居家步行運動改善肺癌病患症狀、生物節律、睡眠品質成效之探討

The effectiveness of home-based walking exercise to improve symptoms, circadian rhythms, and sleep quality in lung cancer patients

陳惠美(Hui-Mei Chen)

指導教授 ： 林佳靜

臺北醫學大學/護理學院/護理學系博士班/博士(2014年)

摘要

本研究為探討居家步行運動對改善肺癌病患症狀、生物節律、睡眠品質的系列研究。本系列研究包含三個主要子計畫，第一為探討生物節律、身體活動及客觀睡眠品質之關係；第二為居家步行運動改善焦慮、憂鬱、癌症相關症狀之成效探討；第三為居家步行運動改善生物節律及睡眠品質之成效探討。期盼此系列研究成果能累進癌症照護的實證新知，提供醫護人員照護參考，進而提升肺癌病患福祉。

子研究一：肺癌病患生物節律、身體活動與客觀睡眠品質關係探討
研究背景：肺癌病患在接受治療過程中，常出現睡眠困擾、生物節律混亂及身體活動量下降等問題。因此，瞭解上述變項之關係十分重要，藉此可研擬出改善肺癌病患睡眠品質之措施。
研究方法：採用橫斷性研究設計(cross-sectional design)，以方便取樣(convenience sampling)方式收集資料，測量工具包括：活動記錄器(actigraph)及三日身體活動記錄(Bouchard 3-day physical activity record ; 3-d PAR)。活動記錄器(actigraph)量測客觀睡眠品質參數，包括：睡眠總時數(total sleep time；TST)、睡眠效率(sleep efficiency；SE)、睡眠潛伏期(sleep onset latency；SOL)；生物節律參數，包括：24小時自動相關係數(24-h autocorrelation coefficient；r24)、二元指標(in bed less than out of bed dichotomy index；I＜O)；身體活動參數，包括：醒時平均活動(UP activity mean)。
研究結果：共收集106位肺癌病患資料，研究結果顯示：每天執行 ≥295分鐘輕度身體活動的病患，相較於不足295分鐘者，有較佳的睡眠總時數(TST)、睡眠效率(SE)、睡眠潛伏期(SOL)、24小時自動相關係數(r24)、二元指標(I＜O) (all of P value ＜.05)。睡眠總時數之預測因子為：年齡(β = -0.31)、I＜O (β = 0.32)以及UP activity mean (β = -0.42)。睡眠潛伏期之預測因子為：目前治療方式(β = 0.20)、I＜O (β = -0.28)、UP activity mean (β = 0.51)以及24小時輕度活動分鐘數(β = -0.23)。
研究結論：顯著的生物節律及足夠的輕度活動可促進肺癌病患之睡眠品質。

子研究二：居家步行運動改善肺癌病患焦慮、憂鬱、癌症相關症狀之成效探討
研究背景：雖然運動曾被討論可作為改善焦慮、憂鬱、癌症相關症狀之輔助療法，但卻鮮少有研究探討運動對肺癌病患的效益。
研究方法：採用隨機分派臨床試驗之研究設計，在北台灣某醫學中心共招募116位肺癌病患，走路運動組及一般照護組各58人，研究介入為中等強度、每天40分鐘、每週三天、為期12週之居家步行運動，以及每週一次的電話運動咨詢服務。測量工具包括：醫院焦慮憂鬱量表( Hospital Anxiety and Depression Scale；HADS)及台灣版安德森症狀量表( Taiwanese version of the MD Anderson Symptom Inventory；MDASI-T)。
研究結果：使用概化估計方程式(generalised estimating equation；GEE )分析運動對改善焦慮、憂鬱及癌症相關症狀之成效，結果顯示：走路運動組相較於一般照護組的焦慮(P = .009 於第三個月; P = .006於第六個月)及憂鬱(P = .00006於第三個月; P = .004於第六個月)程度顯著改善。
研究結論：居家步行運動對於改善肺癌病患之焦慮及憂鬱而言，是一個可行及有效的介入措施，可被考慮成為肺癌復健的重要元素。

子研究三：居家步行運動改善肺癌病患睡眠品質及生物節律之成效探討
研究背景：雖然運動曾被討論可作為改善生物節律及睡眠之輔助療法，但卻鮮少有研究探討運動對肺癌病患的效益。
研究方法：採用臨床試驗之研究設計，在北台灣某醫學中心共招募111位肺癌病患，隨機分派至走路運動組(56人)及一般照護組(55人)，研究介入為中等強度、每天40分鐘、每週三天、為期12週之居家步行運動，以及每週一次的電話運動咨詢服務。測量工具包括：使用活動記錄器(actigraph)測量客觀睡眠品質參數，包括：總睡眠時數(total sleep time；TST)、睡眠效率(sleep efficiency；SE)、睡眠潛伏期(sleep onset latency；SOL)；生物節律參數，包括：24小時自動相關係數(24-h autocorrelation coefficient；r24)、二元指標(in bed less than out of bed dichotomy index；I＜O)；身體活動參數，包括：醒時平均活動(UP activity mean)。並使用台灣版匹茲堡睡眠品質量表(Taiwanese version of the Pittsburgh Sleep Quality Index；PSQI-T)測量主觀睡眠品質。
研究結果：使用概化估計方程式(generalised estimating equation；GEE)分析運動對改善主觀睡眠、客觀睡眠及生物節律之成效，結果顯示：走路運動組相較於一般照護組的台灣版匹茲堡睡眠品質量表(PSQI-T)分數顯著下降(Wald χ2 = 15.16, P = .001)，且總睡眠時數(TST)顯著增加(Wald χ2 = 7.59, P = .023)。二元指標(I＜O)在總睡眠時數(TST)的調節效果達顯著水準(β of group × I＜O = 3.70, P = .032)，二元指標(I＜O)在台灣版匹茲堡睡眠品質量表(PSQI-T)的調節效果接近顯著水準(β of group × I＜O = -0.13, P = .050)。
研究結論：居家步行運動對於改善肺癌病患之主觀及客觀睡眠品質而言，是一個可行及有效的介入措施，可被考慮成為肺癌復健的重要元素。當評估肺癌病患之睡眠品質時，可將生物節律I＜O納入調節因子之考量。

