·712· 中华物理医学与康复杂志2015年9月第37卷第9期Chin J Phys Med Rehabil,September2015,Val.37.No.9 .综述· 瑜伽辅助应用于临床康复治疗的国外研究进展 王会儒顾问 源自印度的瑜伽与中国太极拳一样，注重身心整合，有研究 of1ife,WHOQOL)、知觉压力量表和直腿抬高试验对2组患者的 证实，瑜伽练习不仅可以改善运动系统、神经内分泌系统、心血 生命质量和腰部功能进行了评测和相关性分析9，结果发现， 管系统和呼吸系统的功能，还具有增强免疫力、调节心理状态的 CLBP患者的生命质量和压力呈负相关，瑜伽组患者生命质量和 效果21。在美国，瑜伽已成为补充替代医学的重要组成部分， 腰部功能均显著优于物理锻炼组，差异均有统计学意义(P0.05)。Pushpika (P<0.01)。英国Tilbrook等]也进行了类似的随机对照研究 等刀将瑜伽治疗与常规护理干预CLBP进行比较，使用疼痛强 (哈他瑜伽辅助常规护理与单纯的常规护理进行比较)，他们将 度、疼痛频率、睡眠、生活自理、工作、娱乐等主观评分结合脊柱 干预时间延长至1年，并于干预3、6,12个月后使用Roland功能 前屈、侧屈的测量，结果显示，瑜伽组的各项指标总体缓解 障碍问卷(Roland-Morris disability questionnaire,RMDQ)、亚伯丁 79%,明显好于护理组，差异有统计学意义(P<0.01)。 背部疼痛量表(Aberdeen back pain scale,ABPS)、疼痛自我效能 Tekur等81在印度辩喜瑜伽大学(Vivekananda Yoga Anu- 感问卷(pain self-.efficacy questionnaire,PSEQ)对2组患者进行评 sandhana Samsthana,SVYASA)进行了一项为期7d的短期密集 价，结果显示，哈他瑜伽练习配合常规护理较单纯常规护理，3 型瑜伽干预实验，以探讨瑜伽练习对CLBP患者疼痛、脊柱功能 项指标的改善均更为显著，且随着时间推移差异更为显著，差异 和灵活性的作用。该研究将80例CLBP患者随机分为瑜伽组 均有统计学意义(P<0.01)。该课题后续根据哈他瑜伽练习配 和物理锻炼组，居住在集体宿舍进行密集练习，瑜伽组练习内容 合常规护理的患者仅有60%完成了12个月的瑜伽练习，又采 包括冥想、基础体位法、唱诵和呼吸法等，物理锻炼组进行步行、 用不同分析方法对参与任一阶段锻炼的患者数据进行再次分 特定姿势练习、健康讲座和音乐欣赏等，训练时间为早上5：00 析，结果显示，依从子总体的平均因果效应分析(complier aver 至22：00，练习7d后，瑜伽组的0 swestry功能障碍指数(Oswe- age causal effect analysis,CACE)比“符合方案分析”及按实际处 stry disability index,ODI)以及脊柱角度均显著优于物理锻炼组， 理分析(per-protocol and on-treatment analyses)更为严谨i41,为 差异有统计学意义(P<0.01)。同期，该课题组还采用世界卫 此类研究提供了统计方法学的参考依据。 生组织生命质量测定简表(the World Health Organization quality 以上的临床研究表明，12周以上规律的瑜伽练习对腰痛症 状改善作用较为明显，方法包括有针对性的瑜伽体式和呼吸法 D0I:10.3760/cma.j.issn.0254-1424.2015.09.021 以及艾扬格瑜伽和哈他瑜伽。 基金项目：上海交通大学“科技创新专项资金”项目(11JCY11):国家 瑜伽与RA和KOA 体育总局气功管理中心基金(QG2013004) 作者单位：200240上海，上海交通大学体育系（王会儒）：上海交通 瑜伽被较多地应用于在RA的临床辅助治疗。Badsha 大学附属新华医院老年科（顾问） 等在迪拜针对RA患者47例进行了8周的程序化随机对照 通信作者：王会儒，Email:gcsy@126.com 研究，对照组采用常规治疗，实验组在常规治疗的基础上增加以
!" #$ ! !"# % $ %&'!" ()*+,-. /0! 1 !%&'%&'()*+ , 23456789 :;%?@A BC%DEF GH%78IJKLMNOPQR$S-TUVWX$S- Y $SZ[\$S6]%^_D`abcd-ef gh6 ij . kl%78mnopqrs+ 6@tunvW% wxyz{|}6~% /0,',123 4% 567! - f 0/89:,; 0:/0:%=! -Y- }- }- 69 . 78IJ {| }6ij¡¢£¤EF¥¦%§koV+¨© !6ª«Z EF¬®¯. 567°±=uN²³-´Zµv¶-K·o¸t¹g 6Cº%°Z6»¼|}½=. ?/80 ¾ @ ¿¶À!Wo78IJu-ÁÂÃIJuZ3ÄÅÆ ÇÈ Ju% uÀ!ÉÊWuËÌWÍ¥¦78IJ-ÁÂà IJZ3ÄÅÆ%ÎÏ Ð%ÎÐ %ÑÒ Ó%Ôy ÕuÖ× ÓØx ÷?@)AB :/8K,0'; L8':/ 0)(:, B9':* ,M'M8%KL#5! -CDdBZEFGH uÀ!6 ÷?@Zv]¥¦ ÞZ¤WI %àjáâ% 567À!6÷?@ZdJK¤%78uÀ!÷?@Z v]7ãäåy u%æç7DSè éê C ! . LMN78 *8)0 ,)! °lZOPQR¦678{ ½= . K''¾ 567À! ¿ÜWoLMN 78uZÆSu%LMN78IJu61I TUV*-WX-þ-YZZ[Z {\%¢ K ]Ö^ R %ÆSu_L¥¦ÆS% u7~ Ó%Ôy ~à` ÓÖÞߢ]ÙÚa5-¶a5-xb-¶ ¤6h5Z¦oN¡üýQRcd%àjáâ%LMN78 uÀ!6¶a59üý]7ãäåyÆSu%æç7 DSè éê C ! . ^DEFeH¾fg78 L:/ ,)!wxy 567À!. ?480khij kz{lmnÕopqr a56 567À! ¿ s7.t u%v¡wxo¸!%¾¢Wo 78uZ»ðñ u%78uÎÓ¥¦ Ðfg78 ~%ÎÐ %ÑÒ~ Ó%»ðñ u_¥¦ÑÒ Ó6»ðñ %àjã%fg78uÀ!6¶a5Zyb zx{7ãäOP%9»ðñ uíî%æç7DSè éê C ! . | F'20,,3 }¥¦ ~6ÜEF fg78»ðñ 9"6»ðñ ¥¦íî!%g¾ ~2ì4 .%Ôy~ - - kÖòx <,'; ] ÙÚ0Û <,';A,00;2':*B98:,08%<A#! - ³v¶B =280;88 23 4 '8%=67?!-¶3Äi] 0Û 4 8'M8MM*B98:,08%7?&#! uÀ!¥¦Þ ß%àjã%fg78IJC»ðñ î"»ðñ % ±6OP7oãä%Ü2ìæçoãä%æç 7DSè éê C !. 9:ÖÒÉÊfg78IJ C»ðñ 6À!LD En k678IJ%Ø xK8WI$®9=6À!5Ê¥¦ÐW I%àjã%6s7jiwWI ,4'80H80 )89'8MM8:'*% = &!íCWI ¡H WI 48040,:,,'; ,:08:8:'*8! o %o ¡ EF¬ Sè$ 6®¯Ê. N6ª«EFB% ÓNð¢678IJ¹ gOP xîoã%$ D678\Z[\$ N¡LMN78Zfg78. 78£îz¤wxyk <=6ª«. 6;/ k¥¦ <=À! ¿¥¦ @ Ó6a§¨Ü EF%uØx»ð%Huk»ð6#`©N * + 9ª« . × Û× / 7/*A8; <8/2'% ?84:8280 % G,' % N,
