Systematic review on the efficacy and safety of Tai Chi of traditional body refreshment for improving bone mineral density loss

doi:10.3969/j.issn.2095-4344.1396

Chinese Journal of Tissue Engineering Research ›› 2019, Vol. 23 ›› Issue (27): 4420-4428.doi: 10.3969/j.issn.2095-4344.1396

Systematic review on the efficacy and safety of Tai Chi of traditional body refreshment for improving bone mineral density loss

Zeng Lingfeng1, 2, 3, Yang Weiyi1, Liang Guihong1, 3, Chen Hongyun1, Guo Da1, Luo Minghui1, Pan Jianke1, Zhao Di2, Zhao Jinlong2, #br# Huang Hetao2, Han Yanhong2, Lin Jiongtong2, Hou Senrong2, Wu Ming2, Li Jiahui2, Liang Weixiong1, Ou Aihua1, Liu Jun1, 2, 3

(1the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, Guangdong Province, China; 2the Second Clinical Medical College of Guangzhou University of Chinese Medicine/Post-Doctoral Research Station, Guangzhou 510405, Guangdong Province, China; 3Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, Guangdong Province, China)

Received:2019-04-02 Online:2019-09-28 Published:2019-09-28
Contact: Liu Jun, Master, Chief physician, Doctoral supervisor, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, Guangdong Province, China; the Second Clinical Medical College of Guangzhou University of Chinese Medicine/Post-Doctoral Research Station, Guangzhou 510405, Guangdong Province, China; Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, Guangdong Province, China
About author:Zeng Lingfeng, MD, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, Guangdong Province, China; the Second Clinical Medical College of Guangzhou University of Chinese Medicine/Post-Doctoral Research Station, Guangzhou 510405, Guangdong Province, China; Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, Guangdong Province, China
Supported by:
the National Postdoctoral Science Foundation of China, No. 2018M633036 (to ZLF); the Project of Guangdong Provincial Department of Finance, No. [2014]157 and [2018]8 (both to LJ); the Science and Technology Research Project of Guangdong Provincial Hospital of Chinese Medicine, No. YK2013B2N19 (to LJ); the Medical Science Research Foundation of Guangdong Province, No. B2019091 (to ZLF); the Science and Technology Research Project of Guangdong Provincial Hospital of Chinese Medicine, No. YN2015MS15 (to LJ)

Abstract

Abstract:

BACKGROUND: There is no consensus on the effectiveness and safety of Tai Chi of traditional body refreshment for patients concerning bone mineral density loss, which needs further investigation.
OBJECTIVE: To assess the effectiveness and safety of Tai Chi of traditional body refreshment for improving bone mineral density loss.
METHODS: Databases including CNKI, WanFang, VIP, CBM, PubMed, MEDLINE, EMbase and Cochrane Library were searched by computer for randomized controlled trials involving Tai Chi of traditional body refreshment (including Tai Ji Quan, Tai Chi push hand, Tai Chi softball, et al.) on the effect of bone health/bone mineral density published before January 2019. The related periodicals were also manually retrieved. Literature screening, data extraction and methodological quality were conducted based on the Cochrane methods. Meta-analysis was performed on RevMan 5.3 software.
RESULTS AND CONCLUSION: Fourteen articles including 16 randomized controlled trials were included. Meta-analyses results found that: Tai Chi of traditional body refreshment was superior to the control group in improving bone mineral density of L2-4 (SMD=0.40, 95%CI[0.16, 0.65], P=0.001), and femoral neck (SMD=0.75, 95%CI [0.27, 1.24], P=0.002). Furthermore, no significant differences were observed between groups in bone mineral density of Ward’s triangle (SMD=0.50, 95%CI[-0.10, 1.10], P=0.10), femoral shaft (SMD=0.16, 95%CI [-0.11, 0.44], P=0.25), proximal femoral trochanter (SMD=0.54, 95%CI [-0.01, 1.09], P=0.05), and 1/3 distal radius (SMD=0.20, 95%CI [-0.26, 0.66], P=0.040). No seriously adverse events were reported. Current evidence suggest that Tai Chi of traditional body refreshment shows additive benefits for the improvement of bone mineral density loss of lumbar spine and femoral neck in specific populations (such as elderly, osteoporosis groups, perimenopausal and postmenopausal women). In view of the study of small number and itself limitations, further clinical trials with high quality and rigorous design are needed for further verification.

