| 摘要: | 研究動機：癌因性疲憊為一種與癌症或治療相關，影響生理、情緒或認知的疲累，在癌症治療期間的盛行率約 60-80%。住院期間，病人常因疲憊躺床，減少下床活動，然而休息不會改善癌因性疲憊，反而讓心肺耐力下降、骨骼肌流失，病人需花費更多力氣活動，使活動的動機下降，形成惡性循環；而走路合併彈力帶運動可能是能實際應用於住院期間，克服場地限制，且改善癌因性疲憊與症狀困擾之運動種類。
研究目的：探討走路合併彈力帶運動對住院中癌症病人在癌因性疲憊、症狀困擾、體能的成效。
研究方法：單盲隨機對照實驗，研究對象為住院中的癌症病人，收案天數介於 3–7 天，收案期間每天介入 30–35 分鐘低至中等強度的走路合併彈力帶運動，於前後測蒐集基本人口學屬性、六分鐘步行距離、身體組成，並於每日監測癌因性疲憊、症狀困擾、下肢肌力，並於介入期間 24小時配戴 4G 穿戴式手錶量測心率變異度。
研究成果：癌因性疲憊中，收案天數每增加一天，運動組傾向中重度疲憊的風險減少 24%，常規組傾向中重度風險的程度增加 219%；症狀困擾中，運動組也控制了疲倦、感到想睡、憂鬱、焦慮、自覺健康狀況的惡化，於第一天至第七天無明顯變化，而常規組於第五天開始症狀困擾程度變嚴重；在運動後的立即效果中，可發現運動組在症狀困擾之感到想睡、焦慮、自覺健康狀況變項中，得到顯著改善；膝伸展動作之下肢肌力中，運動組於第一至七天無明顯變化，常規組於第五天開始下滑；生理功能；六分鐘步行距離中，運動組後測顯著比前測多；全身肌肉量中，常規組後側與前測相比，全身肌肉量顯著下降心率變異度；BFI-T改變量與夜間 SDNN 改變量關係為負相關，運動後 SDNN 顯著比運動前低；運動遵從度達 93%，無運動相關不良反應。
結論：針對住院中癌症病人，每日介入 30-35 分鐘低至中等強度的走路合併彈力帶運動，可發現相較於常規組，運動組能有效控制癌因性疲憊、症狀困擾、下肢肌力的惡化，在六分鐘步行距離中，運動組後測較前測顯著增加，全身肌肉量中，常規組後側較前側顯著降低，心率變異度在運動後立即的測試發現 SDNN 顯著下降。
Background: Cancer-related fatigue is a kind of fatigue related to cancer or treatment that affects physiology, emotion, or cognition. During cancer treatment, 60-80% of patients suffer from a certain degree of fatigue. During hospitalization, patients often lie in bed due to fatigue, reduces getting out of bed to do physical activities. However, bed rest will not improve fatigue and even reduce cardiorespiratory endurance and skeletal muscle. Patients need to spend more energy on activities, which will reduce their motivation for activities and form a vicious circle. As for clinical staff, they may worry about safety as patients may fall during activity. Also, they don’t receive relevant training about exercise, so they don’t know how to give individualized and accessible exercise prescriptions. Walking combined with elastic band
exercise may be a type of exercise that can, overcome inconvenience and improve fatigue and symptoms during hospitalization.
Aim: To explore the effects of walking combined with resistance bands exercise on cancer-related fatigue, symptom distress, and physical fitness in hospitalized cancer patients.
Method: Single-blind randomized controlled trial, 30-35 minutes of low to moderate-intensity walking and resistance band exercise is given during research every day. Basic demographics, body composition, and six-minute walking distance were collected before and after the test. During the research, cancer-related fatigue, symptoms, and lower body strength were monitored every day. Also, patients wore 4G smart bracelets to collect heart rate variability.
Results: In cancer-related fatigue, as the number of research days increased, the risk ratio of severe fatigue in the exercise group decreased by 24%. On the other hand, the risk ratio of severe fatigue in the routine care group increased by 219%. In symptom distress, the exercise group also controlled the deterioration of fatigue, drowsiness, depression, anxiety, and perceived health quality. From the first to the seventh day, there were no significant changes in
the exercise group, whereas the routine care group experienced an escalation in the severity of symptom distress starting from the fifth day. In immediate effects, significant improvements were observed in the exercise group including drowsiness, anxiety, and perceived health quality. In lower limb muscle strength of knee extension, the exercise group showed no significant changes from the first to the seventh day, while the routine care group began to decline from the fifth day. Physical fitness, such as the six-minute walking distance, significantly increased in the exercise group post-test compared to the pre-test. Concerning overall muscle mass, the routine care group exhibited a significant decrease compared to the pre-text. There was a negative correlation between changes in the BFI-T and changes in nighttime SDNN. In immediate effect, SDNN was significantly lower compared to pre-exercise levels. The adherence to the exercise program was 93%, with no exercise-related adverse effects.
Conclusion: For hospitalized cancer patients, a daily intervention of 30-35 minutes of low to moderate-intensity walking combined with resistance band exercises is found to be effective in controlling the deterioration of cancer-related fatigue, symptom distress, and lower limb muscle strength. In the six-minute walking distance, the post-test results for the exercise group showed a significant increase compared to the pre-test. Regarding overall muscle mass, the routine care group exhibited a significant decrease in the posttest compared to the pretest. Immediate post-exercise testing revealed a significant decrease in heart rate variability, as indicated by a significant reduction in SDNN. |
