Kwuio 2010-3-29 11:22
運動介入改善癌症病患疲倦與其他預後
作者：Emma Hitt, PhD
出處：WebMD醫學新聞
March 12, 2010（亞特蘭大）－根據一項評估運動介入的隨機分派研究結果，在癌症治療期間運動的病患，相較於較少運動的病患，體力更好、比較不會有疲倦以及情緒緊張的問題。
馬里蘭巴爾的摩約翰霍普金斯護理學院的Jennifer Wenzel博士在第16屆癌症護理國際學會上發表這些發現。這些結果是由已故的、同樣來自約翰霍普金斯大學的Victoria Mock博士所發起的研究。
在620位符合收納條件的病患中，138位同意加入這項研究；其中73位被隨機分派至運動組，65位被隨機分派至常規活動組。新診斷罹患非轉移性癌症患者，以及目前沒有健康問題或限制活動能力的失能問題者，可以加入這項研究。在試驗收納期，他們每週運動次數不超過3次（或120分鐘）。
受試者平均年齡為60.2歲，這些病患中，55.6%罹患攝護腺癌，32.5%罹患乳癌，病患們接受化學治療以及/或是體外放射線治療。
運動組的受試者根據其身體狀況接受量身訂做的運動處方，這些病患們被要求短暫行走10分鐘，逐漸增加到30分鐘，每週5次。行走密集度被設計達到50%至70%最高心跳。以生理活性問卷5項活動次指標（PAQFA）評估行走、慢跑、快跑、游泳與騎車等有氧運動活性，並計算每週每小時的METs。
運動組的受試者，68%能夠順從他們的運動處方；那些在常規活動組的病患，12%的運動活性比運動組受試者高。運動組有68位病患、常規活動組有58位病患完成研究。
在控制試驗前預後、年齡與試驗前後PAQFA後，增加有氧運動顯著地與Piper疲倦指標（P<0.001）、症狀壓力指標（SDS；P<0.005）、以及情況狀態資訊（POMS）疲倦次指標（P<0.02）評估較不容易疲倦有關。
研究期間持續運動的受試者，POMS次指標評估，體力高出7.5%。而在生活品質方面，那些持續運動的受試者，POMS整體指標與醫療預後研究短版情緒健康次指標，相較於那些比較少運動的受試者，情緒壓力也低了3%（P=0.021）。
Wenzel醫師在發表會上表示，一個更具彈性、以家庭為基礎的運動計劃風險較低且有潛在好處，對固體腫瘤患者來說可能是可獲得的。未來針對接受癌症積極治療病患的介入型研究應該評估於特定年齡或治療型式、以及可能的、癌症診斷運動指引的效益。
根據Wenzel醫師表示，許多介入，包括運動，可能需要針對改善較低教育程度、以及那些來自少數族群研究受試者的耐力。她向Medscape腫瘤學表示，缺乏耐力可能讓這些原本就容易挫折的族群放棄參加這些可能有潛在好處的介入。
麻州波士頓大學William F. Connell護理學院助理教授Mary Lou Siefert護理博士表示，越來越多人重視運動介入，這已經被證實有某些好處。她向Medscape腫瘤學表示，我將會繼續建議我的病患們少量運動，例如行走，這將是有幫助的。
根據Siefert博士表示，這項研究確認了其他已經發表在乳癌醫療文獻的發現。她指出，這項研究評估兩種癌症的兩種不同治療。然而，作者們承認，我們確實也需要針對其他癌症與病患進行探討。
這項研究由國家衛生研究院、國家癌症機構、以及國家護理研究機構贊助，額外的補助來自於約翰霍普金斯護理學院（JHUSON）綜合介入性研究中心。Siefert博士表示已無相關資金上的往來。
Exercise Intervention Improves Fatigue, Other Outcomes in Cancer Patients
By Emma Hitt, PhD
Medscape Medical News
March 12, 2010 (Atlanta, Georgia) — Patients who exercised during cancer treatment experienced less fatigue, more vigor, and less emotional distress than those who were less active, according to the findings of a randomized trial evaluating an exercise intervention.
