운동과 암: 예방에서 치료까지?
Exercise and cancer protection: from ‘prevention’ to ‘therapeutics’?
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[목적] 본 연구는 일반적으로 많이 발생하는 여러 암에 대해서 최근 이슈가 되고 있는 안전하고도 비 약물적이며, 비 침습적인 방법 중 하나인 운동활동과 복합적인 운동중재가 암의 예방, 진행 및 예후에 미치는 효과를 다양한 실험적 연구 및 메타분석 리뷰 연구들을 종합적으로 분석하고, 여러 암에 대한 운동중재 분석결과를 기전적인 측면에서 제시하고자 한다. [방법] 본 연구를 수행하기 위하여 전자저널인 Pub Med/Medline, 전자저널 database를 이용하여 2015년도 1월부터 2020년 8월까지 ‘EXERCISE & CANCER & IMMUNITY’ 등의 키워드로 검색한 후 본 연구주제와 적합한 논문들을 검색 및 분석한 후 본 연구를 수행하였다. [결과] 이 연구에서 얻은 주요 결과는 다음과 같다. 본 연구결과 운동중재는 다양한 암환자들의 암의 초기나 중기 혹은 말기, 및 치료시기 등의 다양한 시기에 효과적인 것으로 분석되었다. 하지만 암의 전이 시기에는 다른 부작용이 발생할 수 있어 운동 중재 시 주의를 기울여야 하며, 개인별 차이를 고려하여 다른 복합 처치에 대하여 반영해야 한다. 본 연구결과 암환자에게 운동중재 효과에 관한 기전적인 근거는 운동활동에 따른 교감신경계의 활성화가 심혈관 기능의 개선, 인체 대사율의 증가, 면역세포들의 활성화를 도모하여 면역력을 증가시키기 때문으로 나타났으며, 운동중재가 암으로 인해 발생하는 활성산소들을 효율적으로 제거하는 효과와 이로 인한 피로믈질의 제거가 효율적이기 때문으로 항산화 시스템의 개선으로 인한 만성적인 염증감소 때문으로 분석된다. 특히 운동활동으로 인한 혈관기능 개선과 심혈관 기능의 향상은 감소된 운동능력을 회복시키며, 피로와 통증을 개선하는 효과가 있는 것이다. 그리고 여성에게 흔한 유방암의 경우에는 다른 종류의 암에 비해 운동중재의 효과가 상당하며, 다만 암의 전이시기에는 운동 시 부작용이 발생하지 않도록 개인별 주의를 기울여야 한다. 남성에게 호발하는 전립선암의 경우 역시 상당한 운동효과가 있는 것으로 보고되었고, 이 경우 호르몬 치료에 대한 부작용이 있으므로 육류나 포화지방 섭취를 줄이고 야채와 과일이 풍부한 식단을 함께 병행해야 하며 무엇보다 근력증가 운동이 필수적이다. [결론] 본 종설을 진행한 결과, 운동중재는 거의 모든 암에서 효과적인 것으로 나타났다. 암의 초기, 중기, 말기 및 여러 치료시기 등에서 효과적이며 다양한 종류의 복합적인 운동이 권장되고 운동의 강도는 수행할 수 있을 정도로 적당하게 높은 강도의 운동을 자주 하는 것이 요구된다. 다만 암의 전이시기에는 또 다른 운동 부작용이 발생할 수 있으므로 주의를 기울여야 한다. 추후 면역학적인 측면에서 운동과 암에 관한 다양한 운동 활동 및 중재를 통한 NK세포 수용기들의 활성화나 비활성화에 대한 연구를 통하여 운동중재에 관한 암의 예방 및 치료효과와 운동중재의 면역감시 활성화에 관한 심도 있는 연구가 필요한 실정에 있다. 그리고 암에 대한 운동중재에 관한 다 차원적인 메타 연구가 절실히 필요한 것으로 사료된다.
Abstract
[Purpose] The valuable impacts of exercise-intervention in diverse type of cancer patients were rationally well-prescribed, though many experimental and review researches already performed in this fields. Generally, cancer-related fatigue and pain remains one of the most prevalent problems for cancer populations. Therefore, exercise has become increasingly significant in cancer prevention and progression. The purpose of this recent study was to analyze the combined exercise program on cancer-related fatigue, pain, quality of life and cancer prognosis in diverse type of cancer patients. This study analyses the safety and feasibility of exercise intervention in diverse stages of cancer patients such as early stage, advanced stage and even metastatic periods in cancer populations. we also wanted to know the impacts of dose-response trial of aerobic and resistance exercise on quality of life in cancer survivors. [Methods] we conducted a comprehensive PubMed/MEDILINE electronic database from Jan 2015 to August 2020. The reference lists of eligible experimental research articles and relevant systemic review articles were checked. Inclusion criteria were adult cancer survivors from randomized controlled trials performing well-tailored exercise intervention programs to diverse type of cancer patients, Using predefined search items ‘exercise-intervention, cancer & immunology’. Based on reference search, more than 100 articles were identified whereas 30 research papers met the inclusion criteria and were well connected with exercise-intervention and cancer progression. we analyzed the connections between physical exercise and cancer intervention in the main text. [Results] Moderate to vigorous exercise (aerobic and resistance exercise) revealed to decreased level of cancer-related fatigue, pain, and cancer-related symptoms, however increased level of sleep quality, activities of daily living, exercise performance and health- related quality of life. Exercise intervention reduced pro-inflammatory markers and oxidative stress as well as insomnia, fatigue, pain symptoms whereas it enhanced the antioxidant systems and immune functions. In addition, home-based aerobic physical exercise might enhance muscular strength and quality of life in many types of cancer survivors. Psychological intervention also effective for reducing cancer-related fatigue and pain during and after cancer treatment. they might be the much better intervention than available pharmaceutical options. we believe that it is the related mechanisms of immune cell mobilization and activation such as NK cells which is induced by the activation of sympathetic system during and after physical exercise. [Conclusion] According to the aforementioned results, it was concluded that implementation of exercise intervention appear to be the best non-pharmaceutical interventions for cancer populations, and also revealed to be safe and feasible in early and advanced stages, although not in the metastatic periods. Sometimes, psychological intervention such as mindfulness-based stress reduction (MBSR) might be useful in reducing anxiety, depression, fatigue, pain and enhancing quality of life, quality of sleep for cancer populations. we can conclude, exercise-intervention might not just be prevention effect but might be therapeutics, however more studies are urgently needed to confirm the exercise intervention on the NK-receptors activation and immune connection of cancer populations.
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