体适能较佳与某些癌症及死亡风险较低有关


  【24drs.com】根据一篇新研究,男性中年时体适能较佳与后来的肺癌及大肠直肠癌风险较低有关,但是与前列腺癌无关。这篇研究也指出,中年时的体适能较佳与后来死于癌症或心血管疾病的风险较低有关。
  
  这些结果在线发表于3月26日的JAMA Oncology期刊。
  
  作者们报告指出,这篇研究首度提出,癌症诊断之后,心肺适能(CRF)可以预测某些癌症的发生率,以及死于癌症或心血管疾病的风险。
  
  第一作者、伯灵顿佛蒙特大学Susan G. Lakoski医师表示,发生癌症的男性中,中年时体适能比较良好者,死于研究探讨之三种癌症以及心血管疾病的风险较低;即使体适能只有小幅改善(大约1个代谢当量),存活率就有显著差异,癌症死亡风险降低达10%,心血管风险降低达25%。
  
  Lakoski医师解释,1个代谢当量的差异,相当于每英哩跑11.5分钟(9个代谢当量)与每英哩跑12分钟(8个代谢当量)。
  
  Lakoski医师曾经是职业运动员,对她来说,运动永远是生命中的重要部分,她透露,她的训练已经因为年龄相关的变化与工作行程而有所改变。
  
  她表示,我了解维持规律运动的重要性,我知道我的极限、知道如何根据我之前的体适能测试来督促自己,这也是我们在这篇研究中提倡的。
  
  这篇研究使用在达拉斯一间预防医学诊所进行之「Cooper Center Longitudinal Study」的资料,从1971年到2009年共包括13,949 名男性,都接受了综合体检、心血管风险评估、跑步机测试评估CRF ,参与者的平均年龄为49岁、98%是白人。
  
  研究者使用1999-2009年的Medicare保户资料评估65岁以上者的肺癌、前列腺癌与大肠直肠癌诊断,在6.5年的追踪期间,1,310名男性发生前列腺癌、200人发生肺癌、181人发生大肠直肠癌。
  
  这篇研究指出,相较于CRF低者,中年时的CRF高者,肺癌风险降低55%(校正风险比([HR])为0.45;95%信赖区间([CI])为0.29-0.68),大肠直肠癌风险降低44%(校正HR,0.56;95% CI,0.36- 0.87);至于前列腺癌则未显示有关联(校正HR,1.22;95% CI,1.02-1.46;P= .0004)。
  
  Lakoski医师解释,体适能和前列腺癌风险之间的关联是有争议的,体适能较佳的男性比较可能进行更频繁的预防性健康照护筛检以及/或检测门诊,有比较多的机会比CRF较低的男性诊断出局部前列腺癌。
  
  不过,发生前列腺癌的男性中,如果他们诊断前的体适能程度较佳,死于癌症或心血管疾病的风险较低。
  
  Lakoski医师表示,这代表,即便男性在老年时发生肺癌、前列腺癌或大肠直肠癌,中年时维持体适能对于改善存活是相当重要的。
  
  此外,相较于CRF较差者,中年时的CRF较佳与65岁以上、发生肺癌、前列腺癌或大肠直肠癌男性的各种癌症相关死亡降低32%有关(校正HR,0.68;95% CI,0.47- 0.98)。CRF较佳与癌症诊断之后死于心血管疾病的风险降低68%有关(校正HR,0.32;95% CI,0.16- 0.64)。
  
  研究限制包括,无法评估抽菸菸龄与量、癌症分期、从最初的健康筛检到癌症诊断时的CRF变化,研究结果限于参与研究者与具有Medicare者。
  
  Lakoski医师报告指出,我们并未掌握每个参与者的运动资料,不过,我们都知道增加运动强度与时间可以改善体适能,病患应询问他们的医师,多少运动量对他们是适当的,这是关键的第一步。
  
  她强调,我们认为体适能测试是一个客观的指标,有助于医师就此议题与病患谘商。这些结果支持我们在预防性健康照护范围、或在癌症诊断之后利用CRF评估。
  
  她结论表示,需要后续研究探讨这些结果,分析男性与女性的各种癌症,探讨个人的体适能程度应改善多少才可以看到癌症预防效果。
  
  资料来源:http://www.24drs.com/
  
  Native link:Higher Fitness Levels Linked to Lower Risk of Some Cancers and Death

Higher Fitness Levels Linked to Lower Risk of Some Cancers and Death

By Veronica Hackethal, MD
Medscape Medical News

Higher fitness levels among middle-aged men might be associated with a lower risk for later lung and colorectal cancer, but not prostate cancer, according to a new study. The study also linked higher fitness levels in midlife to a lower risk for later death from cancer or cardiovascular disease.

