Benefícios e Segurança dos Exercícios Físicos em Pacientes com Metástases Ósseas: Revisão Sistemática da Literatura e Metanálise
DOI:
https://doi.org/10.32635/2176-9745.RBC.2022v68n4.2520Palavras-chave:
modalidades de fisioterapia, exercício físico, neoplasias ósseas, metástase neoplásica, ensaio clínico controlado aleatórioResumo
Introdução: A expectativa de vida de pessoas com câncer metastático está aumentando, mas esse grupo de pacientes corre um risco considerável de apresentar problemas psicológicos e de saúde física. Nesse sentido, o exercício físico tem sido um aliado no tratamento de pacientes com metástases ósseas. Objetivo: Realizar uma revisão sistemática e metanálise sobre a segurança e os benefícios do exercício físico em pacientes com metástases ósseas. Método: Metanálise com pesquisa bibliográfica realizada nas bases eletrônicas: PubMed, LILACS, PEDro e Embase. Resultados: Dos 396 estudos, somente dez foram incluídos, com um total de 531 indivíduos. Não foi observado nenhum efeito adverso musculoesquelético durante a intervenção, sendo significativamente seguro o exercício em indivíduos com metástases ósseas. Não houve melhora considerável na capacidade aeróbica, progressão da doença, qualidade de vida, massa magra e gordura corporal. Três dos estudos incluídos avaliaram a dor durante e após a intervenção, demonstrando melhora no escore de dor, assim como a diminuição do uso do analgésico no grupo intervenção. Conclusão: A terapia com exercícios aeróbicos e isométricos e segura para pacientes com metástases ósseas, além de apresentar melhora da dor, mas sem evolução relevante na capacidade aeróbica, na progressão da doença, na massa corporal e na qualidade de vida.
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Referências
Rosenberger F, Sprave T, Clauss D, et al. Spinal stabilization exercises for cancer patients with spinal metastases of high fracture risk: feasibility of the DISPO-II training program. Cancers (Basel). 2021;13(2):201. doi: https://doi.org/10.3390/cancers13020201
Postigo R. Tumores da coluna vertebral: tumores ósseos [Internet]. Curitiba (PR): AOSpine Latin America; [data desconhecida] [acesso 2021 ago 11]. Programa de formação continua AOSpine. Disponível em: https://www.aolatam.org/ftp/edudatabase/open-files/aos_da_n1m4t1_postigo_prt.pdf
Whyne CM, Hu SS, Lotz JC. Biomechanically derived guideline equations for burst fracture risk prediction in the metastatically involved spine. J Spinal Disord Tech. 2003;16(2):180-5. doi: https://doi.org/10.1097/00024720-200304000-00010
Janjan N, Lutz ST, Bedwinek JM, et al. Therapeutic guidelines for the treatment of bone metastasis: a report from the American College of Radiology Appropriateness Criteria Expert Panel on Radiation Oncology. J Palliat Med. 2009;12(5):417-26. doi: https://doi.org/10.1089/jpm.2009.9633
Abrams HL, Spiro R, Goldstein N. Metastases in carcinoma. Analysis of 1000 autopsied cases. Cancer. 1950;3(1):74-85. doi: https://doi.org/10.1002/1097-0142(1950)3:1%3C74::aid-cncr2820030111%3E3.0.co;2-7
Brown HK, Healey JH. Metastatic cancer to the bone. In: DeVita VT Jr, Hellman S, Rosenberg AS. Principles and practice of oncology. 6th ed. Vol. 1. Philadelphia: Lippincott Raven; 2001. p. 1986-97.
