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研究生： 蔡瑋明
Tsai, Wei-Ming
論文名稱： 運動介入對頭頸癌患者化療造成的副作用之影響:運動反應的影響
Effects of Exercise Intervention on Chemotherapy Induced Side-effects in Patients with Head and Neck Cancer: Focus on Exercise Response
指導教授： 蔡昆霖
Tsai, Kun-Ling
學位類別： 碩士
Master
系所名稱： 醫學院 - 物理治療學系
Department of Physical Therapy
論文出版年： 2017
畢業學年度： 105
語文別： 英文
論文頁數： 115
中文關鍵詞： 頭部和頸部癌症 、運動訓練 、心肺耐力 、運動反應
外文關鍵詞： Head and Neck Cancer, Exercise Training, Cardiopulmonary Endurance, Exercise Response
相關次數： 點閱：118  下載：6 
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    • 背景與目的:在全球日前以癌症疾病為最主要導致死亡原因，在台灣前10大死因中第一名是惡性腫瘤已經危害國人健康有35年以上。在男女比例中男性佔為居多，且在口腔癌為多，在近年來研究發現，許多化療藥物會對癌症患者產生需多副作用及併發症尤其是在心臟功損傷為最多案例。
    本研究擬探討運動治療的介入，是否可以改善接受化療的頭頸癌患者減緩或降低化療造成的副作用，以建議癌症的患者可以從事適量的運動，以幫助患者的復原心肺功能的效果。
    研究方法:對七十二名頭頸癌患者。分為38位坐式生活型態組(sedentary group)和34位運動組(Exercise group)，而運動組以60%~70%最大心跳率之運動強度於跑步機上進行訓練，接受運動訓練，每週3天，運動30分，訓練8周。坐式生活型態組(sedentary group)只有一般衛教。訓練前、訓練結束後量測 心跳、血壓、心肌耗氧量、六分鐘行走距離以評估心肺反應。
    結果:經過八周運動訓練後，運動組在心跳、血壓、心肌耗氧量、六分鐘行走距離，比坐式生活型態組有明顯改善(p ＜0.05)。坐式生活型態組(sedentary group) 心跳、血壓、心肌耗氧量皆有明顯提高和六分鐘行走距離都有明顯下降。
    結論:相較於運動組的受試者，運動訓練後都有明顯改善心臟功能。本實驗發現，運動可以增加有接受化療的頭頸癌患者的心肺耐力。

    Background and purpose: In a world, the most common cause of death is cancer. In Taiwan, among the top 10 causes of death in the past 35 years has been the first malignant tumor, and cancer has become a severe threat to human health. Men have been shown to account for the majority of oral cancers. In recent years, studies have found that many chemotherapy drugs will produce multiple side effects and complications in cancer patients, especially in the case of cardiovascular disease. This study was intended to investigate whether an exercise training intervention could improve the prognosis of patients with head and neck cancer who have undergone chemotherapy. It is suggested that cancer patients can engage in moderate exercise training to help them recover their cardiopulmonary function.
    Methods: Seventy-two head and neck cancer patients were assigned to either a sedentary group or exercise group. The exercise group was trained on a treadmill 3 days/week at 60%~70% maximal heart rate for 8 weeks. The sedentary group received only a general health education. The data were collected pre-training and post-training, where the heart rate, blood pressure, MVO2, and the six-minute walking distance were measured.
    Results: In the exercise group, the heart rate, blood pressure, MVO2, and six minutes walking distance was better than the sedentary group. In the sedentary group, heart rate, blood pressure, and MVO2 were significantly increased, and the six-minute walking distance was significantly decreased.
    Conclusions: Compared with the sedentary group, exercise training significantly improved cardiac function. These findings suggested that exercise can help to promote cardiopulmonary endurance for head and neck cancer patients undergoing chemotherapy.

