Schmidt Martina E, Wiskemann Joachim, Ulrich Cornelia M, Schneeweiss Andreas, Steindorf Karen
a Division of Physical Activity, Prevention and Cancer , National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ) , Heidelberg , Germany.
b Division of Medical Oncology , National Center for Tumor Diseases (NCT) and Heidelberg University Hospital , Heidelberg , Germany.
Acta Oncol. 2017 Apr;56(4):618-627. doi: 10.1080/0284186X.2016.1275776. Epub 2017 Jan 13.
Exercise during and after breast cancer treatment has shown several health benefits. However, little is known about the courses, patterns, and determinants of physical activity of breast cancer patients, and the role of exercise interventions on their physical activity behavior in the long run.
Self-reported physical activity was assessed in 227 breast cancer survivors before, during, and three, six, and 12 months post-intervention within two randomized resistance exercise trials performed during adjuvant chemo- or radiotherapy, respectively, with similar designs. Multiple ordinal logistic regression analyses were performed to identify determinants of physical activity at these time points.
While the intervention group exercised a median 1.8 h/week during adjuvant therapy (interquartile range 1.4-2.5), 68% of controls did not engage in any exercise. At 12-months follow-up 32% of patients did not engage in any exercise irrespective of the intervention. Of the patients who cycled for transportation pre-diagnosis about half stopped cycling in the long term in both groups. In contrast, walking was maintained over time. Major determinants of low levels of exercise at 12-months follow-up were low pre-diagnosis levels of exercise, lower education, being postmenopausal, and having breast problems or depressive symptoms. Further, the intervention appeared to influence the type of sports performed, with strength exercise being the most common type of exercise at follow-up in the exercise group, more frequently compared to the control group.
The exercise intervention effectively countervailed the decrease in physical activity during cancer therapy and boosted strength exercise in the months following the intervention, but in the longer term many survivors were insufficiently active. Breast cancer survivors may need continued motivation and practical support tailored to their individual characteristics and physical activity history to incorporate exercise in everyday routine in the long term.
乳腺癌治疗期间及之后进行运动已显示出多种健康益处。然而，对于乳腺癌患者身体活动的过程、模式和决定因素，以及运动干预对其长期身体活动行为的作用，我们知之甚少。
在两项分别于辅助化疗或放疗期间进行的随机抗阻运动试验中，对227名乳腺癌幸存者在干预前、干预期间以及干预后3个月、6个月和12个月的自我报告身体活动情况进行了评估，两项试验设计相似。进行了多项有序逻辑回归分析，以确定这些时间点身体活动的决定因素。
在辅助治疗期间，干预组每周运动时间中位数为1.8小时（四分位间距为1.4 - 2.5小时），而68%的对照组未进行任何运动。在12个月的随访中，无论是否接受干预，32%的患者未进行任何运动。在两组中，约一半在诊断前骑车出行的患者长期停止了骑车。相比之下，步行活动随着时间得以维持。在12个月随访时运动水平较低的主要决定因素包括诊断前运动水平低、教育程度较低、绝经后、有乳腺问题或抑郁症状。此外，干预似乎影响了所进行的运动类型，在运动组随访时，力量训练是最常见的运动类型，与对照组相比更为频繁。
运动干预有效地抵消了癌症治疗期间身体活动的减少，并在干预后的几个月内促进了力量训练，但从长期来看，许多幸存者的活动量仍不足。乳腺癌幸存者可能需要持续的激励以及根据其个人特征和身体活动史量身定制的实际支持，以便长期将运动纳入日常生活。
