运动疗法剂量方案对原发性乳腺癌患者心肺功能受损的影响：一项随机对照试验。
Effects of Exercise Therapy Dosing Schedule on Impaired Cardiorespiratory Fitness in Patients With Primary Breast Cancer: A Randomized Controlled Trial.
机构信息
Memorial Sloan Kettering Cancer Center, New York, NY (J.M.S., C.T.D., A.F.Y., D.C., C.C., C.C., M.G.M., L.W.J.).
Duke University Medical Center, Durham, NC (S.M.T., J.E.H., P.S.D., M.G.K.).
出版信息
Circulation. 2020 Feb 18;141(7):560-570. doi: 10.1161/CIRCULATIONAHA.119.043483. Epub 2020 Feb 17.
BACKGROUND
Current exercise guidelines for clinical populations recommend an exercise therapy (ET) prescription of fixed intensity (moderate), duration (40-50 minutes per session), and volume (120-160 min/wk). A critical overarching element of exercise programming that has received minimal attention is dose scheduling. We investigated the tolerability and efficacy of 2 exercise training dose regimens on cardiorespiratory fitness and patient-reported outcomes in patients with posttreatment primary breast cancer.
METHODS
Using a parallel-group randomized trial, we randomly allocated 174 postmenopausal patients (2.8 years after adjuvant therapy) with impaired peak oxygen consumption (VOpeak) to 1 of 2 supervised exercise training interventions delivered with a standard linear (LET) (fixed dose intensity per session for 160 min/wk) or nonlinear (NLET) (variable dose intensity per session for ≈120 min/wk) schedule compared with a stretching attention control group for 16 consecutive weeks. Stretching was matched to exercise dosing arms on the basis of location, frequency, duration, and treatment length. The primary end point was change in VOpeak (mL O·kg·min) from baseline to after intervention. Secondary end points were patient-reported outcomes, tolerability, and safety.
RESULTS
No serious adverse events were observed. Mean attendance was 64%, 75%, and 80% for attention control, LET, and NLET, respectively. In intention-to-treat analysis, VOpeak increased 0.6±1.7 mL O·kg·min (=0.05) and 0.8±1.8 mL O·kg·min (=0.07) in LET and NLET, respectively, compared with attention control. Change in VOpeak ranged from -2.7 to 4.1 mL O·kg·min and from -3.6 to 5.1 mL O·kg·min in LET and NLET, respectively. Approximately 40% of patients in both exercise dosing regimens were classified as VOpeak responders (ie, Δ ≥1.32 mL O·kg·min). NLET improved all patient-reported outcomes compared with attention control.
CONCLUSIONS
Short-term exercise training, independently of dosing schedule, is associated with modest improvements in cardiorespiratory fitness in patients previously treated for early-stage breast cancer.
CLINICAL TRIAL REGISTRATION
URL: https://www.clinicaltrials.gov. Unique identifier: NCT01186367.
背景
目前针对临床人群的运动指南建议采用固定强度（适度）、时长（每次 40-50 分钟）和运动量（每周 120-160 分钟）的运动疗法（ET）处方。运动方案中一个关键的综合要素是剂量安排，这一要素虽受到关注较少，但却非常重要。我们研究了 2 种运动训练剂量方案对治疗后早期乳腺癌患者心肺功能适应性和患者报告结局的耐受性和疗效。
方法
采用平行组随机试验，我们将 174 名绝经后患者（辅助治疗后 2.8 年）随机分配至 2 种监督下的运动训练干预组中的 1 种，这些患者的峰值摄氧量（VOpeak）受损，1 种采用标准线性（LET）方案（每次 160 分钟/周，固定剂量强度），另 1 种采用非线性（NLET）方案（每次约 120 分钟/周，可变剂量强度），与拉伸注意力对照组进行比较，连续 16 周。拉伸方案在部位、频率、时长和治疗时长上与运动剂量组相匹配。主要终点是从基线到干预后的 VOpeak（mL O·kg·min）变化。次要终点是患者报告结局、耐受性和安全性。
结果
未观察到严重不良事件。注意力控制、LET 和 NLET 组的平均出勤率分别为 64%、75%和 80%。意向治疗分析中，LET 和 NLET 组的 VOpeak 分别增加 0.6±1.7 mL O·kg·min（=0.05）和 0.8±1.8 mL O·kg·min（=0.07），而注意力控制组则降低 0.1±1.6 mL O·kg·min（=0.11）。VOpeak 的变化范围在 LET 和 NLET 组分别为-2.7 至 4.1 mL O·kg·min 和-3.6 至 5.1 mL O·kg·min。在这两种运动剂量方案中，大约 40%的患者被归类为 VOpeak 应答者（即，Δ≥1.32 mL O·kg·min）。与注意力控制组相比，NLET 改善了所有患者报告的结局。
结论
短期运动训练与适度改善早期乳腺癌治疗后患者的心肺功能适应性有关，而与剂量方案无关。
Zotero 插件