Cheema Birinder S, Kilbreath Sharon L, Fahey Paul P, Delaney Geoffrey P, Atlantis Evan
School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith, NSW, 2751, Australia,
Breast Cancer Res Treat. 2014 Nov;148(2):249-68. doi: 10.1007/s10549-014-3162-9. Epub 2014 Oct 17.
The purpose of this study was to assess the safety and efficacy of progressive resistance training (PRT) in breast cancer. Randomized controlled trials (RCTs) published to November 2013 that reported on the effects of PRT (>6 weeks) on breast cancer-related lymphedema (BCRL) (incidence/exacerbation, arm volume, and symptom severity), physical functioning (upper and lower body muscular strength), and health-related quality of life (HRQoL) in breast cancer patients were included. Of 446 citations retrieved, 15 RCTs in 1,652 patients were included and yielded five studies on BCRL incidence/exacerbation (N = 647), four studies on arm volume (N = 384) and BCRL symptom severity (N = 479), 11 studies on upper body muscular strength (N = 1,252), nine studies on lower body muscular strength (N = 1,079), and seven studies on HRQoL (N = 823). PRT reduced the risk of BCRL versus control conditions [OR = 0.53 (95% CI 0.31-0.90); I2 = 0%] and did not worsen arm volume or symptom severity (both SMD = -0.07). PRT significantly improved upper [SMD = 0.57 (95% CI 0.37-0.76); I2 = 58.4%] and lower body muscular strength [SMD = 0.48 (95% CI 0.30-0.67); I2 = 46.7%] but not HRQoL [SMD = 0.17 (95% CI -0.03 to 0.38); I2 = 47.0%]. The effect of PRT on HRQoL became significant in our sensitivity analysis when two studies conducted during adjuvant chemotherapy [SMD = 0.30 (95% CI 0.04-0.55), I2 = 37.0%] were excluded. These data indicate that PRT improves physical functioning and reduces the risk of BCRL. Clinical practice guidelines should be updated to inform clinicians on the benefits of PRT in this cohort.
本研究的目的是评估渐进性抗阻训练（PRT）对乳腺癌患者的安全性和有效性。纳入截至2013年11月发表的随机对照试验（RCT），这些试验报告了PRT（>6周）对乳腺癌相关淋巴水肿（BCRL）（发病率/加重情况、手臂体积和症状严重程度）、身体功能（上半身和下半身肌肉力量）以及乳腺癌患者健康相关生活质量（HRQoL）的影响。在检索到的446篇文献中，纳入了15项RCT，涉及1652例患者，其中有5项关于BCRL发病率/加重情况的研究（N = 647）、4项关于手臂体积的研究（N = 384）和BCRL症状严重程度的研究（N = 479）、11项关于上半身肌肉力量的研究（N = 1252）、9项关于下半身肌肉力量的研究（N = 1079）以及7项关于HRQoL的研究（N = 823）。与对照条件相比，PRT降低了BCRL的风险[比值比（OR）= 0.53（95%置信区间[CI] 0.31 - 0.90）；I² = 0%]，且未使手臂体积或症状严重程度恶化（标准化均数差[SMD]均为 -0.07）。PRT显著改善了上半身[SMD = 0.57（95% CI 0.37 - 0.76）；I² = 58.4%]和下半身肌肉力量[SMD = 0.48（95% CI 0.30 - 0.67）；I² = 46.7%]，但未改善HRQoL[SMD = 0.17（95% CI -0.03至0.38）；I² = 47.0%]。在我们的敏感性分析中，当排除两项在辅助化疗期间进行的研究时，PRT对HRQoL的影响变得显著[SMD = 0.30（95% CI 0.04 - 0.55），I² = 37.0%]。这些数据表明，PRT可改善身体功能并降低BCRL的风险。临床实践指南应更新，以使临床医生了解PRT对该队列患者的益处。
