运动对癌症幸存者抑郁和焦虑症状的影响因患者、临床及干预特征而异：来自26项随机对照试验个体参与者数据汇总分析的结果
Exercise effects on symptoms of depression and anxiety vary by patient, clinical, and intervention characteristics in cancer survivors: Results from pooled analyses of individual participant data of 26 RCTs.
作者信息
Kenkhuis Marlou-Floor, Doorenbos Meike, Mast Isa H, Aaronson Neil K, van Beurden Marc, Bohus Martin, Courneya Kerry S, Daley Amanda J, Galvão Daniel A, Goedendorp Martine M, van Harten Wim H, Hayes Sandi C, Hiensch Anouk E, Irwin Melinda L, Kersten Marie José, Knoop Hans, May Anne M, McConnachie Alex, van Mechelen Willem, Mutrie Nanette, Newton Robert U, Nollet Frans, Oldenburg Hester S, Schmidt Martina E, Schmitz Kathryn H, Schulz Karl-Heinz, Sonke Gabe S, Steindorf Karen, Stuiver Martijn M, Taaffe Dennis R, Thorsen Lene, Velthuis Miranda J, Wiskemann Joachim, Mesters Ilse, Ulrich Cornelia M, van Vulpen Jonna K, Custers Jose A E, Buffart Laurien M
机构信息
Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
出版信息
Support Care Cancer. 2025 Jul 1;33(7):647. doi: 10.1007/s00520-025-09646-9.
PURPOSE
This study aimed to investigate whether socio-demographic, clinical, and intervention-related variables moderate the effects of exercise on depression and anxiety symptoms in cancer survivors.
METHODS
Data from 26 RCTs in the POLARIS database were analyzed using a one-step individual participant data (IPD) meta-analytic approach with linear mixed models to assess exercise effects on depression and anxiety symptoms (z-scores). Interaction terms were added to these models to explore moderators. Results are presented as betas (corresponding to Cohen's d effect size).
RESULTS
Albeit statistically significant, exercise demonstrated negligible effects on symptoms of depression (β = - 0.11; 95% CI = - 0.16; - 0.06) and anxiety (β = - 0.07; 95% CI = - 0.12; - 0.02) compared to controls. The effects of exercise interventions on depressive symptoms were larger for patients who were not living with a partner (β = - 0.23; 95% CI = - 0.35; - 0.11), had a low/medium education level (β = - 0.14; 95% CI = - 0.21; - 0.07), and who had moderate-to-severe symptoms of depression at baseline (β = - 0.30; 95% CI = - 0.43; - 0.16). Patients with moderate-to-severe symptoms of depression at baseline combined with those not living with a partner or a low/medium education level yielded the largest effect size through exercise (β = - 0.61; 95% CI = - 0.89; - 0.33 and β = - 0.37; 95% CI = - 0.57; - 0.17, respectively). Effects on anxiety symptoms were larger for patients with moderate-to-severe symptoms of anxiety at baseline (β = - 0.17; 95% CI = - 0.32; - 0.01) compared to those with no-to-mild symptoms. Sex, age, cancer type, BMI, and intervention-related variables did not moderate the exercise effects.
CONCLUSION
The findings of this study highlight the heterogeneous response to exercise interventions across various patient subgroups. Patients with moderate-to-severe anxiety or depression, those with a low/medium education, and those not living together with a partner may particularly benefit.
目的
本研究旨在调查社会人口统计学、临床和干预相关变量是否会调节运动对癌症幸存者抑郁和焦虑症状的影响。
方法
使用单步个体参与者数据（IPD）荟萃分析方法和线性混合模型分析了北极星数据库中26项随机对照试验的数据，以评估运动对抑郁和焦虑症状（z分数）的影响。在这些模型中加入交互项以探索调节因素。结果以β系数（对应于科恩d效应量）表示。
结果
尽管具有统计学意义，但与对照组相比，运动对抑郁症状（β = -0.11；95%CI = -0.16；-0.06）和焦虑症状（β = -0.07；95%CI = -0.12；-0.02）的影响可忽略不计。对于没有伴侣的患者（β = -0.23；95%CI = -0.35；-0.11）、教育水平低/中等的患者（β = -0.14；95%CI = -0.21；-0.07）以及基线时有中度至重度抑郁症状的患者（β = -0.30；95%CI = -0.43；-0.16），运动干预对抑郁症状的影响更大。基线时有中度至重度抑郁症状且没有伴侣或教育水平低/中等的患者通过运动产生的效应量最大（分别为β = -0.61；95%CI = -0.89；-0.33和β = -0.37；95%CI = -0.57；-0.17）。与无至轻度焦虑症状的患者相比，基线时有中度至重度焦虑症状的患者运动对焦虑症状的影响更大（β = -0.17；95%CI = -0.32；-0.01）。性别、年龄、癌症类型、体重指数和干预相关变量并未调节运动效果。
结论
本研究结果突出了不同患者亚组对运动干预的异质性反应。中度至重度焦虑或抑郁患者、教育水平低/中等的患者以及没有伴侣共同生活的患者可能尤其受益。
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