
  5. Buyukavci, R., Sag, S., Ozkarafakili, M., & Kuran, B. (2017). The effects of respiratory functions on disease activity, functionality, spinal mobility and quality of life in patients with ankylosing spondylitis. Medicine Science | International Medical Journal, 6(1), 1-72. https://doi.org/10.5455/medscience.2016.05.8525
  6. Chang, W., Tsou, Y. M., & Lee, C. (2016). Comparison between specific exercises and physical therapy for managing patients with ankylosing spondylitis: A meta-analysis of randomized controlled trials. International Journal of Clinical and Experimental Medicine, 9(9), 17028-17039.
  7. Dagfinrud, H., Halvorsen, S., Vollestad, N. K., Niedermann, K., Kvien, T. K., & Hagen, K. B. (2011). Exercise programs in trials for patients with ankylosing spondylitis: Do they really have the potential for effectiveness?. Arthritis Care & Research, 63(4), 597-603. https://doi.org/10.1002/acr.20415
  8. Dean, L. E., Jones, G. T., MacDonald, A. G., Downham, C., Sturrock, R. D., & Macfarlane, G. J. (2014). Global prevalence of ankylosing spondylitis. Rheumatology, 53(4), 650-657. https://doi.org/10.1093/rheumatology/ket387
  9. Dincer, U., Cakar, E., Kiralp, M. Z., Bozkanat, E., Kilac, H., & Dursun, H. (2007). The pulmonary involvement in rheumatic diseases: Pulmonary effects of ankylosing spondylitis and its impact on functionality and quality of life. The Tohoku Journal of Experimental Medicine, 212(4), 423-430. https://doi.org/10.1620/tjem.212.423
  10. Donath, J., & Miller, A. (2009). Restrictive chest wall disorders. Seminars in Respiratory and Critical Care Medicine, 30(3), 249-251. https://doi.org/10.1055/s-0029-1222441
  11. Durmus, D., Alayl, G., Uzun, O., Tander, B., Canturk, F., Bek, Y., et al. (2008). Effects of two exercise interventions on pulmonary functions in the patients with ankylosing spondylitis. Joint Bone Spine, 76(2), 150-155. https://doi.org/10.1016/j.jbspin.2008.06.013
  12. Fisher, L. R., Cawley, M. I., & Holgate, S. T. (1990). Relation between chest expansion, pulmonary function, and exercise tolerance in patients with ankylosing spondylitis. Annals of the Rheumatic Diseases, 49(11), 921-925. https://doi.org/10.1136/ard.49.11.921
  13. Kanathur, N., & Lee-Chiong, T. (2010). Pulmonary manifestations of ankylosing spondylitis. Clinics in Chest Medicine, 31(3), 547-554. https://doi.org/10.1016/j.ccm.2010.05.002
  14. Karapolat, H., Akkoc, Y., Sari, I., Eyigor, S., Akar, S., Kirazli, Y., et al. (2008). Comparison of group-based exercise versus homebased exercise in patients with ankylosing spondylitis: Effects on bath ankylosing spondylitis indices, quality of life and depression. Clinical Rheumatology, 27(6), 695-700. https://doi.org/10.1007/s10067-007-0765-0
  15. Kelley, G. A., Kelley, K. S., & Callahan, L. F. (2018). Community-deliverable exercise and anxiety in adults with arthritis and other rheumatic diseases: A systematic review with meta-analysis of randomized controlled trials. BMJ Open, 8(2), e019138. https://doi.org/10.1136/bmjopen-2017-019138
  16. Kim, S. Y., Park, J. E., Seo, Y. J., Jang, B. H., Son, H. J., Suh, H. S., et al. (2011). NECA's guidance for undertaking systematic reviews and meta-analyses for intervention. Seoul: National Evidence-based Health Care Collaborating Agency.
  17. Kucukdeveci, A. A., McKenna, S. P., Kutlay, S., Gursel, Y., Whalley, D., & Arasil, T. (2000). The development and psychometric assessment of the Turkish version of the Nottingham Health Profile. International Journal of Rehabilitation Research, 23, 31-38. https://doi.org/10.1097/00004356-200023010-00004
  18. Lachenbruch, P. A., & Cohen, J. (1989). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Journal of the American Statistical Association, 84(408), 1096. https://doi.org/10.2307/2290095
  19. Millner, J., Barron, J. S., Beinke, K. M., Butterworth, R. H., Chasle, B. E., Dutton, L. J., et al. (2016). Exercise for ankylosing spondylitis: An evidence-based consensus statement. Seminars in Arthritis and Rheumatism, 45(4), 411-427. https://doi.org/10.1016/j.semarthrit.2015.08.003
  20. Ozdemyr, O., Inanici, F., & Hascelik, Z. (2011). Reduced vital capacity leads to exercise intolerance in patients with ankylosing spondylitis. European Journal of Physical and Rehabilitation Medicine, 47(3), 391-397
  21. Sahin, G., Calikoglu, M., Ozge, C., Incel, N., Bicer, A., Ulsubas, B., et al. (2004). Respiratory muscle strength but not BASFI score relates to diminished chest expansion in ankylosing spondylitis. Clinical Rheumatology, 23(3), 199-202. https://doi.org/10.1007/s10067-003-0850-y
  22. Seckin, U., Bolukbasi, N., Gursel, G., Eroz, S., Sepici, V., & Ekim, N. (2000). Relationship between pulmonary function and exercise tolerance in patients with ankylosing spondylitis. Clinical and Experimental Rheumatology, 18(4), 503-506.
  23. Sharan, D., & Rajkumar, J. S. (2017). Physiotherapy for ankylosing spondylitis: Systematic review and a proposed rehabilitation protocol. Current Rheumatology Reviews, 13(2), 121-125. https://doi.org/10.2174/1573397112666161025112750
  24. Shim, J. (2009). Effectiveness of exercise therapy on physical function in patients with ankylosing spondylitis: Systemic review and meta-analysis. Physical Therapy Korea, 16(3), 50-59
  25. Sveaas, S. H., Berg, U., Fongen, C., Provan, S. A., & Dagfinrud, H. (2018). High-intensity cardiorespiratory and strength exercises reduced emotional distress and fatigue in patients with axial spondyloarthritis: A randomized controlled pilot study. Scandinavian Journal of Rheumatology, 47(2), 117-121. https://doi.org/10.1080/03009742.2017.1347276
  26. Wanders, A., Landewe, R., Dougados, M., Mielants, H., van der Linden, S., & van der Heijde, D. (2005). Association between radiographic damage of the spine and spinal mobility for individual patients with ankylosing spondylitis: Can assessment of spinal mobility be a proxy for radiographic evaluation?. Annals of the Rheumatic Diseases, 64(7), 988-994. https://doi.org/10.1136/ard.2004.029728
  27. Zao, A., & Cantista, P. (2017). The role of land and aquatic exercise in ankylosing spondylitis: A systematic review. Rheumatology International, 37(12), 1979-1990. https://doi.org/10.1007/s00296-017-3829-8