认知参与型身体活动对发展儿童青少年执行功能的效果：基于ICF的系统综述

doi:10.3969/j.issn.1006-9771.2024.01.006

摘要/Abstract

摘要：

目的系统评价认知参与型身体活动(CEPA)对儿童青少年执行功能的干预效果。

方法检索Web of Science、PubMed、Medline、EBSCO和中国知网等自建库至2023年11月30日的中、英文文献。根据纳入排除标准筛选出符合要求的文献，并对其做质量评价后进行系统综述。

结果最终纳入15篇文献，发表于2014年至2023年之间，来自8个国家，涉及1 806例年龄在4~16岁的研究对象。PEDro量表评分平均为6.6分。纳入分析的CEPA干预运动强度为64%~93% HR_max，单次干预的持续时间10~60 min，干预频率为每周2~5次，干预周期为4~24周。CEPA的具体形式包括结合认知任务的足球、篮球和地板球，结合认知任务的跑、跳、蹲、坐、旋转和保持平衡，以及结合认知任务的体感游戏。纳入的15项研究中有11项在执行功能的至少1种成分上表现出积极效果，但涉及工作记忆的7项研究有6项未能验证积极效应。在12项对比分析CEPA和身体活动或常规体育课的干预效果差异研究中，有9项发现CEPA对执行功能的干预效果更佳。

结论 CEPA对儿童青少年的认知灵活性有积极影响，对抑制控制的影响有争议，而对工作记忆的影响未得到验证。CEPA的干预类型分为结合认知任务的球类运动、基本动作技能训练和体感游戏。

关键词: 儿童, 青少年, 执行功能, 认知参与型身体活动, 系统综述

Abstract:

Objective To systematically review the intervention effect of cognitively engaging physical activity (CEPA) on executive function of children and adolescents.

Methods Literatures in Chinese and English were retrieved from databases of Web of Science, PubMed, Medline, EBSCO and CNKI, from the establishment to November 30th, 2023. According to the inclusion and exclusion criteria, the literatures that met the requirements were screened, and their quality was evaluated and systematically reviewed.

Results A total of 15 literatures were included, published between 2014 and 2023, from eight countries, involving 1 806 subjects aged four to 16 years. The average score of PEDro scale was 6.6. The intensity of the CEPA intervention ranged from 64% to 93% HR_max, the duration of a single session ranged from ten to 60 minutes, and the frequency of the intervention was two to five sessions a week, for four to 24 weeks. Specific forms of CEPA included football, basketball and floorball combined with cognitive tasks; running, jumping, squatting, sitting, spinning and balancing combined with cognitive tasks; and exergaming combined with cognitive tasks. Eleven researches showed positive effects of CEPA intervention on at least one component of executive function. However, six of the seven researches involving working memory failed to verify the positive effects. Twelve researches compared the intervention effects of CEPA and rutine exercise or regular physical education classes, and nine researches found that CEPA was more effective on executive function.

Conclusion The CEPA is effective on the executive function of children and adolescents, specifically on cognitive flexibility; it shows inconsistent effects on inhibitory control, and its effect on working memory has not been verified. The intervention types of CEPA are divided into ball games combined with cognitive tasks, basic motor skills training combined with cognitive tasks, and exergaming combined with cognitive tasks.

Key words: children, adolescents, executive function, cognitively engaging physical activity, systematic review

中图分类号:

R161.1

闻嘉宁, 金秋艳, 张琦, 李杰, 司琦. 认知参与型身体活动对发展儿童青少年执行功能的效果：基于ICF的系统综述[J]. 《中国康复理论与实践》, 2024, 30(1): 44-53.

WEN Jianing, JIN Qiuyan, ZHANG Qi, LI Jie, SI Qi. Effect of cognitively engaging physical activity on developing executive function of children and adolescents: a systematic review based on ICF[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 44-53.

图/表 4

表1

图1

表2

表3

纳入文献基本特征"

