Review articleThe potential effect of Wuqinxi exercise for primary osteoporosis: A systematic review and meta-analysis
Introduction
Primary osteoporosis (POP) is a common, chronic progressive disorder that mainly occurs in postmenopausal women and older men and is characterized by decreased bone mineral density (BMD) and deteriorated bone microstructure, eventually leading to fracture, usually in parts of spine, wrist, or hip [1], [2], [3]. Based on the fifth population census conducted in 2000, patients with POP have accounted for 6.97% of the total population (1295 millions) in China [4]. In addition, the incidence of POP and osteoporosis-related fractures is on the rise owing to the global aging society [5], [6], [7]. And this increase in the number of osteoporosis will impose large social burden and financial costs, particularly for patients with diagnosed osteoporotic fractures. Approximately 17–20 billion dollars were spent on annual direct medical costs for the management of osteoporosis in USA, based on previously published surveys [8]. Similarly, the latest data revealed that the per-admission inpatient hospital cost and length of stay were ¥18,587 and 19 days in mainland China [9]. As can be seen from these figures, it is a major medical concern that the high rate and treatment of POP.
Complementary and alternative medicine therapies have become increasingly popular [10], [11], [12], [13] and are used regularly by patients with osteoporosis worldwide [14], [15]. According to the up-to-date guidelines from Asian countries, regular exercises including resistance exercises, bearing exercises, aerobic exercises are recommended as basic treatment because they could contribute to improve BMD and reduce the risk of fractures and falls in patients with POP [16], [17]. In some regions, traditional exercise approaches, such as Qigong [18], Baduanjin [19], Taichi [20], and Yoga [21] have been widely accepted and used to promote physical fitness, prevent bone loss and treat POP for middle-aged and aged people. Exercise program is also an important component in the management of patients with osteoporotic compression fractures, which helps to improve quality of life, enhance trunk muscle strengthening, and reduce risk of future fracture [22]. Wuqinxi exercise, also known as “five animals exercise”, originates in ancient China and is considered as one kind of the health Qigong. The practitioners of Wuqinxi exercise imitate the specific movements and breathing patterns of the five animals including tiger, bear, crane, monkey, and deer. As a mind-body conditioning exercise, Wuqinxi has been practiced to prevent and cure diseases more than two thousand years old [23]. Since 1982, Wuqinxi exercise has also been gradually popularized and promoted from university sport teaching to community activity across the country in China. It is demonstrated that the long-term practice of Wuqinxi exercise can attenuate the age decline in physical function, improve BMD and alleviate POP-related symptoms in recent literature review [24]. In view of the slow and gentle movement style, it is also another suitable exercise for the middle-aged and elderly individuals similar to Qigong therapy [25], [26].
However, despite the growing number of studies assessing the efficacy of Wuqinxi exercise for POP, the absence of critically appraised evidence continues to exist, leaving little clarity for evidence-based clinical practice. The following questions are inconclusive: (1) how exactly is the effectiveness of stand-alone intervention, Wuqinxi exercise for POP; (2) how is additional therapeutic effect of Wuqinxi exercise when as an adjunctive treatment to conventional therapy; (3) how long and how often is Wuqinxi exercise recommended to practice at least for. In order to gather and evaluate up-to-date evidence of Wuqinxi exercise for POP, we conducted this systematic review. In the light of our present knowledge, this is the first one which systematically reviewed potential benefits and harms of Wuqinxi exercise for POP to justify their clinical use.
Section snippets
Methods
This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement issued in 2009 (Checklist S1) [27]. The protocol was previously registered in PROSPERO platform (reference number CRD42015023842) [28] which could be available on http://www.crd.york.ac.uk/PROSPERO_REBRANDING/display_record.asp?ID=CRD42015023842 No ethical approval was needed for our research because all the data used are secondary summary data.
Study selection
The database searches returned 113 potentially relevant articles. Two conference papers were identified through supplementary searches. After removing duplicates and screening titles and abstracts of all remaining unique articles, 9 full-text articles were selected for further appraisal in the present study. Five citations from these were excluded because of participants did not meet the inclusion criteria (n = 2); incorrect intervention (n = 1); not recognized control (n = 1); duplication (n = 1).
Summary of evidence
Complementary and alternative medicine has been a research interest in the field of osteoporosis, which is also becoming more and more accepted as a therapeutic option [47], [48], for instance, traditional exercise and herbal medicine. The Cochrane review assessed the beneficial and harmful effects of Chinese herbal medicines treatment for POP [49]. However, there is very little evidence in the literature to substantiate exercise method. As a traditional exercise approach, Wuqinxi has been
Conclusion
Current evidence suggests that Wuqinxi exercise can improve osteoporosis-related pain symptom, but the effects on BMD and biochemical markers owing to poor study design and execution, inconsistency, and imprecision are uncertain. Therefore, more evidence from high quality RCTs is warranted to support the use of Wuqinxi exercise for POP patients.
Authors contribution
Xu Wei: designed the review, completed study protocol registration and participated in the writing this manuscript. Aili Xu: participated in the literature search, extracted data and evaluated the quality of papers, Yukun Yin: participated in the literature search, extracted data and participated in the writing this manuscript. Ranxing Zhang: designed the review, evaluated the quality of papers and analysed data, All of the authors approved the final version of the manuscript.
Conflict of interest
All authors declare that they have no conflict of interests.
Funding
This work was supported by the Wu-Jieping Medical Foundation Project of Beijing City (No. 141107006614002) and the Science and Technology Program of China Academy of Chinese Medical Sciences (No. YS1304).
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