有氧训练和阻力训练相结合可改善超重/肥胖乳腺癌患者和幸存者的身体组成、改变心脏代谢风险并改善癌症相关指标:随机对照试验的系统回顾和元分析

S. B. Al-Mhanna, A. Batrakoulis, M. N. Norhayati, Maha Mohamed, C. Drenowatz, A. Irekeola, Hafeez Abiola Afolabi, M. Gülü, Nouf H Alkhamees, W. S. Wan Ghazali
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引用次数: 0

摘要

患有肥胖症的乳腺癌幸存者面临癌症复发、合并症和死亡率的高风险。本综述旨在系统评估有氧和阻力联合训练(CART)对超重/肥胖的乳腺癌患者和幸存者的身体成分、脂质稳态、炎症、脂肪因子、癌症相关疲劳、睡眠和生活质量的影响。我们在 PubMed、Web of Science、Scopus、Science Direct、Cochrane 和 Google Scholar 数据库中进行了电子检索,检索时间从开始至 2024 年 1 月 8 日。分析选择了符合纳入标准的随机对照试验(RCT)。科克伦偏倚风险工具用于评估符合条件的研究,GRADE 方法用于评估证据质量。采用随机效应模型,并使用连续变量的平均值 (MD) 和标准化平均差 (SMD) 以及 95% 置信区间 (CI) 对数据进行分析。我们对数据进行了偏倚风险、异质性、敏感性、报告偏倚和证据质量评估。系统综述共纳入了 17 项随机对照试验,涉及 1,148 名女性患者和幸存者(平均年龄:54.0 ± 3.4 岁)。主要结果显示,体重指数(SMD -0.57 kg/m2,p = 0.04)、体脂(SMD -0.50%,p = 0.02)、脂肪量(SMD -0.63 kg,p = 0.04)、臀围(MD -3.14 cm,p = 0.02)和无脂肪量(SMD 1.03 kg,p < 0.001)均有明显改善。次要结果显示,高密度脂蛋白胆固醇(MD -0.05 mmol/L,p = 0.008)、自然杀伤细胞(SMD 0.42%,p = 0.04),降低甘油三酯(MD -81.90 mg/dL,p < 0.01)、总胆固醇(SMD -0.95 mmol/L,p < 0.01)、肿瘤坏死因子α(SMD -0.89 pg/mL,p = 0.03)和瘦素(SMD -0.63 ng/mL,p = 0.03)。此外,癌症相关疲劳(SMD -0.98,p = 0.03)、睡眠(SMD -1.17,p < 0.001)和生活质量(SMD 2.94,p = 0.02)评分也出现了有益的变化。大多数结果的估计效果可信度很低或很低。目前的研究结果表明,CART 可被视为一种辅助疗法,支持运动后观察到的传统临床方法。不过,还需要进一步开展高质量的研究,以评估 CART 是否是一种有价值的干预措施,以减少超重/肥胖乳腺癌患者的药物使用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Combined Aerobic and Resistance Training Improves Body Composition, Alters Cardiometabolic Risk, and Ameliorates Cancer-Related Indicators in Breast Cancer Patients and Survivors with Overweight/Obesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Breast cancer survivors with obesity are at a high risk of cancer recurrence, comorbidity, and mortality. This review aims to systematically evaluate the effects of combined aerobic and resistance training (CART) on body composition, lipid homeostasis, inflammation, adipokines, cancer-related fatigue, sleep, and quality of life in breast cancer patients and survivors with overweight/obesity. An electronic search was conducted in PubMed, Web of Science, Scopus, Science Direct, Cochrane, and Google Scholar databases from inception up to January 8, 2024. Randomized controlled trials (RCTs) meeting the inclusion criteria were selected for the analysis. The Cochrane risk of bias tool was used to assess eligible studies, and the GRADE method to evaluate the quality of evidence. A random-effects model was used, and data were analyzed using mean (MD) and standardized mean differences (SMD) for continuous variables with 95% confidence intervals (CI). We assessed the data for risk of bias, heterogeneity, sensitivity, reporting bias, and quality of evidence. A total of 17 randomized controlled trials were included in the systematic review involving 1,148 female patients and survivors (mean age: 54.0 ± 3.4 years). The primary outcomes showed significant improvements in body mass index (SMD -0.57 kg/m2, p = 0.04), body fat (SMD -0.50%, p = 0.02), fat mass (SMD -0.63 kg, p = 0.04), hip circumference (MD -3.14 cm, p = 0.02), and fat-free mass (SMD 1.03 kg, p < 0.001). The secondary outcomes indicated significant increases in high-density lipoprotein cholesterol (MD -0.05 mmol/L, p = 0.008), natural killer cells (SMD 0.42%, p = 0.04), reductions in triglycerides (MD -81.90 mg/dL, p < 0.01), total cholesterol (SMD -0.95 mmol/L, p < 0.01), tumor necrosis factor α (SMD -0.89 pg/mL, p = 0.03), and leptin (SMD -0.63 ng/mL, p = 0.03). Also, beneficial alterations were found in cancer-related fatigue (SMD -0.98, p = 0.03), sleep (SMD -1.17, p < 0.001), and quality of life (SMD 2.94, p = 0.02) scores. There was very low to low confidence in the estimated effect of most of the outcomes. The present findings reveal that CART could be considered an adjunct therapy in supporting the conventional clinical approach observed following exercise. However, further high-quality research is needed to evaluate whether CART would be a valuable intervention to lower aggressive pharmacologic use in breast cancer patients with overweight/obesity.
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