激素剥夺治疗启动时的即时运动与延迟运动对患者生活质量的影响：一项为期一年的随机对照试验结果

Immediate Versus Delayed Exercise on Health-related Quality of Life in Patients Initiating Androgen Deprivation Therapy: Results from a Year-long Randomised Trial

EUROPEAN UROLOGY ONCOLOGY

影响因子:9.3

分区:医学1区 Top / 泌尿学与肾脏学1区肿瘤学2区

发表日期:2025 Apr

作者: Dennis R Taaffe, Robert U Newton, Suzanne K Chambers, Christian J Nelson, Nigel Spry, Hao Luo, Oliver Schumacher, David Joseph, Robert A Gardiner, Dickon Hayne, Daniel A Galvão

DOI: 10.1016/j.euo.2024.09.012

摘要

前列腺癌患者接受激素剥夺治疗（ADT）后，会出现多种治疗相关毒性，影响功能和生活质量（HRQoL）。运动已被证实能缓解部分不良反应，包括生活质量下降，但何时开始运动尚不明确。本研究旨在比较在ADT启动时立即开始运动与在治疗中延迟开始运动对缓解HRQoL不良影响的效果。研究对象为48-84岁的前列腺癌患者，随机分为立即运动组（IMEX，n=54）和延迟运动组（DEL，n=48），持续12个月。IMEX组在ADT开始时进行6个月的有指导的阻力、有氧和冲击运动，随后6个月随访；DEL组则为6个月常规护理后，再进行相同的运动方案。通过Short Form-36评估基础线、6月和12月的HRQoL。采用意向分析，并利用对数转换数据进行组×时间的重复测量方差分析。结果显示，身体功能领域（p=0.045）和身体组成总结得分（p=0.005）与时间存在显著交互作用，身体疼痛（p<0.001）和活力（p<0.001）领域在IMEX组得分保持稳定而在DEL组下降。DEL组的运动逆转了活力和身体组成得分的下降，12个月时与基础线无显著差异。研究的限制包括干预期间的治疗调整。同步开始运动与ADT能有效维持HRQoL，而在既定ADT方案中启动运动可逆转某些HRQoL指标的下降。为了避免治疗初期的不良影响，应在治疗开始时即启动运动治疗。

Abstract

An array of treatment-related toxicities result from androgen deprivation therapy (ADT) in patients with prostate cancer (PCa), compromising function and health-related quality of life (HRQoL). Exercise has been demonstrated to counter a number of these adverse effects including decreased HRQoL; however, when exercise should be initiated is less clear. This study aims to examine whether commencing exercise when ADT is initiated rather than later during treatment is more effective in countering adverse effects on HRQoL.Men with PCa (48-84 yr) initiating ADT were randomised to immediate exercise (IMEX; n = 54) or delayed exercise (DEL; n = 48) for 12 mo. IMEX consisted of 6 mo of supervised resistance/aerobic/impact exercise commenced at the initiation of ADT with 6 mo of follow-up. DEL consisted of 6 mo of usual care followed by 6 mo of the same exercise programme. HRQoL was assessed using the Short Form-36 at baseline and 6 and 12 mo. Intention to treat was utilised for the analyses that included group × time repeated-measures analysis of variance using log transformed data.There were a significant group × time interaction for the physical functioning domain (p = 0.045) and physical component summary score (p = 0.005), and a significant time effect for bodily pain (p < 0.001) and vitality domains (p < 0.001), with HRQoL maintained in IMEX and declining in DEL at 6 mo. Exercise in DEL reversed declines in vitality and in the physical component summary score, with no differences at 12 mo compared with baseline. Limitations include treatment alterations during the intervention.Concurrently initiating exercise and ADT in patients with PCa preserves HRQoL, whereas exercise initiated while on established ADT regimens reverses declines in some HRQoL domains.To avoid initial treatment-related adverse effects on health-related quality of life, exercise medicine should be initiated at the start of treatment.