Network meta-analysis of the efficacy of four traditional Chinese physical exercise therapies on the prevention of falls in the elderly

Dynamic Neural Mechanisms Underlying Sustained Motor Training Post-Stroke: An fNIRS Investigation Employing Time-Varying ALFF and Functional Connectivity Analysis

Motor dysfunction of the upper limbs following a stroke predominantly arises from abnormal motor patterning caused by the disrupted balance of inter-cortical communication within motor-associated cortical regions. Temporal analysis offers a more precise reflection of the cortical functional state in affected patients. This study employed fNIRS to capture hemodynamic responses among 20 stroke patients and 19 healthy controls in both resting and Baduanjin task state. Including computing the coefficient of variation of fractional amplitude of low-frequency fluctuations (fALFF) for each channel, alongside extracting dynamic state metrics. Findings indicate that, during sustained motor tasks, stroke patients exhibit a diminished fALFF variability in targeted cortical regions; these individuals display a higher prevalence of low-intensity states and a lower prevalence of high-intensity states during task execution. These dynamic state attributes are significantly associated with scores on the upper limb motor function scale (FMA-UE), thereby proposing a time-domain perspective for investigating the underlying mechanisms of stroke-induced motor dysfunction.

Tai chi improves balance performance in healthy older adults: a systematic review and meta-analysis

Background

Previous research has indicated that tai chi exercise can effectively enhance balance performance in patients; however, its impact on healthy individuals remains uncertain. Therefore, this meta-analysis aims to investigate the effects of different intensities and styles of tai chi exercise on the balance performance of healthy older adult individuals.

Methods

A targeted search method was employed to identify studies investigating the impact of tai chi exercise on balance in older adults across a range of databases, including Web of Science, PubMed, Cochrane Central, EBSCO, CHKI, and Embase. The studies were conducted in accordance with the PRISMA and PERSiST guidelines, and two independent reviewers were responsible for the search, screening of results, extraction of data, and assessment of study quality. A random-effects model was employed to calculate the weighted mean difference (WMD) and 95% confidence interval (CI).

Results

2000 participants who met inclusion criteria were included in analyses across 28 trials. The findings indicated that tai chi can enhance the balance performance of healthy older adults, as demonstrated by the Timed Up and Go test (WMD = -1.04, 95% CI: -1.36 to-0.72, p < 0.00001, I2 = 71%), functional Reach test (FR) (WMD = 2.81, 95% CI: 1.60 to 4.02, p < 0.00001, I2 = 56%), and Berg Balance Scale (WMD = 2.55, 95% CI: 1.19 to 3.91, p = 0.0002, I2 = 88%), as well as other balance tests such as SLS (WMD = 5.03, 95% CI: 3.08 to 6.97, p < 0.00001, I2 = 85), and GS (WMD = 0.09, 95% CI: 0.05 to 0.12, p < 0.00001, I2 = 54%). Subgroup analyses showed that tai chi exercise for both ≤12 and > 12 weeks was statistically significant (< 0.01, respectively) for balance performance in healthy older adults, especially for tai chi exercise performed more than twice a week (WMD = -1.03, 95% CI: -1.35 to -0.72, p < 0.00001) and for more than 45 min each time (WMD = -1.11, 95% CI: -1.58 to-0.63, p < 0.00001) tai chi exercise had greater benefits on TUG time, FR distance and BBS in healthy older adults. In addition, compared to Sun-style tai chi, Yang-style tai chi was more effective.

Conclusion

The tai chi exercise positively affects the balance performances of healthy older adults. Engaging in short-term (≤12 weeks) exercise for more than two 45-min sessions per week has been found to produce more pronounced effects. The effectiveness of Yang-style tai chi is superior to that of Sun-style tai chi.

Systematic review registration

PROSPERO ID is CRD42024532577 https://www.crd.york.ac.uk/prospero/.

