Wang Jingyu, He Yuxuan, Wang Ziqian, Wang Zhouluo, Miao Yongqi, Choi Jae-Young
Department of Sport Leisure, Sungshin Women's University, Seoul, Republic of Korea.
School of Education and Arts, Jiujiang Polytechnic University of Science and Technology, Jiujiang, China.
Front Immunol. 2025 Aug 14;16:1663560. doi: 10.3389/fimmu.2025.1663560. eCollection 2025.
This study aimed to systematically evaluate the effects of exercise interventions on metabolic and inflammatory biomarkers in cancer patients, and to identify potential dose-response relationships and modulatory mechanisms using Robust Variance Estimation (RVE) and MetaForest models.
A systematic search of five databases was conducted from inception to March 6, 2025, based on the PICOS framework. Randomized controlled trials involving exercise interventions of ≥4 weeks in adults (≥18 years) with cancer were included. Effect sizes were pooled using RVE to estimate overall intervention effects. Risk of bias was assessed using the ROB2 tool, and the certainty of evidence was evaluated with the GRADE approach. Univariable RVE meta-regression was performed to examine the linear effects of each moderator. MetaForest was used to assess variable importance and to explore potential nonlinear relationships between moderators and intervention effects. Subgroup analyses were conducted by cancer type and intervention timing.
A total of 83 eligible articles were included, representing 74 distinct randomized controlled trials, from which data were extracted. Exercise significantly reduced insulin levels (ES = -0.24, SE = 0.08, p < 0.01, I² = 49%), representing a small but meaningful effect. TNF-α showed a small effect (ES = -0.22, SE = 0.13) but was not statistically significant (p = 0.10, I² = 74%). MetaForest modeling revealed that the most favorable changes in IL-6, adiponectin, and IGF-1 were associated with high-intensity aerobic exercise; TNF-α, IL-8, and IL-10 responded best to longer weekly exercise duration; and improvements in glucose, leptin, and CRP were most pronounced when exercise was combined with caloric restriction.
Regular exercise confers modest but favorable effects on metabolic and inflammatory biomarkers in cancer patients. Meta-regression highlighted the importance of high-intensity aerobic exercise (HRR > 85%) in modulating IL-6, adiponectin, and IGF-1, as well as longer weekly exercise duration (>280 min/week) in improving TNF-α and IL-8. Mechanistically, high-intensity aerobic exercise may serve as a primary trigger for activating pathways that mediate metabolic and inflammatory improvements.
本研究旨在系统评估运动干预对癌症患者代谢和炎症生物标志物的影响，并使用稳健方差估计（RVE）和MetaForest模型确定潜在的剂量反应关系及调节机制。
基于PICOS框架，从数据库建库至2025年3月6日对五个数据库进行了系统检索。纳入了≥18岁成年癌症患者中进行≥4周运动干预的随机对照试验。使用RVE合并效应量以估计总体干预效果。使用ROB2工具评估偏倚风险，并采用GRADE方法评估证据的确定性。进行单变量RVE元回归以检验各调节因素的线性效应。使用MetaForest评估变量重要性，并探索调节因素与干预效果之间潜在的非线性关系。按癌症类型和干预时机进行亚组分析。
共纳入83篇符合条件的文章，代表74项不同的随机对照试验，并从中提取了数据。运动显著降低了胰岛素水平（效应量= -0.24，标准误= 0.08，p < 0.01，I² = 49%），这是一个虽小但有意义的效果。肿瘤坏死因子-α（TNF-α）显示出较小的效应（效应量= -0.22，标准误= 0.13），但无统计学意义（p = 0.10，I² = 74%）。MetaForest模型显示，白细胞介素-6（IL-6）、脂联素和胰岛素样生长因子-1（IGF-1）最有利的变化与高强度有氧运动相关；TNF-α、IL-8和IL-10对每周较长的运动时长反应最佳；当运动与热量限制相结合时，血糖、瘦素和C反应蛋白（CRP）的改善最为明显。
规律运动对癌症患者的代谢和炎症生物标志物有适度但有益的影响。元回归强调了高强度有氧运动（心率储备>85%）在调节IL-6、脂联素和IGF-1方面的重要性，以及每周较长的运动时长（>28分钟/周）在改善TNF-α和IL-8方面的重要性。从机制上讲，高强度有氧运动可能是激活介导代谢和炎症改善途径的主要触发因素。