The findings were published online March 26 in JAMA Oncology.

This study is the first to show that cardiorespiratory fitness (CRF) predicts the incidence of certain types of cancer and the risk for death from cancer or cardiovascular disease after being diagnosed with cancer, the authors report.

"Among the men who developed cancer, those who were more fit at middle age had a lower risk of dying from all three cancers studied, as well as from cardiovascular disease," said first author Susan G. Lakoski, MD, MS, from the University of Vermont in Burlington.

"Even a small improvement in fitness (by 1-MET) made a significant difference in survival, reducing the risk of dying from cancer by 10% and from cardiovascular disease by 25%," she told Medscape Medical News.

A 1-MET difference equates to the difference between running an 11.5-minute mile (9 METS) and a 12.0-minute mile (8 METS), Dr Lakoski explained.

Dr Lakoski, a former professional athlete for whom training has "always been an important part of my life," revealed that her training has evolved over the years because of age-related changes and work schedules.

"I understand the importance of staying committed to a regular exercise routine," she said, "I know my limits and how hard to push myself based on my prior fitness testing, which we advocate for in this study."

The study used information from the Cooper Center Longitudinal Study, which was conducted at a preventive medicine clinic in Dallas. It involved 13,949 men who underwent comprehensive medical examination, cardiovascular risk assessment, and treadmill testing to evaluate CRF from 1971 to 2009. The mean age of the participants was 49 years, and 98% of the cohort was white.

The researchers used Medicare claims data from 1999 to 2009 to assess lung, prostate, and colorectal cancer diagnosed in people 65 years and older.

Over a follow-up period of 6.5 years, 1310 men developed prostate cancer, 200 developed lung cancer, and 181 developed colorectal cancer.

The study revealed that a high CRF in midlife, compared with a low CRF, led to a 55% reduction in lung cancer (adjusted hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.29- 0.68) and a 44% reduction in colorectal cancer (adjusted HR, 0.56; 95% CI, 0.36- 0.87). This association did not apply to prostate cancer (adjusted HR, 1.22; 95% CI, 1.02- 1.46; P= .0004).

"The relations between fitness and prostate cancer risk is controversial," Dr Lakoski explained. "It is possible that men with higher CRF are more likely to undergo more frequent preventive healthcare screening and/or detection visits, and have a greater opportunity to be diagnosed with localized prostate cancer than men with lower CRF."

However, men who developed prostate cancer had a lower risk of ultimately dying from cancer or cardiovascular disease if they had higher fitness levels before diagnosis, she pointed out.

This speaks to the importance of being fit in mid-life.

"This speaks to the importance of being fit in mid-life to improve survival, even if a man ultimately develops lung, prostate, or colorectal cancer later in life," Dr Lakoski continued.

In addition, a high CRF in midlife, compared with a low CRF, was associated with a 32% reduction in all cancer-related death in men 65 years and older who developed lung, colorectal, or prostate cancer (adjusted HR, 0.68; 95% CI, 0.47- 0.98). And a high CRF was associated with a 68% reduction in death from cardiovascular disease after receiving a cancer diagnosis (adjusted HR, 0.32; 95% CI, 0.16- 0.64).

Study limitations include the inability to assess the length and intensity of smoking, cancer stage, changes in CRF from the initial health screening to cancer diagnosis, and outcomes that occurred between study entry and Medicare eligibility.

"We did not capture the individual workouts of each participant," Dr Lakoski reported. "However, it is known that increasing both the intensity and duration of exercise improves fitness levels. Patients should talk to their physician about what amount of exercise is right for them to start with. This is the key first step."

"We propose that fitness testing is an objective guide to help physicians counsel their patients on this topic," she emphasized. "These findings provide support for the utility of CRF assessment in preventive healthcare settings, and possibly following a diagnosis of cancer."

"Future studies are needed to test these results across all major cancers in men and women, and to address how much an individual must change their fitness to see cancer prevention benefit," she concluded.

Dr Lakoski reports receiving partial funding from the National Institute of General Medical Sciences/National Institute of Health. Dr Jones reports receiving research grants from the National Cancer Institute.

JAMA Oncol. Published online March26, 2015.

    
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