Cramarossa G, Chow E, Zhang L, et al. Predictive factors for overall quality of life in patients with advanced cancer. Support Care Cancer. 2013;21(6):1709-16. doi: https://doi.org/10.1007/s00520-013-1717-7
Mehnert A, Brähler E, Faller H, et al. Four-week prevalence of mental disorders in patients with cancer across major tumor entities. J Clin Oncol. 2014;32(31):3540-6. doi: https://doi.org/10.1200/JCO.2014.56.0086
Javaheri PA, Nekolaichuk C, Haennel R, et al. Feasibility of a pedometer-based walking program for survivors of breast and head and neck cancer undergoing radiation therapy. Physiother Can. 2015;67(2):205-13. doi: https://doi.org/10.3138/ptc.2014-24
Lucas C, Vidal I, Costa J, et al. Caracterização de metástases ósseas em neoplasias ocultas e neoplasias previamente diagnosticadas. Galicia Clin [Internet]. 2016 [acesso 2021 ago 16];77(4):170-2. Disponível em: https://galiciaclinica.info/PDF/38/943.pdf
Beaton R, Pagdin-Friesen W, Robertson C, et al. Effects of exercise intervention on persons with metastatic cancer: a systematic review. Physiother Can. 2009;61(3):141-53. doi: https://doi.org/10.3138/physio.61.3.141
Sheill G, Guinan EM, Peat N, et al. Considerations for exercise prescription in patients with bone metastases: a comprehensive narrative Review. PM R. 2018;10(8):843-64. doi: https://doi.org/10.1016/j.pmrj.2018.02.006
Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62(4):243-74. doi: https://doi.org/10.3322/caac.21142
Galvão DA, Taaffe DR, Spry N, et al. Exercise preserves physical function in prostate cancer patients with bone metastases. Med Sci Sports Exerc. 2018;50(3):393-9. doi: https://doi.org/10.1249/MSS.0000000000001454
Centro Cochrane do Brasil [Internet]. São Paulo: Cochrane Brazil; c2022. Como fazer uma Revisão Sistemática Cochrane; [acesso 2021 ago 11]. Disponível em: https://brazil.cochrane.org/como-fazer-uma-revis%C3%A3o-sistem%C3%A1tica-cochrane
Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi: https://doi.org/10.1371/journal.pmed.1000097
RoB 2: a revised Cochrane risk-of-bias tool for randomized trials [Internet]. London (UK): Cochrane Methods Bias. 2021 – [cited 2021 May 6]. Available from: https://methods.cochrane.org/bias/resources/rob-2-revised-cochrane-risk-bias-tool-randomized-trials
Bjerre ED, Weller S, Poulsen MH, et al. Safety and effects of football in skeletal metastatic prostate cancer: a subgroup analysis of the FC prostate community randomised controlled trial. Sports Med Open. 2021;7(1):27. doi: https://doi.org/10.1186/s40798-021-00318-6
Cormie P, Newton RU, Spry N, et al. Safety and efficacy of resistance exercise in prostate cancer patients with bone metastases. Prostate Cancer Prostatic Dis. 2013;16(4):328-35. doi: https://doi.org/10.1038/pcan.2013.22
Galvão DA, Taaffe DR, Chambers SK, et al. Exercise intervention and sexual function in advanced prostate cancer: a randomised controlled trial. BMJ Support Palliat Care. 2020;12(1):29-32. doi: https://doi.org/10.1136/bmjspcare-2020-002706
Rief H, Omlor G, Akbar M, et al. Feasibility of isometric spinal muscle training in patients with bone metastases under radiation therapy - first results of a randomized pilot trial. BMC Cancer. 2014;14:67. doi: https://doi.org/10.1186/1471-2407-14-67
Rief H, Welzel T, Omlor G, et al. Pain response of resistance training of the paravertebral musculature under radiotherapy in patients with spinal bone metastases--a randomized trial. BMC Cancer. 2014;14:485. doi: https://doi.org/10.1186/1471-2407-14-485
Rief H, Akbar M, Keller M, et al. Quality of life and fatigue of patients with spinal bone metastases under combined treatment with resistance training and radiation therapy- a randomized pilot trial. Radiat Oncol. 2014;9:151. doi: https://doi.org/10.1186/1748-717X-9-151
Rief H, Petersen LC, Omlor G, et al The effect of resistance training during radiotherapy on spinal bone metastases in cancer patients - a randomized trial. Radiother Oncol. 2014;112(1):133-9. doi: https://doi.org/10.1016/j.radonc.2014.06.008
Rief H, Bruckner T, Schlampp I, et al. Resistance training concomitant to radiotherapy of spinal bone metastases - survival and prognostic factors of a randomized trial. Radiat Oncol. 2016;11:97. doi: https://doi.org/10.1186/s13014-016-0675-x
Taneichi H, Kaneda K, Takeda N, et al. Risk factors and probability of vertebral body collapse in metastases of the thoracic and lumbar spine. Spine (Phila Pa 1976). 1997;22(3):239-45. doi: https://doi.org/10.1097/00007632-199702010-00002
Hettinger T. Isometric muscle training. 6 th ed. Landsberg am Lech (DE): Ecomed; 1994.
