臨床問題：運動訓練是否可以有效改善癌因性疲乏？

Clinical Question: Can Exercise Training Help Improving Cancer-related Fatigue?

黃淑麗(Shok-Li Ng) ； 呂佩真(Pei-Chen Lu) ； 吳英黛(Ying-Tai Wu)

《物理治療》 33卷4期 (2008/08) Pp. 265-272

摘要

目的：探討運動訓練可否有效改善癌因性疲乏(cancer-related fatigue)。方法：以”cancer”、”fatigue”、”exercise”為關鍵字，搜尋PubMed和PEDro資料庫2003至2008年隨機控制之臨床試驗，再利用人工閱讀的方式，選出適合且相關的研究論文，共計五篇。結果：第一篇研究發現坐姿運動訓練(seated exercise)可減緩接受化學治療的乳癌末期患者體能變差和疲乏惡化的速度；第二篇研究認為有氧運動訓練和漸進式的肌肉放鬆訓練均能改善腫瘤切除手術後病人的疲乏，前者還可改善短期內的體能和恢復狀況；第三篇發現手術後的運動訓練無法改善結腸直腸癌病人的身體功能，但可改善疲乏；而第四和第五篇研究則是同一系列不同時期的報告，發現有氧運動訓練和阻力運動訓練雖皆無法顯著改善接受化學治療的乳癌病人的生活品質，但有助於提高其自尊、體能、身體組成和完成化學治療的比率；6個月的追蹤研究進一步發現能維持運動者，其自評成效有更進一步的改善，間接顯示運動訓練對癌因性疲乏之益。結論：適度的運動訓練有助於癌因性疲乏的改善。

關鍵字

癌症 ； 疲乏 ； 運動 ； 癌症末期

並列摘要

Purpose: To discuss the effects of exercise training on cancer-related fatigue. Method: Randomized controlled trials (RCTs) published between year 2003 and 2008 were searched through the PubMed and PEDro computer databases using the keywords ”cancer”, ”fatigue”, ”exercise”. Result: Five RCTs were selected and critically appraised. Among the five studies, two were related, one was mainly the follow-up report of the other one. The first study found that women with advanced breast cancer randomized to the seated exercise intervention group had a slower decline in total and physical well-being and less increase in fatigue score. The second study concluded that a structured aerobic training program improved the physical performance in patients recovering from surgery for solid tumors. However, aerobic exercise training was not better than progressive relaxation training for the treatment of fatigue in this setting. The third study indicated that postoperative training did not improve physical function, but reduced fatigue while in hospital. The fourth and fifth studies investigated the effects of aerobic and resistance exercise training (AET vs. RET) in breast cancer patients receiving chemotherapy. The authors concluded that AET or RET significantly improved patients' self-esteem, physical fitness, body composition and chemotherapy completion rate without causing lymphedema or significant adverse events, but not cancer-specific QOL. At the 6-month follow-up, improvements in self-esteem observed with RET were maintained, but the reduction in anxiety with AET were not observed. Furthermore, a combined aerobic and resistance exercise program after breast cancer chemotherapy was associated with further improvements in patients' self-rated outcomes. It suggested that the beneficial effects of exercise training persisted 6 months after. Conclusion: Summarizing the conclusions of the five studies appraised, exercise training can help improving cancer-related fatigue among cancer patients.

並列關鍵字

Cancer ； Fatigue ； Exercise ； Advanced cancer