A Multicenter Randomized Trial of the Effects of Exercise Dose and Type on Psychosocial Distress in Breast Cancer Patients Undergoing Chemotherapy
A Multicenter Randomized Trial of the Effects of Exercise Dose and Type on Psychosocial Distress in Breast Cancer Patients Undergoing Chemotherapy
复制标题
DOI：
10.1158/1055-9965.epi-13-1163
复制
发表时间：
2014-05-01
影响因子：
3.8
通讯作者：
Segal, Roanne J.
中科院分区：
文献类型：
--
作者：
Courneya, Kerry S.;McKenzie, Donald C.;Segal, Roanne J.
背景：运动可以改善癌症患者的社会心理困扰；然而，很少有研究检验不同类型或剂量运动的影响，或者运动影响是否与基线抑郁水平相关。方法：在加拿大的一项多中心试验中，我们将 301 名开始化疗的乳腺癌患者随机分组，每周三次进行监督运动，包括标准剂量的 25 至 30 分钟的有氧运动 (STAN；n 96)、较高剂量的 50 至 60 分钟的有氧运动 (HIGH；n)。 -101)，或 50 至 60 分钟的有氧运动和抗阻运动的组合剂量 (COMB；n = 104)。主要终点是流行病学研究中心抑郁量表在基线、化疗期间和化疗后两次评估的抑郁情况。次要终点是焦虑、感知压力和自尊。结果：重复测量方差分析表明，HIGH 均不高 [平均差 -0.9； 95% 置信区间 (CI)，+0.0 至 -1.8； P < 0.061] COMB（平均差 -0.4；95% CI，+0.5 至 -1.3；P = 0.36）在治疗抑郁症状方面优于 STAN。在计划的亚组分析中，与基线抑郁水平存在显着的交互作用（Pinteraction 0.027），表明 COMB 和 HIGH 对于控制基线时具有临床水平抑郁症状的患者的抑郁症状有效。结论：与标准量的有氧运动相比，较高量的运动无助于控制未经选择的接受化疗的乳腺癌患者的抑郁症状，但它们对基线时具有临床水平抑郁症状的患者有效。影响：III 期运动试验针对患有乳腺癌的抑郁患者是有必要的。
Background: Exercise mayimprove psychosocial distress in patients with cancer; however, few studies have examined the effects of different types or doses of exercise, or whether exercise effects are related to baseline depression levels.Methods: In a multicenter trial in Canada, we randomized 301 patients with breast cancer initiating chemotherapy to thrice weekly, supervised exercise consisting of either a standard dose of 25 to 30 minutes of aerobic exercise (STAN; n 96), a higher dose of 50 to 60 minutes of aerobic exercise (HIGH; n -101), or a combined dose of 50 to 60 minutes of aerobic and resistance exercise (COMB; n = 104). The primary endpoint was depression assessed by the Center for Epidemiological Studies-Depression scale at baseline, twice during chemotherapy, and postchemotherapy. Secondary endpoints were anxiety, perceived stress, and self-esteem.Results: Repeated measuresANOVAindicated that neither HIGH [mean difference -0.9; 95% confidence interval (CI), +0.0 to -1.8; P 0.061] nor COMB (mean difference -0.4; 95% CI, +0.5 to -1.3; P = 0.36) was superior to STAN for managing depressive symptoms. In a planned subgroup analysis, there was a significant interaction with baseline depression levels (Pinteraction 0.027) indicating that COMB and HIGH were effective for managing depressive symptoms in patients with clinical levels of depressive symptoms at baseline.Conclusions: Compared with a standard volume of aerobic exercise, higher volumes of exercise did not help manage depressive symptoms in unselected patients with breast cancer receiving chemotherapy, but they were effective in patients with clinical levels of depressive symptoms at baseline.Impact: A phase III exercise trial targeting depressed patients with breast cancer is warranted.