Jennifer Wenzel, PhD, RN, assistant professor at Johns Hopkins School of Nursing in Baltimore, Maryland, presented the findings here at the 16th International Conference on Cancer Nursing. The findings represent the completion of work initiated by Victoria Mock, PhD, also from Johns Hopkins, now deceased.
Of 620 eligible patients, 138 consented to be in the study; 73 were randomized to the exercise group and 65 were randomized to the usual-activity group. Patients had newly diagnosed nonmetastatic cancer and had no concurrent health problems or disabilities that limited their ability to participate. At the time of study enrollment, they were not exercising more than 3 times (or 120 minutes) per week.
The mean age of the study participants was 60.2 years. Of the patients, 55.6% had prostate cancer and 32.5% had breast cancer. Patients were to receive treatment with chemotherapy and/or external-beam radiation therapy.
Participants in the exercise group received an individualized exercise prescription on the basis of their physical condition. Patients were asked to walk briskly for 10 minutes, increasing to 30 minutes, 5 days a week. The walking intensity was designed to reach approximately 50% to 70% of maximum heart rate. The level of aerobic activity for walking, jogging, running, swimming, and biking was evaluated using the Physical Activity Questionnaire 5-activity subscale (PAQFA) and calculated in METs/hour per week.
Of participants in the exercise group, 68% adhered to their exercise prescription; of those in the usual-activity group, 12% of exercised at a level greater than that assigned to the exercise group. A total of 68 patients in the exercise group and 58 patients in the usual-activity group completed the study.
Increased aerobic exercise was significantly associated with less fatigue when measured with the Piper Fatigue Scale (P?< .001), the Symptom Distress Scale (SDS) fatigue subscale (P?< .005), and the Profile of Mood States (POMS) fatigue subscale (P < .02), after controlling for baseline outcome, age, and baseline and posttest PAQFA.
Participants who exercised throughout the study period had 7.5% more vigor on the POMS subscale (P?< .001). With respect to quality of life, those who exercised had 3% less emotional distress on both the POMS total scale and the Medical Outcomes Study Short-Form Health Survey (MOS SF-36) emotional well-being subscale, compared with those who were less active (P?= .021).
"A flexible, home-based exercise program has few risks and potential benefit that may be attainable for solid tumor patients, regardless of diagnosis," Dr. Wenzel said during the presentation. "Future intervention studies among patients receiving active cancer treatment should evaluate exercise guidelines specific to age or treatment type and, possibly, to cancer diagnosis."
According to Dr. Wenzel, interventions, including exercise, might need to be targeted to improve retention among study participants with less education and those from minority populations. "Lack of retention may prevent these already vulnerable groups from participating in an intervention that has many potential benefits," she told Medscape Oncology.
"Exercise interventions are receiving increasing attention and have been shown to have some benefit," said Mary Lou Siefert, DNSc, assistant professor at the William F. Connell School of Nursing at Boston College in Massachusetts. "I would continue to suggest to my patients that short amounts of exercise, such as walking, are helpful," she told Medscape Oncology.
According to Dr. Siefert, the findings confirm those of other studies that have been published in the breast cancer literature. "This study evaluated 2 treatment types in 2 types of cancer," she said. "However, as the authors acknowledge, we really need to look at other cancers and populations as well," she said.
The research was supported by a grant from the National Institutes of Health, the National Cancer Institute, and the National Institute of Nursing Research, with additional support provided by the Johns Hopkins University School of Nursing (JHUSON) Center for Collaborative Intervention Research. Dr. Siefert has disclosed no relevant financial relationships.
16th International Conference on Cancer Nursing (ICCN): Abstract?O-36. Presented March?8, 2010.