Nadler MB, Desnoyers A, Langelier DM, et al. The effect of exercise on quality of life, fatigue, physical function, and safety in advanced solid tumor cancers: a meta-analysis of randomized control trials. J Pain Symptom Manage. 2019;58(5):899-908. doi: https://doi.org/10.1016/j.jpainsymman.2019.07.005
Knols R, Aaronson NK, Uebelhart D, et al. Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials. J Clin Oncol. 2005;23(16):3830-42. doi: https://doi.org/10.1200/JCO.2005.02.148
Delrieu L, Jacquet E, Segura-Ferlay C, et al. Analysis of the StoRM cohort reveals physical activity to be associated with survival in metastatic breast cancer. Sci Rep. 2020;10(1):10757. doi: https://doi.org/10.1038/s41598-020-67431-6
Gunter MJ, Hoover DR, Yu H, et al. Insulin, insulin-like growth factor-I, and risk of breast cancer in postmenopausal women. J Natl Cancer Inst. 2009;101(1):48-60. doi: https://doi.org/10.1093/jnci/djn415
McTiernan A. Mechanisms linking physical activity with cancer. Nat Rev Cancer 2008;8(3):205-11. doi: https://doi.org/10.1038/nrc2325
Choudhury F, Bernstein L, Hodis HN, et al. Physical activity and sex hormone levels in estradiol- and placebo-treated postmenopausal women. Menopause. 2011;18(10):1079-86. doi: https://doi.org/10.1097/gme.0b013e318215f7bd
Oh H, Arem H, Matthews CE, et al. Sitting, physical activity, and serum oestrogen metabolism in postmenopausal women: the Women's Health Initiative observational study. Br J Cancer. 2017;117(7):1070-8. doi: https://doi.org/10.1038/bjc.2017.268
Friedenreich CM, Neilson HK, Lynch BM. State of the epidemiological evidence on physical activity and cancer prevention. Eur J Cancer. 2010;46(14):2593-604. doi: https://doi.org/10.1016/j.ejca.2010.07.028
Jones LW, Courneya KS, Mackey JR, et al. Cardiopulmonary function and age-related decline across the breast cancer survivorship continuum. J Clin Oncol. 2012;30(20):2530-7. doi: https://doi.org/10.1200/JCO.2011.39.9014
Guercio BJ, Zhang S, Ou FS, et al. Associations of physical activity with survival and progression in metastatic colorectal cancer: results from cancer and leukemia group B (Alliance)/SWOG 80405. J Clin Oncol. 2019;37(29):2620-31. doi: https://doi.org/10.1200/JCO.19.01019
Palesh O, Kamen C, Sharp S, et al. Physical activity and survival in women with advanced breast cancer. Cancer Nurs. 2018;41(4):E31-E38. doi: https://doi.org/10.1097/NCC.0000000000000525
Hayes SC, Spence RR, Galvão DA, et al. Australian Association for Exercise and Sport Science position stand: optimising cancer outcomes through exercise. J Sci Med Sport. 2009;12(4):428-34. doi: https://doi.org/10.1016/j.jsams.2009.03.002
Vina J, Sanchis-Gomar F, Martinez-Bello V, et al. Exercise acts as a drug; the pharmacological benefits of exercise. Br J Pharmacol. 2012;167(1):1-12. doi: https://doi.org/10.1111/j.1476-5381.2012.01970.x
Wilk M, Kepski J, Kepska J, et al. Exercise interventions in metastatic cancer disease: a literature review and a brief discussion on current and future perspectives. BMJ Support Palliat Care. 2020;10(40):404-10. doi: https://doi.org/10.1136/bmjspcare-2020-002487
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