van Rooijen S J, Engelen M A, Scheede-Bergdahl C, Carli F, Roumen R M H, Slooter G D, Schep G
Department of Surgical Oncology, Máxima Medical Center, Veldhoven, The Netherlands.
Department of Physiotherapy, Máxima Medical Center, Veldhoven, The Netherlands.
Scand J Med Sci Sports. 2018 Feb;28(2):360-370. doi: 10.1111/sms.12907. Epub 2017 May 26.
Colorectal cancer surgery results in considerable postoperative morbidity, mortality and reduced quality of life. As many patients will undergo additional (neo)adjuvant therapy, it is imperative that each individual optimize their physical function. To elucidate the potential of exercise in patient optimization, we investigated the evidence for an exercise program before and after surgical treatment in colorectal cancer patients. A systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions, the guidelines of the Physical Therapy Journal and the PRISMA guidelines. No literature pertaining to exercise training during preoperative neoadjuvant treatment was found. Seven studies, investigating the effects of regular exercise during adjuvant chemotherapy for patients with colorectal cancer or a mixed population, were identified. A small effect (effect size (ES) 0.4) of endurance/interval training and strength training (ES 0.4) was found in two studies conducted in patients with colorectal and gastrointestinal cancer. In five studies that included a mixed population of cancer patients, interval training resulted in a large improvement (ES 1.5; P≤.05). Endurance training alone was found to increase both lower extremity strength and endurance capacity. The effects of strength training in the lower extremity are moderate, whereas, in the upper extremity, the increase is small. There is limited evidence available on exercise training during treatment in colorectal cancer patients. One study concluded exercise therapy may be beneficial for colorectal cancer patients during adjuvant treatment. The possible advantages of training during neoadjuvant treatment may be explored by prehabilitation trials.
结直肠癌手术会导致相当高的术后发病率、死亡率和生活质量下降。由于许多患者将接受额外的（新）辅助治疗，因此每个患者优化自身身体功能势在必行。为了阐明运动在优化患者方面的潜力，我们研究了结直肠癌患者手术治疗前后运动计划的证据。根据《Cochrane系统评价干预措施手册》、《物理治疗杂志》指南和PRISMA指南进行了系统评价。未发现有关术前新辅助治疗期间运动训练的文献。确定了七项研究，调查了结直肠癌患者或混合人群在辅助化疗期间定期运动的效果。在两项针对结直肠癌和胃肠道癌患者的研究中，发现耐力/间歇训练和力量训练有较小的效果（效应量（ES）为0.4）。在五项纳入癌症患者混合人群的研究中，间歇训练带来了较大改善（ES为1.5；P≤0.05）。单独的耐力训练被发现可增加下肢力量和耐力。下肢力量训练的效果中等，而上肢力量训练的增加较小。关于结直肠癌患者治疗期间运动训练的证据有限。一项研究得出结论，运动疗法可能对结直肠癌患者的辅助治疗有益。新辅助治疗期间训练的可能优势可通过术前康复试验进行探索。