中华物理医学与康复杂志2015年9月第37卷第9期Chin J Phys Med Rehabil.September2015,Val.37.No.9 ·713· 椅子上练习为主的胜王瑜伽(Rajia Yoga),每周练习2次，每次 练习的昆达利尼瑜伽则更为适合。有研究比较了3个月阿斯汤 Ih。治疗8周后，采用健康评定问卷(health assessment ques- 噶瑜伽(Ashtanga Yoga)与无氧操练习对轻度高血压患者的干预 tionnaire,.HAQ)、生命质量指数(quality of life,QOL)、SF-36简表 效果，结果发现，阿斯汤噶瑜伽对控制体重、降低血脂和控制血 评估生命质量和28项疾病活动性评分(disease activity score, 压等有一定作用，但与其他运动比较，差异无统计学意义(P> DAS28)评价胜王瑜伽对2组患者的疗效，结果显示，实验组患0.05)241。该研究提示.阿斯汤噶瑜伽可能对心脑血管病疾病 者的DAS28指数和HA0指数较对照组改善更为显著，差异均也有一定作用。 有统计学意义(P0.05)。有学者进行了一项每周3次、每次75mim,为期 为期6个月，每周5次的瑜伽呼吸法和瑜伽洁净法练习后，患者 10周的小型干预研究，结果显示，瑜伽干预可改善RA患者的 的血管收缩压、舒张压及心率均得到控制，总胆固醇(P< HAQ指数，缓解关节疼痛和由疾病所致的抑郁状态6]。Evans 0.01),甘油三酯(P<0.01),高密度脂蛋白(P<0.01)和低密度 等71针对18岁-35岁的青年RA患者进行了6周的艾扬格瑜 脂蛋白(P<0.05)均显著改善，该研究认为，瑜伽呼吸法和放松 伽干预和2个月的随访，结果显示，青年RA患者的HAQ指数、 类体式练习有益于冠状动脉疾病患者。Pullen等]针对心衰 SF-36简表以及疼痛障碍指数(pain disability index,PDI)较组内 患者进行了瑜伽干预，结果发现，经过每周2次，每次40min,持 治疗前均显著改善，差异均有统计学意义(P<0.01),即艾扬格 续12周的瑜伽体式结合呼吸法练习后，心力衰竭患者的明尼苏 瑜伽可作为年轻RA患者的补充疗法，但还需要更多样本的支 达心衰生命质量问卷(Minnesota living with heart failure question~ 持。后续研究中，Evans等]针对18岁-35岁的青年RA患者 naire,MHFQ)评分以及炎症因子指标均显著改善，该研究提 进行了艾扬格瑜伽干预，每周2次，每次90min,连续千预6周. 出，瑜伽可作为心衰常规治疗的辅助。另有2项研究也提示，瑜 本次研究Evans等增加了血压，心率，DAS28和风湿性关节炎自 伽练习对心血管疾病具有辅助治疗作用]。 我效能量表(arthritis self-.efficacy scale,ASES)等评价指标，结果 Holger等]对瑜伽在心血管疾病的应用及其疗效进行了 再次肯定了艾扬格瑜伽对RA的疗效，即艾扬格瑜伽可显著减 荟萃分析，共纳入44项临床实验和3168例心血管患者，最终分 轻RA患者的临床症状，舒缓情绪，提高生命质量。还有研究提 析指出，尽管多项随机临床研究存在偏移系数高、方法缺陷等问 出，哈他瑜伽可作为RA门诊患者辅助治疗方法[) 题，但瑜伽作为普通心血管疾病患者的临床辅助干预手段，其具 瑜伽对KOA的辅助治疗也有一定效果。Ebnezar等01进 备一定疗效的结论可以采信。 行了一项针对骨关节炎患者的大型随机对照研究，250例K0A 患者(35-80岁)被随机分为哈他瑜伽组和物理治疗组，2组分 瑜伽与2型糖尿病 别进行每天20min,持续3个月的干预.结果表明，哈他瑜伽治 随着肥胖的不断普遍化，2型糖尿病(type2 diabetes melli- 疗在改善关节疼痛、膝关节活动度、肿胀，关节摩擦、关节功能等 s,T2DM)及其引发的并发症危害日益严重。越来越多的证据 方面优于经皮电刺激疗法和超声波疗法。W等2]用包括坐 表明，喻伽不仅有助于T2DM及其并发症的临床管理，还可控制 在椅子上的瑜伽体式练习结合印度阿育吠陀(Ayurvedic)治疗 2型糖尿病的发展，改善糖耐量异常，降低胰岛素抵抗，但尚缺 法对KOA进行辅助治疗，用西安大略和麦克马斯特骨关节炎指 乏大型的随机对照临床试验来证实o。Hegde等3]针对 Western Ontario and MeMaster University Osteoarthritis Index, T2DM患者进行了为期3个月的哈他瑜伽体位法干预，结果发 WOAMAC)指数，PDI指数和OOL指数等进行评价，结果也肯定 现，瑜伽练习可控制T2DM患者的血糖水平，降低其氧化应激水 了瑜伽辅助治疗对KOA的作用。 平和BMⅡ指数，且对糖尿病前期的患者也有一定作用。有研究 可能是由于活动受限，关节疼痛等因素的影响，患者依从性 发现，综合瑜伽治疗可显著降低绝经后女性糖尿病患者的空腹 较低，目前瑜伽干预KOA的大样本随机对照研究较少。对RA 血糖、总胆固醇、甘油三酯和低密度脂蛋白-胆固醇水平，其疗效 及KOA患者而言，改良的哈他瑜伽和胜王瑜伽体式练习相对安 显著优于单纯的药物治疗321。Hegde等]在糖尿病前期患者 全。Middleto等]在美国主持了一项国家关节肌肉骨骼及皮肤 的随机对照研究中发现，以社区为试点的哈他瑜伽体式干预可 病研究所项目，该研究旨在从患者的接受度和可行性方面，探讨 以有效地控制患者氧化应激水平，降低其B指数、腰围、血压 瑜伽作在KOA临床治疗的应用前景，以期获得更多的临床数据 以及血糖水平，但该结果还有待更大样本量的支持。Rao等34] 支持。 在研究中将T2DM患者227例按随机数字表法分为整合瑜伽组 瑜伽与高血压、冠心病 和体育锻炼组，整合瑜伽组遵循瑜伽生活规范，有规律地练习瑜 伽体式、呼吸法和冥想，体育锻炼组则采用健身体操进行锻炼 瑜伽练习具有控制血压的效果。Walf等2]将83例20~ 结果发现，2组患者各练习9个月后，整合瑜伽组整体干预效果 80岁的高血压患者随机分为瑜伽练学习班组，居家简易瑜伽练 明显优于体育镀炼组。McDermott等]的研究也认为，瑜伽生 习组和对照组，进行了为期12周的干预实验，对照组维持常规 活方式干预T2DM可减轻忠者的体重和腰围，控制其空腹血糖 治疗方案，喻加练习班增加较为复杂的哈他瑜伽练习，居家练习 且疗效优于步行锻炼。Gaurav等36在Rao等34研究基础上， 组增加相对简单的昆达利尼瑜伽(Kundalini Yoga)练习，结果发 对整合瑜伽组T2DM患者进行了4年的随访，结果发现，坚持瑜 现，瑜伽练学习班组患者的血压和生命质量无明显改变，而居家 伽练生活方式的患者空腹血糖控制情况优于未能坚持瑜伽练生 瑜伽练习组的血压和生命质量改善明显，与对照组比较，差异均 活方式的患者，且空腹血糖和压力呈正相关(r=0.42,P< 有统计学意义(P<0.05)。该研究认为，哈他瑜伽体式复杂，对 0.05),该研究结果提示，瑜伽练习可改善T2DM患者的精神状 身体柔韧性要求高，不适合高血压患者，而动作简单、适合居家 态和对生活的热情，而血糖指标和压力是影响坚持瑜伽练习的
