心肺疾病成人身体活动指南的系统综述：迈向循证推荐
该系统综述检索OVID MEDLINE、EMBASE、CINAHL及灰色文献，纳入29部心肺疾病（慢阻肺、哮喘、心衰）身体活动指南，其中14部为临床实践指南并采用AGREE II评估。多数指南推荐每周至少150分钟中等强度有氧活动，但疾病特异性指导和FITT原则依从性有限，方法学质量在利益相关者参与和适用性方面存在明显不足。
要点
- 多数指南推荐每周至少150分钟中等强度有氧活动。
- 疾病特异性指导和FITT原则的依从性有限。
- 方法学质量在利益相关者参与和适用性方面存在明显不足。
核心结论
- 有氧身体活动被一致推荐，但疾病特异性指导和FITT原则依从性有限。
- 方法学质量在利益相关者参与和适用性方面存在明显不足。
- 指南应标准化活动类型、时长、强度和频率的推荐并纳入证据分级系统。
研究设计与样本
- 系统综述，检索OVID MEDLINE、EMBASE、CINAHL及灰色文献，检索时间为2025年7月并更新至2026年3月。
- 纳入29部指南，其中14部为临床实践指南并采用AGREE II评估方法学质量。
主要发现
- 14部临床实践指南中，7部质量高、6部中等、1部低。
- 多数指南推荐每周至少150分钟中等强度有氧活动。
- 适应性推荐主要针对急性加重和症状管理。
关键数值与推荐
- 多数指南推荐每周至少150分钟中等强度有氧活动。
- AGREE II评估：14部临床实践指南中7部高质量、6部中等、1部低质量。
临床怎么用
- 可参考多数指南推荐，为心肺疾病成人制定每周至少150分钟中等强度有氧活动方案。
- 关注疾病特异性注意事项，特别是急性加重和症状管理相关的适应性推荐。
局限性
- 疾病特异性指导和FITT原则依从性有限。
- 方法学质量在利益相关者参与和适用性方面存在明显不足。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Clin Rehabil. 2026 Sep;40(9):1143-1159. doi: 10.1177/02692155261441158. Epub 2026 Apr 24. ABSTRACT ObjectivesPhysical activity benefits for adults with cardio-respiratory diseases are well established, and evidence-based recommendations are essential for healthcare professionals. This study systematically reviewed existing recommendations on physical activity for adults with cardio-respiratory diseases, specifically chronic obstructive pulmonary disease, asthma, and heart failure, focusing on the frequency, intensity, time and type (FITT).Data SourcesWe searched OVID MEDLINE, EMBASE, CINAHL, and grey literature for guidelines and related documents. The comprehensive search was conducted in July 2025 and subsequently updated through March 2026. Two authors independently screened guidelines, extracted FITT components, and documented disease-specific precautions. Disagreements were resolved with a third author. The AGREE II instrument assessed methodological quality for identified CPGs. Recommendations were categorised based on the FITT framework.ResultsWe included 29 guidelines, of which 14 were classified as Clinical Practice Guideline and assessed with AGREE II. Among the 14 guidelines, 7 demonstrated high quality, 6 were moderate, and 1 was low quality. Most guidelines recommended at least 150 minutes of moderate aerobic activity per week. Adaptive recommendations primarily addressed exacerbations and symptom management.ConclusionWhile aerobic physical activity was consistently recommended, disease-specific guidance and adherence to FITT principles were limited. Significant gaps were noted in methodological quality, particularly in stakeholder involvement and applicability. To enhance usability, guidelines should standardise recommendations for type, duration, intensity, and frequency, incorporating evidence grading system. PMID: 42029388 | PMC: PMC13525178 | DOI: 10.1177/02692155261441158
引用
- 指南共识 · 慢阻肺：A systematic review of physical activity guidelines for adults with cardio-respiratory diseases: Stepping towards evidence-based recommendations
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。