| 摘要: | 本研究為探討老年與年輕癌症存活者身體活動、生物節律與生活品質之關係的系列研究，包含二個子研究。
子研究一:台灣版老人身體活動量表於癌症存活者之發展與測試
研究背景:問卷是一種容易實施且經濟實惠的身體活動評估方法，但是僅有少數研究曾驗證身體活動問卷在癌症存活者的信效度。老人身體活動量表被廣泛使用於需要較緩和性身體活動的族群，但在癌症存活者的信效度尚未被驗證。
研究方法:利用雙向翻譯完成台灣版老人身體活動量表（Taiwanese version of the Physical Activity Scale for the Elderly, PASE-T）基本架構，於血液腫瘤科門診共收集127位癌症存活者資料，研究工具包含:台灣版安德森症狀量表（Taiwanese version of the MD Anderson Symptom Inventory, MDASI-T）、Karnofsky功能評估量表（Karnofsky Performonce Status, KPS）及活動記錄器等。
研究結果:內容效度為0.91，與actigraph平均每分鐘測量次數之斯皮爾曼等級相關係數為0.64，其效標關聯效度良好。與KPS、MDASI-T量表之症狀嚴重度與症狀干擾之斯皮爾曼等級相關係數為0.59, −0.23, −0.21，具備可接受的聚斂效度。此外，此量表能區分出身體功能好與差者的身體活動量。整體量表與次量表之再測信度為0.90, 0.78, 0.83, 0.97。
研究結論:台灣版老人身體活動量表具有良好的信度及效度。
子研究二:老年與年輕癌症存活者身體活動、生物節律與生活品質之關係:生物節律中介角色與劑量反應關係之探討
研究背景:愈來愈多的實證研究顯示身體活動可以促進癌症存活者的生活品質，但是尚不了解身體活動與生活品質之間潛在的生物關係，亦缺乏身體活動、生物節律與生活品質劑量反應關係之實證研究，此劑量反應關係是否存在年齡差異亦不清楚。
研究方法:採用橫斷式研究設計，共收集143位年輕及92位老年癌症存活者資料。研究工具包含:KPS、PASE-T、台灣版SF-36健康評估量表及活動記錄器等，以多種中介分析方法測試中介反應，並利用多變量變異數分析探討身體活動與生物節律及生活品質的劑量反應關係。
研究結果:不論是老年或年輕族群，生物節律都是身體活動與生理層面生活品質的中介因子，生物節律在老年族群的中介反應大於年輕族群。於心理層面的生活品質，在年輕族群，未發現生物節律的中介效果，但在老年族群，生物節律具有部分中介效果。於兩個族群，身體活動與生物節律及生活品質均具有線性的劑量反應關係，達到癌症存活者身體活動量建議者，都有較佳的生物節律及生理層面生活品質，一週總身體活動持續時間，年輕者達到19小時以上，老年者達到12小時以上，能有較佳的生物節律及生活品質。
研究結論:身體活動與生活品質之間的關係具有年齡差異性，而身體活動與生物節律及生活品質具有劑量反應關係，但無年齡差異。
總結，本系列研究結果有助於瞭解不同年齡層癌症存活者身體活動與生活品質之間潛在的生物關係，以及其差異性。此外，也提出不同年齡層癌症存活者身體活動、生物節律與生活品質劑量反應關係之實證證明，以作為未來年輕及老年癌症存活者身體活動介入的參考。
Project 1: Measurement of Physical Activity in Cancer Survivors: A Validity Study
Background: Few studies have verified the reliability and validity of the various physical activity questionnaires in cancer patients.
Objective: To validate the Taiwanese version of the Physical Activity Scale for the Elderly (PASE-T).
Methods: One hundred twenty-seven cancer survivors participated in this study. Instruments consisted of the PASE-T, the Taiwanese version of the MD Anderson Symptom Inventory (MDASI-T), Karnofsky Performance Status (KPS), and actigraph. Reliability was assessed by calculating the test-retest reliability. The validity was assessed by the content validity, criterion-related validity, convergent validity, and known group validity.
Results: The test-retest reliability was 0.90 over a 2-week interval, based on a sample of 30 patients. The content validity index was very acceptable at 0.91. Convergent validity was demonstrated by its significant association with MADSI-T scores (symptom severity: r = -0.23, p = 0.001; symptom interference: r = -0.21, p = 0.001) and KPS scores (r = 0.59, p < 0.001). Criterion-related validity was established by a significant relationship to the actigraph total counts per minute (r = 0.64, p < 0.001). Known group validity was established by its ability to detect significant differences according to a patient’s performance status.
Conclusion: The PASE-T is a reliable and valid instrument for measurement of physical activity among cancer survivors in Taiwan.
Project 2: The relationship of physical activity, circadian rhythm and quality of life in younger and older cancer survivors
Background: Increasing evidence suggests that physical activity (PA) improves the quality of life (QoL) of cancer survivors. However, the biological associations underlying the relationship between PA and QoL are unclear. There is lack of dose-response information about PA, CR and QoL in cancer survivors and it is unclear whether young and old cancer survivor differs in the relationship between PA, CR, and QoL.
Objective: 1.To determine whether the relationship between PA and QoL differs in younger and older cancer survivors and whether circadian rhythm (CR) mediates this relationship. 2. To explore the dose-response relationship between physical activity, CR and QoL in young and old cancer survivors.
Methods: The participants were 235 cancer survivors, comprising 143 younger and 92 older patients. Data were collected using the PASE-T and Short Form-36. The robustness and stability of the CR were measured using an actigraph. Mediation was tested using multiple mediation analyses. Multivariate analysis of variance was used to determine the dose-response relationships between PA to CR and QoL.
Results: The CR mediated the relationship between PA and the physical domain of QoL in younger and older cancer survivors (23% and 59% mediating effects, respectively). The CR partially mediated the effect of PA on the mental dimension of QoL in older cancer survivors (36% mediating effect), but not in younger cancer survivors. There was a liner dose-response relationship between PA, CR, and QoL in each age group. Meeting the PA recommendations was with higher CR and physical domain of QoL. Cancer survivors who reported total PA more than 19 hours of young and 12 hours of old over the past week had a better QoL and CR.
Conclusion: The mediating effect differed in younger and older cancer survivors. The dose-response relationship of PA on CR and QoL appeared the same in young and old cancer survivors.
In conclusion, the results of the series studies help to understand the the biological mechanisms underlying the relationship between PA and QoL among cancer survivors with different age groups. In addition, the results also provide evidence that the dose-response relationship of PA to CR and QoL among different age groups. These results can serve as a reference in designing individualized PA programs for cancer survivors. |
