Exercise for women receiving adjuvant therapy for breast cancer

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Abstract
A huge clinical research database on adjuvant cancer treatment has verified improvements in breast cancer outcomes such as recurrence and mortality rates. On the other hand, adjuvant therapy with agents such as hormone therapy, chemotherapy and radiotherapy impacts on quality of life due to substantial short‐ and long‐term side effects. To assess the effect of aerobic or resistance exercise interventions during adjuvant treatment for breast cancer on treatment‐related side effects such as physical deterioration, fatigue, psychosocial distress and physiological, morphological and biological changes. We searched the Cochrane Breast Cancer Specialised Register (16 July 2004) and the following electronic databases: MEDLINE (1966 to 2004), EMBASE (1988 to 2004), CINAHL (1982 to 2004), SPORTDiscus (1975 to 2004), PsycINFO (1872 to 2003), SIGLE (1880 to 2004), ProQuest Digital Dissertations (1861 to 2004) and Conference Papers Index (1973 to 2004). Furthermore, we screened references in relevant reviews and clinical trials and handsearched relevant journals. We included randomised and non‐randomised controlled trials that examined aerobic or resistance exercise, or both, in women undergoing adjuvant treatment for breast cancer. Two authors independently extracted data and assessed methodological quality and adequacy of the training stimulus following a set of standardised criteria. Meta‐analyses were performed for physical fitness, fatigue and weight gain using a random‐effects model. Nine trials involving 452 women met the inclusion criteria. Meta‐analysis for cardiorespiratory fitness (involving 207 participants) suggested that exercise improves cardiorespiratory fitness (SMD 0.66, 95% CI 0.20 to 1.12). Meta‐analysis for fatigue (317 participants) found statistically non‐significant improvements for participants in the exercise intervention groups compared to control (non‐exercising) groups (SMD ‐0.12, 95% CI ‐0.37 to 0.13); the same applied for the meta‐analysis of weight gain (147 participants) (SMD ‐1.11, 95% CI ‐2.44 to 0.22). Evidence for other outcomes remains limited. Adverse effects (lymphedema and shoulder tendonitis) were observed in two trials. The results from non‐randomised controlled trials are similar to those of randomised controlled trials and do not appear to produce any bias. This review is based on a small number of trials with a considerable degree of clinical heterogeneity regarding adjuvant cancer treatments and exercise interventions. Exercise during adjuvant treatment for breast cancer can be regarded as a supportive self‐care intervention which results in improved physical fitness and thus the capacity for performing activities of daily life, which may otherwise be impaired due to inactivity during treatment. Improvements in fatigue were ambiguous and there was a lack of evidence for improvement with exercise for other treatment‐related side effects. Since exercise interventions (for sedentary participants) require behaviour change, strategies for behaviour change should underpin these interventions. Furthermore, long‐term evaluation is required due to possible long‐term side effects. 運動於接受乳癌輔助治療的女性 大量臨床研究資料證實乳癌接受輔助治療可改善後果，如復發和致死率。另一方面，輔助治療如荷爾蒙治療、化學治療及放射治療，會因為短期和長期的副作用而影響生活品質。 評估在乳癌接受輔助療法期間，介入性有氧或阻力運動對於治療副作用的影響，如體力衰退、疲勞、精神與人際壓力、生理及身體外觀的改變。 我們搜尋考科藍乳癌專科登記(2004年7月16日)和以下的電子資料庫：MEDLINE (1966到2006年)、EMBASE (1988到2004年)、CINAHL (1982到2004年)、SPORTDiscus (1975到2004年)、PsycINFO (1872到2003年)、 IGLE (1880到2004年)、ProQuest Digital Dissertations (1861到2004年)以及Conference Papers Index (1973到2004年)。此外，我們搜尋了相關綜論及臨床試驗的參考文獻和相關期刊。 我們檢驗包括乳癌接受輔助治療的女性，進行有氧或阻力運動、或者兩者兼具的隨機和非隨機控制試驗。 兩位作者依照單一組標準，分別獨立擷取資料並評估方法學的品質以及刺激訓練的適當性。以隨機結果模式分別對於身體健康、疲勞和體重增加進行系統性的統計分析。 九個試驗共包含452名女性符合收錄標準。針對心肺健康(含207位參與者)進行統計分析，證實運動可改善心肺健康(SMD 0.66，95% 信賴區間0.20至1.12)。對於疲勞進行統計分析(317位參與者)，發現在運動介入組和控制(無運動)組之間，在統計並無明顯改善(SMD −0.12，95% 信賴區間−0.37至0.13)；相同的，體重在統計上也沒有顯著的增加(147位參與者) (SMD −1.11, 95% 信賴區間−2.44至0.22)。對其他後果的影響證據仍有限。在兩個試驗中，有觀察到不良效果(淋巴水腫和肩膀肌腱炎)。非隨機控制試驗結果和隨機控制試驗相似，而且沒有任何偏頗。這篇綜論是基於少量的試驗結果，且有關臨床癌症輔助治療和運動介入的程度卻有相當的異質性。 在乳癌接受輔助療法治療期間，運動被視為支持性自我照護治療，可改善身體健康和日常的活動能力，否則在治療期間不運動會導致身體功能受損。運動改善疲勞的效果不明確，目前也缺乏證據顯示運動可以改善其他治療相關的副作用。因為運動介入(對於久坐的參與者)必須有行為改變，因此需要行為改變策略的支持。此外，治療可能發生長期副作用，因此需要長期的評估。 本摘要由中山醫學大學附設醫院高潘福翻譯。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。...