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有氧和抗阻运动对早期乳腺癌存活者的作用

  编者按代谢综合征(以胰岛素抵抗为基本特征,合并有高血压以及葡萄糖与脂质代谢异常的综合征,主要表现为肥胖尤其中心性肥胖、2型糖尿病或糖调节受损、低密度脂蛋白升高、高密度脂蛋白胆固醇降低、高血压,甚或涉及非酒精性脂肪肝、高尿酸血症、微量白蛋白尿、血管内皮功能异常、低度炎症反应、血液凝固及纤溶系统活性异常、神经内分泌异常及多卵巢综合征等多种疾病的综合征,其导致患心血管事件的发生率及死亡风险增加)与乳腺癌存活者心血管疾病2型糖尿病乳腺癌复发风险增加相关。

  2018年1月22日,美国临床肿瘤学会《临床肿瘤学杂志》在线发表美国南加利福尼亚大学、希望之城癌症中心、伯明翰阿拉巴马大学、德克萨斯大学MD安德森癌症中心、加拿大阿尔伯塔大学的研究报告,评定了4个月有氧运动(强度低、有节奏、时间长的运动方式,主要增强耐力和心肺功能,大多被用于减重)和抗阻运动(主动进行对抗阻力的运动方式,阻力可以来自器械或他人,主要提高肌肉力量,大多被用于增肌)对超重(体重指数≥25kg/m²)或肥胖(体重指数≥30kg/m²)乳腺癌存活者代谢综合征肌肉减少型肥胖血清生物学指标的作用。

  该随机对照研究于2012年8月1日~2016年12月31日入组0~3期乳腺癌治疗<6个月、不吸烟、久坐(每周运动少于60分钟)、体重指数≥25kg/m²或体脂>30%、腰围≥88cm、不同种族的乳腺癌存活者100例(年龄53±10.4岁,其中46%为体重指数≥30kg/m²,74%为少数种族)进行随机分组,运动组、对照组各50例。运动组参加16周每周3次有监督的中等至剧烈(达到相应年龄组最高心率的65%~85%)有氧+抗阻运动。对照组仅接受常规保健。干预开始时、干预4个月时、随访3个月时(仅运动组)评定代谢综合征z评分(主要结局)、肌肉减少型肥胖、血清生物学指标。

  结果,干预坚持率为95%,干预后评定率为91%。干预组与对照组相比:

  • 代谢综合征评分显著改善

  • 相差:-4.4(95%:-5.9~-2.7,P<0.001)

  • 肌肉减少型肥胖显著改善

  • 四肢骨骼肌指数(P=0.001)

  • 体重指数(P=0.001)

  • 血清生物学指标显著改善

  • 胰岛素(P=0.002)

  • 胰岛素样生长因子-1(P=0.001)

  • 瘦素或瘦蛋白(P=0.001)

  • 脂联素或脂连蛋白(P=0.001)

  • 随访期间,所有代谢综合征指标仍然显著好于干预开始时(P<0.01)

  因此,抗阻+有氧运动有效改善了久坐、超重或肥胖乳腺癌存活者不同种族样本人群的代谢综合征、肌肉减少型肥胖、相关生物标志。该研究结果表明,有针对的运动处方,可以改善乳腺癌存活者的代谢综合征,并支持将有监督的临床运动方案纳入乳腺癌治疗和存活者保健计划。

J Clin Oncol. 2018 Jan 22. [Epub ahead of print]

Effects of Aerobic and Resistance Exercise on Metabolic Syndrome, Sarcopenic Obesity, and Circulating Biomarkers in Overweight or Obese Survivors of Breast Cancer: A Randomized Controlled Trial.

Christina M. Dieli-Conwright, Kerry S. Courneya, Wendy Demark-Wahnefried, Nathalie Sami, Kyuwan Lee, Thomas A. Buchanan, Darcy V. Spicer, Debu Tripathy, Leslie Bernstein, Joanne E. Mortimer.

University of Southern California, Los Angeles; City of Hope, Duarte, CA; University of Alberta, Edmonton, Alberta, Canada; University of Alabama at Birmingham, Birmingham, AL; The University of Texas MD Anderson Cancer Center, Houston, TX.

PURPOSE: Metabolic syndrome is associated with an increased risk of cardiovascular disease, type 2 diabetes, and breast cancer recurrence in survivors of breast cancer. This randomized controlled trial assessed the effects of a 16-week combined aerobic and resistance exercise intervention on metabolic syndrome, sarcopenic obesity, and serum biomarkers among ethnically diverse, sedentary, overweight, or obese survivors of breast cancer.

METHODS: Eligible survivors of breast cancer (N = 100) were randomly assigned to exercise (n = 50) or usual care (n = 50). The exercise group participated in supervised moderate-to-vigorous—65% to 85% of heart rate maximum—aerobic and resistance exercise three times per week for 16 weeks. Metabolic syndrome z-score (primary outcome), sarcopenic obesity, and serum biomarkers were measured at baseline, postintervention (4 months), and 3-month follow-up (exercise only).

RESULTS: Participants were age 53 ± 10.4 years, 46% were obese, and 74% were ethnic minorities. Adherence to the intervention was 95%, and postintervention assessments were available in 91% of participants. Postintervention metabolic syndrome z-score was significantly improved in exercise versus usual care (between-group difference, -4.4; 95% CI, -5.9 to -2.7; P < .001). Sarcopenic obesity (appendicular skeletal mass index, P = .001; body mass index, P = .001) and circulating biomarkers, including insulin (P = .002), IGF-1 (P = .001), leptin (P = .001), and adiponectin (P = .001), were significantly improved postintervention compared with usual care. At 3-month follow-up, all metabolic syndrome variables remained significantly improved compared with baseline in the exercise group (P < .01).

CONCLUSION: Combined resistance and aerobic exercise effectively attenuated metabolic syndrome, sarcopenic obesity, and relevant biomarkers in an ethnically diverse sample of sedentary, overweight, or obese survivors of breast cancer. Our findings suggest a targeted exercise prescription for improving metabolic syndrome in survivors of breast cancer and support the incorporation of supervised clinical exercise programs into breast cancer treatment and survivorship care plans.

PMID: 29356607

DOI: 10.1200/JCO.2017.75.7526

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