Onkologische Trainings- und Bewegungstherapie (OTT)

Zusammenfassung

Eine medizinisch-onkologische Therapie, aber auch die Krebserkrankung selbst verursacht zahlreiche akute wie auch chronische Nebenwirkungen. Vermehrt bestätigen Studien die validen Effekte von Bewegungstherapie zur bio-psycho-sozialen Regeneration. Doch fehlen in der onkologischen Versorgung bislang patientenorientierte Bewegungskonzepte, die die Translation wissenschaftlicher Erkenntnisse in die Therapie und Praxis ermöglichen. Reviews und RCT-Studien zu den Effekten von körperlicher Aktivität auf krebsspezifische Defizite zeigen, dass spezifische Bewegungsprogramme einen positiven Einfluss auf Fatigue-Syndrom, Harninkontinenz, Lymphödem, Polyneuropathie, Arthralgie und den Nebenwirkungen einer Hormontherapie haben. Mit der zunehmend aussagekräftigeren Evidenz zur körperlichen Aktivität in der Onkologie können im nächsten Schritt die aus den Studien resultierenden Empfehlungen in Praxis und Therapie übertragen werden. Dazu wurde das personalisierte Behandlungskonzept „Onkologische Trainings- und Bewegungstherapie“ (OTT) entwickelt.

Abstract

Oncological treatments can lead to acute and chronic cancer related toxicities. In recent years, a large number of clinical studies have reported positive effects of exercise to the bio-psycho-social regeneration of cancer patients. However, very few evidence-based programs have been implemented into practice with little opportunity for cancer patients to engage in such programs. Reviews and RCT studies on exercise and cancer are showing that specific exercise programs have a positive impact on fatigue syndrome, urinary incontinence, lymphedema, polyneuropathy, arthralgia, and androgen deprivation related toxicities. With the increasing evidence for exercise oncology interventions, recommendations arising from clinical trials should be translated into clinical practice and this should be viewed as an important next step in this fast moving field of exercise oncology. For that the personalized treatment concept „Oncologic clinical exercise“ (OTT) was developed.

Schlüsselwörter

Bewegungstherapie - körperliche Aktivität - Krebs - onkologische Trainings- und Bewegungstherapie - OTT

