应用类风湿关节炎患者生活质量量表评估有氧运动训练的治疗效应

背景目前关于药物阻止或延缓类风湿关节炎关节的破坏,减轻疼痛的治疗研究较多,但是,有氧运动训练结合药物治疗对类风湿关节炎患者生活质量有何影响?目的应用类风湿关节炎患者生活质量专业量表评估有氧运动训练结合药物治疗与单纯药物治疗的效应.设计随机对照实验.单位泸州医学院附属医院康复医学科及风湿病科.对象泸州医学院附属医院康复医学科、风湿病科2003-12/2004-07收治类风湿关节炎患者148例.纳入126例,男24例,女102例,均自愿参加.随机分为有氧训练组85例和对照组41例.方法有氧训练组在接受以甲氨蝶呤为主的药物治疗基础上,进行4次/周的有氧运动训练,30 min/次,共12周.对照组只接受常规的药物治疗,运用<类风湿关节炎患者生活质量量表>在治疗前以及治疗3个月后对两组患者进行评分.测评方法生活质量量表中每一问题按1～5分五级评分,计算各亚表分值,应用极距加权法得出生活质量总分.为消除治疗前初始值的影响,两组间生活质量的比较采用改善值[即(治疗前值-治疗后值)]和改善百分率[即(改善值/治疗前值)×100%].主要观察指标类风湿关节炎患者治疗前后生活质量量表评分.结果按意向处理分析,共有患者148例,纳入126例,进入结果分析126例.①有氧训练前两组患者生活质量评分比较有氧训练组生理、心理、社会功能、健康自我认识、总体生活质量与对照组差异均无显著性意义(有氧训练组17,19,14,20,1.8分;对照组17.5,20,14,21,1.7分,P＞0.05).②有氧训练后两组患者生活质量评分比较有氧训练组生理、心理、社会功能、健康自我认识、总体生活质量评分均高于对照组(有氧训练组3.5,2.0,3.0,20,3.4分;对照组2.0,1.4,1.6,0,2.0分,P＜0.05).③两组患者治疗后生活质量改善情况有氧训练组生理、心理、社会功能、健康自我认识和总体生活质量评分均较治疗前显著改善(12%～28%),优于对照组.结论有氧运动训练较单纯药物治疗对类风湿关节炎患者的心理及健康自我认识能力有明显改善,提高了患者的关节活动功能和运动参与意识.

Assessment of curative effect of aerobic exercise with quality of life questionnaire for patients with rheumatoid arthritis

BACKGROUND: At present, there are many therapeutic studies on drugs for preventing or postponing the destruction of joint and alleviating the pain in patients with rheumatoid arthritis (RA). However, what is the effect of aerobic exercise combined with medicative therapy on the quality of life in patients with RA?OBJECTIVE: To evaluate the effect of aerobic exercise combined with medicative therapy and single medicative therapy with quality of life (QOL)questionnaire for patients with RADESIGN: Randomized and controlled trialSETTING: Department of Rehabilitation Medicine and Department of Rheumatology, Affiliated Hospital of Luzhou Medical College PARTICIPANTS: Totally 148 patients with RA accepting treatment in the Department of Rehabilitation Medicine and Department of Rheumatology, Affiliated Hospital of Luzhou Medical College between December 2003 and July 2004 were recruited. Altogether 126 patients were involved,including 24 male and 102 female, and all of them participated in this trial voluntarily. The patients were randomized into aerobic exercise group (n=85) and control group (n=41).METHODS: Patients in the aerobic exercise group were given aerobic exercise four times a week, 30 min/time for 12 weeks on the basis of the medicative therapy (methopterin mainly). Patients in the control group were given only the routine medicative therapy. Quality of life questionnaire for patients with rheumatoid arthritis was used to score the patients in the two groups before and 3 months after the therapy. Test methods: Each item of the questionnaire was rated on a 5-point questionnaire, and the score of each subquestionnaire was calculated. Weighting method was applied in scoring the quality of life. In order to avoid the influence of initial value before therapy,the ameliorative value was adopted in the comparison of QOL between the two groups [i.e.Value before therapy-Value after therapy] and the percent of amelioration [ (Ameliorative value/Value before therapy) × 100%].MAIN OUTCOME MEASURES: Scores of the QOL before and aftertherapy in patients with RARESULTS: According to intention-to-treat analysis, 126 of the 148 patients were recruited in this trial and all the 126 patients entered the retwo groups before aerobic exercise: There was no significant difference of the score of physical, emotional/ psychological, social functions, selfrecognized health status and overall QOL between the aerobic exercise group and the control group (aerobic exercise group: 17, 19, 14, 20, 1.8scores respectively; control group: 17.5, 20, 14, 21, 1.7 scores respectwo groups after aerobic exercise: the score of physical, emotional/psychological, social functions, self-recognized health status and overall QOL of the patients in the aerobic exercise group was all higher than that in the control group(aerobic exercise group: 3.5, 2.0, 3.0, 20, 3.4 scores respecAmeliorative condition of QOL of the patients in the two groups after therapy: the score of physical, emotional/ psychological, social functions, selfrecognized health status and overall QOL of the patients in the aerobic exercise group after therapy was ameliorative as compared with that before therapy (12%-28%), which was superior to that in the control group.CONCLUSION: Aerobic exercise combined with medicative therapy has obviously ameliorative effect on psychological function and self-recognized health status as compared with that of single medicative therapy, and it also improves the muscular power and the desire to participate in exercise as well as the function of joint motion.