Effects of Yi Jin Jing on enhancing muscle strength and physical performance in older individuals: a systematic review and meta-analysis

Background

The aging population is rapidly increasing, leading to physical decline and higher risks of chronic diseases, including sarcopenia, which adversely affects muscle quality and strength. Yi Jin Jing (YJJ), a traditional Chinese exercise method, can enhance flexibility and strength, but evidence regarding its effectiveness in older adults is conflicting. This meta-analysis aims to systematically evaluate the effects of YJJ on muscle strength and physical performance in this demographic.

Methods

We searched seven electronic databases: China National Knowledge Infrastructure, Wanfang Data, Sinomed, Web of Science, PubMed, Cochrane Library, and EMBASE to identify randomized controlled trials (RCTs). Following PRISMA guidelines, we quantified the effects of YJJ on muscle strength (grip strength, isokinetic strength) and physical performance (chair sit-to-stand, squatting-to-standing, shoulder flexibility, sit-and-reach tests). Treatment effects were calculated using Hedges'g. The Cochrane tool assessed risk of bias, the PEDro scale evaluated methodological quality, and the GRADE method assessed evidence quality. Data analysis was conducted using Stata 17.0 software, utilizing standardized mean differences (SMD) and 95% confidence intervals (CIs).

Results

This meta-analysis included 10 RCTs involving 590 participants. The overall risk of bias was assessed to be low. The methodological quality of these studies was generally moderate, and the quality of the main results varied from low to moderate. The findings revealed that YJJ had considerable effects on the chair sit-to-stand test (Hedges'g = 1.06), squatting-to-standing test (Hedges'g = 1.08), and small to moderate effects on handgrip strength (Hedges'g = 0.25), 60°/s extensor peak torque (Hedges'g = 0.47), 60°/s extensor average power (Hedges'g = 0.31), 60°/s extensor total work (Hedges'g = 0.29), 60°/s flexor peak torque (Hedges'g = 0.42), 60°/s flexor average power (Hedges'g = 0.37), and 180°/s extensor peak torque (Hedges'g = 0.29), and left shoulder flexibility (Hedges'g = 0.4). However, there were no significant improvement effects in 180°/s extensor average power (Hedges'g = 0.19), 180°/s extensor total work (Hedges'g = 0.11), 180°/s flexor peak torque (Hedges'g = 0.01), 180°/s flexor average power (Hedges'g = -0.08), right shoulder flexibility (Hedges'g = 0.09), and sit-and-reach test (Hedges'g = 0.15).

Conclusion

YJJ significantly enhances specific aspects of physical performance, particularly chair sit-to-stand and squatting-to-standing tests, while showing small and moderate improvements in handgrip strength and knee muscle strength. However, it had no significant effects on other metrics, including shoulder flexibility and sit-and-reach tests.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024530487, Registration number: CRD42024530487.

Dilemmas in Elderly Diabetes and Clinical Practice Involving Traditional Chinese Medicine

Diabetes is a widespread chronic disease that occurs mainly in the elderly population. Due to the difference in pathophysiology between elderly and young patients, the current clinical practice to treat elderly patients with anti-diabetes medications still faces some challenges and dilemmas, such as the urgent need for early diagnosis and prevention, and an imbalance between restricted dietary intake and the risk of undernutrition. Traditional Chinese medicine (TCM) offers various treatment regimens that are actively utilized in the field of diabetes management. Through multiple targets and multiple pathways, TCM formulas, medicinal herbs, and active natural products enhance the efficacy of diabetes prevention and diabetes control measures, simplify complex medication management, and improve common symptoms and common diabetic complications in elderly people. Historically, natural products have played a key role in material composition analysis of TCM and mechanism interpretation to enable drug discovery. However, there have been few conclusions on this topic. This review summarizes the development of TCM for the prevention and management of diabetes in elderly people, existing evidence-based clinical practices, and prospects for future development.

