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身压力源。虽然威胁生命的疾病的诊断是有压力的，但接受癌症治疗，包括手术，放疗和化疗，会给患者带来压力。此外，癌症治疗通常与代谢综合征特征性的疲劳、身体条件反射和代谢异常相关，导致推测癌症治疗可能使幸存者更容易发展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，我们检测到高脂血症和体脂含量增加的高发病率，有氧运动能力和肌肉骨骼功能下降，以及儿童肉瘤长期幸存者的心理困扰参数的高频率（1，3）。基于这些数据和研究结果，似乎需要设计一个计划，不仅可以帮助癌症幸存者改善肌肉骨骼功能和有氧运动能力，作为体育锻炼计划，但除了缓解心理压力，提高癌症幸存者的福祉后，完成多模态治疗。太极拳（TCC）已在亚洲文化中使用了几个世纪，以改善健康，减轻压力，并通过改善气的流动来促进愈合。虽然许多研究为不同人群的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确定。 自研究开始以来，我们共收到233例PRPL转介，其中135例是自2007年8月31日以来在过去一年转介的。在这233例转诊患者中，55例（24%）已在研究期间入组，13例（6%）是目前正在筛选过程中的潜在候选人，53例（23%）通过电话筛选不合格，12例（5%）将在以后重新评估以确定合格性，100例（43%）不感兴趣，不是好的候选人或失访。因此，自上一份年度报告以来，我们又招募了37名研究参与者（自去年以来增加了49%）。 在研究期间入组的55名研究参与者中，其中8名完成了等待列表对照组，并被重新随机分配到一种运动干预中;因此，共有63名可评价参与者。 其中，36例（57%）完成了12周的研究期，19例（30%）正在进行中（2例正在完成当前队列，10例入组2008年秋季队列，7例已申请未来队列），9例（14%）在开始前或参与研究期间退出。 在9名退出的参与者中，4名在研究开始前退出（1名由于怀孕，2名由于家庭/工作安排冲突，1名不想进入对照组），5名在研究期间退出（1名由于足底筋膜炎恶化，4名由于与工作安排冲突）。 完成等待名单对照组的另外三名参与者选择在重新随机化之前退出参与;他们退出的原因包括从该地区搬迁，由于残疾女儿而导致的时间安排冲突，以及不想参加研究的自行车组。 本研究旨在采用随机、等待列表对照设计，比较TCC与运动计划在改善恶性实体瘤成年幸存者有氧运动能力和耐力、减轻压力和改善生活质量方面的疗效。

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 didn't 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.