纳入文献	国家	研究对象	研究设计	干预环境	干预方案		测量工具	结局指标
纳入文献	国家	研究对象	研究设计	干预环境	对照组	试验组	测量工具	结局指标
Jãger等^[20](2014)	瑞士	年龄(7.9±0.42)岁对照组(n = 53) 试验组(n = 51)	RCT	学校体育馆	无额外身体活动	20 min，单次，运动强度77% HR_max，结合认知任务的基本动作技能训练	图像更新任务；Flanker任务	抑制控制的反应时加快
Schmidt等^[14](2015)	瑞士	年龄(11.35±0.6)岁对照组A (n = 57) 对照组B (n = 55) 试验组(n = 69)	Cluster- RCT	学校	对照组A：有氧锻炼对照组B：常规体育课	每次45 min，每周2次，持续6周，运动强度74% HR_max，结合认知任务的球类运动	2-back任务； Flanker任务	认知灵活性的反应时加快
Benzing等^[21](2016)	瑞士	年龄(14.51±1.08)岁对照组A (n = 23) 对照组B (n = 21) 试验组 (n = 21)	RCT	学校教室	对照组A：跑步对照组B：无额外身体活动	15 min，单次，运动强度72% HR_max，结合认知任务的体感游戏	Delius-Kaplan执行功能系统	认知灵活性测试的标准化分数提高
Pesce等^[22](2016)	意大利	年龄5~10岁对照组(n = 228) 试验组(n = 232)	Cluster- RCT	学校	常规体育课	每次60 min，每周4次，持续24周，运动强度≥ 69% HR_max，结合认知任务的基本动作技能训练	随机数生成任务	抑制控制的标准化分数提高
Egger等^[23](2018)	瑞士	年龄(7.94±0.44)岁对照组A (n = 53 对照组B (n = 50) 对照组C (n = 54) 试验组 (n = 59)	Cluster- RCT	学校教室	对照组A：认知训练对照组B：有氧锻炼对照组C：无额外身体活动	20 min，单次，运动强度67% HR_max，结合认知任务的基本动作技能训练	倒序颜色回忆任务； Flanker任务	认知灵活性的反应时减慢
Egger等^[24](2019)	瑞士	年龄(7.91±0.4)岁对照组A (n = 49) 对照组B (n = 46) 试验组 (n = 47)	Cluster- RCT	学校教室	对照组A：有氧锻炼对照组B：认知训练	每次10 min，每周2次，持续20周，运动强度70%~85% HR_max，结合认知任务的基本动作技能训练	倒序颜色回忆任务； Flanker任务	认知灵活性的反应时加快
Gao等^[25](2019)	美国	年龄(4.72±0.73)岁对照组 (n = 14) 试验组 (n = 18)	RCT	家庭	无额外身体活动干预	每次≥ 30 min，每周5次，持续12周，运动强度未说明，结合认知任务的体感游戏	维度变化卡排序测试	认知灵活性测试总分提高
Xiong等^[26](2019)	中国	平均年龄4.52岁对照组 (n = 30) 试验组 (n = 30)	Cluster- RCT	托儿中心	常规体育课	每次20 min，每周5次，持续8周，运动强度未说明，结合认知任务的体感游戏	维度变化卡排序测试	认知灵活性反应时加快
Layne等^[27](2021)	美国	年龄8~9岁对照组(n = 21) 试验组(n = 19)	Cluster- RCT	学校教室	常规体育课	每次10 min，每周5次，持续4周，运动强度为中高强度，结合认知任务的体感游戏	Go/No-Go任务	抑制控制反应时加快、错误率降低、准确性改善
Van der Fels等^[28](2020)	荷兰	年龄 (8.8±0.6)岁对照组A (n = 23) 对照组B (n = 47) 试验组(n = 19)	Cluster- RCT	学校	对照组A：常规体育课对照组B：无额外身体活动	35 min，单次，运动强度64%~93%HR_max，结合认知任务的球类运动	停止信号任务	抑制控制准确率降低
Bedard等^[15](2021)	加拿大	年龄 (7.04±1.37)岁对照组A (n = 16) 对照组B (n = 16) 试验组 (n = 16)	RCT	实验室	对照组A：跑步对照组B：无额外身体活动	20 min，单次，运动强度66%~79%HR_max，结合认知任务的基本动作技能训练	Flanker任务	无干预效果
Giordano等^[29] (2022)	意大利	年龄(5.68±0.32)岁对照组A (n = 25) 对照组B (n = 25) 试验组 (n = 25)	Cluster- RCT	幼儿园	对照组A：自由游戏对照组B：常规体育课	每次15 min，每周3次，持续6周，运动强度未说明，结合认知任务的基本动作技能训练	白天-黑夜Stroop任务；头-脚-膝-肩测试	认知抑制控制正确率提高、反应时加快，行为抑制控制准确性和信息加工速度改善
Liu等^[30] (2022)	中国	年龄(4.90±0.31)岁对照组 (n = 24) 试验组 (n = 24)	RCT	幼儿园	常规体育课	每次30 min，每周5次，持续4周，运动强度未说明，结合认知任务的体感游戏	Go/No-Go任务；卡片分类任务；“蚂蚁先生”视空间工作记忆任务	抑制控制、认知灵活性和工作记忆任务的标准化分数均提高
Kolovelonis等^[31] (2023)	希腊	年龄(10.13±0.57)岁对照组A (n = 34) 对照组B (n = 32) 试验组 (n = 36)	Cluster- RCT	学校	对照组A：有氧锻炼对照组B：无额外身体活动	每次45 min，单次，运动强度未说明，结合认知任务的基本动作技能训练	图案流畅性测试	改善抑制控制和认知可塑性
Mavilidi等^[32] (2023)	澳大利亚	年龄(4.41±0.61)岁对照组A (n = 48) 对照组B (n = 41) 试验组 (n = 55)	Cluster- RCT	幼儿园	对照组A：认知训练对照组B：无额外身体活动	每次17 min，每周2次，持续6周，运动强度为中高强度，结合认知任务的基本动作技能训练	Go/No-Go任务；卡片分类任务；“蚂蚁先生”视空间工作记忆任务	无干预效果

表3

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纳入文献	符合标准	随机分配	分配隐藏	基线相似	被试施盲	治疗师施盲	评估者施盲	退出率≤ 15%	意向性分析	组间统计比较	点测量和变异量值	总分
Jager等^[20](2014)	√	√	√	√				√	√	√	√	7
Schmidt等^[14](2015)	√	√		√		√		√	√	√	√	7
Benzing等^[21](2016)	√	√		√				√	√	√	√	6
Pesce等^[22](2016)	√	√		√				√	√	√	√	6
Egger等^[23](2018)	√	√	√	√				√	√	√	√	7
Egger等^[24](2019)	√	√		√		√		√	√	√	√	7
Gao等^[25](2019)	√	√	√	√				√	√	√	√	7
Xiong等^[26](2019)	√	√		√				√	√	√	√	6
Layne等^[27](2020)	√	√		√				√	√	√	√	6
Van der Fels等^[28](2020)	√	√		√				√	√	√	√	6
Bedard等^[15](2021)	√	√		√				√	√	√	√	6
Giordano等^[29](2022)	√	√		√				√	√	√	√	6
Liu等^[30](2022)	√	√		√	√	√	√	√	√	√	√	9
Kolovelonis等^[31](2023)	√	√		√				√	√	√	√	6
Mavilidi等^[32](2023)	√	√		√			√	√	√	√	√	7