针对有需要的癌症患者的运动干预措施：一项个体患者数据荟萃分析。
Targeting Exercise Interventions to Patients With Cancer in Need: An Individual Patient Data Meta-Analysis.
机构信息
Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
出版信息
J Natl Cancer Inst. 2018 Nov 1;110(11):1190-1200. doi: 10.1093/jnci/djy161.
BACKGROUND
Exercise effects in cancer patients often appear modest, possibly because interventions rarely target patients most in need. This study investigated the moderator effects of baseline values on the exercise outcomes of fatigue, aerobic fitness, muscle strength, quality of life (QoL), and self-reported physical function (PF) in cancer patients during and post-treatment.
METHODS
Individual patient data from 34 randomized exercise trials (n = 4519) were pooled. Linear mixed-effect models were used to study moderator effects of baseline values on exercise intervention outcomes and to determine whether these moderator effects differed by intervention timing (during vs post-treatment). All statistical tests were two-sided.
RESULTS
Moderator effects of baseline fatigue and PF were consistent across intervention timing, with greater effects in patients with worse fatigue (Pinteraction = .05) and worse PF (Pinteraction = .003). Moderator effects of baseline aerobic fitness, muscle strength, and QoL differed by intervention timing. During treatment, effects on aerobic fitness were greater for patients with better baseline aerobic fitness (Pinteraction = .002). Post-treatment, effects on upper (Pinteraction < .001) and lower (Pinteraction = .01) body muscle strength and QoL (Pinteraction < .001) were greater in patients with worse baseline values.
CONCLUSION
Although exercise should be encouraged for most cancer patients during and post-treatments, targeting specific subgroups may be especially beneficial and cost effective. For fatigue and PF, interventions during and post-treatment should target patients with high fatigue and low PF. During treatment, patients experience benefit for muscle strength and QoL regardless of baseline values; however, only patients with low baseline values benefit post-treatment. For aerobic fitness, patients with low baseline values do not appear to benefit from exercise during treatment.
背景
运动对癌症患者的影响通常较小，这可能是因为干预措施很少针对最需要的患者。本研究调查了基线值对癌症患者在治疗期间和治疗后疲劳、有氧健身、肌肉力量、生活质量（QoL）和自我报告的身体功能（PF）的运动结果的调节作用。
方法
从 34 项随机运动试验（n=4519）中汇总了个体患者数据。使用线性混合效应模型研究了基线值对运动干预结果的调节作用，并确定这些调节作用是否因干预时机（治疗期间与治疗后）而异。所有统计检验均为双侧检验。
结果
基线疲劳和 PF 的调节作用在干预时机上是一致的，疲劳程度较重（P 交互作用 =.05）和 PF 较差的患者（P 交互作用 =.003）的效果更大。基线有氧健身、肌肉力量和 QoL 的调节作用因干预时机而异。在治疗期间，基线有氧健身较好的患者，有氧运动效果更好（P 交互作用 =.002）。治疗后，基线值较差的患者，上肢（P 交互作用<.001）和下肢（P 交互作用 =.01）肌肉力量和 QoL 的效果更大（P 交互作用<.001）。
结论
尽管应鼓励大多数癌症患者在治疗期间和治疗后进行运动，但针对特定亚组可能更有益且具有成本效益。对于疲劳和 PF，治疗期间和治疗后应针对疲劳程度高和 PF 低的患者。在治疗期间，无论基线值如何，患者都会从肌肉力量和 QoL 中受益；然而，只有基线值较低的患者在治疗后受益。对于有氧健身，基线值较低的患者在治疗期间似乎不会从运动中受益。
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