Physical activity and exercise interventions for disease‐related physical and mental health during and following treatment in people with non‐advanced colorectal cancer
Physical activity and exercise interventions for disease‐related physical and mental health during and following treatment in people with non‐advanced colorectal cancer
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非晚期结直肠癌患者治疗期间和治疗后对疾病相关身心健康的体力活动和运动干预
DOI：
10.1002/14651858.cd012864
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发表时间：
2017
影响因子：
8.4
通讯作者：
M. Tully
中科院分区：
文献类型：
--
作者：
Maresa McGettigan;C. Cardwell;M. Cantwell;M. Tully
结直肠癌是全球第三大最常诊断的癌症。结直肠癌的诊断和随后的治疗可能对个人的身心健康产生不利影响。身体活动干预在减轻治疗副作用方面的益处已在其他癌症人群中得到证实。鉴于有规律的体育活动可以降低结直肠癌的风险，而心血管健康是全因和癌症死亡风险的有力预测指标，体育活动干预可能在结直肠癌控制连续体中发挥作用。体力活动干预在这一人群中的有效性证据尚不清楚。目的评估体育活动干预对诊断为T1-4 N0-2 M0、手术或新辅助或辅助治疗（即化疗、放疗或放化疗）或两者同时治疗的非晚期结直肠癌患者疾病相关身心健康的有效性和安全性。我们检索了Cochrane中央对照试验注册库（Central; 2019，第6期），以及OVID MEDLINE、其他6个数据库和4个试验注册库，没有语言或日期限制。我们筛选了相关出版物的参考书目，并手工检索了相关组织的会议摘要和会议记录，以获取更多相关研究。所有搜索均于2019年6月6日至6月14日期间完成。我们纳入了随机对照试验（rct）和分组rct，对非晚期结直肠癌成人患者进行体育活动干预、常规护理或不进行体育活动干预进行比较。数据收集和分析两位综述作者独立选择研究，进行数据提取，评估偏倚风险，并使用GRADE标准对研究质量进行评分。我们按随访时间汇总数据进行荟萃分析，尽可能使用随机效应或固定效应模型报告平均差异（MDs）或标准化平均差异（SMDs）。如果不能进行荟萃分析，我们对研究进行叙述性综合。我们纳入16项随机对照试验，涉及992名受试者；524人被分配到体育活动干预组，468人被分配到常规护理对照组。参与者的平均年龄在51岁到69岁之间。十项研究包括完成积极治疗的参与者，两项研究包括正在接受积极治疗的参与者，两项研究包括正在接受积极治疗和已完成积极治疗的参与者。在两项研究中，尚不清楚参与者是否正在接受或完成治疗。身体活动干预的类型、设置和持续时间在不同的试验中有所不同。3项研究选择了监督干预，5项研究选择了基于家庭的自我指导干预，7项研究选择了监督和自我指导相结合的方案。一项研究没有报告干预设置。最常见的干预时间为12周（7项研究）。体育活动的类型包括散步，骑自行车，阻力运动，瑜伽和核心稳定运动。判断研究偏倚的大多数不确定性来自分配、隐藏和结果评估者的盲化缺乏明确性。参加者和工作人员不可能被蒙蔽。证据的质量总体上从极低到中等。由于结果有很大的差异和效果方向的不一致，我们没有汇总即时随访的身体功能结果。与常规护理相比，我们不确定体育活动干预是否能改善身体功能。我们没有发现与常规护理相比，体育活动干预对疾病相关心理健康(焦虑：SMD -0.11, 95%可信区间(CI) -0.40至0.18；4项研究，198名受试者；I2 = 0%；抑郁：SMD -0.21, 95% CI -0.50 ~ 0.08；4项研究，198名受试者；I2 = 0%；中等质量的证据)在短期或中期随访。七项研究报告了不良事件。由于报告和测量不一致，我们没有汇总不良事件。我们没有发现干预组和常规护理组发生严重不良事件的证据。轻微的不良事件，如颈部、背部和肌肉疼痛是最常见的报道。没有研究报告了总生存率或无复发生存率，也没有研究评估了长期随访的结果。我们发现了体力活动干预对身体健康的有氧健身部分（SMD 0.82, 95% CI 0.34至1.29；7项研究，295项；I2 = 68%；低质量证据）、癌症相关疲劳(MD 2.16, 95% CI 0.18至4.15；6项研究，230名参与者；I2 = 18%；低质量证据)和与健康相关的生活质量（SMD 0.36, 95% CI 0.10至0.62；6项研究，230名参与者；I2 = 0%；中等质量证据）。在短期随访中也观察到这些积极效果，但在中期随访中没有观察到。只有三项研究报告了癌症相关疲劳和健康相关生活质量的中期随访。由于纳入的研究数量少且证据质量高，本综述的结果应谨慎解读。我们不确定体育活动干预是否能改善身体机能。身体活动干预可能对与疾病相关的心理健康没有影响。在长达6个月的随访中，体育活动干预可能有益于有氧健身、癌症相关疲劳和与健康相关的生活质量。在报告中，不良事件一般较小。为了评估体育活动干预对疾病相关的身心健康以及对非晚期结直肠癌患者的生存的影响，需要足够有力、方法学质量高、长期随访的随机对照试验。不良事件应充分报告。
Background Colorectal cancer is the third most commonly diagnosed cancer worldwide. A diagnosis of colorectal cancer and subsequent treatment can adversely affect an individuals physical and mental health. Benefits of physical activity interventions in alleviating treatment side effects have been demonstrated in other cancer populations. Given that regular physical activity can decrease the risk of colorectal cancer, and cardiovascular fitness is a strong predictor of all-cause and cancer mortality risk, physical activity interventions may have a role to play in the colorectal cancer control continuum. Evidence of the efficacy of physical activity interventions in this population remains unclear. Objectives To assess the effectiveness and safety of physical activity interventions on the disease-related physical and mental health of individuals diagnosed with non-advanced colorectal cancer, staged as T1-4 N0-2 M0, treated surgically or with neoadjuvant or adjuvant therapy (i.e. chemotherapy, radiotherapy or chemoradiotherapy), or both. