PDF(Pubmed)
Abstract：
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.
摘要：
肥胖的乳腺癌幸存者有很高的癌症复发风险，合并症，和死亡率。本文旨在系统评价有氧和抗阻联合训练（CART）对身体成分的影响。脂质稳态，炎症,脂肪因子,癌症相关的疲劳，睡眠,乳腺癌患者和超重/肥胖幸存者的生活质量。在PubMed进行了电子搜索，WebofScience,Scopus,科学直接，科克伦,和谷歌学术数据库从成立到2024年1月8日。选择符合纳入标准的随机对照试验(RCTs)进行分析。Cochrane偏倚风险工具用于评估符合条件的研究，并采用GRADE法对证据质量进行评价。使用了随机效应模型，数据采用95%置信区间(CI)的连续变量均值(MD)和标准化均值差(SMD)进行分析.我们评估了数据的偏倚风险，异质性，灵敏度,报告偏见，和证据的质量。共有17项随机对照试验纳入系统评价，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显著改善（SMD-0.57kg/m2，p=0.04），身体脂肪(SMD-0.50%，p=0.02),脂肪质量(SMD-0.63kg，p=0.04),臀围（MD-3.14cm，p=0.02),和无脂质量(SMD1.03千克，p<0.001)。次要结果提示高密度脂蛋白胆固醇显著升高（MD-0.05mmol/L，p=0.008),自然杀伤细胞(SMD0.42%，p=0.04),甘油三酯的降低（MD-81.90mg/dL，p<0.01),总胆固醇（SMD-0.95mmol/L，p<0.01),肿瘤坏死因子α（SMD-0.89pg/mL，p=0.03),和瘦素（SMD-0.63ng/mL，p=0.03)。此外，在癌症相关性疲劳中发现了有益的改变（SMD-0.98，p=0.03），睡眠（SMD-1.17，p<0.001），和生活质量（SMD2.94，p=0.02）评分。对大多数结果的估计效果的置信度非常低。目前的发现表明，CART可以被认为是支持运动后观察到的常规临床方法的辅助疗法。然而,对于超重/肥胖的乳腺癌患者,CART是否是降低积极药物使用的有价值的干预措施,还需要进一步的高质量研究.
