運動有助癌症病患療程


  【24drs.com】根據線上發表於8月15日考科藍實證醫學資料庫的兩篇回顧,運動可以改善積極治療時和治療後的生活品質。
  
  兩篇研究都發現對於健康相關生活品質(HRQoL)的某些方面有幫助,包括癌症相關顧慮、身形/自尊、情緒健康、性、睡眠障礙和社會功能。
  
  運動計畫期間與之後,也可有效降低焦慮、疲勞與疼痛。
  
  兩篇回顧的第一作者、新墨西哥大學預防研究中心副主任Shiraz I. Mishra博士表示,整體而言,這些回顧認為運動可以改善正在接受或接受完癌症治療之患者的生活品質。
  
  Mishra博士在聲明中解釋,不過,我們須謹慎因應這些結果,因為我們納入分析的運動計畫很多元,因運動類型、計畫期間、難度等而有所不同。我們需藉由後續研究暸解,如何長期維持運動的正面影響,特定類型的癌症是否有特定的運動類型。
  
  越來越多證據認為,運動有助於改善存活、預防體適能衰退、改善結果(如減輕疲勞與情緒壓力),以及減少某些癌症風險。
  
  在非轉移型疾病患者的一篇研究中(55.6%有前列腺癌、32.5%有乳癌),參與有氧運動計畫與較少疲勞及更有活力有顯著關聯。
  
  最近的文獻回顧發現,體能活動與改善乳癌及大腸癌患者的存活有關。乳癌存活者的證據最明顯,和觀察型研究的結果相當一致,不論是乳癌診斷前後的運動,都和乳癌特定死亡或各種原因死亡率降低有關。風險降低程度達統計上的顯著意義,約半數研究的結果為41%-51%。
  
  第二高的證據為大腸直腸癌,多篇研究顯示,大腸直腸癌特定死亡率風險降低範圍為45%-61%。
  
  波士頓哈佛公衛學院營養系Edward L. Giovannucci博士在編輯評論中表示,有許多治療可增加存活,但會影響生活品質;運動或許無法延長壽命,但是可促進生活品質。
  
  他指出,雖然運動對於癌症的直接效益還未明確證實,但是運動一般是安全的,可改善癌症病患的生活品質,有許多其他健康助益,適當運動可以納入癌症照護的一環。
  
  最近其他研究發現,劇烈運動可預防前列腺癌惡化,是因為對DNA修補與細胞循環路徑的效果,約150分鐘的中度到劇烈運動可以降低子宮內膜癌風險,運動甚至對末期肺癌病患也有幫助。
  
  第一篇回顧包括56篇試驗、2,286名病患被隨機分到運動組、1,985人被隨機分到對照組。這些試驗中,36篇納入的病患是採取積極治療疾病、10篇探討在治療期間後之後的病患、10篇探討預定進行積極治療的病患。
  
  56篇研究評估的運動類型各異,包括散步(自己走動或者合併騎腳踏車、耐力訓練或強化訓練)、耐力訓練、強化訓練、騎腳踏車、瑜珈和氣功。作者們寫道,結果認為,相較於對照組,運動介入對於整體的HRQoL和某些HRQoL有正面影響。
  
  進行次組分析時,乳癌存活者在焦慮方面比其他癌症者更有顯著改善;至於乳癌之外的其他類型癌症存活者,在憂鬱、疲勞、睡眠障礙等方面有顯著改善,在HRQoL、情緒健康、身體功能、角色功能等也有較大改善。
  
  此外,相較於輕微運動,中度和劇烈運動可改善HRQoL與身體功能、減少焦慮、疲勞、睡眠障礙。
  
  作者們提醒,須謹慎詮釋這些結果,因為運動計畫有異質性,使用評估HRQoL和HRQoL的測量方式,許多試驗可能有偏見風險。
  
  他們結論表示,需要後續研究探討如何隨著時間仍保有運動的正面效果,以根據癌症類型和癌症治療確認運動的基本屬性(模式、強度、頻率、期間、時間),以確認對於HRQoL等的適當效果。
  
  第二篇回顧包括了40篇試驗,其中1,927人被隨機分到運動組、1,764人被隨機分到對照組。
  
  這些試驗中,30篇包括完成對初次或復發癌症治療的病患、10篇試驗探討完成癌症治療期間與之後的病患。運動介入包括強度訓練、耐力訓練、散步、騎腳踏車、瑜珈、氣功與太極。使用多種測量方式分析HRQoL各面向。
  
  這篇回顧中,作者們未做出運動介入對於HRQoL之認知功能、身體功能、一般健康角度、角色功能、靈性等面向效果的任何結論。 
  
  如同第一篇回顧,作者們建議應謹慎詮釋這些結果,因為有異質性與偏見風險。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6919&x_classno=0&x_chkdelpoint=Y
  

Exercise Benefits Cancer Patients During and After Treatment

By Roxanne Nelson
Medscape Medical News

August 20, 2012 — Exercise can improve quality of life for patients both during and after the end of active treatment, according to 2 reviews published online August 15 in the Cochrane Database of Systematic Reviews.

