【medical-news】【资讯翻译】体育锻炼可减少芳香酶..._蛋白酶类_酶_蛋白类_知道

Exercise Program Reduces Aromatase Inhibitor–Associated Joint Pain
运动锻炼能够降低芳香化酶抑制剂引起的关节痛

Amid studies of novel targeted therapies, genetic analyses of tumors, and new ways to approach the treatment of breast cancer, a low-tech study presented at the 2013 San Antonio Breast Cancer Symposium found that a yearlong exercise program reduced joint pain associated with aromatase inhibitors in breast cancer survivors.1 This is the first study to examine the impact of exercise vs usual care on the side effects of aromatase inhibitors.
在2013年圣安东尼奥乳腺癌研讨大会上，科研人员公布了一系列的研究成果，诸如新靶点疗法、肿瘤遗传学分析、乳腺癌治疗新途径等，而在这些研究中还包含一项科技含量不那么高的科研发现，即研究发现为期一年的运动项目能够缓解乳腺癌存活者因使用芳香化酶抑制剂而引发的关节痛。这是首次将运动与常规护理进行比较，来检测它们对于芳香化酶抑制剂引起的副作用的影响。

The finding that exercise reduces joint pain could improve adherence to aromatase inhibitor therapy, improve quality of life, and reduce breast cancer recurrence and mortality risk, said the authors.
研究发现运动能够缓解关节痛，这也许能够提高芳香化酶抑制剂疗法的依从性，提高生活质量，降低乳腺癌的复发和死亡风险，作者说道。

Poor Adherence Common
依从性普遍偏低

“[Aromatase inhibitors] are standard of care for hormone receptor–positive breast cancer, but numerous studies show that the side effects lead to poor adherence and drug discontinuation. Approximately 20% of women discontinue [aromatase inhibitors], and 40% don’t take the medications as prescribed. Arthralgias are reported in up to 50% of women within 6 months of starting [aromatase inhibitor] therapy,” said lead author Melinda L. Irwin, PhD, MPH, Associate Professor at the Yale School of Public Health and Co-Leader of Cancer Prevention and Control at the Yale Cancer Center, New Haven, Connecticut. “Many women report joint pain before starting an [aromatase inhibitor], and the pain gets worse [while they’re on the aromatase inhibitor],” she added.
“芳香化酶抑制剂是激素受体阳性乳腺癌的标准治疗药物，但是大量的研究表明由于副作用，药物依从性较差并常出现停药现象。大约有20%的女性停止服用芳香化酶抑制剂，有40%则未按照医嘱服药。在服用芳香化酶抑制剂6个月里，有高达50%的女性声称受到关节痛的困扰。”来自耶鲁大学（康涅狄格州，纽黑文）公共健康学院的副教授、耶鲁癌症中心癌症预防与控制项目共同负责人，该文章的第一作者Melinda L. Irwin（博士，公共卫生学硕士）说道。“也有很多女性声称，服用芳香化酶抑制剂会加重原有的关节痛症状。”她补充道。

“Our study showed that the better the adherence to exercise, the less joint pain the person experienced. The more research findings we have, the more likely clinicians will be to refer patients to exercise,” Dr. Irwin added.
Irwin博士继续说到，“我们的研究表明越是坚持体育锻炼，患者的关节疼痛症状就会越轻。我们研究的越充分，医师就更加愿意指导患者进行运动治疗。”

“We’ve known for a long time that exercise is beneficial in breast cancer survivors, yet there aren’t many programs that patients can be referred to. Most medical oncologists haven’t focused on prescribing or recommending exercise, and the overall prevalence of exercise, especially strength-training, is low in breast cancer survivors,” stated co-author Jennifer A. Ligibel, MD, Assistant Professor of Medicine, Harvard Medical School and Dana-Farber Cancer Center.
“我们很久以前就知道运动对于乳腺癌存活者十分有益，然而对于患者而言，没有太多的项目让他们去参与。大多数的肿瘤医生对于医嘱或推荐运动锻炼并不十分在意，这样一来，乳腺癌存活者总体锻炼普及水平，尤其是力量训练的普及水平，比较低，”该文章的共同作者Jennifer A. Ligibel博士（MD）说道，她现在是哈佛医学院和Dana-Farber癌症中心的医学助理教授。

