运动对癌症相关认知障碍的影响及物理治疗的应用：随机对照试验的系统评价。
The Effect of Exercise on Cancer-Related Cognitive Impairment and Applications for Physical Therapy: Systematic Review of Randomized Controlled Trials.
机构信息
Department of Physical Therapy, University of British Columbia 212-2177 Wesbrook Mall, Vancouver, British Columbia, Canada V7J 3K6.
Rehabilitation Sciences, University of British Colombia.
出版信息
Phys Ther. 2020 Mar 10;100(3):523-542. doi: 10.1093/ptj/pzz090.
BACKGROUND
Cancer-related cognitive impairment (CRCI), often called "chemo-brain" or "chemo-fog," is a common side effect among adults with cancer, which can persist well after treatment completion. Accumulating evidence demonstrates exercise can improve cognitive function in healthy older adults and adults with cognitive impairments, suggesting exercise may play a role in managing CRCI.
PURPOSE
The purpose was to perform a systematic review of randomized controlled trials (RCTs) to understand the effect of exercise on CRCI.
DATA SOURCES
Relevant literature was retrieved from CINAHL, Medline (Ovid), and EMBASE.
STUDY SELECTION
Eligible articles were RCTs that prescribed aerobic, resistance, combined aerobic/resistance, or mind-body (eg, yoga or Qigong) exercise during or following cancer treatment and included cognitive function outcome measures.
DATA EXTRACTION
Descriptive information and Cohen d effect sizes were directly extracted or calculated for included trials.
DATA SYNTHESIS
Twenty-nine trials were included in the final analysis. A statistically significant effect of exercise on self-reported cognitive function, both during and postadjuvant treatment, was reported in 12 trials (41%) (Cohen d range: 0.24-1.14), most commonly using the EORTC QLQ-C30. Ten trials (34%) performed neuropsychological testing to evaluate cognitive function; however, only 3 trials in women with breast cancer reported a significant effect of exercise (Cohen d range: 0.41-1.47).
LIMITATIONS
Few RCTs to date have evaluated the effect of exercise on CRCI as a primary outcome. Twenty-six trials (90%) in this review evaluated CRCI as secondary analyses.
CONCLUSIONS
Evidence supporting exercise as a strategy to address CRCI is limited. Future research evaluating CRCI as a primary outcome, including self-reported and objective measures, is needed to confirm the possible role of exercise in preventing and managing cognitive impairments in adults with cancer.
背景
癌症相关认知障碍（CRCI），也称为“化疗脑”或“化疗雾”，是癌症患者的常见副作用，在治疗完成后仍会持续存在。越来越多的证据表明，运动可以改善健康老年人和认知障碍成年人的认知功能，这表明运动可能在管理 CRCI 方面发挥作用。
目的
本研究旨在对随机对照试验（RCT）进行系统评价，以了解运动对 CRCI 的影响。
数据来源
从 CINAHL、Medline（Ovid）和 EMBASE 检索相关文献。
研究选择
纳入的文章为在癌症治疗期间或之后规定进行有氧运动、抗阻运动、有氧和抗阻运动相结合或身心运动（如瑜伽或气功）的 RCT，且包含认知功能的测量结果。
数据提取
直接提取或计算纳入试验的描述性信息和 Cohen d 效应量。
数据综合
最终分析纳入了 29 项试验。有 12 项（41%）（Cohen d 范围：0.24-1.14）试验报告了运动对自我报告的认知功能在治疗期间和治疗后均有统计学显著影响，最常用的是 EORTC QLQ-C30。有 10 项（34%）试验进行了神经心理学测试以评估认知功能；然而，仅有 3 项针对乳腺癌女性的试验报告了运动的显著效果（Cohen d 范围：0.41-1.47）。
局限性
迄今为止，很少有 RCT 评估运动对 CRCI 的影响作为主要结果。本综述中的 26 项（90%）试验将 CRCI 作为次要分析进行评估。
结论
支持运动作为解决 CRCI 策略的证据有限。需要进一步开展评估 CRCI 作为主要结果的研究，包括自我报告和客观测量，以确认运动在预防和管理癌症患者认知障碍方面的可能作用。
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