悪液質に対する非薬物療法（＝運動療法）

悪液質に対する非薬物療法（＝運動療法）のレビュー論文を紹介します。

Maddocks M, Murton AJ, Wilcock A. Improving muscle mass and function in cachexia: non-drug approaches. Curr Opin Support Palliat Care. 2011 Dec;5(4):361-4.

抄録しか読めていませんが、運動によって、筋肉の代謝、インスリン感受性、炎症の程度を調整することで、悪液質の効果を緩和できるかもしれません。進行がん患者であっても、末梢の筋肉は運動療法に反応します。

問題は実際に運動療法を行うことで、軽負荷の運動でも継続困難となりがちです。そのため、より実行可能な運動療法のプログラムを、より早期から低負荷で様々な形で行うことが求められます。

前悪液質、悪液質の段階で早期に悪液質を診断して、早期に運動介入することが重要です。慢性呼吸不全、慢性心不全、慢性腎不全では運動療法が有用という質の高いエビデンスはあります。これを他の慢性炎症性疾患でも検証すること、栄養療法と併用することが重要かと思います。

Abstract
PURPOSE OF REVIEW: Therapeutic exercise may help maintain or slow down the rate of decline in muscle mass and physical function that occurs with cachexia. This review considers recent evidence in relation to patients with cachexia as regards the rationale for the use of exercise, the challenges in its clinical application and future developments.

RECENT FINDINGS: Exercise may attenuate the effects of cachexia by modulating muscle metabolism, insulin sensitivity and levels of inflammation. Studies targeting cachectic patients have demonstrated that even in advanced disease peripheral muscle has the capacity to respond to exercise training. Nonetheless, there are challenges in implementing the use of exercise, particularly once cachexia is established in which tolerance to even low levels of exercise is poor. Strategies to make exercise a more accessible therapy are required and could include offering exercise earlier on in the course of the disease, at lower intensities and in various forms, including more novel approaches.

SUMMARY: The use of therapeutic exercise has a sound rationale, even in patients with advanced disease and cachexia. Because of practical issues with its application, further study is required to examine if benefits achieved in small studies can be translated to a wider clinical population.