1月23日,，發(fā)表在《內(nèi)科學(xué)文獻(xiàn)》（Archives of Internal Medicine）上的一項(xiàng)研究表明，運(yùn)動(dòng)可減輕慢性病患者的抑郁癥狀,，效果最好的患者為有輕—中度抑郁癥狀的患者,，以及運(yùn)動(dòng)可改善其功能相關(guān)轉(zhuǎn)歸的患者。
在慢性病病人中,，體力活動(dòng)少和抑郁癥狀共存很常見(jiàn),。沒(méi)有人就運(yùn)動(dòng)鍛煉對(duì)慢性病病人抑郁癥狀影響的隨機(jī)對(duì)照研究進(jìn)行過(guò)系統(tǒng)回顧。近期,，美國(guó)學(xué)者就運(yùn)動(dòng)鍛煉對(duì)抑郁癥狀的影響進(jìn)行了評(píng)估,，并確定這種影響是否因病人的特征、運(yùn)動(dòng)特征和臨床環(huán)境而改變,。
研究者們采用美國(guó)科學(xué)數(shù)據(jù)庫(kù)體力活動(dòng)指南,、Google Scholar、MEDILINE,、PsycINFO,、PubMed和科學(xué)網(wǎng)，檢索2011年6月1日前發(fā)表的文章,。結(jié)果共找到90篇文章,，涉及10534例久坐少活動(dòng)的慢性病病人。研究包括的文章要求：（1）病人隨機(jī)分入運(yùn)動(dòng)干預(yù)組和不運(yùn)動(dòng)對(duì)照組,；（2）在基線,、干預(yù)期過(guò)半和（或）干預(yù)期結(jié)束評(píng)估抑郁癥狀。計(jì)算Hedges d效應(yīng)大小,，評(píng)估研究質(zhì)量,，采用隨機(jī)效應(yīng)模型估計(jì)抽樣誤差和觀察效應(yīng)的總體方差。
結(jié)果顯示,，運(yùn)動(dòng)鍛練顯著減少抑郁癥狀,，異質(zhì)性平均效應(yīng)的Δ值為0.30。下列情況可獲得較大的抗抑郁效果：（1）基線抑郁癥狀較嚴(yán)重,，（2）達(dá)到推薦的體力活動(dòng)水平的病人,。在基線抑郁癥狀屬輕—中度的病人中,，臨床研究的主要轉(zhuǎn)歸——功能相關(guān)性轉(zhuǎn)歸顯著改善。（生物谷Bioon.com）
doi:10.1001/archinternmed.2011.696
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Effect of Exercise Training on Depressive Symptoms Among Patients With a Chronic Illness
A Systematic Review and Meta-analysis of Randomized Controlled Trials
Matthew P. Herring, PhD; Timothy W. Puetz, PhD; Patrick J. O’Connor, PhD; Rodney K. Dishman, PhD
Background Physical inactivity and comorbid depressive symptoms are prevalent among patients with a chronic illness. To our knowledge, randomized controlled trials of the effects of exercise training on depressive symptoms among patients with a chronic illness have not been systematically reviewed. We estimated the population effect of exercise training on depressive symptoms and determined whether the effect varied according to patient characteristics and modifiable features of exercise exposure and clinical settings.
Methods Articles published before June 1, 2011, were located using the Physical Activity Guidelines for Americans Scientific Database, Google Scholar, MEDLINE, PsycINFO, PubMed, and Web of Science. Ninety articles involving 10 534 sedentary patients with a chronic illness were selected. Included articles required (1) randomized allocation to an exercise intervention or nonexercise comparison condition and (2) a depression outcome assessed at baseline and at mid- and/or postintervention. Hedges d effect sizes were computed, study quality was evaluated, and random effects models were used to estimate sampling error and population variance of the observed effects.
Results Exercise training significantly reduced depressive symptoms by a heterogeneous mean effect size delta () of 0.30 (95% CI, 0.25-0.36). Larger antidepressant effects were obtained when (1) baseline depressive symptoms were higher, (2) patients met recommended physical activity levels, and (3) the trial primary outcome, predominantly function related, was significantly improved among patients having baseline depressive symptoms indicative of mild-to-moderate depression.
Conclusions Exercise reduces depressive symptoms among patients with a chronic illness. Patients with depressive symptoms indicative of mild-to-moderate depression and for whom exercise training improves function-related outcomes achieve the largest antidepressant effects.