    ABSTRACT I 摘要 II 致謝 XI ABBREVIATION XIII CHAPTER I INTRODUCTION 1 1.1 PREVALENCE OF CANCER 1 1.2 CHEMOTHERAPY INDUCES HUMAN SYSTEMIC SIDE EFFECTS 3 1.3 CHEMOTHERAPY INDUCES CARDIOTOXICITY 5 1.4 THE EFFECT OF EXERCISE ON THE HUMAN PHYSIOLOGICAL SYSTEM 6 1.5 THE EFFECT OF EXERCISE ON CANCER PATIENTS 7 CHAPTER II MATERIALS AND METHODS 11 2.1 STUDY DESIGN 11 2.2 STUDY PARTICIPANTS 11 2.3 PROCEDURE 12 2.4 INSTRUMENTS 13 2.5 FUNCTIONAL CAPACITY - SIX-MINUTE WALK TEST 14 2.6 STUDY PROTOCOL FOR THE EXERCISE GROUP 15 2.6.1 Aerobic exercise training 15 2.6.2 Resistance exercise training 16 2.7 STATISTICAL ANALYSIS 16 CHAPTER III RESULTS 17 3.1 BASIC CHARACTERISTICS AND BODY COMPOSITION OF THE SEDENTARY GROUP AND EXERCISE GROUP AT BASELINE 17 3.2 CANCER TYPES AND CANCER METASTASIS FOR THE HEAD AND NECK CANCER PATIENT 18 3.3 MEDICINE BEING TAKEN BY THE HEAD AND NECK CANCER PATIENTS 18 3.4 SIX-MINUTE WALK TEST 19 3.4.1 Blood pressure (SBP, DBP mean arterial pressure; MAP) in sedentary and exercise groups 19 3.4.2 Heart rate (rest, peak, rest 1and 3minute, recovery ) in the sedentary and exercise groups 20 3.4.3 Oxygen Saturation ;SpO2 (resting, peak, resting 1 and 3 minutes) in the sedentary and exercise groups 21 3.4.4 Rate of Perceived Exertion; RPE (resting, peak, resting 1and 3 minutes) in sedentary and exercise groups 21 3.4.5 Distance in sedentary and exercise groups 22 3.4.6 Myocardial Oxygen Consumption; MVO2 (resting, peak, resting 1 and 3 minutes) in sedentary and exercise groups 22 3.4.7 Blood pressure (SBP, DBP and MAP) in the exercise group 23 3.4.8 Heart rate (resting, peak, resting 1and 3 minutes, and HRR ) in the exercise group 24 3.4.9 Oxygen Saturation ;SpO2 (resting, peak, and resting 1 and 3 minutes) in the exercise group 24 3.4.10 Rate of Perceived Exertion; RPE (resting, peak, resting 1 and 3 minutes) in the exercise group 25 3.4.11 Myocardial Oxygen Consumption; MVO2 (resting, peak, resting 1 and 3 minutes) in the exercise group 25 3.5 THE EXERCISE GROUPS WITH EXERCISE INTERVETION IN PRE-TRAINING AND POST TRAINING 26 3.5.1 Blood pressure (SBP, DBP and MAP) 26 3.5.2 Heart rate (resting, peak, resting 1 and 3 minutes, and HRR) 27 3.5.3 Oxygen Saturation; SpO2 (resting, peak, and resting 1 and 3 minutes) 27 3.5.4 Rate of Perceived Exertion; RPE (resting, peak, and resting 1 and 3 minutes) 28 3.5.5 Myocardial Oxygen Consumption; MVO2 (restinig, peak, and resting 1 and 3 minutes) 28 CHAPTER IV DISCUSSION 29 4.1 CHARACTERISTICS AND BODY COMPOSITION OF HEAD AND NECK CANCER PATIENTS 30 4.2 EFFECT OF EXERCISE TRAINING ON THE BLOOD PRESSURE AND MEAN ARTERIAL PRESSURE