¬IJo¸6%78 6º ». ÖÒEF %&H @ u P u6¶. =6}D=)ij. &28(0 ¥ ¦ =fÀ!6 ÜEF% ¿ >= À! P@ u!£ÜWofg78uZ u% uW Í¥¦Îà %»Ò k6~%àjB%fg78 kOPf¶-føR5-ÄÅ-fÆÇ-f] ÈåyUÉÊËÌ$ZÍÎh$. K:: x V k¬678\IJàC45ÏÐÑ =*90H8;! $ >=¥¦%xÒÓ ÔZÕÖ×Ø(f± 5 K8:80 :0,; AA:80QH80:*:8,0:/0:;8J% K=A= !±5-7±5Z #5±5¥¦Þß%àj}¼) 78 >=6 x. M]°±yøRÙÚ-f¶Û6ÜÝ%À! îm%þ78~ >=6 >ÜEFîÞ. =À!¯ß%Oà6fg78Z%78\IJ¤Ó á. A;;'8:,kl¸» =fâãä¡Éå }EF²%EF§kÀ!6æÙ5ZM¦È% 78 k >=ª«6wxþç%N èéz6ª«5Ê º». 78IJ_DêëY6ij. K,'MM ¾ @ ¿ P @ u6YÀ!ÜWo78I Jìu-Aí78I JuZu%¥¦ o Ó6~H%uî»»ð %78IJì`©îoª6fg78IJ%IJ u`©¤A"6ïðñò78 >9;' ,)!IJ%àjá â%78I JìuÀ!6YZ÷?@ïãOó%¯ 78IJu6YZ÷?@OPã%9uíî%æç7 DSè éê C ! . EFôo%fg78\ª% Aõöt÷%K·CYÀ!%¯R A"-·C IJ6ïðñò78_o·C. DEFíî kÏØø ù78 =/:) ,)!9ïúÃIJ¸5YÀ!6~ ij%àjáâ%ÏØøù78êë@-ûmYüZêëY D=) x%ë9¢gQRíî%æçïSè éê D ! . EF¬%ÏØøù78M] ýY }|} }D=) x. = }À! ¿6ÜEFã %Uþ o k%ÎÓ Ð678[\$Z78$IJÖ%À! 6Y n- ¡ ô % C !% C !%5 C !Z5 C !ãäOP%EFo%78[\Z IJDygR|}À!. 79''8 À!¥¦78~%àjáâ%UÎÓ Ð-ÎÐ - Ò Ó678àC[\ IJÖ% d À!6 ÷0Û A8,:'H)1:/ /80:M'908B98:, 08%A5LO#!ÞWN¡¹±ãäOP%EF¬ %78M o »ð6. D EF¬%7 8IJ Y |}_D x . L,')80 78k Y |}6wx¡¢i¥¦ W% Õ ª«H Z @ ¿ Y À!% W ±% zܪ«EFk$-0 %ë78 o Y |}À!6ª«~%¢_ = i6à MNØ1. Ü 6K% } :*48 ;28:88'' :9%FA!¡¢á6Ôá¹ Ï @. z6GÊ %78KLDy FA¡¢Ôá¹6ª« %^M }6áÂ%OPç»%%ë 6Ü ª« !"G H . L8);8 FAÀ!¥¦#o$ %&6'(78#~%àjá â%78IJM FAÀ!6Y)*%¢+w,) *Z 6A±-%.}þ$6À!/D= x. DEF áâ%C78MãäUÖ0}À!612 Y-345- 678Z95:!345)*%¢i ãäåy";6?o!@6'(78A~M NDiBÀ!+w,)*%¢ 6A±--C-Y N¡Y)*%ëDàj^DEF >6GH. <, kEF ¾ FAÀ! ¿IÜ -JWoBC78u ZKLu%BC78uMN78÷øðO%DðPBIJ7 8A-[\ZQR%KLuSØxÆAÃ¥¦KL% àjáâ% uÀ! IJ %&Ö%BC78uB~ij ãåyKLu. A80,:: 6EF/To%78÷ øUA~ FAMVWÀ!6@ZC%¢12Y% .iåy"¦KL. $90H k <, EFX% BC78u FAÀ!¥¦# .6ÜÝ%àjáâ%YH7 8I÷øUA6À!12YËÌåyZ]YH78I÷ øUA6À!%.12YZd[\¤ R % C !%DEFàj¬]%78IJMOP FAÀ!6^Tg hZ÷ø6_Ë%`Y±#Zd°abYH78IJ6 *= + 9cd . &× Û× $ / 7/*A8; <8/2'% ?84:8280 % G,' % N,
·714· 中华物理医学与康复杂志2015年9月第37卷第9期Chin J Phys Med Rehabil.September2015,Val.37.No.9 重要因素。Kyizom等1观察了瑜伽呼吸法结合体式练习对 尚难确定哪种瑜伽更具针对性的疗效。 T2DM患者事件相关电位潜伏期和振幅的影响，结果发现.瑜伽 艾扬格瑜伽以著名瑜伽导师B.K.S Iyengar的名字命名，又 组（体式+呼吸法+清洁法+常规药物治疗）患者的事件相关 称为辅助瑜伽，其最大特点是借助椅子，靠垫、砖头等辅助工具， 电位N200和P300的潜伏期以及振幅均显著优于常规药物治 使瑜伽体式变得简单，更加适合不同人群的生理特点。艾扬格 疗组（单纯的常规药物治疗），提示常规药物治疗结合瑜伽练习 瑜伽其实是哈他瑜伽经典体式的人性化革新，因此受众面较广。 可改善糖尿病患者的认知功能。 针对KOA患者，可采用改良的、椅子上的改良瑜伽体式练习，以 综上所述，可以认为，T2DM患者遵循瑜伽倡导的生活方 降低膝关节的承受力。阿斯汤噶瑜伽的难度和强度均非常高 式，有规律地练习瑜伽体式和呼吸法可使其肢体放松、压力缓 (如倒立类、力量类练习)，无基础的健康人也很难完成，因此不 解，有助于控制血糖，改善其认识功能和精神状态，从而达到辅 太适合于心血管及关节问题的患者。昆达利尼瑜伽是由一 助治疗糖尿病的目的。 系列的瑜伽动作组合组成的，呼吸法和唱诵较多，对柔韧性要求 不高，可建议心血管疾病、肿瘤以及压力大者练习。如何从上百 瑜伽与乳腺癌 种的瑜伽体式，以及呼吸法和冥想练习中，根据疾病的特点制定 有研究显示，瑜伽干预可作为肿瘤（如乳腺癌）的辅助治疗 个性化的瑜伽练习处方，可能是未来需要解决的问题。 方案。Carson等81（瑜伽觉知练习8周）、Bower等91（艾扬格 瑜伽倡导科学的生活方式，从饮食习惯到日常作息，均有明 瑜伽练习12周)和Banasik等o](艾扬格瑜伽8周)的瑜伽干 确的规定：而瑜伽呼吸控制法和瑜伽冥想还具有心理疏导的作 预研究均显示，规律的瑜伽练习可改善乳腺癌存活者的持续疲 用。如何借鉴国外研究成果，将瑜伽治疗运用于临床实践中，减 劳症状，增加活力。Littman等4]研究结果显示，6个月的哈他 轻患者的痛苦，降低药物治疗的频率和减少副反应，是国内医务 瑜伽练习不足以改善乳腺癌患者的疲劳症状，须进行更长时间 工作者需要努力的方向。 的练习。Moadel等4]的研究提出，增加瑜伽练习的强度才可改 善乳腺癌患者的疲劳症状。Chandwani等4]的研究也发现，6 参考文献 周的瑜伽练习可以改善乳腺癌患者的生命质量，但未见疲劳状 [1]Posadzki P,Emst E.Yoga for low back pain:a systematic review of 态的明显改善。Danhauer等[4的研究则发现，治疗12周后，瑜 randomized clinical trials[J].Clin Rheumatol,2011,30(9):1257- 伽练习组（能量修复瑜伽+常规药物治疗）的情绪和药物治疗 1262. 的副反应情况均优于常规药物组(P0.05)。 [3]Field T.Yoga clinical research review [J].Complement Ther Clin 在对乳腺癌症患者进行治疗的过程中，心理健康问题常被 Pract..2011.17(1):1-8. 忽略。Mackenzie等451的研究结果显示，经6个月的瑜伽冥想 [4]Derry HM,Jaremka LM,Bennett JM,et al.Yoga and self-reported 干预，乳腺癌患者的不安情绪、抑郁症状及健康相关生命质量 cognitive problems in breast cancer survivors:a randomized controlled (health-related quality of life,HRQL)均显著改善。