Exercise for Neuropathic Pain: A Systematic Review and Expert Consensus.

Background: Neuropathic pain (NP), a severe and disruptive symptom following many diseases, normally restricts patients' physical functions and leads to anxiety and depression. As an economical and effective therapy, exercise may be helpful in NP management. However, few guidelines and reviews focused on exercise therapy for NP associated with specific diseases. The study aimed to summarize the effectiveness and efficacy of exercise for various diseases with NP supported by evidence, describe expert recommendations for NP from different causes, and inform policymakers of the guidelines. Design: A systematic review and expert consensus. Methods: A systematic search was conducted in PubMed. We included systematic review and meta-analysis, randomized controlled trials (RCTs), which assessed patients with NP. Studies involved exercise intervention and outcome included pain intensity at least. Physiotherapy Evidence Database and the Assessment of Multiple Systematic reviews tool were used to grade the quality assessment of the included RCTs and systematic reviews, respectively. The final grades of recommendation were based on strength of evidence and a consensus discussion of results of Delphi rounds by the Delphi consensus panel including 21 experts from the Chinese Association of Rehabilitation Medicine. Results: Eight systematic reviews and 21 RCTs fulfilled all of the inclusion criteria and were included, which were used to create the 10 evidence-based consensus statements. The 10 expert recommendations regarding exercise for NP symptoms were relevant to the following 10 different diseases: spinal cord injury, stroke, multiple sclerosis, Parkinson's disease, cervical radiculopathy, sciatica, diabetic neuropathy, chemotherapy-induced peripheral neuropathy, HIV/AIDS, and surgery, respectively. The exercise recommended in the expert consensus involved but was not limited to muscle stretching, strengthening/resistance exercise, aerobic exercise, motor control/stabilization training and mind-body exercise (Tai Chi and yoga). Conclusions: Based on the available evidence, exercise is helpful to alleviate NP intensity. Therefore, these expert consensuses recommend that proper exercise programs can be considered as an effective alternative treatment or complementary therapy for most patients with NP. The expert consensus provided medical staff and policymakers with applicable recommendations for the formulation of exercise prescription for NP. This consensus statement will require regular updates after five-ten years.

Tai Chi for improving cardiopulmonary function and quality of life in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.

OBJECTIVE: To examine the effect of Tai Chi on cardiopulmonary function and quality of life in chronic obstructive pulmonary disease. DATA SOURCES: Cochrane Library, PUBMED, EMBASE, China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang database. METHODS: Articles on randomized controlled trials comparing Tai Chi with other treatments or no treatment were identified. A random-effects model was used to calculate the pooled mean difference (MD) with 95% confidence interval (CI). RESULTS: Fifteen articles involving 1354 participants were included. Compared with the control group, Tai Chi was more effective in improving exercise capacity on 6-minute walking distance (short term: MD = 16.02, 95% CI 2.86 to 29.17; mid term: MD = 30.90, 95% CI 6.88 to 54.93; long term: MD = 24.63, 95% CI 2.30 to 46.95), as well as pulmonary functions on forced expiratory volume in the first second (mid term: MD = 0.10; 95% CI 0.01 to 0.19), and forced vital capacity (mid term: MD = 0.20; 95% CI 0.04 to 0.36). Concerning quality of life, we found Tai Chi was better than the control group for the Chronic Respiratory Disease Questionnaire dyspnoea score (short term: MD = 0.90; 95% CI 0.51 to 1.29), fatigue score (short term: MD = 0.75; 95% CI 0.42 to 1.09), and total score (short term: MD = 1.92; 95% CI 0.54 to 3.31). CONCLUSIONS: Tai Chi may improve exercise capacity in the short, mid, and long terms. However, no significant long term differences in pulmonary function and quality of life were observed for patients with chronic obstructive pulmonary disease.

Effect of Traditional Chinese Exercise on Gait and Balance for Stroke: A Systematic Review and Meta-Analysis.

OBJECTIVE: A systematic review is conducted to determine the effect of traditional Chinese exercise for patients with stroke. METHODS: Studies are obtained from PubMed, Embase, Cochrane Library, EBSCO, Web of Science, and CNKI. Only randomized controlled trials were left to evaluate the effects of traditional Chinese exercise for patients with stroke, and with no limits on study data or language. The primary outcome was the Berg balance score (BBS), Functional walking scale. And a random-effects model was used to calculate the pooled mean difference (MD) with 95% confidence interval (CI). RESULTS: A total of 9 studies on 820 participants conform to the inclusion criteria, whereas eight studies on 704 participants are used as data sources for the meta-analysis, all trials were published between 2004 and 2013. The BBS indicates that the efficacy of traditional Chinese exercise on balance of patients with stroke is better than that of other training or no training in short term [MD (95%CI) = 11.85 [5.41, 18.30], P < 0.00001]. And the short physical performance battery, Functional walking scale, limit of stability were observed significant differences on balance (p<0.05) and gait (p<0.05) between traditional Chinese exercise and other exercises or no exercise. In addition, there is an article showed that some other form (physiotherapy exercises focused on balance) significantly improved balance ability for stroke patients compared to tai chi chuan practice (Berg test = 0.01, Romberg, and standing on one leg). CONCLUSION: In our meta analysis, the positive findings of this study suggest traditional Chinese exercise has beneficial effects on the balance ability in short term. However, we drew the conclusion according to the extreme heterogeneity, and evidence of better quality and from a larger sample size is required. Because of the inconsistent outcomes, there are short of enough good evidence for patients with stroke to prove the effects of traditional Chinese exercise on gait. SYSTEMATIC REVIEW REGISTRATION: http://www.crd.york.ac.uk/PROSPERO PROSPERO registration number: CRD42013006474.