臺灣博碩士論文加值系統

背景
回顧過去文獻中顯示，乳癌患者經過化學治療後可能導致左心室功能受損並提高罹患心血管疾病風險，同時運動能力表現，不論在化學治療中或是癌症治療完的患者，最大攝氧量都顯著低於同年齡女性，並且研究結果指出最大攝氧量與患者預後及死亡率存在高度相關。在乳癌患者中也發現體適能包含身體組成、柔軟度與肌力有衰退的趨勢，至於肺功能則是缺乏研究探討化療對其影響。過去研究中顯示，運動介入能就有效改善乳癌存活者之心臟功能與心肺耐力，並降低罹患心血管疾病之風險，透過有氧運動、肌力訓練，與伸展運動也可以改善乳癌存活者的身體組成，並增進柔軟度與肌力，進而改善整體生活品質。目前多數研究都探討乳癌存活者之運動介入效果，研究運動介入於化療過程中的影響則佔少數，並缺乏一致定論。因此本篇研究目的主要探討運動介入對於乳癌化療患者心臟功能、運動能力與體適能表現之效果，並將研究結果應用於臨床改善乳癌化療患者整體照護品質。
方法
本篇研究收入乳癌患者將其隨機分組至運動介入組或控制組。運動訓練包含有氧運動、肌力訓練與伸展運動，共24次運動介入，為期三個月。研究探討化療前和三個月後藉由雙向與M-型心臟超音波檢查所得之左心室射出率。並於化療前、化療後一個半月和化療後三個月測量參數包含心肺運動測試中的最大攝氧量、身體組成、柔軟度、肌力與肺功能，探討運動介入於乳癌化療過程中對副作用改善之成效。
結果
本篇研究共收入16位乳癌患者，運動組與控制組分別為10人與6人。化療開始三個月後的測試結果顯示運動組左心室射出率明顯高於控制組，而控制組左心室射出率與化療前相比則是明顯下降(運動組:70.55%至72.67%比較控制組70.22%至63.95%, p〈 0.05).，兩者組間有顯著差異。三個月後測試結果同樣觀察到運動組最大攝氧量明顯高於控制組(運動組:14.0比較控制組:11.8, p〈 0.05)。控制組的體脂肪、內臟脂肪與骨骼肌比率相較化療前有明顯衰退，然而體重則是兩組都有顯著增加。在體適能包含三分鐘登階測試、柔軟度、肌力與肺功能在運動介入前後兩組間或組內並無顯著改善效果。
結論
在乳癌患者化療的過程當中，進行運動訓練能夠有效避免左心室射出率下降，同時改善最大攝氧量與心肺適能。然而運動介入對於乳癌患者之體重增加、柔軟度、肌力與肺功能則是沒有顯著影響效果。

Background
Reviewed studies shown, breast cancer patients were observed decreased in left ventricle function and increased the risk of cardiovascular disease after received chemotherapy. Exercise capacity associated with peakVO2 reduction were also found in breast cancer survivors and patients receiving chemotherapy that was significant related to prognosis and over-all mortality. Moreover, body composition, flexibility and muscle strength of breast cancer survivors were observed deteriorated that may induced other comorbidities. In addition, studies of pulmonary function in breast cancer were insufficient. Previous studies shown exercise intervention was effective in improving cardiac function and exercise capacity to reduce risk of cardiovascular disease among breast cancer survivors. And exercise was suggested to improve body composition, and increased flexibility and muscle strength after cancer treatment. However, most of the current studies focused on exercise intervention in breast cancer survivors. Studies of exercise training in breast cancer patient during chemotherapy were insufficient and inconsistent. Therefore, this study aimed to evaluate the effect of exercise intervention on cardiac function, exercise capacity and physical fitness in breast cancer patients during chemotherapy.
Methods
This randomized control trial enrolled breast cancer patients to investigate the effect of exercise training during chemotherapy in subclinical cardiotoxicity, exercise capacity, physical fitness and pulmonary function compared to usual cancer care.
Participants were randomly assigned to either exercise training group (EX) with 24 sessions of program combined aerobic, resistance and flexibility training, or control group (CTL) that was under usual cancer care. The primary outcome was left ventricular cardiac function examined by 2D and M-mode echocardiography before and 3 mons after starting chemotherapy and the variables of cardiopulmonary exercise test that was test at baseline. The secondary outcomes involved body composition, hemodynamic response of 3-min-step test, flexibility, muscle strength and pulmonary function evaluated at baseline, 1.5 months and 3.0 months after starting chemotherapy.
Results
A total of 16 breast cancer patient was involved in this study (EX: n=10; CTL: n=6). LVEF was significantly higher in exercise group (72.67%) in contrast with reduction in control group (from baseline to 3 mons: 70.22% to 63.95%). PeakVO2 was significantly different between groups at 3.0 months after starting chemotherapy (EX vs. CTL: 14.0 vs.11.8). Body weight gain was found in both groups. Whole body fat, visceral fat and skeletal muscle rate significant deteriorated in control group. The result of 3-min-step test, flexibility, muscle strength and pulmonary function were found no intragroup or intergroup difference.
Conclusions
Exercise during chemotherapy prevents deterioration of LVEF and improve
cardiac capacity in peak VO2 in breast cancer patients. However, there are no significant effects in flexibility, muscle strength and pulmonary function.