Kovacie等6] trial[J].Psychooncology,2014,DOI:10.1002/pon.3707. 的研究结果也显示，系统的瑜伽生活方式可改善乳腺癌术后患 [5]Cramer H,Rabsilber S,Lauche R,et al.Yoga and meditation for 者的焦虑情绪，压力和自我认知度。还有研究认为，瑜伽呼吸法 menopausal symptoms in breast cancer survivors-A randomized con- 不仅可以提高乳腺肿瘤化疗患者的生命质量，还可改善其焦虑 trolled trial[J].Canner,2015,DOI:10.1002/cancer.29330 抑郁，睡眠障碍等症状t4。Cramer等[s]对瑜伽干预乳腺癌的 [6]Sherman KJ,Cherkin DC,Wellman RD,et al.A randomized trial 临床研究进行了荟萃分析，共纳入12项随机对照研究和472例 comparing yoga,stretching,and a self-care book for chronic low back 患者，结果发现，短期的瑜伽练习可作为乳腺癌患者的辅助恢复 paim[J].Arch Intern Med,2011,171(22):2019-2026 [7]Pushpika A,Somarathna AM,Vyas KI,et al.Clinical evaluation of 方法，其疗效基本可以肯定。 selected Yogic procedures in individuals with low back pain[J].Ayu 小结 2010.31(2):245-250. (8]Tekur P,Singphow C,Nagendra HR,et al.Effect of short-term inten- 已有大量临床实验证实，瑜伽可作为疾病的辅助治疗手段， sive yoga program on pain,functional disability and spinal flexibility in 但实验设计和研究方法等方面还有值得商讨之处。如入选标准 chronic low back pain:a randomized control study[J].J Altern Com- 和干预周期不统一，评价方法主要采用问卷和主观打分，患者的 plement Med,2008.14(6):637-644. 依从性低和随访流失等问题，使结果难以让人完全信服。近年 [9]Tekur P,Chametcha S,Hongasandra RN,et al.Effect of yoga on 来，有研究者尝试采用更为严谨、偏差性较小的统计方法来解决 quality of life of CLBP patients:a randomized control study[.Int J 上述部分问题。这对于研究中国传统健身方式（如太极拳）的 Yoga,2010,3(1):10-17. 疾病干预极具参考价值。 [10]Michalsen A,Jeitler M,Brunnhuber S,et al.lyengar yoga for dis- tressed women:a 3-armed randomized controlled trial[J].Evid Based 应用于临床干预的瑜伽种类呈多样化，包括艾扬格瑜伽、哈 Complement Alternat Med,2012,(2012):539-539. 他瑜伽，瑜伽清洁法、阿斯汤噶瑜伽、昆达利尼瑜伽、能量修复瑜 [11]Williams KA,Petronis J,Smith D,et al.Effect of lyengar yoga thera 伽以及瑜伽生活方式等，其中艾扬格瑜伽应用较多。由于目前 py for chronic low back pain[J].Pain,2005,115(1):107-117. 的实验设计中，一般将常规药物治疗的非镀炼组、健康教育，或 [12]Saper RB,Sherma K],Cullum DD,et al.Yoga for chronie low back 者其它运动作为对照组，较少采用不同瑜伽种类进行比较，因此 pain in a predominantly minority population:a pilot randomized con-
@te. >*(, û$#78[\àCAIJ FAÀ!fg¤h#ij$Zk%6ab%àjáâ%78 u A S[\ Slm S»ð,H 6EFàj/ã]%$S678÷øUAMOPÖÀ !6Ë-dZ3ÄT'5. ^DEFTo%78[\ KLMN¬uvÀ!6÷12%^MOP¢- -õöÙÚ¹g . 080 78~6 ª«EF¥¦#W% Õ Ü EFZ ¿ À!%àjáâ%3$678IJM oÀ!6 U%¢iMN . $% mD ª«H"GH%78M o|}6% ëH"4èZEFUU^D5½. Õ#6 Z~Ó$KS=%ÞßU¸tØx0ÛZ¸ûW%À!6 sZÜÝ780%òàj9N:1. ;. %DEF!!ØxFo -¡æî¢6SèU+SÆAUA :;%£ -./78-' (78-78lm-¤¥¦§78-¨t©ª78-]7 8N¡78÷øUA%¢ -./78wxîz. «yþ 6H"4è %=¬¾»ð ? *8)06²J1²%³ Do78%¢ E@°´µ¶-·F-¸¹©_% ò78AºG"%F{·CKAH6÷ E@. -./ 78¢H°'(78U»A6I%e°¼½îJ. >=À!%MØxO¾6-µ¶6O¾78AIJ%N f6¿¼d. ¤¥¦§78695Za5&» ÀK -d IJ!%ïX6Æ/ 9n%e°K :·Cy Y ¡f06À! . ¨t©ª78°«= $Á678R uCun6%[\ZLMîz%ÂÃtÄ K%MNO Y |}-uvN¡d !IJ. ÅsÆ {678A%N¡[\ZQRIJ %ÉÊ|}6E@ %678IJU%M]°ZÇt+ % /803 % K8'' % 8:' ''8H'9:, ,M 8'8:8; ,)40,8;908 ;H;9'1:/ ',123 4T U =*9% % ! T@U F83907% ?)4/,1 % N)8;0L=% 78:0, % ?:/ % 8:' &MM8:,M*8)0*,):/80 4*M,0/0,',123 4T U 7% % ! TU ?480 % 9''9% 8:' ,)M,0/0,',123 4 408;,:'*,0:*4,49':, 4',:0;,(8; , *= + 9cd . &× Û× $ / 7/*A8; <8/2'% ?84:8280 % G,' % N,
