Courneya Kerry S, McKenzie Donald C, Mackey John R, Gelmon Karen, Reid Robert D, Friedenreich Christine M, Ladha Aliya B, Proulx Caroline, Vallance Jeffrey K, Lane Kirstin, Yasui Yutaka, Segal Roanne J
Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada.
Cancer. 2008 Apr 15;112(8):1845-53. doi: 10.1002/cncr.23379.
Exercise training improves supportive care outcomes in patients with breast cancer who are receiving adjuvant therapy, but the responses are heterogeneous. In this study, the authors examined personal and clinical factors that may predict exercise training responses.
Breast cancer patients who were initiating adjuvant chemotherapy (N=242) were assigned randomly to receive usual care (UC) (n=82), resistance exercise training (RET) (n=82), or aerobic exercise training (AET) (n=78) for the duration of chemotherapy. Endpoints were quality of life (QoL), aerobic fitness, muscular strength, lean body mass, and body fat. Moderators were patient preference for group assignment, marital status, age, disease stage, and chemotherapy regimen.
Adjusted linear mixed-model analyses demonstrated that patient preference moderated QoL response (P= .005). Patients who preferred RET improved QoL when they were assigned to receive RET compared with UC (mean difference, 16.5; 95% confidence interval [95% CI], 4.3-28.7; P= .008) or AET (mean difference, 11; 95% CI, -1.1-23.4; P= .076). Patients who had no preference had improved QoL when they were assigned to receive AET compared with RET (mean difference, 23; 95% CI, 4.9-41; P= .014). Marital status also moderated QoL response (P= .026), age moderated aerobic fitness response (P= .029), chemotherapy regimen moderated strength gain (P= .009), and disease stage moderated both lean body mass gain (P< .001) and fat loss (P= .059). Unmarried, younger patients who were receiving nontaxane-based therapies and had more advanced disease stage experienced better outcomes. The findings were not explained by differences in adherence.
Patient preference, demographic variables, and medical variables moderated the effects of exercise training in breast cancer patients who were receiving chemotherapy. If replicated, these results may inform clinical practice.
运动训练可改善接受辅助治疗的乳腺癌患者的支持性护理结局，但反应存在异质性。在本研究中，作者考察了可能预测运动训练反应的个人因素和临床因素。
开始辅助化疗的乳腺癌患者（N = 242）被随机分配，在化疗期间接受常规护理（UC）（n = 82）、抗阻运动训练（RET）（n = 82）或有氧运动训练（AET）（n = 78）。终点指标为生活质量（QoL）、有氧适能、肌肉力量、瘦体重和体脂。调节因素为患者对分组的偏好、婚姻状况、年龄、疾病分期和化疗方案。
调整后的线性混合模型分析表明，患者偏好调节了生活质量反应（P = .005）。与接受常规护理（平均差异，16.5；95%置信区间[95%CI]，4.3 - 28.7；P = .008）或有氧运动训练（平均差异，11；95%CI， - 1.1 - 23.4；P = .076）相比，偏好抗阻运动训练的患者在被分配接受抗阻运动训练时生活质量得到改善。与接受抗阻运动训练相比，无偏好的患者在被分配接受有氧运动训练时生活质量得到改善（平均差异，23；95%CI，4.9 - 41；P = .014）。婚姻状况也调节了生活质量反应（P = .026），年龄调节了有氧适能反应（P = .029），化疗方案调节了力量增加（P = .009），疾病分期调节了瘦体重增加（P < .001）和脂肪减少（P = .059）。未婚、年轻、接受非紫杉烷类治疗且疾病分期较晚的患者结局更好。这些发现不能用依从性差异来解释。
患者偏好、人口统计学变量和医学变量调节了接受化疗的乳腺癌患者运动训练的效果。如果得到重复验证，这些结果可能为临床实践提供参考。
