Biobehavioral Effects of Qigong for Prostate Cancer Survivors with Fatigue

大约16%的美国男性被诊断患有前列腺癌，年龄中值为67岁， 房价很高。由于长期的副作用，幸存者可能会经历较差的生活质量(QOL) 治疗伴随着与年龄相关的身体、精神和社会功能的下降。疲劳是其中之一 前列腺癌幸存者最常见的症状之一，但也是最不常见的症状之一 了解癌症相关症状。疲劳与心理困扰、睡眠障碍有关 与健康相关的生活质量的质量和损害。下丘脑的炎症过程和变化- 垂体-肾上腺(HPA)轴和自主神经系统也可能在癌症相关性疲劳中发挥作用。 因此，迫切需要有效的治疗老年前列腺癌幸存者疲劳的方法。前期研究 研究表明，太极气功(TCQ)，一种身心运动干预，可以改善身体和情绪 健康。然而，没有明确的临床试验表明，与活动匹配和 健康教育对照组，作为对老年、不活跃的前列腺癌幸存者疲劳的治疗。 因此，我们建议进行一项随机对照试验，以减轻前列腺癌患者的疲劳。 幸存者。这种身心运动干预侧重于深呼吸技巧，缓慢而深思熟虑 运动，保持特定的姿势，冥想以诱导放松。在这项试验中，210名老年前列腺 有疲劳的癌症幸存者(≥60岁)将完成TCQ、伸展运动或健康教育 班级。课程时间为60分钟，每周两次，为期12周。由生物心理社会指导 和心理神经免疫学模型，我们将测试TCQ干预的假设，与 伸展运动或健康教育将：1)减少不活跃的老年人前列腺的疲劳(主要结果) 癌症幸存者；2)通过垂直整合的方法减少炎症：系统水平的促癌 和抗炎细胞因子(ELISA)、Toll样受体(TLR)-4刺激单核细胞产生 炎症细胞因子、炎症相关转录因子(例如，NF-κB)和基因的激活 用基于启动子的生物信息学进行表达谱分析；以及3)调节两个基因的表达 先前发现与前列腺癌患者疲劳有关的主要功能簇：a) 炎症、血管扩张和代谢物感觉以及b)能量和肾上腺素能激活。测量结果 (基线、为期6周的中间价干预，以及干预后1周、3个月和12个月)将评估 疲劳以及潜在的中介因素，包括心理困扰、精神和身体生活质量、睡眠 质量、感受到的压力、体力活动和社交幸福。我们假设，相对于拉伤 运动和健康教育控制条件下，TCQ将导致疲劳、炎症的改善 与疲劳相关的生物标志物和基因表达标志物。我们还将评估潜在的物理、 TCQ对疲劳发挥作用的心理、社会和生物途径。

Prostate cancer is diagnosed in approximately 16% of U.S. men, at a median age of 67 years, and the survival rates are high. Survivors are likely to experience poorer quality of life (QOL) due to the long-term side effects of treatment that are coupled with age-related declines in physical, mental and social functioning. Fatigue is one of the most commonly reported symptoms in prostate cancer survivors, but it is also one of the least understood cancer-related symptoms. Fatigue is associated with psychological distress, disruptions of sleep quality, and impairments in health-related QOL. Inflammatory processes and changes in the hypothalamic- pituitary-adrenal (HPA) axis and autonomic nervous system may also play a role in cancer-related fatigue. Thus, effective treatments for fatigue in elderly prostate cancer survivors are urgently needed. Prior research has shown that Tai Chi Qigong (TCQ), a mind-body exercise intervention, can improve physical and emotional health. However, no definitive clinical trial has demonstrated its efficacy compared to activity-matched and health education control groups as a treatment for fatigue in senior, inactive prostate cancer survivors. Therefore, we propose to conduct a randomized controlled trial of TCQ for reducing fatigue in prostate cancer survivors. This mind-body exercise intervention focuses on deep breathing techniques, slow deliberate movements, holding specific postures, and meditation to induce relaxation. In this trial, 210 elderly prostate cancer survivors (≥ 60 years) with fatigue will complete either a TCQ, streching movement or health education class. Classes will be held for 60 minutes, twice a week, over a 12-week period. Guided by biopsychosocial and psycho-neuroimmunology models we will test the hypotheses that a TCQ intervention, as compared to stretching movement or health education, will: 1) reduce fatigue (primary outcome) in inactive, elderly, prostate cancer survivors; 2) reduce inflammation as indexed by a vertically integrated approach: systemic levels of pro- and anti-inflammatory cytokines (ELISA), Toll-like receptor (TLR)-4 stimulated monocyte production of inflammatory cytokines, activation of inflammation-related transcription factors (e.g., NF-κB) and gene expression profiling with promoter based bioinformatics; and 3) regulate the expression of genes from two major functional clusters previously found to be associated with fatigue in prostate cancer patients: a) inflammation, vasodilation and metabolite sensing and b) energy and adrenergic activation. Measurements (baseline, 6-week midpoint intervention, and 1-week, 3-months, and 12-months post-intervention) will assess fatigue as well as potential mediating factors including psychological distress, mental and physical QOL, sleep quality, perceived stress, physical activity, and social well being. We hypothesize that relative to the streching movement and health education control conditions, TCQ will result in improvements in fatigue, in inflammation biomarkers and gene expression markers associated with fatigue. We will also evaluate underlying physical, psychosocial and biological pathways by which TCQ exerts its effects on fatigue.