中华物理医学与康复杂志2015年9月第37卷第9期Chin J Phys Med Rehabil.September2015,Val.37.No.9 ·715· trolled trial[J].Altern Ther Health Med,2009,15(6):18-27. [30]Innes KE,Vincent HK.The influence of yoga-based programs on risk [13]Tilbrook HE,Cox H,Hewit CE,et al.Yoga for chronic low back profiles in adults with type 2 diabetes mellitus:a systematic review pain:a randomized trial[J].Ann Intern Med,2011,155(9):569- [J].Evid Based Complement Alternat Med,2007,4(4):469486. 578. [31]Hegde SV,Adhikari P,Kotian S,et al.Effect of 3-month yoga on oxi- [14]Tilbrook HE,Hewit CE,Aplin JD,et al.Compliance effects in a ran- dative stress in type 2 diabetes with or without complications:a con- domised controlled trial of yoga for chronie low back pain:a methodo- trolled clinical trial[J].Diabetes Care,2011,34(10):2208-2210. logical study[J].Physiotherapy,2014,100(3):256-262. [32]Madanmohan,Bhavanani AB,Dayanidy G,et al.Effect of yoga therapy [15]Badsha H.Chhabra V,Leibman C,et al.The benefits of yoga for on reaction time,biochemical parameters and wellness score of peri and rheumatoid arthritis:results of a preliminary,structured 8-week pro- pos menopausal diabetic atients[].Int J Yoga,2012,5(1):10-15. gram[J].Rheumatol Int,2009.29(12):1417-1421. [33]Hegde SV,Adhikari P,Shetty S,et al.Effect of community-based yo- [16]Bosch PR,Traustadottir T,Howard P,et al.Functional and physio- ga intervention on oxidative stress and glycemic parameters in prediabe- logical effects of yoga in women with rheumatoid arthritis:a pilot study tes:a randomized controlled trial[J].Complement Ther Med,2013. [J].Alter Ther Health Med,2009.15(4):24-31. 21(6):571-576. [17]Evans Moieni M,Taub R,et al.lyengar yoga for young adults with [34]Rao RM,Raghuram N,Nagendra HR,et al.Effects of an integrated rheumatoid arthritis:results from a mixed-methods pilot study[J].J Yoga program on self-reported depression scores in breast cancer pa- Pain Symptom Manage,2010,39(5):904-913. tients undergoing conventional treatment:a randomized controlled trial [18]Evans S,Cousins L,Tsao JC,et al.A randomized controlled trial ex- [J ]Indian J Palliat Care,2015,21(2):174-181. amining lyengar yoga for young adults with heumatoid arthritis:a study [35]MeDermott KA,Rao MR,Nagarathna R,et al.A yoga intervention for protocol[J].Trials,2011,19(12):8-15. type 2 diabetes risk reduction:a pilot randomized controlled trial[]. [19]Ward L,Trehame G],Stebbings S,et al.The suitability of yoga as a BMC Complement Altern Med,2014,14(7):212. potential therapeutic intervention for heumatoid arthritis:a focus group [36]Gaurav K,Aarti J,Sridhar MK.Importance of adherance to yoga in approach[]].Musculoskeletal Care,2011.9(4):211-221. management of type 2 diabetes[J].Int J Diabetes Dev Ctries,2015, [20]Ebnezar J,Nagarathna R,Yogitha B.et al.Effects of an integrated D0I10.1007/s13410-0150351-y. approach of hatha yoga therapy on functional disability,pain,and fle- [37]Kyizom T,Singh S,Singh KP,et al.Effect of pranayama &yoga-asana xibility in osteoarthritis of the knee joint:a randomized controlled study on cognitive brain functions in type 2 diabetes-P3 event related evoked [J].J Altern Complement Med,2012,18(5):463472. potential(ERP)[J].Indian J Med Res,2010,131(5):636-640. [21]Witt CM,Michalsen A,Roll S,et al.Comparative effectiveness of a [38]Carson JW,Carson KM,Porter IS,et al.Yoga of Awareness program complex Ayurvedic treatment and conventional standard care in osteoar- for menopausal symptoms in breast cancer survivors:results from a ran- thritis of the knee--study protocol for a randomized