Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
JAMA Netw Open. 2024 Oct 1;7(10):e2437964. doi: 10.1001/jamanetworkopen.2024.37964.
Depression is prevalent among patients with cancer, affecting their quality of life and survival. Aerobic physical activity (APA) is an effective strategy for managing depression in the general population, but its effectiveness for reducing depressive symptoms among patients with cancer requires further study.
To evaluate whether APA decreases depression severity in patients with cancer by synthesizing data from published randomized clinical trials (RCTs).
Six databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and Scopus) were systematically searched for relevant citations published between January 1, 1980, and July 5, 2023.
This systematic review and meta-analysis included RCTs comparing APA interventions with usual care, waitlist control, or attention control for managing depression in patients with cancer, irrespective of age and cancer type.
Two reviewers independently conducted screening and data extraction. Risk of bias was evaluated using the Cochrane Risk of Bias Tool, version 2. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline was followed. Standardized mean differences (SMDs) were calculated using a random-effects model. Data collection and analyses were performed between June 2022 and March 2024.
The primary outcome was severity of self-reported depression reported within 1 month of the end of intervention (short term). Secondary outcomes were severity of self-reported depression between 1 and 6 months post intervention (medium term) and between 6 and 12 months post intervention (long term).
This meta-analysis included 25 RCTs with a total of 1931 adults with cancer (age range, 18-80 years). Ten RCTs (40%) had low risk of bias. Aerobic physical activity was associated with decreased self-reported depression among adults with cancer across the 25 included trials (n = 1931 participants; SMD, -0.38 [95% CI, -0.59 to -0.18]; P < .001; I2 = 76%). This decrease in depression scores was also significant for the secondary outcomes of long-term depression across 3 trials (n = 299 participants; SMD, -0.32 [95% CI, -0.60 to -0.04]; P = .03; I2 = 31%) but not for medium-term depression across 2 trials (n = 143 participants; SMD, -0.27 [95% CI, -0.60 to 0.06]; P = .10; I2 = 0%).
In this systematic review and meta-analysis, APA was associated with modest short-term and long-term reductions of depression among adults with cancer. Future studies should discern the effectiveness of APA in combination with other strategies for managing depression across various populations of patients with cancer.
抑郁症在癌症患者中普遍存在，影响其生活质量和生存。有氧运动是管理普通人群中抑郁症的有效策略，但它在降低癌症患者的抑郁症状方面的有效性还需要进一步研究。
通过综合已发表的随机临床试验 (RCT) 的数据，评估有氧运动是否能降低癌症患者的抑郁严重程度。
从 1980 年 1 月 1 日至 2023 年 7 月 5 日，六个数据库（MEDLINE、Embase、Cochrane 对照试验中心注册库、CINAHL、PsycINFO 和 Scopus）系统地搜索了相关引文。
本系统评价和荟萃分析纳入了 RCT，比较了 APA 干预与常规护理、等待对照或注意力对照在癌症患者中管理抑郁症的效果，无论年龄和癌症类型如何。
两名评审员独立进行筛选和数据提取。使用 Cochrane 风险偏倚工具，版本 2 评估风险偏倚。遵循了系统评价和荟萃分析的 Preferred Reporting Items (PRISMA) 报告指南。使用随机效应模型计算标准化均数差值 (SMD)。数据收集和分析在 2022 年 6 月至 2024 年 3 月之间进行。
主要结果是干预结束后 1 个月内自我报告的抑郁严重程度（短期）。次要结果是干预后 1 至 6 个月（中期）和 6 至 12 个月（长期）自我报告的抑郁严重程度。
本荟萃分析纳入了 25 项 RCT，共纳入了 1931 名成年癌症患者（年龄范围 18-80 岁）。10 项 RCT（40%）的风险偏倚较低。有氧运动与癌症患者的抑郁自评呈负相关，这在纳入的 25 项研究中都有体现（n=1931 名参与者；SMD，-0.38[95% CI，-0.59 至 -0.18]；P<0.001；I2=76%）。这种抑郁评分的降低在 3 项试验的长期抑郁结果中也具有统计学意义（n=299 名参与者；SMD，-0.32[95% CI，-0.60 至 -0.04]；P=0.03；I2=31%），但在 2 项试验的中期抑郁结果中不具有统计学意义（n=143 名参与者；SMD，-0.27[95% CI，-0.60 至 0.06]；P=0.10；I2=0%）。
在这项系统评价和荟萃分析中，有氧运动与癌症患者的短期和长期抑郁程度降低有关。未来的研究应该确定有氧运动与其他策略相结合在各种癌症患者人群中管理抑郁症的有效性。
