體適能較佳與某些癌症及死亡風險較低有關


  【24drs.com】根據一篇新研究,男性中年時體適能較佳與後來的肺癌及大腸直腸癌風險較低有關,但是與前列腺癌無關。這篇研究也指出,中年時的體適能較佳與後來死於癌症或心血管疾病的風險較低有關。
  
  這些結果線上發表於3月26日的JAMA Oncology期刊。
  
  作者們報告指出,這篇研究首度提出,癌症診斷之後,心肺適能(CRF)可以預測某些癌症的發生率,以及死於癌症或心血管疾病的風險。
  
  第一作者、伯靈頓佛蒙特大學Susan G. Lakoski醫師表示,發生癌症的男性中,中年時體適能比較良好者,死於研究探討之三種癌症以及心血管疾病的風險較低;即使體適能只有小幅改善(大約1個代謝當量),存活率就有顯著差異,癌症死亡風險降低達10%,心血管風險降低達25%。
  
  Lakoski醫師解釋,1個代謝當量的差異,相當於每英哩跑11.5分鐘(9個代謝當量)與每英哩跑12分鐘(8個代謝當量)。
  
  Lakoski醫師曾經是職業運動員,對她來說,運動永遠是生命中的重要部分,她透露,她的訓練已經因為年齡相關的變化與工作行程而有所改變。
  
  她表示,我瞭解維持規律運動的重要性,我知道我的極限、知道如何根據我之前的體適能測試來督促自己,這也是我們在這篇研究中提倡的。
  
  這篇研究使用在達拉斯一間預防醫學診所進行之「Cooper Center Longitudinal Study」的資料,從1971年到2009年共包括13,949 名男性,都接受了綜合體檢、心血管風險評估、跑步機測試評估CRF ,參與者的平均年齡為49歲、98%是白人。
  
  研究者使用1999-2009年的Medicare保戶資料評估65歲以上者的肺癌、前列腺癌與大腸直腸癌診斷,在6.5年的追蹤期間,1,310名男性發生前列腺癌、200人發生肺癌、181人發生大腸直腸癌。
  
  這篇研究指出,相較於CRF低者,中年時的CRF高者,肺癌風險降低55%(校正風險比([HR])為0.45;95%信賴區間([CI])為0.29-0.68),大腸直腸癌風險降低44%(校正HR,0.56;95% CI,0.36- 0.87);至於前列腺癌則未顯示有關聯(校正HR,1.22;95% CI,1.02-1.46;P= .0004)。
  
  Lakoski醫師解釋,體適能和前列腺癌風險之間的關聯是有爭議的,體適能較佳的男性比較可能進行更頻繁的預防性健康照護篩檢以及/或檢測門診,有比較多的機會比CRF較低的男性診斷出局部前列腺癌。
  
  不過,發生前列腺癌的男性中,如果他們診斷前的體適能程度較佳,死於癌症或心血管疾病的風險較低。
  
  Lakoski醫師表示,這代表,即便男性在老年時發生肺癌、前列腺癌或大腸直腸癌,中年時維持體適能對於改善存活是相當重要的。
  
  此外,相較於CRF較差者,中年時的CRF較佳與65歲以上、發生肺癌、前列腺癌或大腸直腸癌男性的各種癌症相關死亡降低32%有關(校正HR,0.68;95% CI,0.47- 0.98)。CRF較佳與癌症診斷之後死於心血管疾病的風險降低68%有關(校正HR,0.32;95% CI,0.16- 0.64)。
  
  研究限制包括,無法評估抽菸菸齡與量、癌症分期、從最初的健康篩檢到癌症診斷時的CRF變化,研究結果限於參與研究者與具有Medicare者。
  
  Lakoski醫師報告指出,我們並未掌握每個參與者的運動資料,不過,我們都知道增加運動強度與時間可以改善體適能,病患應詢問他們的醫師,多少運動量對他們是適當的,這是關鍵的第一步。
  
  她強調,我們認為體適能測試是一個客觀的指標,有助於醫師就此議題與病患諮商。這些結果支持我們在預防性健康照護範圍、或在癌症診斷之後利用CRF評估。
  
  她結論表示,需要後續研究探討這些結果,分析男性與女性的各種癌症,探討個人的體適能程度應改善多少才可以看到癌症預防效果。
  
  資料來源:http://www.24drs.com/
  
  Native link:Higher Fitness Levels Linked to Lower Risk of Some Cancers and Death

Higher Fitness Levels Linked to Lower Risk of Some Cancers and Death

By Veronica Hackethal, MD
Medscape Medical News

Higher fitness levels among middle-aged men might be associated with a lower risk for later lung and colorectal cancer, but not prostate cancer, according to a new study. The study also linked higher fitness levels in midlife to a lower risk for later death from cancer or cardiovascular disease.