The effects of different types of Tai Chi exercise on anxiety and depression in older adults: a systematic review and network meta-analysis

Background

The body of evidence supporting the beneficial effects of Tai Chi in reducing anxiety and depressive symptoms in older adults is steadily increasing. Nonetheless, there remains a scarcity of studies directly comparing the clinical effectiveness of various Tai Chi exercises in addressing anxiety and depressive symptoms in older adults. Thus, this study aimed to systematically review and analyze the therapeutic efficacy of four types of Tai Chi interventions in enhancing anxiety and depressive symptoms in older adults.

Methods

During the period up to July 26, 2023, searches were conducted in the Web of Science, PubMed, the Cochrane Library, CNKI, and the Chinese Scientific Journal Database (VIP). The language scope encompassed both English and Chinese. Two independent reviewers conducted the literature review and data extraction. Review Manager 5.4 was employed for traditional meta-analysis and risk assessment, while version 15 of STATA software was used for generating evidence and funnel plots for network meta-analysis. This study was registered in PROSPERO number CRD 42023442270.

Result

In this analysis, a total of 20 studies were included, involving 1798 participants. The findings of the pairwise meta-analysis revealed that Tai Chi intervention was more effective than the control group in reducing anxiety (SMD: -1.19, 95% CI: -2.04, -0.34, p < 0.05) and depression (SMD: -0.65, 95% CI: -0.95, -0.65, p < 0.05) symptoms among older adults. The network meta-analysis specifically focused on anxiety symptoms and found that Yang-style Tai Chi (69.9%) had the most favorable outcome, followed by the 24-form Simplified Tai Chi (66.8%). In terms of depression symptoms, the Tai Chi Exercise Program (92.6%) had the highest performance, followed by Yang-style Tai Chi (77.9%).

Conclusion

The findings of this study imply that Tai Chi can have beneficial outcomes in the reduction of anxiety and depressive symptoms among older individuals. Specifically, when examining various forms of Tai Chi interventions, it was observed that Yang-style Tai Chi exhibited a greater efficacy in alleviating anxiety symptoms, whereas Tai Chi exercise programs demonstrated a higher effectiveness in improving depressive symptoms. Nonetheless, it is strongly advised that older adults select an exercise program that aligns with their interests and preferences, as this can enhance social integration and overall well-being.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023442270, identifier [CRD42023442270].

Exploring the efficacy of traditional Chinese medicine exercise in alleviating anxiety and depression in older adults: a comprehensive study with randomized controlled trial and network meta-analysis

Background

Anxiety and depression pose a significant global health challenge for elderly individuals. Research has demonstrated the potential of traditional Chinese medicine (TCM) exercise therapies in alleviating these conditions. However, ongoing debate and uncertainty persist regarding the optimal therapy and its impact on anxiety and depression. This study aims to evaluate and prioritize TCM exercise therapies for anxiety and depression in older adults, to identify the most effective intervention, and to provide a basis for informed decision-making in clinical practice.

Methods

We conducted a comprehensive search of electronic databases including The Web of Science, PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wang Fang, and Wei Pu database up to July 2022. Two researchers independently reviewed all included studies and extracted relevant data. Traditional meta-analysis was performed using Review Manager version 5.4, while network meta-analysis was conducted using STATA software version 15.1 to generate network evidence plots and funnel plots.

Result

A total of 30 trials, involving 2,806 participants, met the eligibility criteria. The traditional meta-analysis revealed that TCM exercise significantly improved anxiety (SMD = -0.82, 95% CI = -1.39, -0.26, p = 0.004) and depression (SMD = -0.63, 95% CI = -0.85, -0.41, p < 0.01) compared to the control group. In the network meta-analysis, Tai Chi exercise was ranked as the most effective intervention for anxiety (68.3%), followed by Yi Jin Jing (63.6%). For depression, the Tai Chi exercise was ranked as the most effective (87.8%), followed by the Ba Duan Jin exercise (74.1%).

Conclusion

TCE exercise can improve anxiety and depression in older adults, Among the four TCE exercise therapies included, Tai Chi exercise showed better efficacy than other types of treatment. Nevertheless, further research is required to validate the effectiveness of this exercise therapy through larger and more rigorous clinical trials.

Systematic review registration

http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023438697.