Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, AUSTRALIA.
UniSA Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, AUSTRALIA.
Med Sci Sports Exerc. 2022 Aug 1;54(8):1389-1399. doi: 10.1249/MSS.0000000000002918. Epub 2022 Mar 22.
The purpose of this systematic review and meta-analysis was to evaluate the effects of exercise on (i) the prevention of cancer-related lymphedema (CRL) and (ii) the treatment of CRL, lymphedema-associated symptoms, and other health outcomes among individuals with CRL.
An electronic search was undertaken for exercise studies measuring lymphedema and involving individuals at risk of developing or with CRL. The Effective Public Health Practice Project Quality scale was used to assess study quality, and overall quality of evidence was assessed using the Grading of Recommendation, Assessment, Development and Evaluation approach. Meta-analyses were performed to evaluate effects of exercise on CRL incidence, existing CRL status, lymphedema-associated symptoms, and health outcomes.
Twelve studies ( n = 1955; 75% moderate-high quality) and 36 studies ( n = 1741; 58% moderate-high quality) were included in the prevention and treatment aim, respectively. Relative risk of developing CRL for those in the exercise group compared with the nonexercise group was 0.90 (95% confidence interval (CI), 0.72 to 1.13) overall and 0.49 (95% CI, 0.28 to 0.85) for those with five or more lymph nodes removed. For those with CRL in the exercise group, the standardized mean difference (SMD) before to after exercise of CRL was -0.11 (95% CI, -0.22 to 0.01), and compared with usual care postintervention, the SMD was -0.10 (95% CI, -0.24 to 0.04). Improvements after intervention were observed for pain, upper-body function and strength, lower-body strength, fatigue, and quality of life for those in the exercise group (SMD, 0.3-0.8; P < 0.05).
Findings support the application of exercise guidelines for the wider cancer population to those with or at risk of CRL. This includes promotion of aerobic and resistance exercise, and not just resistance exercise alone, as well as unsupervised exercise guided by symptom response.
本系统评价和荟萃分析的目的是评估运动对（i）预防癌症相关淋巴水肿（CRL）和（ii）治疗 CRL、淋巴水肿相关症状和 CRL 患者其他健康结果的影响。
对测量淋巴水肿并涉及有发展或患有 CRL 风险的个体的运动研究进行了电子检索。使用有效公共卫生实践项目质量量表评估研究质量，使用推荐评估、制定与评价分级方法评估证据的总体质量。进行荟萃分析以评估运动对 CRL 发病率、现有 CRL 状况、淋巴水肿相关症状和健康结果的影响。
纳入了预防和治疗目的的 12 项研究（n=1955；75%为中高度质量）和 36 项研究（n=1741；58%为中高度质量）。与非运动组相比，运动组发生 CRL 的相对风险为 0.90（95%置信区间，0.72 至 1.13），对于淋巴结切除数为 5 个或以上的个体为 0.49（95%置信区间，0.28 至 0.85）。对于运动组中患有 CRL 的个体，运动前后 CRL 的标准化均数差值（SMD）为-0.11（95%置信区间，-0.22 至 0.01），与干预后常规护理相比，SMD 为-0.10（95%置信区间，-0.24 至 0.04）。运动组干预后疼痛、上半身功能和力量、下半身力量、疲劳和生活质量得到改善（SMD，0.3-0.8；P<0.05）。
研究结果支持将运动指南应用于更广泛的癌症人群，包括有或有 CRL 风险的人群。这包括促进有氧运动和抗阻运动，而不仅仅是抗阻运动，以及根据症状反应进行无监督的运动。