關鍵字

運動 ； 肺癌 ； 症狀 ； 生物節律 ； 睡眠品質

並列摘要

Project 1: Relationships of circadian rhythms and physical activity with objective sleep parameters in lung cancer patients

Background: Lung cancer patients undergo various treatments leading to sleep problems, rest-activity circadian rhythms disruption, and reduced levels of physical activity. It is important to understand the relationships among these variables. Appropriate interventions can possibly be implemented to improve sleep quality in lung cancer patients.
Objective: This study was to examine the relationships of circadian rhythms and physical activity with objective sleep parameters in 106 of Taiwanese lung cancer patients.
Methods: This study used a cross-sectional design. The instruments included an actigraph to measure the objective sleep parameters (total sleep time, TST; sleep efficiency, SE; and sleep onset latency, SOL), rest-activity circadian rhythms (r24 and I＜O), and physical activity frequency (UP activity mean). The daily physical activity amount in minutes was measured by the Bouchard 3-day physical activity record (3-d PAR).
Results: Patients performing light-intensity physical activity of ≥ 295 min/day had better values for the TST, SE, SOL, r24, and I＜O than those performing ≥ 295 min/day (all of P value ＜.05). Significant predictors of the TST included age (β = -0.31), I＜O (β = 0.32), and UP activity mean (β = -0.42). Predictors of the SOL included current treatment (β = 0.20), I＜O (β = -0.28), UP activity mean (β = 0.51), and 24-h light-activity minutes (β = -0.23).
Conclusions: Marked circadian rhythms and adequate light-intensity physical activity may improve sleep quality in lung cancer patients.

Project 2: Randomised controlled trial on the effectiveness of home-based walking exercise on anxiety, depression and cancer-related symptoms in patients with lung cancer

Background: Although exercise has been addressed as an adjuvant treatment for anxiety, depression and cancer-related symptoms, few studies have evaluated the effectiveness of exercise in patients with lung cancer.
Methods: We recruited 116 patients from a medical centre in northern Taiwan, and randomly assigned them to either a walking-exercise group (n = 58) or a usual-care group (n = 58). We conducted a 12-week exercise programme that comprised home-based, moderate-intensity walking for 40 min/d for 3 days per week and weekly exercise counselling. The outcome measures included the Hospital Anxiety and Depression Scale and the Taiwanese version of the MD Anderson Symptom Inventory.
Results: We analysed the effects of the exercise programme on anxiety, depression and cancer-related symptoms by using a generalised estimating equation method. The patients in the exercise group exhibited a significant improvement over time in their levels of anxiety (P = .009 at third month; P = .006 at sixth month) and depression (P = .00006 at third month; P = .004 at sixth month) compared with those in the usual-care group.
Conclusion: The home-based walking exercise programme is a feasible and effective intervention for anxiety and depression in lung cancer survivors, and can be considered as an essential component of lung cancer rehabilitation.

Project 3: Randomised controlled trial on the effectiveness of home-based walking exercise on circadian rhythms and sleep quality in patients with lung cancer

Background: Although exercise has been addressed as an adjuvant treatment for circadian rhythms and sleep quality, few studies have evaluated the effectiveness of exercise in patients with lung cancer.
Methods: We recruited 111 patients from a medical centre in northern Taiwan, and randomly assigned them to either a walking-exercise group (n = 56) or a usual-care group (n = 55). We conducted a 12-week exercise programme that comprised home-based, moderate-intensity walking for 40 min/d for 3 days per week and weekly exercise counselling. The outcome measures included an actigraph to measure the objective sleep parameters (total sleep time, TST; sleep efficiency, SE; and sleep onset latency, SOL), rest-activity circadian rhythms (r24 and I＜O). The Taiwanese version of the Pittsburgh Sleep Quality Index (PSQI-T) was used to measure the subjective sleep quality.
Results: We analysed the effects of the exercise programme on sleep and circadian rhythms by using a generalised estimating equation method. The PSQI-T (Wald χ2 = 15.16, P = .001) and TST (Wald χ2 = 7.59, P = .023) of patients in the exercise group significantly improved over time compared to that of participants in the usual-care group. The moderate effect of I ＜ O on the TST was significant (β of group × I ＜ O = 3.70, P = .032). The moderate effect of I ＜ O on the PSQI was marginally significant (β of group × I ＜ O = -0.13, P = .050).
Conclusion: The home-based walking exercise programme is a feasible and effective intervention for subjective and objective sleep quality in lung cancer survivors, and can be considered as an essential component of lung cancer rehabilitation. Circadian rhythms can be employed as a modifier when evaluating the sleep quality of lung cancer patients.

並列關鍵字

exercise ； symptoms ； circadian rhythms ； sleep quality ； lung cancer

參考文獻

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