Keywords

exercising - physical activity - cancer - personalized exercise concept

• Literatur

• 1 Ahmed R, Thomas W, Yee D, Schmitz K. Randomized controlled trial of weight training and lymphedema in breast cancer survivors. J Clin Oncol 2006; 24: 2765-2772
• 2 American College of Sports Medicine. Position Stand: Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults. Med Sci Sports Exerc 2011; 1334-1359
• 3 Andersen C, Rørth M, Ejlertsen B et al. The effects of a six-week supervised multimodal exercise intervention during chemotherapy on cancer-related fatigue. Eur J Oncol Nurs 2013; 17: 331-339
• 4 Baumann FT, Bernhörster M, Dimeo FC et al. Kommission „Krebs und Sport“ der Deutschen Krebsgesellschaft. Teil 1: Richtlinien für die Anwendung von Sport und körperlicher Aktivität in der Prävention, supportiven Therapie und Rehabilitation neoplastischer Erkrankungen. Forum – Das offizielle Magazin der Deutschen Krebsgesellschaft e. V. 2009; 4: 14-17
• 5 Baumann FT, Bernhörster M, Dimeo FC et al. Kommission „Krebs und Sport“ der Deutschen Krebsgesellschaft. Teil 2: Richtlinien für die Anwendung von Sport und körperlicher Aktivität in der Prävention, supportiven Therapie und Rehabilitation neoplastischer Erkrankungen. Forum – Das offizielle Magazin der Deutschen Krebsgesellschaft e. V. 2009; 5: 9-12
• 6 Baumann FT, Zopf EM, Bloch W. Clinical exercise interventions in prostate cancer patients – a systematic review of randomized controlled trials. Support Care Cancer 2012; 20: 212-233
• 7 Baumann FT, Bloch W, Weissen A et al. Physical activity in breast cancer patients during medical treatment and in the aftercare. Breast Care 2013; 8: 330-334
• 8 Ballard-Barbash R, Friedenreich CM, Courneya KS et al. Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst 2012; 104: 815-840
• 9 Cantarero-Villanueva I, Fernández-Lao C, Cuesta-Vargas AI et al. The effectiveness of a deep water aquatic exercise program in cancer-related fatigue in breast cancer survivors: a randomized controlled trial. Arch Phys Med Rehabil 2013; 94: 221-230
• 10 Carayol M, Bernard P, Boiché J et al. Psychological effect of exercise in women with breast cancer receiving adjuvant therapy: what is the optimal dose needed?. Ann Oncol 2013; 24: 291-300
• 11 Centemero A, Rigatti L, Giraudo D et al. Preoperative pelvic floor muscle exercise for early continence after radical prostatectomy: a randomised controlled study. Eur Urol 2010; 57: 1039-104
• 12 Cormie P, Galvão DA, Spry N et al. Can supervised exercise prevent treatment toxicity in patients with prostate cancer initiating androgen-deprivation therapy: a randomised controlled trial. BJU Int 2014; 115: 256-266
• 13 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: 328-335
• 14 Cormie P, Pumpa K, Galvão DA et al. Is it safe and efficacious for women with lymphedema secondary to breast cancer to lift heavy weights during exercise: a randomised controlled trial. J Cancer Surviv 2013; 7: 413-424
• 15 Cormie P, Spry N, Jasas K et al. Exercise as medicine in the management of pancreatic cancer: a case study. Med Sci Sports Exerc 2014; 46: 664-670
• 16 Courneya KS, Friedenreich CM. Physical Activity and Cancer. Berlin: Springer; 2011
• 17 Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2012; 11 CD006145
• 18 Dimeo F, Stieglitz RD, Novelli-Fischer U et al. Correlation between physical performance and fatigue in cancer patients. Ann Oncol 1997; 8: 1251-1255
• 19 Fernandez-Lao CC, Cantarero-Villanueva I, Ariza-Garcia A et al. Water versus land-based multimodal exercise program effects on body composition in breast cancer survivors: a controlled clinical trial. Support Care Cancer 2013; 21: 521-530
• 20 Serdà BC, Marcos-Gragera R. Urinary incontinence and prostate cancer: A progressive rehabilitation program design. Rehabil Nurs 2014; 39: 271-280
• 21 Galvão DA, Spry N, Denham J et al. A multicentre year-long randomised controlled trial of exercise training targeting physical functioning in men with prostate cancer previously treated with androgen suppression and radiation from TROG 03. 04 RADAR. Eur Urol 2014; 65: 856-864
• 22 Galvão DA, Taaffe DR, Spry N et al. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol 2010; 28: 340-347
• 23 Galvão DA, Taaffe DR, Spry N, Newton RU. Exercise can prevent and even reverse adverse effects of androgen suppression treatment in men with prostate cancer. Prostate Cancer Prostatic Dis 2007; 10: 340-346
