不同类型运动疗法改善卒中后抑郁的有效性：系统综述和网络荟萃分析

摘要(中文译文)

为系统评价有氧运动（CAE）、太极拳（TC）、八段锦（BDJ）、抗阻训练（RE）、五禽戏（WQX）、瑜伽（YG）及康复训练（RT）等运动疗法对脑卒中后抑郁（PSD）患者抑郁症状、日常生活能力、运动功能及平衡功能的影响，采用网状Meta分析方法比较各干预措施的相对疗效，为临床选择最优干预策略提供高质量循证医学数据。系统检索中国知网、万方数据、维普资讯、中国生物医学文献数据库、PubMed、Embase、Cochrane Library及Web of Science，检索截止日期为2026年4月5日。纳入评价运动疗法干预PSD的随机对照试验（RCT）。由两名研究者独立进行筛选、数据提取及RoB 2.0偏倚风险评估。采用Stata 17.0在频率框架下进行网状Meta分析，连续型结局以均数差（MD）及95%置信区间（CI）表示，并采用SUCRA进行排序。共纳入33项RCT（=2339），比较了7种干预类型：CAE、TC、BDJ、RE、WQX、YG和RT。网状Meta分析显示，与对照组相比，RT[MD=-8.45，95%CI（-11.59，-5.31）]、WQX[MD=-5.55，95%CI（-11.00，-0.10）]、BDJ[MD=-3.41，95%CI（-6.24，-0.58）]和TC[MD=-3.02，95%CI（-5.32，-0.71）]可显著降低汉密尔顿抑郁量表（HAMD）评分；CAE[MD=-12.48，95%CI（-17.79，-7.17）]可显著降低抑郁自评量表（SDS）评分；RT[MD=9.47，95%CI（2.39，16.55）]在改善Barthel指数（BI）评分方面效应量最大；RE（SUCRA=96.7%）是改善Fugl-Meyer评定量表（FMA）评分最有效的干预措施；BDJ[MD=8.20，95%CI（2.73，13.67）]可显著提高Berg平衡量表（BBS）水平。HAMD和SDS用于评估患者抑郁状态，BI用于评价日常生活能力，FMA用于评估运动功能，BBS用于评价平衡功能。运动疗法可作为PSD综合管理中的有效辅助干预手段，在缓解抑郁症状及改善某些功能结局方面显示出潜在获益。不同运动方式的疗效在不同结局维度上存在差异：RT在改善HAMD评分和BI方面表现更优，CAE在提高SDS评分方面更具优势，RE在促进FMA改善方面排名最高，BDJ在改善BBS评分方面疗效最佳。鉴于纳入研究的总体方法学质量有限、部分结局样本量较小、证据网络相对稀疏以及多数研究随访时间较短，上述发现仍需通过高质量、大样本、长期随机对照试验进一步验证。CRD420261333356。

Abstract

To systematically evaluate the effects of exercise therapies such as aerobic exercise (CAE), Tai Chi (TC), Baduanjin (BDJ), resistance training (RE), Wuqinxi (WQX), yoga (YG), and rehabilitation training (RT) on depressive symptoms, daily living abilities, motor function, and balance function in patients with post-stroke depression (PSD). A network meta-analysis method was employed to compare the relative efficacy of various interventions, providing high-quality evidence-based medical data for clinical selection of optimal intervention strategies. We conducted systematic searches in China National Knowledge Infrastructure, Wanfang Data, VIP Information, Chinese Biomedical Literature Database, PubMed, Embase, Cochrane Library, and Web of Science, with the search period concluding on April 5, 2026. Randomized controlled trials (RCTs) evaluating exercise therapy interventions for PSD were included. Two investigators independently performed screening, data extraction, and RoB 2.0 bias risk assessment. A network meta-analysis was performed using Stata 17.0 under the frequency framework, with continuous outcomes expressed as mean difference (MD) and 95% confidence interval (CI), and ranked by SUCRA. A total of 33 RCTs ( = 2,339) were included, comparing seven types of interventions: CAE, TC, BDJ, RE, WQX, YG, and RT. The network meta-analysis revealed that compared with the control group, RT [MD = -8.45, 95% CI (-11.59, -5.31)], WQX [MD = -5.55, 95% CI (-11.00, -0.10)], BDJ [MD = -3.41, 95% CI (-6.24, -0.58)], and TC [MD = -3.02, 95% CI (-5.32, -0.71)] significantly reduced the Hamilton Depression Rating Scale (HAMD) scores; CAE [MD = -12.48, 95% CI (-17.79, -7.17)] significantly decreased Self-Rating Depression Scale (SDS) scores; RT[MD = 9.47, 95% CI (2.39, 16.55)] demonstrated the largest effect size in improving the Barthel Index (BI) scores; RE (SUCRA = 96.7%) was the most effective intervention for improving the Fugl-Meyer Assessment (FMA) scores; BDJ [MD = 8.20, 95% CI (2.73, 13.67)] significantly enhanced the Berg Balance Scale (BBS) levels. HAMD and SDS were used to assess patients' depressive status, BI to evaluate daily living abilities, FMA to assess motor function, and BBS to evaluate balance function. Exercise therapy can serve as an effective adjunctive intervention in the comprehensive management of PSD, demonstrating potential benefits in alleviating depressive symptoms and improving certain functional outcomes. The efficacy of different exercise modalities varies across outcome dimensions: RT shows superior performance in improving HAMD scores and BI, CAE exhibits greater advantages in enhancing SDS scores, RE ranks highest in promoting FMA improvement, and BDJ demonstrates optimal efficacy in improving BBS scores. Given the overall limited methodological quality of included studies, small sample sizes for some outcomes, relatively sparse evidence networks, and short follow-up durations in most studies, these findings require further validation through high-quality, large-sample, long-term randomized controlled trials. CRD420261333356.

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