controlled trial[] domized trial[J].Support Care Cancer,2009,17(10):1301-1309. Trials.2013,14:149(22):2591-2597. [39]Banasik J.Williams H,Haberman M,et al.Effect of lyengar yoga [22]Middleton KR,Ward MM,Haaz S,et al.A pilot study of yoga as self- practice on fatigue and diumal salivary cortisol concentration in breast care for arthritis in minority communities[J].Health Qual Life Out- cancer survivors[].J Am Acad Nurse Pract,2011,23(3):135- comes,2013.11:55 142. [23]Wolff M.Sundquist K,Linn SL,et al.Impact of yoga on blood pres- [40]Bower JE,Garet D,Sternlieb B,et al.Yoga for persistent fatigue in sure and quality of life in patients with hypertension:a controlled trial breast cancer survivors:a randomized controlled trial [J].Cancer, in primary care,matched for systolie blood pressure[BMC Cardio- 2012,118(15):3766-3775. vase Disord.2013,13(1):2260-2260. [41]Littman AJ,Bertram LC,Ceballos R,et al.Randomized controlled [24]Hagins M,Rundle A,Consedine NS,et al.A randomized controlled pilot trial of yoga in overweight and obese breast cancer survivors: trial comparing the effects of yoga with an active control on ambulatory effects on quality of life and anthropometric measures [J].Support blood pressure in individuals with prehypertension and stage I hyper- Care Cancer,.2012,20(2):267-277. tension[J].J Clin Hypertens,2014,16(1):54-62. [42]Moadel AB,Shah C,Wylie R J.et al.Randomized controlled trial of [25]Pal A,Srivastava N,Tiwari S,et al.Effect of yogic practices on lipid yoga among a multiethnic sample of breast cancer patients:effects on profile and body fat composition in patients of coronary artery disease quality of life[J].J Clin Oncol,2007,25(28):4387-4395 [J].Complement Ther Med,2011,19(3):122-127 [43]Chandwani KD,Thornton B,Perkins GH,et al.Yoga improves quali- 26]Pullen PR,Thompson WR,Thompson D,et al.Benefits of yoga for ty of life and benefit finding in women undergoing radiotherapy for African American heart failure patients[J].Med Sci Sports Exerc, breast cancer[]J Soc Integr Oncol,2010,8(2):43-55. 2010,42(4):651-657. [44]Danhauer SC,Mihalko SL,Russell GB,et al.Restorative yoga for [27]Wang J,Xiong XJ,Liu W.Yoga for essential hypertension:a syste- women with breast cancer:findings from a randomized pilot study[J]. matic review[J].PLoS One,2013,8(10):e76357. Psychooncology,2009,18(4):360-368. [28]Lau HL,Kwong JS,Yeung F,et al.Yoga for secondary prevention of [45]Mackenzie MJ,Carlson LE,Ekkekakis P,et al.Affect and mindful- coronary heart disease[J].Cochrane Database Syst Rev,2012,12 ness as predictors of change in mood disturbance,stress symptoms (6):CD009506. and quality of life in a commnity-based yoga program for cancer survi- [29]Holger C.Romy L,Heidemarie H,et al.Effects of yoga on cardiovas- vors J].Evid Based Complement Alternat Med,2013,2013: cular disease risk factors:a systematic review and meta-analysis[J] 419496 nt J Cardiol,2014,173(2):170-l83. [46]Kovacic T,Zagoricnik M,Kovacic M.Impact of relaxation training ac-
