Introduction: Insulin resistance (IR), a key aspect of type 2 diabetes and a defining characteristic of obesity and its associated conditions, emerges as a mechanistic pathway potentially implicated in cancer pathophysiology. This presents an appealing intervention target for cancer patients. The objective of this study is to conduct a systematic review, examining the scientific evidence regarding the impact of physical activity on modifying insulin resistance in individuals with cancer. Methods: The selection criteria were specific: only randomized controlled clinical trials published in the last 13 years and written in English or Spanish were included. The databases utilized for the search included PubMed, Scopus, Cochrane Library, EBSCO, and WEB OF SCIENCE. The protocol for this review was duly registered in the International Register of Systematic Reviews (CRD42023435002). The final search was conducted on 14 May 2023. Results: The outcomes were assessed using the tool proposed by the Cochrane Handbook to evaluate the risk of bias in the included studies. Among the 12 studies incorporated, 8 demonstrated a low risk of bias, two had an unclear risk of bias, and the remaining two showed a high risk of bias. The variety of exercise types used across all studies was extensive, making definitive conclusions challenging. Physical activity was linked to enhanced insulin sensitivity in seven studies, while five studies showed no significant changes in insulin resistance between the intervention and control groups. Importantly, none of the interventions employed in the included studies exhibited adverse effects on the study participants. Conclusions: The role of exercise as a medicine against insulin resistance has been evidenced in many different studies, mostly related to obesity and cardiovascular diseases. Engaging in physical activity could be a healthy option to combat the effects of insulin resistance in cancer patients, although evidence is weak and limited, according to the results of our systemic review. We further found that literature is lacking at the level of optimal doses, timing, and type of exercise. More studies are needed with more defined PA programs in type and length.
引言：胰岛素抵抗作为2型糖尿病的核心特征，也是肥胖及其相关疾病的标志性病理生理改变，其机制通路可能参与癌症的病理进程，这为癌症患者提供了具有潜力的干预靶点。本研究旨在通过系统综述，探讨体力活动对癌症患者胰岛素抵抗影响的科学证据。方法：文献筛选标准明确限定为近13年内发表、以英文或西班牙文撰写的随机对照临床试验。检索数据库包括PubMed、Scopus、Cochrane Library、EBSCO和WEB OF SCIENCE。本综述方案已在国际系统综述注册平台注册（CRD42023435002），最终检索日期为2023年5月14日。结果：采用Cochrane手册推荐的偏倚风险评估工具对纳入研究进行质量评价。在最终纳入的12项研究中，8项显示低偏倚风险，2项偏倚风险不明确，其余2项存在高偏倚风险。各研究采用的运动干预方案差异显著，导致难以得出确定性结论。其中7项研究显示体力活动可改善胰岛素敏感性，而5项研究显示干预组与对照组在胰岛素抵抗指标上无显著差异。值得注意的是，所有纳入研究中采用的干预措施均未对参与者产生不良影响。结论：大量研究已证实运动作为改善胰岛素抵抗的干预手段在肥胖和心血管疾病领域的积极作用。本系统综述表明，虽然现有证据尚不充分，但进行体力活动可能是改善癌症患者胰岛素抵抗的健康选择。我们进一步发现，目前缺乏关于运动最佳剂量、时机和类型的文献支持。未来需要开展更多具有明确运动类型和时长方案的研究。
Physical Activity, Insulin Resistance and Cancer: A Systematic Review
肿瘤(癌症)患者之家