癌症患者化疗期间运动干预焦虑和抑郁状态效果的Meta分析

doi:10.3969/j.issn.1006-9771.2025.02.008

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (2): 184-193.doi: 10.3969/j.issn.1006-9771.2025.02.008

癌症患者化疗期间运动干预焦虑和抑郁状态效果的Meta分析

杨益成¹, 王丹丹², 沈群策³, 张磊¹, 吴雪萍¹()

1.上海体育大学体育教育学院，上海市 200438
2.上海理工大学体育教学部，上海市200093
3.广东碧桂园学校，广东佛山市 528312

收稿日期:2024-10-23 修回日期:2024-12-20 出版日期:2025-02-25 发布日期:2025-02-25
通讯作者: 吴雪萍(1972-)，女，汉族，广东东莞市人，教授，博士研究生导师，主要研究方向：适应体育理论与实践，E-mail： wuxueping@sus.edu.cn。
作者简介:杨益成(2002-)，女，汉族，江西宜春市人，硕士研究生，主要研究方向：适应体育理论与实践。
基金资助:
上海市海外高层次人才项目(TP2020063)

Effect of exercise on cancer patients with anxiety and depression during chemotherapy: a meta-analysis

YANG Yicheng¹, WANG Dandan², SHEN Qunce³, ZHANG Lei¹, WU Xueping¹()

1. School of Physical Education, Shanghai University of Sport, Shanghai 200438, China
2. Department of Physical Education, University of Shanghai for Science and Technology, Shanghai 200093, China
3. Guangdong Country Garden School, Foshan, Guangdong 528312, China

Received:2024-10-23 Revised:2024-12-20 Published:2025-02-25 Online:2025-02-25
Contact: WU Xueping, E-mail: wuxueping@sus.edu.cn
Supported by:
Shanghai Overseas High-level Talent Program(TP2020063)

摘要/Abstract

摘要：

目的探讨运动干预对化疗期间癌症患者焦虑和抑郁状态的改善效果和最佳运动剂量。

方法构建PICO架构，系统检索PubMed、Web of Science、The Cochrane Library、Embase、Medline、中国知网、维普和万方数据库，纳入有关运动干预对化疗期间癌症患者焦虑和抑郁状态影响的随机对照试验。检索时限建库至2023年11月。采用Cochrane偏倚风险评估工具和物理治疗证据数据库(PEDro)量表对纳入文献进行质量评价，采用Rev Man5.3进行数据合并和分析，采用Stata 18.0进行偏倚风险评估。

结果最终纳入13篇随机对照试验，涉及1 340例患者。PEDro量表评分5~8分。运动干预对化疗期间癌症患者的焦虑(SMD = -0.70, 95%CI -1.18~-0.22, P = 0.004)和抑郁(SMD = -0.89, 95%CI -1.43~-0.34, P = 0.002)状态的改善效果均显著优于对照组。亚组分析发现，改善焦虑状态的最佳运动剂量为每次≤ 45 min (SMD = -0.26, 95%CI -0.46~-0.05, P = 0.01)，每周≥ 3次(SMD = -0.26, 95%CI -0.46~-0.05, P = 0.01)，干预周期≤ 12周(SMD = -0.21, 95%CI -0.36~-0.07, P = 0.005)；改善抑郁状态的最佳运动剂量为单次运动时长≤ 45 min (SMD = -0.69, 95%CI -1.29~-0.08, P = 0.03)，每周≥ 3次(SMD = -0.69, 95%CI -1.29~-0.08, P = 0.03)，干预周期≤ 12周(SMD = -0.52, 95%CI -0.92~-0.13, P = 0.01)。中高强度的运动干预对焦虑(SMD = -0.21, 95%CI -0.37~-0.06, P = 0.007)和抑郁(SMD = -0.21, 95%CI -0.41~-0.01, P = 0.04)状态的改善效果显著优于对照组。

结论运动干预能有效改善化疗期间癌症患者的焦虑和抑郁状态，推荐中高强度运动，每次≤ 45 min，每周≥ 3次，不超过12周。

关键词: 癌症, 化疗, 焦虑, 抑郁, 运动干预, Meta分析

Abstract:

Objective To explore the effect of exercise on anxiety and depression in cancer patients during chemotherapy, as well as the optimal exercise dosage.

Methods A PICO framework was constructed, and randomized controlled trials (RCTs) on the effect of exercise on anxiety and depression in cancer patients during chemotherapy were retrieved from databases of PubMed, Web of Science, Cochrane Library, Embase, Medline, CNKI, VIP and Wanfang data, from the establishment to November, 2023. The quality of the literature was evaluated with Cochrane Risk of Bias Tool and Physiotherapy Evidence Database (PEDro) scale. Data were synthesized and analyzed using RevMan 5.3, and the risk of bias was evaluated using Stata 18.0.

