Christina M. Dieli-Conwright, Nathalie Sami, Kyuwan Lee, Thomas A. Buchanan, and Darcy V. Spicer, University of Southern California, Los Angeles; Leslie Bernstein and Joanne E. Mortimer, City of Hope, Duarte, CA; Kerry S. Courneya, University of Alberta, Edmonton, Alberta, Canada; Wendy Demark-Wahnefried, University of Alabama at Birmingham, Birmingham, AL; and Debu Tripathy, The University of Texas MD Anderson Cancer Center, Houston, TX.
J Clin Oncol. 2018 Mar 20;36(9):875-883. doi: 10.1200/JCO.2017.75.7526. Epub 2018 Jan 22.
Purpose Metabolic syndrome is associated with an increased risk of cardiovascular disease, type 2 diabetes, and breast cancer recurrence in survivors of breast cancer. This randomized controlled trial assessed the effects of a 16-week combined aerobic and resistance exercise intervention on metabolic syndrome, sarcopenic obesity, and serum biomarkers among ethnically diverse, sedentary, overweight, or obese survivors of breast cancer. Methods Eligible survivors of breast cancer (N = 100) were randomly assigned to exercise (n = 50) or usual care (n = 50). The exercise group participated in supervised moderate-to-vigorous-65% to 85% of heart rate maximum-aerobic and resistance exercise three times per week for 16 weeks. Metabolic syndrome z-score (primary outcome), sarcopenic obesity, and serum biomarkers were measured at baseline, postintervention (4 months), and 3-month follow-up (exercise only). Results Participants were age 53 ± 10.4 years, 46% were obese, and 74% were ethnic minorities. Adherence to the intervention was 95%, and postintervention assessments were available in 91% of participants. Postintervention metabolic syndrome z-score was significantly improved in exercise versus usual care (between-group difference, -4.4; 95% CI, -5.9 to -2.7; P < .001). Sarcopenic obesity (appendicular skeletal mass index, P = .001; body mass index, P = .001) and circulating biomarkers, including insulin ( P = .002), IGF-1 ( P = .001), leptin ( P = .001), and adiponectin ( P = .001), were significantly improved postintervention compared with usual care. At 3-month follow-up, all metabolic syndrome variables remained significantly improved compared with baseline in the exercise group ( P < .01). Conclusion Combined resistance and aerobic exercise effectively attenuated metabolic syndrome, sarcopenic obesity, and relevant biomarkers in an ethnically diverse sample of sedentary, overweight, or obese survivors of breast cancer. Our findings suggest a targeted exercise prescription for improving metabolic syndrome in survivors of breast cancer and support the incorporation of supervised clinical exercise programs into breast cancer treatment and survivorship care plans.
代谢综合征与心血管疾病、2 型糖尿病风险增加以及乳腺癌幸存者癌症复发相关。本随机对照试验评估了 16 周有氧和抗阻运动联合干预对代谢综合征、肌肉减少性肥胖和乳腺癌幸存者血清生物标志物的影响，这些乳腺癌幸存者为不同种族、久坐、超重或肥胖。
符合条件的乳腺癌幸存者（N=100）被随机分配到运动组（n=50）或常规护理组（n=50）。运动组每周进行 3 次、16 周、中等至剧烈强度（心率最大的 65%至 85%）有氧和抗阻运动。在基线、干预后（4 个月）和 3 个月随访（仅运动组）时测量代谢综合征 z 评分（主要结局）、肌肉减少性肥胖和血清生物标志物。
参与者的年龄为 53±10.4 岁，46%为肥胖，74%为少数民族。干预的依从性为 95%，91%的参与者可进行干预后评估。与常规护理相比，运动组的代谢综合征 z 评分在干预后显著改善（组间差异，-4.4；95%置信区间，-5.9 至-2.7；P<.001）。肌肉减少性肥胖（四肢骨骼肌指数，P=.001；体重指数，P=.001）和循环生物标志物，包括胰岛素（P=.002）、IGF-1（P=.001）、瘦素（P=.001）和脂联素（P=.001），与常规护理相比，在干预后均显著改善。在 3 个月随访时，与基线相比，运动组所有代谢综合征变量均显著改善（P<.01）。
联合抗阻和有氧运动有效减轻了不同种族、久坐、超重或肥胖的乳腺癌幸存者的代谢综合征、肌肉减少性肥胖和相关生物标志物。我们的发现表明，针对代谢综合征，为乳腺癌幸存者制定有针对性的运动处方，并支持将监督下的临床运动方案纳入乳腺癌治疗和生存护理计划。
