辅助化疗期间低强度身体活动和中高强度体育锻炼对身体适应性、疲劳和化疗完成率的影响：PACE 随机临床试验结果。
Effect of Low-Intensity Physical Activity and Moderate- to High-Intensity Physical Exercise During Adjuvant Chemotherapy on Physical Fitness, Fatigue, and Chemotherapy Completion Rates: Results of the PACES Randomized Clinical Trial.
机构信息
Hanna van Waart, Martijn M. Stuiver, Wim H. van Harten, Jacobien M. Kieffer, Marianne de Maaker-Berkhof, Gabe S. Sonke, Neil K. Aaronson, The Netherlands Cancer Institute; Edwin Geleijn, Laurien M. Buffart, and Epie Boven, VU University Medical Center; Laurien M. Buffart, EMGO Institute for Health and Care Research; Maud M. Geenen, Sint Lucas Andreas Hospital; Jetske M. Meerum Terwogt, Onze Lieve Vrouwe Gasthuis; Jeanette A.J.H. Hellendoom-van Vreeswijk, Comprehensive Cancer Centre of the Netherlands, Amsterdam; Jolanda Schrama, Spaarne Hospital, Hoofddorp; Aart van Bochove and Simone M. van den Heiligenberg, Esperanz, North Holland; Aart van Bochove, Zaans Medisch Centrum, Zaandam; Vera Lustig, Flevohospital, Almere; Simone M. van den Heiligenberg, Westfries Gasthuis, Hoorn; and Carolien H. Smorenburg, Medical Center Alkmaar, Alkmaar, the Netherlands.
出版信息
J Clin Oncol. 2015 Jun 10;33(17):1918-27. doi: 10.1200/JCO.2014.59.1081. Epub 2015 Apr 27.
PURPOSE
We evaluated the effectiveness of a low-intensity, home-based physical activity program (Onco-Move) and a moderate- to high-intensity, combined supervised resistance and aerobic exercise program (OnTrack) versus usual care (UC) in maintaining or enhancing physical fitness, minimizing fatigue, enhancing health-related quality of life, and optimizing chemotherapy completion rates in patients undergoing adjuvant chemotherapy for breast cancer.
PATIENTS AND METHODS
We randomly assigned patients who were scheduled to undergo adjuvant chemotherapy (N = 230) to Onco-Move, OnTrack, or UC. Performance-based and self-reported outcomes were assessed before random assignment, at the end of chemotherapy, and at the 6-month follow-up. We used generalized estimating equations to compare the groups over time.
RESULTS
Onco-Move and OnTrack resulted in less decline in cardiorespiratory fitness (P < .001), better physical functioning (P ≤ .001), less nausea and vomiting (P = .029 and .031, respectively) and less pain (P = .003 and .011, respectively) compared with UC. OnTrack also resulted in better outcomes for muscle strength (P = .002) and physical fatigue (P < .001). At the 6-month follow-up, most outcomes returned to baseline levels for all three groups. A smaller percentage of participants in OnTrack required chemotherapy dose adjustments than those in the UC or Onco-Move groups (P = .002). Both intervention groups returned earlier (P = .012), as well as for more hours per week (P = .014), to work than the control group.
CONCLUSION
A supervised, moderate- to high-intensity, combined resistance and aerobic exercise program is most effective for patients with breast cancer undergoing adjuvant chemotherapy. A home-based, low-intensity physical activity program represents a viable alternative for women who are unable or unwilling to follow the higher intensity program.
目的
我们评估了低强度、基于家庭的体力活动计划（Onco-Move）和中高强度、联合监督的阻力和有氧运动计划（OnTrack）与常规护理（UC）相比，在维持或增强体能、最大程度减少疲劳、提高健康相关生活质量以及优化接受辅助化疗的乳腺癌患者的化疗完成率方面的有效性。
方法
我们随机分配了 230 名计划接受辅助化疗的患者到 Onco-Move、OnTrack 或 UC 组。在随机分组前、化疗结束时和 6 个月随访时评估了基于表现的和自我报告的结局。我们使用广义估计方程比较了各组随时间的变化。
结果
与 UC 相比，Onco-Move 和 OnTrack 导致心肺功能下降较少（P <.001），身体功能更好（P ≤.001），恶心和呕吐更少（分别为 P =.029 和 P =.031），疼痛更少（分别为 P =.003 和 P =.011）。OnTrack 还导致肌肉力量（P =.002）和身体疲劳（P <.001）的结局更好。在 6 个月随访时，所有三组的大多数结局都恢复到基线水平。OnTrack 组需要调整化疗剂量的参与者比例小于 UC 组或 Onco-Move 组（P =.002）。与对照组相比，这两个干预组更早（P =.012），每周恢复工作的时间也更长（P =.014）。
结论
对于接受辅助化疗的乳腺癌患者，监督的中高强度、联合阻力和有氧运动计划最为有效。对于无法或不愿意参加更高强度计划的女性，基于家庭的低强度体力活动计划是一种可行的替代方案。
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