Ramaiah College of Physiotherapy, Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India.
Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
PeerJ. 2024 Mar 8;12:e17053. doi: 10.7717/peerj.17053. eCollection 2024.
Disrupted circadian rhythm commonly reported in cancer survivors is closely associated with cancer related fatigue, sleep disturbances and compromised quality of life. As more cancer survivors request non-pharmacological treatment strategies for the management of their chronic sleep-related symptoms, there is a need for meta-analyses of various interventions such as exercise on sleep and circadian rhythm disturbances.
A search for RCT's was conducted in April 2020 and updated in July 2023 using relevant keywords for cancer, sleep, circadian rhythm and exercise interventions on PubMed, Scopus, Web of Science, PEDro and CINAHL.
Thirty-six studies were included for qualitative analysis and 26, for meta-analysis. Thirty-five studies analyzed sleep outcomes, while five analyzed circadian rhythm. RCT's studying the effect of aerobic exercise, resistance exercise, combined aerobic and resistance exercise, physical activity, yoga, or tai chi were included. Meta-analysis results showed significant exercise-related improvements on sleep quality assessed by Pittsburgh Sleep Quality index (PSQI) (SMD = -0.50 [-0.87, -0.13], = 0.008), wake after sleep onset (WASO) (SMD = -0.29 [-0.53, -0.05], = 0.02) and circadian rhythm, assessed by salivary cortisol levels (MD = -0.09 (95% CI [-0.13 to -0.06]) mg/dL, < 0.001). Results of the meta-analysis indicated that exercise had no significant effect on sleep efficiency, sleep onset latency, total sleep time and circadian rhythm assessed by accelerometry values.
While some sleep and circadian rhythm outcomes (PSQI, WASO and salivary cortisol) exhibited significant improvements, it is still somewhat unclear what exercise prescriptions would optimize different sleep and circadian rhythm outcomes across a variety of groups of cancer survivors.
As exercise does not exacerbate cancer-related circadian rhythm and sleep disturbances, and may actually produce some significant benefits, this meta-analysis provides further evidence for cancer survivors to perform regular exercise.
癌症幸存者中常见的昼夜节律紊乱与癌症相关疲劳、睡眠障碍和生活质量下降密切相关。随着越来越多的癌症幸存者要求采用非药物治疗策略来管理其慢性睡眠相关症状，因此需要对各种干预措施（如运动对睡眠和昼夜节律紊乱的影响）进行荟萃分析。
于 2020 年 4 月和 2023 年 7 月使用 PubMed、Scopus、Web of Science、PEDro 和 CINAHL 上与癌症、睡眠、昼夜节律和运动干预相关的关键词进行了 RCT 检索。
36 项研究进行了定性分析，26 项研究进行了荟萃分析。35 项研究分析了睡眠结果，5 项研究分析了昼夜节律。纳入了研究有氧运动、抗阻运动、有氧和抗阻运动相结合、身体活动、瑜伽或太极对睡眠影响的 RCT。荟萃分析结果表明，匹兹堡睡眠质量指数（PSQI）（SMD=-0.50[-0.87，-0.13]， =0.008）、睡眠后觉醒时间（WASO）（SMD=-0.29[-0.53，-0.05]， =0.02）和唾液皮质醇水平评估的昼夜节律方面，运动相关的睡眠质量有显著改善。结果表明，运动对睡眠效率、入睡潜伏期、总睡眠时间和加速度计评估的昼夜节律没有显著影响。
虽然一些睡眠和昼夜节律结果（PSQI、WASO 和唾液皮质醇）有显著改善，但对于不同的癌症幸存者群体，哪种运动处方能优化不同的睡眠和昼夜节律结果仍不太清楚。
由于运动不会加重癌症相关的昼夜节律和睡眠障碍，实际上可能会产生一些显著的益处，因此这项荟萃分析为癌症幸存者进行定期运动提供了进一步的证据。