• 24 Hayes S, Spence R, Galvao D et al. Australian Association for Exercise and Sport Science Position Stand: Optimising cancer outcomes through exercise. J Sci Med Sport  2009; 12: 428-434
• 25 Husebø AM, Dyrstad SM, Mjaaland IA et al. Effects of scheduled exercise on cancer-related fatigue in women with early breast cancer. Sci World J 2014;
• 26 Irwin ML, Cartmel B, Gross CP et al. Randomized exercise trial of aromatase inhibitor-induced arthralgia in breast cancer survivors. J Clin Oncol 2015; 1; 33: 1104-1111
• 27 Jeffs E, Wiseman T. Randomised controlled trial to determine the benefit of daily home-based exercise in addition to self-care in the management of breast cancer-related lymphoedema: a feasibility study. Support Care Cancer 2013; 21: 1013-1023
• 28 Knols R, Aaronson NK, Uebelhart D, Fransen J, Aufdemkampe G. Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials. J Clin Oncol 2005; 23: 3830-3842
• 29 Letellier ME, Towers A, Shimony A, Tidhar D. Breast cancer-related lymphedema. A randomized controlled pilot and feasibility study. Am J Phys Med Rehabil 2014; 93: 751-759
• 30 McNeely ML, Courneya KS. Exercise programs for cancer-related fatigue: evidence and clinical guidelines. J Natl Compr Canc Netw 2010; 8: 945-953
• 31 Mishra SI, Scherer RW, Geigle PM et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev 2012; 15; 8 CD007566
• 32 Mishra SI, Scherer RW, Snyder C et al. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev 2012; 15; 8 CD008465
• 33 Nikander R, Sievänen H, Ojala K et al. Effect of exercise on bone structural traits, physical performance and body composition in breast cancer patients – a 12-month RCT. J Musculoskelet Neuronal Interact 2012; 12: 127-135
• 34 Overgard M, Angelsen A, Lydersen S, Morkved S. Does physiotherapist-guided pelvic floor muscle training reduce urinary incontinence after radical prostatectomy? A randomised controlled trial. Europ Urol 2008; 54: 438-448
• 35 Segal RJ, Reid RD, Courneya KS, Malone SC, Parliament MB, Scott CG et al. Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol 2003; 21: 1653-1659
• 36 Segal RJ, Reid RD, Courneya RJ et al. Randomized controlled trial of resistance or aerobic exercise in men receiving radiation for prostate cancer. J Clin Oncol 2009; 27: 344-351
• 37 Schmitz KH, Courneya KS, Matthews C et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 2010; 42: 1409-1426
• 38 Schmitz K, Ahmed RL, Troxel A et al. Weight lifting in women with breast cancer-related lymphedema. New Engl J Med 2009; 361: 664-673
• 39 Schüle K. Thirty years of physical activity in oncology in Germany – from the birth of the first rehabilitative cancer sports group until today. Europ Rev Aging Phys Activity 2013; 10: 61-64
• 40 Singh F, Newton RU, Galvão DA et al. A systematic review of pre-surgical exercise intervention studies with cancer patients. Surg Oncol 2013; 22: 92-104
• 41 Steindorf K, Schmidt ME, Klassen O et al. Randomized, controlled trial of resistance training in breast cancer patients receiving adjuvant radiotherapy: results on cancer-related fatigue and quality of life. Ann Oncol 2014; 25: 2237-2243
• 42 Streckmann F, Zopf EM, Lehmann HC et al. Exercise intervention studies in patients with peripheral neuropathy: A systematic review. Sports Medicine 2014; 44: 1289-1304
• 43 Streckmann F, Kneis S, Leifert JA et al. Exercise program improves therapy-related side-effects and quality of life in lymphoma patients undergoing therapy. Ann Oncol 2014; 25: 493-499
• 44 Streckmann F, Rittweger J, Bloch W et al. Bewegungsempfehlungen bei Chemotherapieinduzierter peripherer Polyneuropathie. B&G Bewegungstherapie und Gesundheitssport 2014; 30: 179-182
• 45 Tidhar D, Katz-Leurer M. Aqua lymphatic therapy in women who suffer from breast cancer treatment-related lymphedema: a randomized controlled study. Support Care Cancer 2009; 18: 383-392
• 46 Uth J, Hornstrup T, Schmidt JF et al. Football training improves lean body mass in men with prostate cancer undergoing androgen deprivation therapy. Scand J Med Sci Sports 2014; 105-112
• 47 Winters-Stone KM, Dobek JC, Bennett JA et al. Resistance training reduces disability in prostate cancer survivors on androgen deprivation therapy: Evidence from a randomized controlled trial. Arch Phys Med Rehabil 2015; 96: 7-14
• 48 WHO. International Classification of Functioning, Disability and Health (ICF). http://www.who.int/classifications/icf/en/ (letzter Zugriff 3.9.2015)