OF THE HEAD AND NECK CANCER PATIENTS 32 4.3 EFFECT OF EXERCISE TRAINING ON HEAD AND NECK CANCER PATIENT`S HEART RATE AND HEART RATE RECOVERY 34 4.4 EFFECT OF EXERCISE TRAINING ON THE MYOCRDIAL OXGYEN CONSUMPTION OF HEAD AND NECK CANCER PATIENTS 36 4.5 EFFECT OF EXERCISE TRAINING ON THE OXYGEN SATURATION, RATE OF PERCEIVED EXERTION AND DISTANCE IN HEAD AND NECK CANCER PATIENTS 37 CHAPTER VI CONCLUSION 39 REFERENCES 40 FIGURES 45 FIG 1. FLOW CHART FOR RECRUITING HEAD AND NECK CANCER PATIENTS 45 FIG 2. NON-INVASIVE MECHANICAL SPHYGMOMANOMETER -SPIRIT CG0434 46 FIG 3. OXYGEN SATURATION- GM601 47 FIG 4. BODY COMPOSITIONS, WEIGHT, BMI- OMRON 47 FIG 5. AEROBIC EXERCISE TREADMILL TRAINING- LIFE GEAR 97018 48 FIG 6. RATE OF OF PERCEIVED EXERTION 49 FIG 7. SHOULDER FLEXION 50 FIG 8. SHOULDER EXTENSION 50 FIG 10. HIP EXTENSION 51 FIG 12.SHOULDER ABDUCTION 52 FIG 13: THE SIX-MINUTE WALK TEST: RESTING SYSTOLIC BLOOD PRESSURE OF THE SEDENTARY AND EXERCISE GROUPS. 53 FIG 14: THE SIX-MINUTE WALK TEST: RESTING DIASTOLIC BLOOD PRESSURE OF THE SEDENTARY AND EXERCISE GROUPS. 54 FIG 15: THE SIX-MINUTE WALK TEST: PEAK SYSTOLIC BLOOD PRESSURE OF THE SEDENTARY AND EXERCISE GROUPS. 55 FIG 16: THE SIX-MINUTE WALK TEST: PEAK DIASTOLIC BLOOD PRESSURE OF THE SEDENTARY AND EXERCISE GROUPS. 56 FIG 17: THE SIX-MINUTE WALK TEST: 1 MINUTE SYSTOLIC BLOOD PRESSURE RECOVERY OF THE SEDENTARY AND EXERCISE GROUPS. 57 FIG 18: THE SIX-MINUTE WALK TEST: 1 MINUTE DIASTOLIC BLOOD PRESSURE RECOVERY OF THE SEDENTARY AND EXERCISE GROUPS. 58 FIG 19: THE SIX-MINUTE WALK TEST: 3 MINUTE SYSTOLIC BLOOD PRESSURE RECOVERY OF THE SEDENTARY AND EXERCISE GROUPS. 59 FIG 20: THE SIX-MINUTE WALK TEST: 1 MINUTE DIASTOLIC BLOOD PRESSURE RECOVERY OF THE SEDENTARY AND EXERCISE GROUPS. 60 FIG 22: THE SIX-MINUTE WALK TEST: RESTING MEAN ARTERIAL PRESSURE OF THE SEDENTARY AND EXERCISE GROUPS. 61 FIG 23: THE SIX-MINUTE WALK TEST: PEAK MEAN ARTERIAL PRESSURE OF THE SEDENTARY AND EXERCISE GROUPS. 62 FIG 24: THE SIX-MINUTE WALK TEST: 1 MINUTE MEAN ARTERIAL PRESSURE OF THE SEDENTARY AND EXERCISE GROUPS. 63 FIG 25: THE SIX-MINUTE WALK TEST: 3 MINUTE MEAN ARTERIAL PRESSURE (MAP) OF THE SEDENTARY AND EXERCISE GROUPS. 64 FIG 26: THE SIX-MINUTE WALK TEST: RESTING HEART RATE(HR) OF THE SEDENTARY AND EXERCISE GROUPS. 65 FIG 27: THE SIX-MINUTE WALK TEST: PEAK HEART RATE OF THE SEDENTARY AND EXERCISE GROUPS. 66 FIG 28: THE SIX-MINUTE WALK TEST: RESTING 1-MINUTE HEART RATE OF THE SEDENTARY AND EXERCISE GROUPS. 67 FIG 29: THE SIX-MINUTE WALK TEST: RESTING 3-MINUTE HEART RATE OF SEDENTARY AND EXERCISE GROUPS. 