Key words: Tai Chi, traditional body refreshment, bone mineral density loss, Tai Ji Quan, Tai Chi push hand, Tai Chi softball, systematic review, meta-analysis, randomized controlled design

CLC Number:

Zeng Lingfeng, , , Yang Weiyi, Liang Guihong, , Chen Hongyun, Guo Da, Luo Minghui, Pan Jianke, Zhao Di, Zhao Jinlong, . Systematic review on the efficacy and safety of Tai Chi of traditional body refreshment for improving bone mineral density loss[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(27): 4420-4428.

Figures/Tables 5

2.2 纳入研究的基本特征及质量评价具体纳入研究基本特征见表2。纳入研究的方法学质量评价见表1。 2.3 Meta分析结果 2.3.1 传统太极功法干预对脊柱腰椎(L2-4)骨密度的影响森林图比较：见图2。纳入的13篇文献(共15个RCT研究)报道了传统太极功法干预及对照组患者脊柱腰椎(L2-4)骨密度的比较[11-22，24]。鉴于各研究结果间存有较大的统计学异质性，故采用随机定效应模型进行Meta分析，结果提示：治疗组患者接受传统太极功法干预后，在脊柱腰椎(L2-4)骨密度改善方面优于对照组(SMD=0.40，95%CI[0.16，0.65]，P=0.001)。敏感性分析：以上结果存在较大的统计学异质性(I2=67%，P=0.000 1)，为分析潜在的异质性来源以及结果的稳定性，进行了敏感性分析，即采用将纳入研究作依次排除的方法以评价是否对结局指标产生影响；相关结果见表3。其中，当剔除研究[14，22]之后，异质性I2值从67%减少至0%，对脊柱腰椎(L2-4)骨密度影响的效应值合成结果为(SMD=0.20，95%CI[0.06，0.35]，P=0.005)，仍有统计学意义；而且逐项排除一个研究后，对相关研究进行数据合成分析仍有正向的统计学意义(表3)，对该项结局指标尚未产生影响。故此次研究结果相对稳定，即患者接受传统太极功法干预后，在脊柱腰椎(L2-4)骨密度改善方面优于对照组。发表偏倚：对纳入文献所绘漏斗图呈对称分布，提示当前尚无确凿的证据表明存有发表偏倚可能性。具体见图3。 2.3.2 传统太极功法干预对股骨颈骨密度的影响见图4。纳入的7个研究报道了传统太极功法干预及对照组患者股骨颈骨密度的比较[11，14-16，22-24]，随机效应模型Meta分析结果显示，患者接受传统太极功法干预后，在股骨颈骨密度影响方面优于对照组(SMD=0.75，95%CI[0.27，1.24]，P=0.002)。 2.3.3 传统太极功法干预对Ward's三角骨密度的影响见图5。纳入的3个研究报道了传统太极功法干预及对照组患者Ward's三角骨密度的比较[19-20，24]，Meta分析结果显示，患者接受传统太极功法干预后，在Ward's三角骨密度改善方面与对照组比较，两组组间差异无统计学意义(SMD=0.50，95%CI[-0.10，1.10]，P=0.10)。 2.3.4 传统太极功法干预对股骨干骨密度的影响见图6。纳入的3个研究报道了传统太极功法干预及对照组患者股骨干骨密度的比较[19-20，24]，Meta分析结果显示，患者接受传统太极功法干预后，在股骨干骨密度改善方面与对照组比较，两组组间差异无统计学意义(SMD=0.16，95%CI [-0.11，0.44]，P=0.25)。 2.3.5 传统太极功法干预对股骨近端转子骨密度的影响见图7。在纳入的文献中，有4个研究报道了传统太极功法干预及对照组患者股骨近端转子骨密度的比较[11，20，23-24]，采用随机效应模型进行Meta分析，结果提示：患者接受传统太极功法干预后，在股骨近端转子骨密度改善方面与对照组比较，两组组间差异无统计学意义(SMD=0.54，95%CI [-0.01，1.09]，P=0.05)。 2.3.6 传统太极功法干预对桡骨远端1/3处骨密度的影响见图8。纳入的2个研究报道了传统太极功法干预及对照组患者桡骨远端1/3处骨密度的比较[19-20]，Meta分析结果显示，患者接受传统太极功法干预后，在桡骨远端1/3处骨密度改善方面与对照组比较，两组组间差异无统计学意义(SMD=0.20，95%CI [-0.26，0.66]，P=0.040)。 "

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Systematic review on the efficacy and safety of Tai Chi of traditional body refreshment for improving bone mineral density loss

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