Results A total of 13 RCTs involving 1 340 subjects were included. The scores of PEDro scale were five to eight. Exercise interventions significantly improved anxiety (SMD = -0.70, 95%CI -1.18 to -0.22, P= 0.004) and depression (SMD = -0.89, 95%CI -1.43 to -0.34, P= 0.002) compared to the control group. Subgroup analyses showed that, the exercise effect on anxiety was less than 45 minutes a time (SMD = -0.26, 95%CI -0.46 to -0.05, P= 0.01), more than three times a week (SMD = -0.26, 95%CI -0.46 to -0.05, P= 0.01), and less than twelve weeks (SMD = -0.21, 95%CI -0.36 to -0.07, P= 0.005). For depression, it was less than 45 minutes a time (SMD = -0.69, 95%CI -1.29 to -0.08, P= 0.03), more than three times a week (SMD = -0.69, 95%CI -1.29 to -0.08, P= 0.03), and less than twelve weeks (SMD = -0.52, 95%CI -0.92 to -0.13, P= 0.01). Moderate to high-intensity exercise interventions significantly outperformed the control group in improving anxiety (SMD = -0.21, 95%CI -0.37 to -0.06, P= 0.007) and depression (SMD = -0.21, 95%CI -0.41 to -0.01, P= 0.04).

Conclusion Exercise interventions can effectively improve anxiety and depression in cancer patients during chemotherapy, and it suggests for high-intensity exercise, less than 45 minutes a time, more than three times a week, and less than twelve weeks.

Key words: cancer, chemotherapy, anxiety, depression, exercise intervention, meta-analysis

中图分类号:

R730.9

杨益成, 王丹丹, 沈群策, 张磊, 吴雪萍. 癌症患者化疗期间运动干预焦虑和抑郁状态效果的Meta分析[J]. 《中国康复理论与实践》, 2025, 31(2): 184-193.

YANG Yicheng, WANG Dandan, SHEN Qunce, ZHANG Lei, WU Xueping. Effect of exercise on cancer patients with anxiety and depression during chemotherapy: a meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(2): 184-193.

图/表 8

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纳入文献基本情况"

纳入文献	国家	样本量/n		年龄/岁	癌症类型	干预人员	干预场所	试验组干预方案		结局指标	测量工具
纳入文献	国家	T	C	年龄/岁	癌症类型	干预人员	干预场所	干预措施	干预剂量	结局指标	测量工具
Gokal等^[19] (2016)	英国	25	25	18~75	乳腺癌	医生	医院	中等强度步行	每次10~30 min，每周5次，共12周	焦虑和抑郁状态	HADS
Loh等^[38] (2019)	美国	130	122	≥ 60	混合癌症	研究员	社区癌症中心	中高强度有氧和阻力练习	每次22 min，每周3次，共6周	焦虑状态	STAI
Travier等^[39](2015)	荷兰	87	77	25~75	乳腺癌	医生	医院	有氧和力量练习	每次60 min，每周2次，共18周	焦虑和抑郁状态	HADS
Quist等^[40] (2020)	丹麦	66	67	> 18	肺癌	医生	医院	中高强度有氧和力量练习	每次90 min，每周2次，共12周	焦虑和抑郁状态	HADS
Wei等^[41] (2022)	中国	32	35	40~75	乳腺癌	医生	医院	八段锦	每次30 min，每周5次，共12周	焦虑和抑郁状态	HADS
Rehman等^[42](2023)	巴基斯坦	20	20	20~55	肺癌	医生	医院	有氧练习	每次30 min，每周5次，共4周	焦虑和抑郁状态	HADS
Midtgaard等^[43](2011)	丹麦	106	103	18~65	混合癌症	医生	医院	高强度阻力和放松练习	每周9 h，共6周	焦虑和抑郁状态	HADS
Van Vulpen等^[44] (2016)	荷兰	15	13	25~75	结肠癌	医生	医院	有氧和力量练习	每次60 min，每周2次，共18周	焦虑和抑郁状态	HADS
Lanctôt等^[45](2016)	加拿大	54	38	≥ 18	乳腺癌	医生	医院	瑜伽	每次90 min，每周8次，共8周	焦虑和抑郁状态	STAI，BDI-II
Salchow等^[46](2021)	德国	16	14	≥ 18	乳腺癌	研究员	运动康复学院	Kyusho武术	每次90 min，每周2次，共24周	焦虑和抑郁状态	HADS
Mostafaei等^[47](2021)	伊朗	30	30	18~54	乳腺癌	医生	医院	抗阻和平衡练习	每次30 min，每周3次，共6周	抑郁状态	BDI-II
Yang等^[48] (2021)	中国	40	40	18~75	胃肠道癌	医生	医院	五禽戏-猿戏	每次15~18 min，每周5次，共4周	抑郁状态	SDS
乔晓丽等^[49](2021)	中国	68	67	18~65	妇科癌症^a	医生	医院	步行和爬楼梯	每次60~80 min，每周2~5次，共24周	焦虑状态	SAS