Study Details
研究细节

The HOPE study enrolled 121 women with stage I to IIIC hormone receptor–positive breast cancer who were taking aromatase inhibitors for an average of 1.5 years and experiencing at least mild arthralgias. Women were randomly assigned to a yearlong program of exercise or usual care. The exercise program, based upon the standard exercise recommendations from the U.S. Surgeon General, entailed twice-weekly supervised sessions that included six common strength-training exercises and 2.5 hours per week of moderate-intensity aerobic exercise. Patients assigned to usual care were provided with written information and physical activity recommendations and monitored with monthly phone calls to assess aromatase inhibitor adherence. Usual care patients were also offered a visit with an exercise trainer at the end of the study.
在HOPE研究中，共招募了121名患有Ⅰ到ⅢC激素受体阳性乳腺癌的女性，平均1.5年芳香化酶抑制剂的药用史，并均患有轻度及以上的关节痛。受试者被随机分为一年期运动锻炼组和常规护理组两组。锻炼项目是基于美国公共卫生署推荐的标准运动项目设计的，即在监督下每周进行两次6种常见的力量训练锻炼和每周2.5小时的中等强度的有氧运动。对于常规护理组的受试者，则提供书面资料和身体锻炼的建议，并通过每月的电话联系监测评估芳香化酶抑制剂的依从性。在实验结束时，会安排常规护理组受试者与运动教练进行一次会面。

Pain was measured on the Brief Pain Inventory (BPI) scale of 0 to 10, where a score of 3 to 4 signified mild pain; 5 to 7, moderate pain; and 8 to 10, severe pain, with 10 signifying the most severe pain. Women entering the study had a mean BPI score of 6.
疼痛级别按照简明疼痛量表（BPI）分为0~10级进行测量，3~4分为轻度疼痛，5~7为中度疼痛，8~10为重度疼痛，10代表了最为严重的疼痛。参与研究的受试者BPI的平均分为6。

Women assigned to exercise were able to increase their exercise by about 110 minutes per week compared with the usual care group (P = .0001). Seventy percent of women assigned to the exercise program attended all of the twice-weekly strength-training sessions. Patients in the exercise program significantly increased their cardiorespiratory fitness (P = .0013) and reduced their body weight (P = .026) compared with those receiving usual care.
与常规护理组相比，运动组中的受试女性每周运动锻炼时间能多出110分钟（p=0.0001）。运动组中70%的受试者能够参加所有的每周2次的力量训练项目。与常规护理组相比，运动组的受试者的心肺健康显著提高（p=0.0013），而体重也明显下降（p=0.026）。

Over 12 months, patients assigned to exercise experienced a 30% decrease in worst pain, a 20% decrease in pain severity, and a 20% decrease in the amount of interference pain caused in daily activities, whereas those assigned to usual care experience about a 5% increase in these three parameters (P < .05 for all three comparisons).
12过后，运动组的受试者中，最严重疼痛减少了30%，严重疼痛减少了20%，而有日常活动引起的干扰性疼痛发生率也降低了20%，与此相比，日常护理组的这三项指标都有约5%的上升（三项指标相比p值皆小于0.05

Dose-Response Relationship
量效关系
Morever, a dose-response relationship was seen with exercise. That is, the more adherent patients had more improvement in joint pain.
此外，运动锻炼存在着量效关系，即受试者依从度越高，关节痛缓解的效果就越好。

“Even some exercise improved outcomes,” Dr. Irwin pointed out. “Women assigned to exercise who only adhered some of the time experienced a 15% improvement in joint pain. Exercise makes activities easier to perform, and therefore people experience less pain,” she said.
“甚至有些运动能够改善结局，”Irwin博士指出，“有的运动组的受试者仅仅参加部分时间段的锻炼，关节痛的缓解率也提高了15%。运动锻炼能使得活动进行越容易，因此受试者经受的疼痛也就越少。”

“Exercise has the potential to improve [aromatase inhibitor] adherence and quality of life. Improvement in joint pain with exercise in this study has been shown to be better than with glucosamine, vitamin D, and acupuncture in other studies,” Dr. Irwin said.
运动锻炼能潜在的提高芳香化酶抑制剂的依从性并提高生活质量。该研究表明使用运动缓解关节痛的效果，比起其他研究使用的葡萄糖胺，维生素D，针灸等疗法的效果要更好。

The study was based on women who had free gym memberships, which made it easier for them to participate. Only five women dropped out of the exercise program. Dr. Irwin noted that there are a growing number of free exercise programs for cancer survivors, but these are typically available in larger cities and metropolitan areas.
该研究中的参与女性都拥有免费的健身馆会员资格，这样使她们更容易参与其中。只有5名女性中途退出运动项目。Irwin博士指出，尽管现在针对癌症存活者的免费运动项目越来越多，但主要都集中在大城市或大都市地区。

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【medical-news】【资讯翻译】体育锻炼可减少芳香酶...