The findings were published online March 26 in JAMA Oncology.

This study is the first to show that cardiorespiratory fitness (CRF) predicts the incidence of certain types of cancer and the risk for death from cancer or cardiovascular disease after being diagnosed with cancer, the authors report.

"Among the men who developed cancer, those who were more fit at middle age had a lower risk of dying from all three cancers studied, as well as from cardiovascular disease," said first author Susan G. Lakoski, MD, MS, from the University of Vermont in Burlington.

"Even a small improvement in fitness (by 1-MET) made a significant difference in survival, reducing the risk of dying from cancer by 10% and from cardiovascular disease by 25%," she told Medscape Medical News.

A 1-MET difference equates to the difference between running an 11.5-minute mile (9 METS) and a 12.0-minute mile (8 METS), Dr Lakoski explained.

Dr Lakoski, a former professional athlete for whom training has "always been an important part of my life," revealed that her training has evolved over the years because of age-related changes and work schedules.

"I understand the importance of staying committed to a regular exercise routine," she said, "I know my limits and how hard to push myself based on my prior fitness testing, which we advocate for in this study."

The study used information from the Cooper Center Longitudinal Study, which was conducted at a preventive medicine clinic in Dallas. It involved 13,949 men who underwent comprehensive medical examination, cardiovascular risk assessment, and treadmill testing to evaluate CRF from 1971 to 2009. The mean age of the participants was 49 years, and 98% of the cohort was white.

The researchers used Medicare claims data from 1999 to 2009 to assess lung, prostate, and colorectal cancer diagnosed in people 65 years and older.

Over a follow-up period of 6.5 years, 1310 men developed prostate cancer, 200 developed lung cancer, and 181 developed colorectal cancer.

The study revealed that a high CRF in midlife, compared with a low CRF, led to a 55% reduction in lung cancer (adjusted hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.29- 0.68) and a 44% reduction in colorectal cancer (adjusted HR, 0.56; 95% CI, 0.36- 0.87). This association did not apply to prostate cancer (adjusted HR, 1.22; 95% CI, 1.02- 1.46; P= .0004).

"The relations between fitness and prostate cancer risk is controversial," Dr Lakoski explained. "It is possible that men with higher CRF are more likely to undergo more frequent preventive healthcare screening and/or detection visits, and have a greater opportunity to be diagnosed with localized prostate cancer than men with lower CRF."

However, men who developed prostate cancer had a lower risk of ultimately dying from cancer or cardiovascular disease if they had higher fitness levels before diagnosis, she pointed out.

This speaks to the importance of being fit in mid-life.

"This speaks to the importance of being fit in mid-life to improve survival, even if a man ultimately develops lung, prostate, or colorectal cancer later in life," Dr Lakoski continued.

In addition, a high CRF in midlife, compared with a low CRF, was associated with a 32% reduction in all cancer-related death in men 65 years and older who developed lung, colorectal, or prostate cancer (adjusted HR, 0.68; 95% CI, 0.47- 0.98). And a high CRF was associated with a 68% reduction in death from cardiovascular disease after receiving a cancer diagnosis (adjusted HR, 0.32; 95% CI, 0.16- 0.64).

Study limitations include the inability to assess the length and intensity of smoking, cancer stage, changes in CRF from the initial health screening to cancer diagnosis, and outcomes that occurred between study entry and Medicare eligibility.

"We did not capture the individual workouts of each participant," Dr Lakoski reported. "However, it is known that increasing both the intensity and duration of exercise improves fitness levels. Patients should talk to their physician about what amount of exercise is right for them to start with. This is the key first step."

"We propose that fitness testing is an objective guide to help physicians counsel their patients on this topic," she emphasized. "These findings provide support for the utility of CRF assessment in preventive healthcare settings, and possibly following a diagnosis of cancer."

"Future studies are needed to test these results across all major cancers in men and women, and to address how much an individual must change their fitness to see cancer prevention benefit," she concluded.

Dr Lakoski reports receiving partial funding from the National Institute of General Medical Sciences/National Institute of Health. Dr Jones reports receiving research grants from the National Cancer Institute.

JAMA Oncol. Published online March26, 2015.

    
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