68 FIG 30: THE SIX-MINUTE WALK TEST: 1-MINUTE HEART RATE RECOVERY OF THE SEDENTARY AND EXERCISE GROUPS. 69 FIG 31: THE SIX-MINUTE WALK TEST: 3-MINUTE HEART RATE RECOVERY OF THE SEDENTARY AND EXERCISE GROUPS. 70 FIG 32: THE SIX-MINUTE WALK TEST: RESTING SPO2 OF THE SEDENTARY AND EXERCISE GROUPS. 71 FIG 33: THE SIX-MINUTE WALK TEST: PEAK SPO2 OF THE SEDENTARY AND EXERCISE GROUPS. 72 FIG 34: THE SIX-MINUTE WALK TEST: RESTING 1-MINUTE SPO2 OF THE SEDENTARY AND EXERCISE GROUPS. 73 FIG 35: THE SIX-MINUTE WALK TEST: RESTING 3-MINUTE SPO2 OF THE SEDENTARY AND EXERCISE GROUPS. 74 FIG 36: THE SIX-MINUTE WALK TEST: RESTING RATE OF PERCEIVED EXERTION OF THE SEDENTARY AND EXERCISE GROUPS. 75 FIG 37: THE SIX-MINUTE WALK TEST: PEAK RATE OF PERCEIVED EXERTION OF THE SEDENTARYAND EXERCISE GROUPS. 76 FIG 38: THE SIX-MINUTE WALK TEST: RESTING 1-MINUTE RATE OF PERCEIVED EXERTION OF THE SEDENTARY AND EXERCISE GROUPS. 77 FIG 39: THE SIX-MINUTE WALK TEST: RESTING 3-MINUTE RATE OF PERCEIVED EXERTION OF THE SEDENTARY AND EXERCISE GROUPS. 78 FIG 40: THE SIX-MINUTE WALK TEST: DISTANCE OF SEDENTARY AND EXERCISE GROUPS. 79 FIG 41: THE SIX-MINUTE WALK TEST: RESTING MYOCARDIAL OXYGEN CONSUMPTION OF THE SEDENTARY AND EXERCISE GROUPS. 80 FIG 42: THE SIX-MINUTE WALK TEST: PEAK MYOCARDIAL OXYGEN CONSUMPTION OF THE SEDENTARY AND EXERCISE GROUPS. 81 FIG 43: THE SIX-MINUTE WALK TEST: RESTING 1-MINUTE MYOCARDIAL OXYGEN CONSUMPTION OF THE S SEDENTARY AND EXERCISE GROUPS. 82 FIG 44: THE SIX-MINUTE WALK TEST: RESTING 3-MINUTE MYOCARDIAL OXYGEN CONSUMPTION OF THE SEDENTARY AND EXERCISE GROUPS. 83 FIG 45: THE RESTING BLOOD PRESSURE OF THE EXERCISE GROUP WITH EXERCISE INTERVENTION IN PRE-TRAINING AND POST-TRAINING. 84 FIG 46: THE PEAK BLOOD PRESSURE OF THE EXERCISE GROUP WITH EXERCISE INTERVENTION IN PRE-TRAINING AND POST-TRAINING. 85 FIG 47: THE 1-MINUTE BLOOD PRESSURE RECOVERY OF THE EXERCISE GROUP WITH EXERCISE INTERVENTION IN PRE-TRAINING AND POST-TRAINING. 86 FIG 48: THE 3-MINUTE BLOOD PRESSURE RECOVERY OF THE EXERCISE GROUP WITH EXERCISE INTERVENTION IN PRE-TRAINING AND POST-TRAINING. 87 FIG 49: THE MEAN ARTERIAL PRESSURE (RESTING AND PEAK) OF THE EXERCISE GROUP WITH EXERCISE INTERVENTION IN PRE-TRAINING AND POST-TRAINING. 88 FIG 50: THE MEAN ARTERIAL PRESSURE ( RESTING 1 & 3 MINUTES) OF THE EXERCISE GROUP WITH EXERCISE INTERVENTION IN PRE-TRAINING AND POST-TRAINING. 89 FIG 51: THE HEART RATE ( RESTING & PEAK) OF THE EXERCISE GROUP WITH EXERCISE INTERVENTION IN PRE-TRAINING AND POST-TRAINING. 90 FIG 52: THE HEART RATE ( RESTING 1 & 3 MINUTES) OF THE EXERCISE GROUP WITH EXERCISE INTERVENTION IN PRE-TRAINING AND POST-TRAINING. 