Both found that exercise has a beneficial effect on a number of health-related quality of life (HRQoL) domains, including cancer-specific concerns, body image/self-esteem, emotional wellbeing, sexuality, sleep disturbance, and social functioning.

Exercising during and after the exercise program was also found to be effective in reducing anxiety, fatigue, and pain.

"Together, these reviews suggest that exercise may provide quality-of-life benefits for people who are undergoing or who have undergone treatment for cancer," said Shiraz I. Mishra, MBBS, PhD, lead author of both reviews and associate director of the Prevention Research Center at the University of New Mexico in Albuquerque.

"However, we need to treat these findings with caution because the trials we included looked at many different kinds of exercise programs, which varied by type of exercise, length of the program, and how hard the participants had to exercise," explained Dr. Mishra in a statement. "We need to understand from future trials how to maintain the positive impacts of exercise in the longer term and whether there are particular types of exercise that are suited to particular types of cancer."

Plethora of Evidence

A growing body of evidence suggests that exercise helps improve survival, prevent declines in fitness, improve outcomes (e.g., reduce fatigue and emotional distress), and reduce the risk for certain cancers.

In one study of patients with nonmetastatic disease (55.6% had prostate cancer and 32.5% had breast cancer), participating in an aerobic exercise program was significantly associated with less fatigue and more vigor.

A recent literature review found that physical activity is associated with improved survival in people with breast and colon cancer. The strongest evidence was seen for breast cancer survivors, with "fairly consistent evidence" from observational studies that physical activity either before or after a breast cancer diagnosis is associated with a reduction in both breast-cancer-specific and all-cause mortality. The risk reduction was statistically significant, ranging from 41% to 51% in nearly half the studies.

The next strongest evidence was for colorectal cancer, with statistically significant reduced risks for colorectal-cancer-specific mortality ranging from 45% to 61% in several studies.

In an editorial accompanying that study, Edward L. Giovannucci, MD, ScD, from the Department of Nutrition at the Harvard School of Public Health, Boston, Massachusetts, explained that "many treatments may increase survival, but at a cost of quality of life; physical activity may not only extend life but may also enhance its quality."

"Even though direct effects of physical activity on cancer are not definitely proven, given that physical activity is generally safe, improves quality of life for cancer patients, and has numerous other health benefits, adequate physical activity should be a standard part of cancer care," he noted.

Other recent studies have found that vigorous physical activity appears to offer protection against prostate cancer progression because of its effects on DNA repair and cell-cycle pathways, that about 150 minutes of moderate to vigorous activity can reduce the risk for endometrial cancer, and that exercise even provides benefits for patients with advanced lung cancer.

Improvement Noted Across Domains

The first review involved 56 trials, in which 2286 participants were randomized to an exercise group and 1985 were randomized to a comparison group. Of these trials, 36 involved patients who were undergoing active treatment for their disease, 10 looked at patients during and after treatment, and 10 involved patients who were scheduled for active treatment.

The type of exercise evaluated varied in the 56 studies, and included walking (by itself or in combination with cycling, resistance training, or strength training), resistance training, strength training, cycling, yoga, and Qigong.

"The results suggest that exercise interventions compared with control interventions have a positive impact on overall HRQoL and certain HRQoL domains," write the authors.

When looking at subgroups, breast cancer survivors had a significantly greater reduction in anxiety than patients with other types of cancer. For survivors with other types of cancer, but not breast cancer, there was a greater reduction in depression, fatigue, and sleep disturbances, and a greater improvement in HRQoL, emotional wellbeing, physical functioning, and role function.

In addition, moderate and vigorous exercise improved HRQoL and physical functioning, and reduced in anxiety, fatigue, and sleep disturbances better than mild exercise.

Cautious Interpretation

The authors warn that these results need to be "interpreted cautiously" because of the heterogeneity of exercise programs and the measures used to assess HRQoL and HRQoL domains, and the risk for bias in many trials.

"Further research is required to investigate how to sustain positive effects of exercise over time and to determine essential attributes of exercise (mode, intensity, frequency, duration, timing) by cancer type and cancer treatment for optimal effects on HRQoL and its domains," they conclude.

Similar Benefits Observed

The second review involved 40 trials, in which 1927 participants were randomized to an exercise group and 1764 were randomized to a comparison group.

Of these trials, 30 involved patients who had completed treatment for primary or recurrent cancer and 10 trials looked at patients both during and after completing cancer treatment. Exercise interventions included strength training, resistance training, walking, cycling, yoga, Qigong, and tai chi. A wide variety of measures were used for HRQoL and its domains.

In this review, the authors could not draw any conclusions about the effects of exercise interventions on the HRQoL domains of cognitive function, physical functioning, general health perspective, role function, and spirituality.

As with the first review, the authors advise caution when interpreting the results because of heterogeneity and risk for bias.

The first study was funded by the National Institute for Health Research Health Technology Assessment Programme, UK; and HTA Project 10/81/01. The second study was funded by Cancer Restitution Funds to the State of Maryland; the National Institute for Health Research Health Technology Assessment Programme, UK; and HTA Project 10/81/01. The authors have disclosed no relevant financial relationships.

Cochrane Database Syst Rev. 2012;8:CD008465, CD007566.

    
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