化疗治疗早期乳腺癌患者的中枢疲劳加重和运动能力降低。
Exacerbated central fatigue and reduced exercise capacity in early-stage breast cancer patients treated with chemotherapy.
机构信息
Biomedicine Research Centre of Strasbourg (CRBS), Mitochondria, Oxidative Stress, and Muscular Protection Laboratory (UR 3072), Strasbourg, France.
Faculty of Sport Sciences, European Centre for Education, Research and Innovation in Exercise Physiology (CEERIPE), University of Strasbourg, 4 rue Blaise Pascal, CS 90032, 67081, Strasbourg Cedex, France.
出版信息
Eur J Appl Physiol. 2023 Jul;123(7):1567-1581. doi: 10.1007/s00421-023-05177-5. Epub 2023 Mar 20.
PURPOSE
The present study aimed to characterize the etiology of exercise-induced neuromuscular fatigue and its consequences on the force-duration relationship to provide mechanistic insights into the reduced exercise capacity characterizing early-stage breast cancer patients.
METHODS
Fifteen early-stage breast cancer patients and fifteen healthy women performed 60 maximal voluntary isometric quadriceps contractions (MVCs, 3 s of contraction, 2 s of relaxation). The critical force was determined as the mean force of the last six contractions, while W' was calculated as the force impulse generated above the critical force. Quadriceps muscle activation during exercise was estimated from vastus lateralis, vastus medialis and rectus femoris EMG. Central and peripheral fatigue were quantified via changes in pre- to postexercise quadriceps voluntary activation (ΔVA) and quadriceps twitch force (ΔQTw) evoked by supramaximal electrical stimulation, respectively.
RESULTS
Early-stage breast cancer patients demonstrated lower MVC than controls preexercise (- 15%, P = 0.022), and this reduction persisted throughout the 60-MVC exercise (- 21%, P = 0.002). The absolute critical force was lower in patients than in controls (144 ± 29N vs. 201 ± 47N, respectively, P < 0.001), while W' was similar (P = 0.546), resulting in lower total work done (- 23%, P = 0.001). This was associated with lower muscle activation in the vastus lateralis (P < 0.001), vastus medialis (P = 0.003) and rectus femoris (P = 0.003) in patients. Immediately following exercise, ΔVA showed a greater reduction in patients compared to controls (- 21.6 ± 13.3% vs. - 12.6 ± 7.7%, P = 0.040), while ΔQTw was similar (- 60.2 ± 13.2% vs. - 52.8 ± 19.4%, P = 0.196).
CONCLUSION
These findings support central fatigue as a primary cause of the reduction in exercise capacity characterizing early-stage breast cancer patients treated with chemotherapy.
CLINICAL TRIALS REGISTRATION
No. NCT04639609-November 20, 2020.
目的
本研究旨在描述运动诱导的神经肌肉疲劳的病因及其对力-时间关系的影响，为早期乳腺癌患者运动能力下降的机制提供深入了解。
方法
15 名早期乳腺癌患者和 15 名健康女性进行了 60 次最大自主等长股四头肌收缩（MVC，收缩 3 秒，放松 2 秒）。临界力被确定为最后六次收缩的平均力，而 W'则被计算为超过临界力的力冲量。运动过程中股外侧肌、股内侧肌和股直肌的肌电图用于估计股四头肌的激活情况。通过测量超最大电刺激诱发的股四头肌自主激活（ΔVA）和股四头肌 twitch 力（ΔQTw）前后的变化，分别量化中枢和外周疲劳。
结果
与对照组相比，早期乳腺癌患者在运动前的 MVC 明显降低（-15%，P=0.022），且在 60-MVC 运动过程中一直持续（-21%，P=0.002）。患者的绝对临界力明显低于对照组（分别为 144±29N 和 201±47N，P<0.001），而 W'相似（P=0.546），导致总做功减少（-23%，P=0.001）。这与患者的股外侧肌（P<0.001）、股内侧肌（P=0.003）和股直肌（P=0.003）的肌肉激活降低有关。运动后即刻，与对照组相比，患者的 ΔVA 下降更为明显（-21.6±13.3% vs.-12.6±7.7%，P=0.040），而 ΔQTw 相似（-60.2±13.2% vs.-52.8±19.4%，P=0.196）。
结论
这些发现支持中枢疲劳是化疗治疗的早期乳腺癌患者运动能力下降的主要原因。
临床试验注册
无。NCT04639609-2020 年 11 月 20 日。
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