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 6), along with OVID MEDLINE, six other databases and four trial registries with no language or date restrictions. We screened reference lists of relevant publications and handsearched meeting abstracts and conference proceedings of relevant organisations for additional relevant studies. All searches were completed between 6 June and 14 June 2019. Selection criteria We included randomised control trials (RCTs) and cluster-RCTs comparing physical activity interventions, to usual care or no physical activity intervention in adults with non-advanced colorectal cancer. Data collection and analysis Two review authors independently selected studies, performed the data extraction, assessed the risk of bias and rated the quality of the studies using GRADE criteria. We pooled data for meta-analyses by length of follow-up, reported as mean differences (MDs) or standardised mean differences (SMDs) using random-effects wherever possible, or the fixed-effect model, where appropriate. If a meta-analysis was not possible, we synthesised studies narratively. Main results We identified 16 RCTs, involving 992 participants; 524 were allocated to a physical activity intervention group and 468 to a usual care control group. The mean age of participants ranged between 51 and 69 years. Ten studies included participants who had finished active treatment, two studies included participants who were receiving active treatment, two studies included both those receiving and finished active treatment. It was unclear whether participants were receiving or finished treatment in two studies. Type, setting and duration of physical activity intervention varied between trials. Three studies opted for supervised interventions, five for home-based self-directed interventions and seven studies opted for a combination of supervised and self-directed programmes. One study did not report the intervention setting. The most common intervention duration was 12 weeks (7 studies). Type of physical activity included walking, cycling, resistance exercise, yoga and core stabilisation exercise. Most of the uncertainty in judging study bias came from a lack of clarity around allocation concealment and blinding of outcome assessors. Blinding of participants and personnel was not possible. The quality of the evidence ranged from very low to moderate overall. We did not pool physical function results at immediate-term follow-up due to considerable variation in results and inconsistency of direction of effect. We are uncertain whether physical activity interventions improve physical function compared with usual care. We found no evidence of effect of physical activity interventions compared to usual care on disease-related mental health (anxiety: SMD -0.11, 95% confidence interval (CI) -0.40 to 0.18; 4 studies, 198 participants; I2 = 0%; and depression: SMD -0.21, 95% CI -0.50 to 0.08; 4 studies, 198 participants; I2 = 0%; moderate-quality evidence) at short- or medium-term follow-up. Seven studies reported on adverse events. We did not pool adverse events due to inconsistency in reporting and measurement. We found no evidence of serious adverse events in the intervention or usual care groups. Minor adverse events, such as neck, back and muscle pain were most commonly reported. No studies reported on overall survival or recurrence-free survival and no studies assessed outcomes at long-term follow-up We found evidence of positive effects of physical activity interventions on the aerobic fitness component of physical fitness (SMD 0.82, 95% CI 0.34 to 1.29; 7 studies, 295; I2 = 68%; low-quality evidence), cancer-related fatigue (MD 2.16, 95% CI 0.18 to 4.15; 6 studies, 230 participants; I2 = 18%; low-quality evidence) and health-related quality of life (SMD 0.36, 95% CI 0.10 to 0.62; 6 studies, 230 participants; I2 = 0%; moderate-quality evidence) at immediate-term follow-up. These positive effects were also observed at short-term follow-up but not medium-term follow-up. Only three studies reported medium-term follow-up for cancer-related fatigue and health-related quality of life. Authors' conclusions The findings of this review should be interpreted with caution due to the low number of studies included and the quality of the evidence. We are uncertain whether physical activity interventions improve physical function. Physical activity interventions may have no effect on disease-related mental health. Physical activity interventions may be beneficial for aerobic fitness, cancer-related fatigue and health-related quality of life up to six months follow-up. Where reported, adverse events were generally minor. Adequately powered RCTs of high methodological quality with longer-term follow-up are required to assess the effect of physical activity interventions on the disease-related physical and mental health and on survival of people with non-advanced colorectal cancer. Adverse events should be adequately reported.
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影响因子：
3.3
作者：
C. Caspersen;K. Powell;G. Christenson
通讯作者：
C. Caspersen;K. Powell;G. Christenson
DOI：
10.1007/s11764-017-0647-7
发表时间：
2018-03
期刊：
Journal of cancer survivorship : research and practice
影响因子：
--
作者：
Mayer DK;Landucci G;Awoyinka L;Atwood AK;Carmack CL;Demark-Wahnefried W;McTavish F;Gustafson DH
通讯作者：
Gustafson DH
化疗期间实施的简短瑜伽干预：一项随机对照试点研究。
影响因子：
3.6
作者：
Sohl,StephanieJ;Danhauer,SuzanneC;Birdee,GurjeetS;Nicklas,BarbaraJ;Yacoub,George;Aklilu,Mebea;Avis,NancyE
通讯作者：
Avis,NancyE
影响因子：
2.2
作者：
Brown JC;Troxel AB;Ky B;Damjanov N;Zemel BS;Rickels MR;Rhim AD;Rustgi AK;Courneya KS;Schmitz KH
通讯作者：
Schmitz KH
血浆胰岛素样生长因子 1 和结合蛋白 3 与女性结直肠肿瘤风险的前瞻性研究。
DOI：
--
发表时间：
2000
期刊：
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.
影响因子：
--
作者：
Giovannucci,E;Pollak,MN;Platz,EA;Willett,WC;Stampfer,MJ;Majeed,N;Colditz,GA;Speizer,FE;Hankinson,SE
通讯作者：
Hankinson,SE