Jessica M. Scott, Emily C. Zabor, Scott C. Adams, Chaya S. Moskowitz, Konstantina Matsoukas, Neil M. Iyengar, Chau T. Dang, Lee W. Jones, Memorial Sloan Kettering Cancer Center; Graeme J. Koelwyn, New York University Langone Medical Center; and Chaya S. Moskowitz, Neil M. Iyengar, Chau T. Dang, Lee W. Jones, Weill Cornell Medical College, New York, NY; Emily Schwitzer, Duke University Medical Center, Durham, NC; and Tormod S. Nilsen, The Norwegian School of Sport Sciences, Oslo, Norway.
J Clin Oncol. 2018 Aug 1;36(22):2297-2305. doi: 10.1200/JCO.2017.77.5809. Epub 2018 Jun 12.
Purpose To evaluate the effects of exercise therapy on cardiorespiratory fitness (CRF) in randomized controlled trials (RCTs) among patients with adult-onset cancer. Secondary objectives were to evaluate treatment effect modifiers, safety, and fidelity. Methods A systematic search of PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library was conducted to identify RCTs that compared exercise therapy to a nonexercise control group. The primary end point was change in CRF as evaluated by peak oxygen consumption (VO; in mL O × kg × min) from baseline to postintervention. Subgroup analyses evaluated whether treatment effects differed as a function of exercise prescription (ie, modality, schedule, length, supervision), study characteristics (ie, intervention timing, primary cancer site), and publication year. Safety was defined as report of any adverse event (AE); fidelity was evaluated by rates of attendance, adherence, and loss to follow-up. Results Forty-eight unique RCTs that represented 3,632 patients (mean standard deviation age, 55 ± 7.5 years; 68% women); 1,990 (55%) and 1,642 (45%) allocated to exercise therapy and control/usual care groups, respectively, were evaluated. Exercise therapy was associated with a significant increase in CRF (+2.80 mL O × kg × min) compared with no change (+0.02 mL O × kg × min) in the control group (weighted mean differences, +2.13 mL O × kg × min; 95% CI, 1.58 to 2.67; I, 20.6; P < .001). No statistical significant differences were observed on the basis of any treatment effect modifiers. Thirty trials (63%) monitored AEs; a total of 44 AEs were reported. The mean standard deviation loss to follow-up, attendance, and adherence rates were 11% ± 13%, 84% ± 12%, and 88% ± 32%, respectively. Conclusion Exercise therapy is an effective adjunctive therapy to improve CRF in patients with cancer. Our findings support the recommendation of exercise therapy for patients with adult-onset cancer.
评估运动疗法对成年期癌症患者心肺功能适应性（CRF）的随机对照试验（RCT）的效果。次要目标是评估治疗效果的调节因素、安全性和忠实度。
系统检索 PubMed、Embase、Cumulative Index to Nursing and Allied Health Literature 和 Cochrane Library，以确定比较运动疗法与非运动对照组的 RCT。主要终点是根据基线至干预后峰值耗氧量（VO；以毫升 O×kg×min 表示）评估的 CRF 变化。亚组分析评估了治疗效果是否因运动处方（即方式、时间表、长度、监督）、研究特征（即干预时机、主要癌症部位）和出版年份而异。安全性定义为任何不良事件（AE）的报告；忠实度通过出勤率、依从性和随访丢失率来评估。
评估了 48 项独特的 RCT，代表了 3632 名患者（平均年龄标准差为 55±7.5 岁；68%为女性）；1990（55%）和 1642（45%）名患者分别分配到运动疗法和对照组/常规护理组。与对照组无变化（+0.02 毫升 O×kg×min）相比，运动疗法与 CRF 显著增加（+2.80 毫升 O×kg×min）相关（加权平均差异，+2.13 毫升 O×kg×min；95%CI，1.58 至 2.67；I，20.6；P<.001）。没有观察到任何治疗效果调节因素的统计学显著差异。30 项试验（63%）监测了 AE；共报告了 44 例 AE。随访丢失、出勤率和依从率的平均值标准差分别为 11%±13%、84%±12%和 88%±32%。
运动疗法是一种有效的辅助疗法，可以提高癌症患者的 CRF。我们的研究结果支持向成年期癌症患者推荐运动疗法。