:0,''8; :0'T U =':80 F/80L8':/ A8;% % ! @ T U F'20,,3 L&% ,JL% L81: &% 8:' ,)M,0/0,',123 4 0;,(8; :0'T U = :80 A8;% % ! @ TU F'20,,3 L&% L81: &% =4' %8:' ,4'88MM8: 0 ;,8; ,:0,''8; :0',M*,)M,0/0,',123 4 8:/,;, ',)':9;*T U 7/*,:/804*% % ! TU 6;/L% //20G% 582 % 8:' F/8288M:,M*,)M,0 0/89:,; 0:/0: 089':,M408'0*% :09:908; @1883 40, )0T U % 5V ?5% 8:' 4:,M*,), 2',,; 408 908; B9':*,M'M8 4:8:1:/ /*480:8, ,:0,''8; :0' 400*08% :/8; M,0*:,'2',,; 408908T U 6A 0;, H,0;% % ! TU L)A% 1,) ?% 89)O% 8:' ,)M,08,;0*408H8:, ,M ,0,0*/80:;88T U ,/08:28?*:&% G8:L> F/8M'988,M*,)28; 40,)0, 03 40,M'8 ;9':1:/ :*48 ;28:88'':9 *:8:08H81 T U &H; 68; ,4'88:=':80:A8;% % ! @ T U L8);8?G% =;/307% >,: ?% 8:' &MM8:,M ,:/ *,), ,J ;:H8:08 :*48 ;28:81:/ ,01:/,9:,4':, , :0,''8; '':0'T U 28:8 08% % ! @ T U A;,/%6/H=6%*;*$%8: &MM8:,M*,):/804* , 08:, :8%2,/8'408:80; 18''8,08,M480; 4,8,49';28::8:T U : ,)% % ! T U L8);8?G% =;/307% ?/8::*?% 8:' &MM8:,M,9:*28; *, ):80H8:, , ,J;:H8:08; )'*8408:80 408;28 :8 0;,(8; ,:0,''8; :0'T U ,4'88:F/80A8;% ! T U =% % =0: % ?0;/0A> 4,0:8,M;/808:,*,) )88:,M:*48 ;28:8T U : 28:88H :08% % * T U >*(,F%?)/ ?%?)/ >7%8:' &MM8:,M40*X*,) , ,):H820 M9:, :*48 ;28:87 8H8:08':8; 8H,38; 4,:8:' &A% 7,0:805?% 8:' ,),M=108840,)0 M,08,49'*4:, 208:8090HH,0 089':M0,0 ;,(8; :0'T U ?944,0: 08 80% % ! T U 63 % K''L% L280 A% 8:' &MM8:,M*8)0*,) 40:8, M:)98; ;90''H0*,0:,',8:0:, 208: 8090HH,0T U = =; N90870:% % ! T U 6,180 &% $08:% ?:80'82 6% 8:' ,)M,0480:8:M:)98 208:8090HH,0 0;,(8; ,:0,''8; :0'T U 80% %@ ! TU 5:: = % 680:05 % 82'',% F/,0:, 6% 7803$L% 8:' ,)40,H8B9' :*,M'M8; 288M:M;) 1,8 9;80),)0;,:/804*M,0 208:80T U ?,:8)0,'% %@ ! T U /980? % A/'3,?5% ,H F% Y),03 A% >,HA 4:,M08'J:, :0) *= + 9cd . &× Û× $ / 7/*A8; <8/2'% ?84:8280 % G,' % N,
·716· 中华物理医学与康复杂志2015年9月第37卷第9期Chin J Phys Med Rehabil.September2015,Val.37.No.9 cording to the Yoga In Daily Life(R)system on anxiety after breast er,2012,12(27):412. cancer surgery[J].J Complement Integr Med,2013,16(7):10. [49]Bhavanani AB.RamanathanM,Balaji R,et al.Comparative immediate [47]Dhruva A,Miaskowsk C,Abrams D,et al.Yoga breathing for cancer effect of different yoga asanas on heart rate and blood pressure in chemotherapy-associated symptoms and quality of life:results of a pilot healthy young volunteers[]Int J Yoga,2014.7(2):89-95. randomized controlled trial[]J Altern Complement Med,2012.18 (5):473479. (修回日期：20150801) [48]Cramer H,Lange S,Klose P,et al.Yoga for breast cancer patients (本文编辑：阮仕衡) and survivors:a systematic review and meta-analysis[J].BMC Canc- ·外刊撷英· Antidepressant use and cognitive decline BACKGROUND AND OBJECTIVE Depression is consistently associated with cognitive impairment and increased risk for dementia. This study was designed to better understand the association between pharmacologic treatment of depression and cognitive decline. METHODS Data for this study were derived from the nationally representative Health and Retirement Study(HRS)and the HRS Pre- scription Drug Study (PDS),which included serial assessments of cognitive function,depression and antidepressant treatment.Data were drawn from the 2004,2006,2008 and 2010 findings of the HRS and from the 2005 and 2007 findings of the PDS.Baseline depression status was determined using the 2004 wave of the HRS. RESULTS Of the 3,714 respondents,12%were taking antidepressant medication at baseline.No significant differences were detected in cognition scores between the patients taking antidepressants and those who were not.At six year follow-up,both