[[alternative]]The Effect of Home-based Exercise Program on Exercise Tolerance and Quality of Life of Postoperative Lung Cancer Patients

[[abstract]]肺癌為全球癌症發生率最高，自2012年起持續列於台灣癌症前三名(衛生福利部國民健康署，2015年2月)。手術為早期肺癌主要治療方式，術後病人常因心肺功能受損與活動功能減退，而影響存活期的生活品質，少有研究探討運動介入對肺癌術後病人的成效，因此本研究目的為探討居家運動介入對肺癌術後病人的運動耐力及生活品質的改善成效。採實驗性研究設計，於北部兩間醫學中心之胸腔外科門診進行收案，以方便取樣，招募37位符合條件並同意參與本研究之肺癌術後一個月至三個月病人參與研究，依收案順序隨機分派至運動組(17人)與對照組(20人)。運動組進行12週的居家運動介入，對照組未接受與本研究相關之措施。兩組研究對象在收案時、收案後4週及12週進行資料收集，包括六分鐘走路距離測試及肺癌健康相關生活品質問卷填答。所得資料運用SPSS軟體進行統計分析。以卡方檢定、獨立樣本T檢定檢視兩組樣本的人口學與疾病特性，針對主要成效變項：六分鐘走路距離和健康相關生活品質，以獨立樣本T檢定比較兩組在各時間點的組間差異，以成對樣本T檢定前後時間點的組內差異，以廣義估計方程式(generalized estimating equation)分析組間、時間與組間及時間交互作用的效應。 研究對象平均年齡為60.30±8.79歲，以肺腺癌IA期居多，兩組在人口學與疾病變項上均無顯著差異。在運動耐力方面，兩組在前測無顯著差異，GEE模式顯示組別及組別與時間的交互作用未達統計上的顯著效應，但時間則有顯著效應，顯示兩組病人的運動耐力皆隨著時間而逐漸增加。在健康相關生活品質方面，兩組在前測的生活品質沒有顯著的組間差異，但在12週時運動組的健康相關的生活品質平均分數為69.99±7.68分顯著高於控制組的59.74±16.61分(t=2.134, p=.041)，GEE統計呈現組別對健康相關生活品質有顯著效應。 本研究結果呈現居家運動介入可改善肺癌術後病人的運動耐力和健康相關生活品質的成效，居家運動訓練適用於肺癌術後病人，建議未來可擴大收案族群的研究進行，設計適用於肺癌族群的居家運動訓練計畫，臨床可推廣肺癌治療病人及存活者的居家運動措施。[[abstract]]Lung cancer has the highest incident rate among all cancers globally and it is the third most common cancer in Taiwan since 2012. Surgery approach remains the cornerstone of treatment of early-stage non-small cell lung cancer. Cardiopulmonary function and physical function impairments negatively impact on quality of life in postoperative patients’ survivorship. Few studies investigate the effect of exercise on exercise tolerance and quality of life of postoperative lung cancer patients. Therefore, the purpose of this study is to test the efficacy of home-based exercise on exercise tolerance and quality of life in postoperative lung cancer patients.This study was an experimental design. A convenience sample of postoperative lung cancer patients were recruited from thoracic surgery clinics of two medical centers in the northern Taiwan. 37 postoperative lung cancer patients in 1 to 3 months were qualified and agreed to participate in the study and the they were randomly assigned to the exercise group(n=17) or the control group(n= 20). Patients in the exercise group received a 12-week home-based exercise intervention. Patients in the control group didn’t receive any intervention from the study. Data on exercise tolerance and health-related quality of life were collected at baseline and week 4 and week 12, by using the functional assessment of cancer therapy-lung (FACT-L) and six minutes walking test. Data were analyzed by using SPSS statistic software. Chi-square tests and independent sample T tests were used to analyze the demographics and disease characteristics of two groups. Independent T tests were used to analyze the differences of exercise tolerance and quality of life between groups at each time point. The effect of home-based exercise program on exercise tolerance and quality of life were analyzed by using generalized estimating equation to test the group effect and group and time interaction effects. The average age of the participants was 60.30±8.79 years old. Most participants were diagnosed with stage IA adenocarcinoma. There was no between-group difference in demographics, disease characteristics and exercise tolerance at baseline. GEE results showed that there was no group or group by time interaction effect, but a significant time effect on exercise tolerance, indicating the exercise tolerance was increased in both groups. There was no between- group difference in the health-related quality of life at baseline. However, at week 12, the average score of FACT-L of exercise group (69.99±7.68) was significant higher than ( t=2.134, p=.041) it of the control group. GEE results showed that there was a significant group effect on health-related quality of life. The study results supports the potential efficacy of home-based exercise for improving exercise tolerance and health-related quality of life lung cancer patients. Home-based exercise training is applicable for lung cancer postoperative patient. It is recommended to expand research group for future research, and design the home-based exercised program for lung cancer patient and promote to lung cancer patients and survivors