A Randomized Study of the Effect of Tai Chi Chuan Compared to Exercise

癌症的诊断和治疗对任何患者来说都是一个主要的终生压力源。虽然诊断出危及生命的疾病是有压力的，但接受包括手术、放疗和化疗在内的癌症治疗会给患者带来压力。此外，癌症治疗往往与代谢综合征特有的疲劳、身体失调和代谢异常有关，这导致人们猜测，癌症治疗可能使幸存者更容易患上代谢综合征及其后遗症——心血管疾病。在最近进行的一项研究中，我们发现在儿童肉瘤的长期幸存者中高脂血症的发生率高，体脂含量增加，有氧运动和肌肉骨骼功能下降，心理困扰参数的频率高（1,3）。基于这些数据和发现，设计一个方案似乎是可取的，它不仅可以帮助癌症幸存者改善肌肉骨骼功能和有氧运动，就像体育锻炼项目所提供的那样，而且还可以缓解心理压力，提高癌症幸存者在完成多模式治疗后的幸福感。几个世纪以来，太极拳在亚洲文化中一直被用来改善健康，减轻压力，并通过改善气的流动来促进愈合。虽然许多研究在不同人群中为这些说法提供了科学支持，但TCC在癌症幸存者管理中的有益作用尚未得到证实。

Diagnosis and treatment for cancer represent a major life-time stressor for any patient. While the diagnosis of a life-threatening illness is stressful, undergoing treatment for cancer including surgery, radiotherapy and chemotherapy result in stress to the patient. In addition, cancer treatment frequently is associated with fatigue, physical de-conditioning and metabolic abnormalities characteristic of the metabolic syndrome, leading to speculations that cancer therapy may render survivors more prone to developing metabolic syndrome and its sequelae, cardiovascular disease. In a recently conducted study we detected a high incidence of hyperlipidemia and increased body fat content, decreased aerobic performance and musculoskeletal functioning and a high frequency of parameters of psychological distress in long-term survivors of pediatric sarcoma (1, 3). Based on these data and findings, it appears desirable to devise a program that would help cancer survivors not only to improve musculoskeletal functioning and aerobic performance, as a physical exercise program would offer, but in addition relieve psychological stress and enhance the well-being of cancer survivors after completion of treatment with multimodality therapy. Tai Chi Chuan (TCC) has been used in Asian culture for centuries to improve wellness, reduce stress, and to promote healing by improving the flow of Qi. While a number of studies have provided scientific support for these claims in different populations, a beneficial role for TCC in the management of cancer survivors has not been established. We received a total 233 referrals from PRPL since the study began, 135 of which were referred in the past year since 8/31/07. Of these 233 referrals, 55 (24%) have been enrolled on-study, 13 (6%) are potential candidates currently in the screening process, 53 (23%) were ineligible by phone screen, 12 (5%) are to be re-evaluated later to determine eligibility, and 100 (43%) were not interested, not good candidates, or lost-to-follow-up. Thus, since our last annual report, we have enrolled an additional 37 study participants on-study (49% increase since last year). Of the total 55 study participants enrolled on-study, 8 of them completed the wait-list control arm and were re-randomized into one of the exercise interventions; thus, there are a total of 63 total evaluable participants. Of these, 36 (57%) completed the 12 week study period, 19 (30%) are in process (2 are completing the current cohort, 10 are enrolled for the fall 2008 cohort, and 7 have requested a future cohort), and 9 (14%) withdrew prior to beginning or while participating on-study. Of the 9 participants who withdrew, 4 withdrew prior to starting the study (1 due to pregnancy, 2 due to family/work scheduling conflicts, and 1 didnt want to be in the control group) and 5 withdrew while on-study (1 due to worsening plantar fascitis and 4 due to conflicts with work schedule). Three additional participants who completed the wait list control group chose to withdraw participation before re-randomization; their reasons for withdrawing included relocation from the area, scheduling conflicts due to a disabled daughter, and not wanting to be in the cycling arm of the study. This study aims to compare in a randomized, wait-list controlled design, the efficacy of TCC to an exercise program in improving aerobic exercise capacity and endurance, reducing stress and improving Quality of Life in adult survivors of malignant solid tumors.