Navarro-Ledesma Santiago, Hamed-Hamed Dina, González-Muñoz Ana, Pruimboom Leo
Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Campus of Melilla Querol Streel 5, 52004 Melilla, Spain.
University Chair in Clinical Psychoneuroimmunology, University of Granada and PNI Europe, 52004 Melilla, Spain.
Cancers (Basel). 2024 Feb 3;16(3):656. doi: 10.3390/cancers16030656.
Insulin resistance (IR), a key aspect of type 2 diabetes and a defining characteristic of obesity and its associated conditions, emerges as a mechanistic pathway potentially implicated in cancer pathophysiology. This presents an appealing intervention target for cancer patients. The objective of this study is to conduct a systematic review, examining the scientific evidence regarding the impact of physical activity on modifying insulin resistance in individuals with cancer.
The selection criteria were specific: only randomized controlled clinical trials published in the last 13 years and written in English or Spanish were included. The databases utilized for the search included PubMed, Scopus, Cochrane Library, EBSCO, and WEB OF SCIENCE. The protocol for this review was duly registered in the International Register of Systematic Reviews (CRD42023435002). The final search was conducted on 14 May 2023.
The outcomes were assessed using the tool proposed by the Cochrane Handbook to evaluate the risk of bias in the included studies. Among the 12 studies incorporated, 8 demonstrated a low risk of bias, two had an unclear risk of bias, and the remaining two showed a high risk of bias. The variety of exercise types used across all studies was extensive, making definitive conclusions challenging. Physical activity was linked to enhanced insulin sensitivity in seven studies, while five studies showed no significant changes in insulin resistance between the intervention and control groups. Importantly, none of the interventions employed in the included studies exhibited adverse effects on the study participants.
The role of exercise as a medicine against insulin resistance has been evidenced in many different studies, mostly related to obesity and cardiovascular diseases. Engaging in physical activity could be a healthy option to combat the effects of insulin resistance in cancer patients, although evidence is weak and limited, according to the results of our systemic review. We further found that literature is lacking at the level of optimal doses, timing, and type of exercise. More studies are needed with more defined PA programs in type and length.
胰岛素抵抗（IR）是2型糖尿病的一个关键方面，也是肥胖及其相关病症的一个决定性特征，它作为一种潜在涉及癌症病理生理学的机制途径而出现。这为癌症患者提供了一个有吸引力的干预靶点。本研究的目的是进行一项系统综述，审查关于体育活动对癌症患者胰岛素抵抗改善影响的科学证据。
选择标准很明确：仅纳入过去13年发表的、用英语或西班牙语撰写的随机对照临床试验。用于检索的数据库包括PubMed、Scopus、Cochrane图书馆、EBSCO和科学网。本综述的方案已在国际系统评价注册库（CRD42023435002）正式注册。最终检索于2023年5月14日进行。
使用Cochrane手册提出的工具评估纳入研究中的偏倚风险来评估结果。在纳入的12项研究中，8项显示偏倚风险低，2项偏倚风险不明确，其余2项显示偏倚风险高。所有研究中使用的运动类型多种多样，难以得出明确结论。7项研究表明体育活动与胰岛素敏感性增强有关，而5项研究表明干预组和对照组之间胰岛素抵抗无显著变化。重要的是，纳入研究中采用的干预措施均未对研究参与者产生不良影响。
运动作为对抗胰岛素抵抗的药物的作用在许多不同研究中都得到了证实，这些研究大多与肥胖和心血管疾病有关。根据我们系统综述的结果，进行体育活动可能是对抗癌症患者胰岛素抵抗影响的一个健康选择，尽管证据薄弱且有限。我们进一步发现，在运动的最佳剂量、时间和类型方面缺乏相关文献。需要更多关于运动类型和时长更明确的体育活动计划的研究。
