| 摘要: | 研究背景：癌症是一種發生率高且盛行率持續升高的疾病，目前癌症治療以手術切除、化學治療以及放射線治療為主，在化學治療及（或）放射線治療中，常會對人體產生毒性並伴隨許多不良反應，對病人造成許多影響，例如：肌肉質量降低、肌力降低、浮腫指數上升、體細胞量降低、相位角降低以及身體功能下降，最終導致其生活品質下降。
研究目的：探討抗阻力運動和健走運動介入措施是否能夠改善接受化學治療或同步放化治療癌症患者的骨骼肌肌肉質量、肌力、身體浮腫指數、體細胞量、相位角、以及身體功能，並進一步探討是否能改善接受化療或同步放化療的癌症患者的生活品質。
研究方法：本研究採用隨機對照試驗，於北部某醫學中心的門診，納入診斷為癌症並需接受化學治療或同步放化治療癌症患者，隨機分組對照組、健走組、抗阻力運動組、以及抗阻力運動加健走組，共4組。於運動介入前及運動介入12週後，分別以相同測量工具收集其人口學資料、手握力、五次起立坐下測驗、骨骼肌肌肉質量、浮腫指數、體細胞量，相位角、及生活品質。統計方法於四組組間比較使用Kraskal-Wallis test，另外探討組別與時間的關係，使用廣義估計式（GEE，Generalized estimating equations）來比較四組與時間之間的相關性。
結果:本研究刪除運動執行率低於70％者後共納入34位癌症病人進行統計分析，分為四組：對照組、健走組、抗阻力運動組以及抗阻力加健走組。介入前受試者各資料中，在社會人口學資料中發現身高及癌症分期有顯著差異，在整體身體狀況中發現右上肢骨骼肌肉質量及右上肢手握力有差異，其他項目無差異。研究發現經過12週運動介入後，運動介入組癌症個案肌肉質量、浮腫指數、相位角、右上肢手握力以及5次起立坐下測驗有顯著改善。生活品質方面在總量表(Total)、身體健康(PWB)以及社交和家庭生活(SWB)子量表中，發現抗阻力運動介入組相較於對照組有顯著提升，表示抗阻力運動介入能提升接受放射化學治療癌症患者的生活品質。在執行率方面，健走組最高，抗阻力組次之，抗阻力加健走組最低。
總結: 抗阻力運動或健走能改善接受放射化學治療癌症患者的肌肉質量、浮腫指數、相位角、右上肢手握力以及5次起立坐下測驗。抗阻力運動能顯著提升接受放射化學治療癌症患者的生活品質。
Background: Cancer is a disease with high incidence and increasing prevalence. Currently, cancer treatments are mainly based on surgical resection, chemotherapy and radiotherapy. Chemotherapy and/or radiotherapy often lead to systemic toxicity to the human body and are accompanied by many adverse reactions, causing many effects on patients, such as: reduced muscle mass, reduced muscle strength, increased edema index, decreased body cell mass, decreased phase angle and decreased physical function. Ultimately, the quality of life of cancer patients decreases.
Purpose: To explore whether resistance exercise and walking, as a kind of exercise intervention, can improve the skeletal muscle mass, muscle strength, ECW/TBW, body cell mass (BCM), phase angle (PhA) and physical function of cancer patients, and further improve the quality of life of cancer patients who undergoing chemotherapy or concurrent chemoradiotherapy.
Methods: This study used a randomized controlled trial in the outpatient clinic of a northern medical center. Patients diagnosed with cancer and requiring chemotherapy or concurrent radio-chemotherapy were included. The subjects were randomized into four groups, control group, walking group, resistance exercise group, and resistance exercise plus walking group separately. Their demographics, handgrip strength, five times sit-to-stand test, skeletal muscle mass, edema index, body cell mass, phase angle and quality of life were collected before and after 12 weeks of exercise intervention. Statistical methods used the Kraskal-Wallis test for comparisons among the four groups. In addition, the interaction effect between groups and time was evaluated using generalized estimating equations (GEE) to compare the correlation between the four groups and time effect.
Result: A total of 34 cancer patients receiving chemoradiotherapy were included for data analysis in this study. Divide into four groups, control group, walking group, resistance exercise group and resistance plus walking group respectively, after excluding those whose exercise execution rate is lower than 70%. Among the various data of the subjects before intervention, there were significant differences in height and cancer stage were found in the demographic data. In the overall physical condition, significant differences were found in the skeletal muscle mass of the right upper limb and hand grip strength of the right upper limb, but no significant statistical difference in other items before intervention. The study found that after 12 weeks of exercise intervention, there were statistical improvements in muscle mass, edema index, phase angle, right upper limb hand grip strength and five times sit-to-stand test in cancer patients receiving chemoradiotherapy. Significant increases in quality of life were found in FACT-G Total, Physical Well-being (PWB) and Social/Family Well-being (SWB) after 12 weeks of resistance exercise. Indicates that resistance exercise is effective in promoting quality of life in cancer patients receiving chemoradiotherapy. The execution rate was highest in the walking group, second in the resistance group, and lowest in the resistance plus walking group.
Conclusion: Resistance exercise or walking significantly improve muscle mass, edema index, phase angle, right upper limb handgrip strength and the 5 stand-up-sit test in cancer patients receiving radiochemotherapy. Resistance exercise is effective in promoting quality of life in cancer patients receiving chemoradiotherapy. |
