Artese Ashley L, Zhou Xingtao, Tometich Danielle B, Small Brent J, Ahles Tim A, Ahn Jaeil, Bethea Traci N, Breen Elizabeth C, Cohen Harvey J, Extermann Martine, Graham Deena, Isaacs Claudine, Jim Heather S L, McDonald Brenna C, Nakamura Zev M, Patel Sunita K, Rentscher Kelly E, Root James C, Saykin Andrew J, Van Dyk Kathleen, Zhai Wanting, Carroll Judith E, Mandelblatt Jeanne
Department of Exercise Science and Health Promotion, Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, FL, USA.
Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA.
J Natl Cancer Inst. 2024 Dec 1;116(12):2009-2021. doi: 10.1093/jnci/djae182.
Physical activity can improve cognition; however, little is known regarding the relationships between longitudinal objectively measured physical activity, cognition, and inflammation in older breast cancer survivors.
Older (aged 60 years and older) breast cancer survivors (n = 216) and frequency-matched noncancer control participants (n = 216) were assessed at baseline (presystemic therapy for survivors) and annually for up to 5 years. Assessments included hip-worn actigraphs worn for 7 days, neuropsychological tests, the Functional Assessment of Cancer Therapy-Cognitive Function perceived cognitive impairment subscale, and circulating levels of C-reactive protein and interleukin-6. Data were analyzed using linear mixed-effect, random-effect contemporaneous fluctuation, and multilevel mediation models, considering covariates; a P value less than .05 (2-sided) was considered statistically significant.
Survivors had fewer minutes of moderate-to-vigorous physical activity than controls at 36-, 48-, and 60-month time points (P < .03). Fewer survivors met aerobic physical activity guidelines at 36 months than control participants (17.7% vs 33.0%, P = .030). When guidelines were met (vs not), Functional Assessment of Cancer Therapy-Cognitive Function perceived cognitive impairment scores were 2.1 (1.0) (P = .034) points higher. Higher moderate-to-vigorous physical activity and meeting aerobic guidelines were not related to objective neuropsychological performance. Moderate-to-vigorous physical activity was inversely associated with C-reactive protein and interleukin-6 (P < .001), but inflammation did not mediate physical activity effects on perceived cognition.
Older breast cancer survivors were less physically active than older noncancer controls, especially farther from baseline. Meeting aerobic guidelines was associated with better perceived cognition in survivors. Survivorship care should consider physical activity monitoring and referral to rehabilitation and supervised exercise programs to promote physical activity and improve recovery in older survivors.
体育活动可改善认知功能；然而，关于老年乳腺癌幸存者纵向客观测量的体育活动、认知功能和炎症之间的关系，我们所知甚少。
对年龄在60岁及以上的乳腺癌幸存者（n = 216）和频率匹配的非癌症对照参与者（n = 216）在基线时（幸存者进行全身治疗前）进行评估，并每年评估一次，持续长达5年。评估内容包括佩戴7天的髋部活动记录仪、神经心理学测试、癌症治疗功能评估-认知功能感知认知障碍子量表，以及C反应蛋白和白细胞介素-6的循环水平。在考虑协变量的情况下，使用线性混合效应模型、随机效应同期波动模型和多水平中介模型对数据进行分析；P值小于0.05（双侧）被认为具有统计学意义。
在36个月、48个月和60个月的时间点，幸存者的中度至剧烈体育活动分钟数少于对照组（P < 0.03）。在36个月时，达到有氧体育活动指南的幸存者少于对照参与者（17.7%对33.0%，P = 0.030）。当达到指南要求时（与未达到相比），癌症治疗功能评估-认知功能感知认知障碍评分高2.1（1.0）分（P = 0.034）。较高的中度至剧烈体育活动和达到有氧指南与客观神经心理学表现无关。中度至剧烈体育活动与C反应蛋白和白细胞介素-6呈负相关（P < 0.001），但炎症并未介导体育活动对感知认知的影响。
老年乳腺癌幸存者的身体活动比老年非癌症对照者少，尤其是离基线时间越远。达到有氧指南与幸存者更好的感知认知相关。幸存者护理应考虑监测体育活动，并转诊至康复和监督运动项目，以促进老年幸存者的体育活动并改善康复情况。