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人群(Population)	干预(Intervention)	比较(Comparison)	结局(Outcome)
癌症患者	干预场所	化疗过程中的运动干预和常规化疗的比较	焦虑和抑郁状态
2B51.Y其他特指部位骨和关节软骨骨肉瘤	医院		6A73混合性抑郁焦虑障碍
2C84其他特指的男性生殖器官恶性肿瘤	康复服务中心		b152情感功能
2D4Z未特指部位的未特指的恶性肿瘤	干预人员		焦虑状态
QC61.Z未特指的恶性肿瘤家族史	医生		6E63继发性焦虑综合征
化疗期间	康复治疗师		6B0Z未特指的焦虑或恐惧相关性障碍
QB97肿瘤的化学治疗疗程	干预措施		抑郁状态
年龄≥ 18岁	运动干预		6A7Z未特指的抑郁障碍
	干预剂量		6A7Y其他特指的抑郁障碍
	运动周期		MB24.5抑郁心境
	运动频率
	单次运动时长
	运动强度

纳入文献	受试者纳入条件	随机分配	分配隐藏	基线相似	治疗师施盲	结果评估施盲	参与率> 85%	意向治疗分析	组间统计结果分析	点测量和差异值	总分
Gokal等^[19](2016)	√			√			√	√	√	√	5
Loh等^[38](2019)	√	√	√	√			√	√	√	√	7
Travier等^[39](2015)	√	√	√	√		√	√	√	√	√	8
Quist等^[40](2020)	√	√		√			√	√	√	√	6
Wei等^[41](2022)	√	√	√	√		√	√	√	√	√	8
Rehman等^[42](2023)	√	√	√	√	√		√	√	√	√	8
Midtgaard等^[43](2011)	√	√	√	√				√	√	√	6
Van Vulpen等^[44](2016)	√	√	√			√		√	√	√	6
Lanctôt等^[45](2016)	√	√	√	√				√	√	√	6
Salchow等^[46](2021)	√	√	√				√	√	√	√	6
Mostafaei等^[47](2021)	√	√	√	√			√	√	√	√	7
Yang等^[48](2021)	√	√	√	√			√	√	√	√	7
乔晓丽等^[49](2021)	√	√		√			√	√	√	√	6

结局指标	纳入研究数/n	异质性检验结果		效应模型	Meta分析结果
结局指标	纳入研究数/n	P值	I²	效应模型	SMD(95%CI)	P值
焦虑状态	11^{[19,38⇓⇓⇓⇓⇓⇓⇓- 46,49]}	< 0.001	93%	随机	-0.70(-1.18~-0.22)	0.004
抑郁状态	11^{[19,39⇓⇓⇓⇓⇓⇓⇓⇓-48]}	< 0.001	93%	随机	-0.89(-1.43~-0.34)	0.002

亚组		焦虑状态					抑郁状态
亚组		纳入研究数/n	SMD(95%CI)	Z值	P值	I²值	纳入研究数/n	SMD(95%CI)	Z值	P值	I²值
单次运动时长	每次≤ 45 min	3	-0.26(-0.46~-0.05)	2.46	0.01	0%	4	-0.69(-1.29~-0.08)	2.24	0.03	82%
单次运动时长	每次> 45 min	5	-0.35(-1.07~0.37)	0.96	0.34	93%	4	-0.21(-0.42~-0.00)	2.00	0.05	0%
运动频次	< 3次/周	4	-0.03(-0.29~0.24)	0.19	0.85	28%	4	-0.21(-0.42~-0.00)	2.00	0.05	0%
运动频次	≥ 3次/周	3	-0.26(-0.46~-0.05)	2.46	0.01	0%	4	-0.69(-1.29~-0.08)	2.24	0.03	82%
运动周期	≤ 12周	5	-0.21(-0.36~-0.07)	2.83	0.005	0%	6	-0.52(-0.92~-0.13)	2.59	0.01	81%
运动周期	> 12周	4	-0.37(-1.39~0.65)	0.71	0.48	94%	3	-0.11(-0.38~0.15)	0.84	0.40	0%
运动强度	中高强度	4	-0.21(-0.37~-0.06)	2.69	0.007	0%	3	-0.21(-0.41~-0.01)	2.07	0.04	0%

癌症患者化疗期间运动干预焦虑和抑郁状态效果的Meta分析

Effect of exercise on cancer patients with anxiety and depression during chemotherapy: a meta-analysis

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