users and nonusers of an- tidepressants had experienced a cognitive decline.Adjusted analysis revealed that cognitive decline did not differ between those taking and those not taking antidepressant medications. CONCLUSION This longitudinal study of a population representative cohort of older adults found that antidepressant use is not associ- ated with changes in cognitive function over a six-year period. [Saczynski JS,Rosen AB,McCammon RJ,et al.Antidepressant use and cognitive decline:the health and retirement study.A- mer J Med.2015,128(7):739-746.】 Obesity paradox in type ii diabetes BACKGROUND AND OBJECTIVE The association between obesity and an increased risk for cardiovascular disease is well estab- lished.However,there is growing evidence that overweight patients with cardiovascular disease survive longer than do their normal weight counterparts,an effect referred to as the "obesity paradox".This study was designed to determine whether such a paradox exists among pa- tients with diabetes mellitus (DM). METHODS Patients with known type II DM diabetes,followed in a British clinic,were enrolled in an electronic database from 1995 to 2005.Data collected included comorbid conditions,age,diabetes history and duration,smoking history,height,weight and blood pressure, collected at the time of the initial visit.This cohort was followed for clinical events until 2011.The primary outcome measure was all-cause mortality,with the secondary outcome being hospitalizations for cardiovascular events. RESULTS A total of 10,568 patients with an average age of 63 years were followed for an average of 10.6 years.Overweight or obese patients had a higher rate of cardiac events requiring hospitalizations than did those with normal weight.However,the risk for cerebrovascular accidents was greater only in those with a body mass index of 30 to 34.9 kg/m and among those in the 57 to 67 year age group.Assessment of mortality risk of those hospitalized for these events revealed a survival advantage for higher body mass index categories (P<0.001 )A Cox regression analysis demonstrated that those who were overweight had a reduced mortality risk as compared to normal weight individuals, while those who were obese had a similar mortality risk as those with normal weight.The lower mortality risk conferred by being overweight or obese developed around age of 60 years. CONCLUSION This study of patients with type II diabetes found that being overweight or obese was associated with a higher risk of nonfatal cardiovascular events,but not a higher risk of mortality. [Costanzo P,Cleland JG,Pellicori P,et al.The Obesity Paradox in Type II Diabetes Mellitus:Relationship with Body Mass In- dex to Prognosis.Ann Intern Med,2015,162(9):610-618.]
,0;):,:/8 ,) '*5M8 ',87% 8:' ,)M,0208:804:8: ; 90HH,0 *:8:08H81; 8:'*T U 6A 80% % ! TU 6/H=6 <:/A% 6'<% 8:' ,40:H88;:8 8MM8:,M;MM808:*,), /80:0:8; 2',,; 408908 /8':/**,9)H,'9:880T U : ,)% % !@ ÎÏ$ @ ! ÏVW Ð! £Ñ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Ò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Ò3 ,:(,7% '8'; $% 78'',07% 8:' F/828:*70;,J F*4828:8A8'':9 <8':,/4 1:/ 6,;*A ;8J:,70,), = :80 A8;% % ! @ [ *= + 9cd . &× Û× $ / 7/*A8; <8/2'% ?84:8280 % G,' % N,