Heldens A F J M, Bongers B C, de Vos-Geelen J, van Meeteren N L U, Lenssen A F
Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Physical Therapy, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
Eur J Surg Oncol. 2016 Sep;42(9):1322-30. doi: 10.1016/j.ejso.2016.03.021. Epub 2016 Apr 9.
Diverse fractions of patients with locally advanced resectable rectal cancer receive neoadjuvant chemoradiotherapy (NACRT). NACRT is known to decrease physical fitness, an undesirable side effect. This pilot aimed to determine the feasibility and preliminary effectiveness of a supervised outpatient physical exercise training program during NACRT in these patients.
We included 13 out of 20 eligible patients (11 males, mean ± SD age: 59.1 ± 19.7 years) with rectal cancer who participated in the exercise training program during NACRT. Feasibility was determined by adherence and number of adverse events. Physical fitness was compared at baseline (B), after five (T1) and ten weeks (T2) of training, and eight weeks postoperatively (T3) using repeated-measures analysis of variance.
Nine patients (69.2%) completed the program without adverse events. Four patients dropped out. The program was feasible and safe, with a total attendance rate of 95.7%. Leg muscle strength (mean ± SD: 104.0 ± 32.3 versus 144.8 ± 45.6 kg; P < 0.001) and arm muscle strength (mean ± SD: 48.7 ± 13.8 kg versus 36.1 ± 11.0 kg, P = 0.002) increased significantly between B and T2, respectively. A slight, non-significant, increase in functional exercise capacity was found.
This pilot demonstrated that a supervised outpatient physical exercise training program for individual patients with locally advanced resectable rectal cancer during NACRT is feasible for a large part of the patients, safe and seems able to prevent an often seen decline in physical fitness during NACRT. A larger study into the cost-effectiveness of this approach is warranted.
不同比例的局部晚期可切除直肠癌患者接受新辅助放化疗（NACRT）。已知NACRT会降低体能，这是一种不良副作用。本试验旨在确定在这些患者接受NACRT期间进行有监督的门诊体育锻炼训练计划的可行性和初步效果。
我们纳入了20名符合条件的直肠癌患者中的13名（11名男性，平均±标准差年龄：59.1±19.7岁），他们在NACRT期间参加了锻炼训练计划。通过依从性和不良事件数量来确定可行性。使用重复测量方差分析在基线（B）、训练五周（T1）和十周（T2）后以及术后八周（T3）比较体能。
9名患者（69.2%）完成了该计划且无不良事件。4名患者退出。该计划可行且安全，总出勤率为95.7%。在B和T2之间，腿部肌肉力量（平均±标准差：104.0±32.3对144.8±45.6千克；P<0.001）和手臂肌肉力量（平均±标准差：48.7±13.8千克对36.1±11.0千克，P = 0.002）分别显著增加。发现功能锻炼能力有轻微的、不显著的增加。
本试验表明，为局部晚期可切除直肠癌个体患者在NACRT期间进行有监督的门诊体育锻炼训练计划对大部分患者是可行的、安全的，并且似乎能够防止NACRT期间常见的体能下降。有必要对这种方法的成本效益进行更大规模的研究。
