Stout Nicole L, Baima Jennifer, Swisher Anne K, Winters-Stone Kerri M, Welsh Judith
National Institutes of Health, Clinical Center, Rehabilitation Medicine Department, Bethesda, MD(∗).
University of Massachusetts Memorial Health Care, Physical Medicine and Rehabilitation, Worcester, MA(†).
PM R. 2017 Sep;9(9S2):S347-S384. doi: 10.1016/j.pmrj.2017.07.074.
Evidence supports the benefits of exercise for patients with cancer; however, specific guidance for clinical decision making regarding exercise timing, frequency, duration, and intensity is lacking. Efforts are needed to optimize clinical recommendations for exercise in the cancer population.
To aggregate information regarding the benefit of exercise through a systematic review of existing systematic reviews in the cancer exercise literature.
PubMed, CINAHL Plus, Scopus, Web of Science, and EMBASE.
Systematic reviews and meta-analyses of the impact of movement-based exercise on the adult cancer population.
Two author teams reviewed 302 abstracts for inclusion with 93 selected for full-text review. A total of 53 studies were analyzed. A Measurement Tool to Assess Systematic Reviews (AMSTAR) was used as a quality measure of the reviews. Information was extracted using the PICO format (ie, participants, intervention, comparison, outcomes). Descriptive findings are reported.
Mean AMSTAR score = 7.66/11 (±2.04) suggests moderate quality of the systematic reviews. Exercise is beneficial before, during, and after cancer treatment, across all cancer types, and for a variety of cancer-related impairments. Moderate-to-vigorous exercise is the best level of exercise intensity to improve physical function and mitigate cancer-related impairments. Therapeutic exercises are beneficial to manage treatment side effects, may enhance tolerance to cancer treatments, and improve functional outcomes. Supervised exercise yielded superior benefits versus unsupervised. Serious adverse events were not common.
Movement-based exercise intervention outcomes are reported. No analysis of pooled effects was calculated across reviews due to significant heterogeneity within the systematic reviews. Findings do not consider exercise in advanced cancers or pediatric populations.
Exercise promotes significant improvements in clinical, functional, and in some populations, survival outcomes and can be recommended regardless of the type of cancer. Although generally safe, patients should be screened and appropriate precautions taken. Efforts to strengthen uniformity in clinical trial reporting, develop clinical practice guidelines, and integrate exercise and rehabilitation services into the cancer delivery system are needed.
有证据支持运动对癌症患者有益；然而，在运动时间、频率、持续时间和强度方面缺乏临床决策的具体指导。需要努力优化针对癌症患者运动的临床建议。
通过对癌症运动文献中现有系统评价进行系统综述，汇总有关运动益处的信息。
PubMed、CINAHL Plus、Scopus、Web of Science和EMBASE。
对基于运动的锻炼对成年癌症患者影响的系统评价和荟萃分析。
两个作者团队审查了302篇摘要以确定是否纳入，其中93篇被选作全文审查。共分析了53项研究。使用系统评价评估测量工具（AMSTAR）作为评价的质量指标。采用PICO格式（即参与者、干预措施、对照、结局）提取信息。报告描述性结果。
平均AMSTAR评分为7.66/11（±2.04），表明系统评价质量中等。运动在癌症治疗前、治疗期间和治疗后均有益，适用于所有癌症类型以及各种癌症相关功能障碍。中等到剧烈运动是改善身体功能和减轻癌症相关功能障碍最佳的运动强度水平。治疗性运动有助于管理治疗副作用，可能增强对癌症治疗的耐受性，并改善功能结局。有监督的运动比无监督的运动产生更好的效果。严重不良事件并不常见。
报告了基于运动的锻炼干预结局。由于系统评价中存在显著异质性，未对各评价中的合并效应进行分析。研究结果未考虑晚期癌症或儿科人群的运动情况。
运动能显著改善临床、功能结局，在某些人群中还能改善生存结局，无论癌症类型如何均可推荐。虽然运动总体上是安全的，但应对患者进行筛查并采取适当预防措施。需要努力加强临床试验报告的一致性，制定临床实践指南，并将运动和康复服务纳入癌症治疗体系。