91 FIG 53: THE HEART RATE RECOVERY (RESTING 1 & 3 MINUTES) OF THE EXERCISE GROUP WITH EXERCISE INTERVENTION IN PRE-TRAINING AND POST-TRAINING. 92 FIG 54: THE SPO2 (RESTING & PEAK) OF THE EXERCISE GROUP WITH EXERCISE INTERVENTION IN PRE-TRAINING AND POST-TRAINING. 93 FIG 55: THE SPO2 (RESTING 1 & 3 MINUTES) OF THE EXERCISE GROUP WITHS EXERCIE INTERVENTION IN PRE-TRAINING AND POST-TRAINING. 94 FIG 56: THE RATE OF PERCEIVED EXERTION (RESTING & PEAK) OF THE EXERCISE GROUP WITH EXERCISE INTERVENTION IN PRE-TRAINING AND POST-TRAINING. 95 FIG 57: THE RATE OF PERCEIVED EXERTION (RESTING 1 & 3 MINUTES) OF THE EXERCISE GROUP WITH EXERCISE INTERVENTION IN PRE-TRAINING AND POST-TRAINING. 96 FIG 58: THE MYOCARDIAL OXYGEN CONSUMPTION (RESTING & PEAK) OF THE EXERCISE GROUP WITH EXERCISE INTERVENTION IN PRE-TRAINING AND POST-TRAINING. 97 FIG 59: THE MYOCARDIAL OXYGEN CONSUMPTION (RESTING 1 & 3 MINUTES) OF THE EXERCISE GROUP WITH EXERCISE INTERVENTION IN PRE-TRAINING AND POST-TRAINING. 98 TABLE 99 TABLE 1 BASIC CHARACTERISTICS IN SEDENTARY GROUP AND EXERCISE GROUP AT BASELINE 99 TABLE 2 BODY COMPOSITION IN SEDENTARY GROUP AND EXERCISE GROUP AT BASELINE 100 TABLE 3 BASIC CHARACTERISTICS AND BODY COMPOSITION IN SEDENTARY AND EXERCISE GROUP AT PRE/POST TRAINING 101 TABLE4 HEAD AND NECK CANCER PATIENT`S CHARACTERISTICS OF PRIMARY CANCER TYPES AND CANCER METASTASIS 102 TABLE 5 HEAD AND NECK CANCER PATIENT`S CHARACTERISTICS OF MEDICINE 103 TABLE 6 THE SIX-MINUTE WALK TEST: BLOOD PRESSURE IN SEDENTARY AND EXERCISE GROUP AT PRE/POST TRAINING 104 TABLE 7 THE SIX-MINUTE WALK TEST: HEART RATE IN SEDENTARY AND EXERCISE GROUP AT PRE/POST TRAINING 105 TABLE 8 THE SIX-MINUTE WALK TEST: SPO2 IN SEDENTARY AND EXERCISE GROUP AT PRE/POST TRAINING 106 TABLE 9 THE SIX-MINUTE WALK TEST: RPE IN SEDENTARY AND EXERCISE GROUP AT PRE/POST TRAINING 107 TABLE 10 THE SIX-MINUTE WALK TEST: DISTANCE IN SEDENTARY AND EXERCISE GROUP AT PRE/POST TRAINING 108 TABLE 11 THE SIX-MINUTE WALK TEST: MVO2 IN SEDENTARY AND EXERCISE GROUP AT PRE/POST TRAINING 109 TABLE 12 THE EXERCISE INTERVENTION: BLOOD PRESSURE IN EXERCISE GROUP AT PRE/POST TRAINING 110 TABLE 13 THE EXERCISE INTERVENTION: HEART RATE IN EXERCISE GROUP AT PRE/POST TRAINING 111 TABLE 14 THE EXERCISE INTERVENTION: SPO2 IN EXERCISE GROUP AT PRE/POST TRAINING 112 TABLE 15 THE EXERCISE INTERVENTION: RPE IN EXERCISE GROUP AT PRE/POST TRAINING 113 TABLE 16 THE EXERCISE INTERVENTION: MVO2 IN EXERCISE GROUP AT PRE/POST TRAINING 114 APPENDICES 115

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    衛生福利部國民健康署編 中華民國 105 年1月出版(2016) 中華民國 102年癌症登記報告

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