Preventing falls after cancer: Tai chi vs. strength training

描述(申请人提供)：癌症女性明显比其他女性更容易摔倒，这使她们面临与跌倒相关的骨折、其他伤害和残疾的更高风险。我们对癌症女性跌倒的理解相对较新。目前，还没有专门针对女性癌症幸存者的循证预防跌倒战略。这项拟议的研究的目的是比较两种截然不同的运动--太极和力量训练--在预防完成癌症治疗的女性跌倒方面的效果。我们提出了一项三组、单盲、平行设计、随机对照试验，研究对象为50-75岁的癌症化疗女性，比较1)太极拳和2)力量训练与3)安慰剂对照组的坐式拉伸运动。妇女将参加为期六个月的每周三次的监督学习计划，并在正式培训停止后再跟踪六个月。这项研究的具体目的是：1)确定和比较太极训练和力量训练对老年女性癌症幸存者减少跌倒的有效性；2)确定太极和力量训练各自减少跌倒的机制(S)；3)确定在结构化训练停止后，每种干预措施的益处是否持续。这项拟议的研究在方法上是创新的，因为它是首次尝试直接比较两种主要的锻炼方式(例如，太极和力量训练)，每种锻炼方式都有不同的训练属性，以减少癌症幸存者的跌倒。这一创新将导致对潜在机制的更好理解，这些机制是改善平衡和力量并随后减少癌症女性跌倒的基础。这一创新还可能在选择最有效的康复方法来治疗跌倒风险较高的癌症患者方面影响临床实践。这项拟议研究的长期目标是开发针对癌症幸存者特定健康需求的有效和实用的干预措施。这项申请符合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，以扩大癌症护理，以防止癌症幸存者日益增长的人口中的功能障碍和残疾。这项研究与公共健康相关，因为有600多万女性在癌症中幸存下来，但面临着极大的跌倒风险。目前，在癌症康复领域还没有专门针对癌症女性跌倒预防的循证治疗选择。因此，这项拟议的研究既解决了一个重要的公共卫生问题，也解决了临床实践中的一个关键障碍。如果这些目标成功实现，这项研究的结果不仅将产生关于两种基于运动的治疗方案的有效性的新知识，还将促进临床康复实践。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.