Preventing falls after cancer: Tai chi vs. strength training

描述（由申请人提供）：患癌症的女性比其他女性更容易摔倒，这使她们有更高的摔倒相关骨折、其他伤害和残疾的风险。我们对女性癌症患者摔倒的理解相对较新。目前，尚无专门针对女性癌症幸存者的基于证据的跌倒预防策略。这项研究的目的是比较两种截然不同的运动——太极和力量训练——对完成癌症治疗的女性预防跌倒的效果。我们提出一项三组，单盲，平行设计，随机对照试验，年龄在50-75岁，完成癌症化疗的女性，比较1)太极拳，2)力量训练和3)安慰剂对照组坐着伸展运动。女性将在六个月内每周参加三次有监督的学习项目，并在正式培训结束后再进行六个月的学习。本研究的具体目的是：1)确定并比较太极拳训练和力量训练减少老年女性癌症幸存者跌倒的功效，2)确定太极拳和力量训练各自减少跌倒的机制，3)确定每种干预措施的益处是否在结构化训练停止后持续。这项拟议中的研究在方法上是创新的，因为它是第一次尝试直接比较两种主要的运动方式（例如，太极拳和力量训练），每一种都有不同的训练特性，以减少癌症幸存者的跌倒。这一创新将使我们更好地了解改善平衡和力量的潜在机制，从而减少癌症女性的跌倒。这一创新也可能影响临床实践，选择最有效的康复方法来治疗跌倒风险较高的癌症患者。拟议研究的长期目标是针对癌症幸存者的具体健康需求制定有效和实际的干预措施。该应用程序解决了国家癌症研究所的战略目标，即投资于癌症幸存者长期健康的干预研究，以及医学研究所的建议，即扩大癌症护理，以防止不断增长的癌症幸存者群体出现功能障碍和残疾。这项研究与公共卫生有关，因为有600多万妇女从癌症中幸存下来，但她们有很大的跌倒风险。目前，癌症康复领域还没有针对女性癌症患者预防跌倒的循证治疗方案。因此，拟议的研究既解决了重要的公共卫生问题，也解决了临床实践中的关键障碍。如果目标成功实现，这项研究的发现不仅会产生关于两种基于运动的治疗方案有效性的新知识，而且还会推进临床康复实践。这些因素，再加上这两种运动方案在实践中很容易获得和实施，增加了这项研究对癌症女性生活质量的潜在影响。

DESCRIPTION (provided by applicant): Women with cancer are significantly more likely to fall than other women and this puts them at higher risk of fall-related fractures, other injuries and disability. Our understanding of falls in women with cancer is relatively new. Currently, there are no evidence-based fall prevention strategies that specifically target female cancer survivors. The purpose of the proposed study is to compare the efficacy of two very distinct types of exercise, tai chi versus strength training, to prevent falls in women who have completed treatment for cancer. We propose a three-group, single-blind, parallel design, randomized controlled trial in women, aged 50-75 years old, who have completed chemotherapy for cancer comparing 1) tai chi to 2) strength training against 3) a placebo control group of seated stretching exercise. Women will participate in supervised study programs three times per week for six months and will be followed for an additional six months after formal training stops. The specific aims of this study are to: 1) Determine and compare the efficacy of both tai chi training and strength training to reduce falls in older female cancer survivors, 2) Determine the mechanism(s) by which tai chi and strength training each reduces falls and, 3) Determine whether or not the benefits of each intervention last after structured training stops. The proposed study is innovative in its approach because it is the very first attempt at a direct comparison of two prominent exercise modalities (e.g., tai chi and strength training), each with distinct training properties, to reduce falls in a population of cancer survivors. This innovation will lead to a better understanding of potential mechanisms that underlie improvements in balance and strength and subsequently, reduced falls in women with cancer. This innovation may also impact clinical practice in terms of choosing most effective rehabilitative methods for treating cancer patients with an elevated risk of falling. The long-term goal of the proposed research is to develop effective and practical interventions that target the specific health needs of cancer survivors. This application addresses the National Cancer Institute's strategic goals to invest in intervention research on long-term health in cancer survivors and the Institute of Medicine recommendations to broaden cancer care to prevent dysfunction and disability in the growing population of cancer survivors. This study is relevant to public health because there are over 6 million women who have survived cancer but who are at great risk of falling. Currently, evidence-based therapeutic treatment options specific to fall prevention in women with cancer are not available in the cancer rehabilitation field. The proposed study, therefore, addresses both an important public health problem and a critical barrier in clinical practice. If the aims are successfully achieved, findings from this study will not only generate new knowledge about the effectiveness of two exercise-based treatment options but will also advance clinical rehabilitative practice. These factors, combined with the fact that the two exercise regimens are easily accessible and implementable in practice, increase the potential impact of this research on the quality of life in women with cancer. PUBLIC HEALTH RELEVANCE: This study is relevant to public health because over 6 million women have survived cancer, but now have an increased risk of falls and fractures. The knowledge gained from this study could provide evidence-based therapeutic treatment options for prevention of falls in clinical practice and cancer rehabilitation.