The Comparative Effectiveness of Traditional Chinese Medicine Exercise Therapies in Elderly People With Mild Cognitive Impairment: A Systematic Review and Network Meta-Analysis

Background: Mild cognitive impairment (MCI) in the elderly is a health problem worldwide. Studies have confirmed that traditional Chinese medicine (TCM) exercise therapies can improve MCI. However, which therapy is the best and their impacts on brain function remain controversial and uncertain. This study aims to compare and rank TCM exercise therapies for MCI in the elderly, and analyze their effects on brain function, in order to find an optimal intervention and provide a basis for clinical treatments decision-making. Methods: The Web of Science, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Clinical Trials, China National Knowledge Infrastructure (CNKI), Wangfang database, China Science and Technology Journal Database, and Chinese Biomedical Medicine (CBM) were searched through October 28, 2021. Two researchers reviewed all the studies and extracted the data. The ADDIS software version 1.16.8 and the Bayesian hierarchical model were used for pair-wise meta-analysis and network meta-analysis, and the STATA software version 14.0 was used to draw the network evidence plots and funnel plots. Results: A total of 23 studies on 2282 participants were included in this study. In the pair-wise meta-analysis, TCM exercise therapies (Baduanjin exercise, Tai Chi, Liuzijue exercise and finger exercise) were superior to non-TCM exercise therapies (stretching and toning exercise, usual care, health education and routine daily activities) in terms of MMSE, MoCA and ADL outcomes. In the network meta-analysis, the MMSE outcome ranked Baduanjin exercise (78%) as the best intervention and Tai Chi (36%) as the second. The MoCA outcome ranked Baduanjin exercise (62%) as the best intervention. For the ADL outcome, Baduanjin exercise (60%) ranked the best, and followed by finger exercise (43%). Conclusion: TCM exercise therapies may improve the cognitive function in elderly patients with MCI. Among the four therapies included, the Baduanjin exercise may be the preferred therapy for MCI in the elderly, and its mechanism may be related to the regulation of cognitive-related brain function and structure.