摘要 I
ABSTRACT III
誌謝 V
ABBREVIATION VI
CHAPTER I INTRODUCTION 1
I.1 Breast cancer and chemotherapy 1
I.2 Chemotherapy-induced cardiotoxicity and risk of CVD 1
I.3 Chemotherapy and physical fitness 2
I.3.1 Body fitness 2
I.3.2 Cardiac fitness 3
I.3.3 Flexibility and muscle fitness 3
I.4 Chemotherapy and pulmonary function 4
I.5 Exercise training in breast cancer patients 4
I.6 Exercise training on chemotherapy-induced cardiotoxicity 5
I.7 Exercise training on physical fitness 5
I.7.1 Body fitness 5
I.7.2 Cardiac fitness 6
I.7.3 Flexibility and muscle fitness 6
I.8 Purpose of the study 6
CHAPTER II MATERIALS AND METHODS 8
II.1 Research design 8
II.2 Study participants 8
II.3 Procedures 9
II.4 Study protocol 9
II.4.1 Aerobic exercise training 9
II.4.2 Resistance exercise training 10
II.4.3 Flexibility exercise training 10
II.5 Assessments 10
II.5.1 Echocardiography 11
II.5.2 Cardiopulmonary exercise test (CPET) 11
II.5.3 Physical fitness 12
II.5.4 Body composition 12
II.5.5 Cardiac fitness (3-min-step test) 13
II.5.6 Flexibility fitness (Flexibility of upper and lower extremities) 13
II.5.7 Muscle fitness (Muscle strength of upper and lower extremities) 14
II.5.8 Pulmonary function and respiratory muscle strength 14
II.5.9 Attendance and adherence of exercise intervention during chemotherapy 14
II.6 Outcome measurements 15
II.7 Statistical analysis 15
CHAPTER III RESULTS 16
III.1 Demographic, clinical characteristics 16
III.2 Body composition 16
III.3 Echocardiography 17
III.4 Cardiopulmonary exercise test 17
III.5 Physical fitness 18
III.5.1 3-min-step test 18
III.5.2 Flexibility and muscle strength 19
III.6 Pulmonary function and maximal respiratory pressure 20
CHAPTER IV DISCUSSION 21
IV.1 Exercise prevented decrease in cardiac function during chemotherapy 21
IV.2 Exercise prevented reduction of cardiorespiratory fitness during chemotherapy 22
IV.3 Exercise did not prevent weight gain during chemotherapy 23
IV.4 Exercise did not improve hemodynamic responses assessed by 3-min-step test 23
IV.5 Exercise intervention was insufficient to improve flexibility 24
IV.6 Exercise intervention was insufficient to improve muscle strength 25
IV.7 Exercise intervention do not change pulmonary function 25
IV.8 Exercise was an effective strategy with high attendance and adherence to prevent chemotherapy-related side effects 26
IV.9 Limitation and contribution of this study 26
CHAPTER V CONCLUSIONS 28
CHAPTER VI REFERENCES 29
TABLES 34
FIGURES 44
APPENDICES 64

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