がん化学療法誘因性末梢神経障害に対する運動療法の検討—末梢神経障害のある患者を対象とした運動療法の効果に関する文献レビューから

Consideration of Exercise for Chemotherapy-Induced Peripheral Neuropathy: Review of Exercise Therapy Effect for Patients with Peripheral Neuropathy

要旨

目的：がん化学療法誘因性末梢神経障害への効果的な運動療法について，文献から検討を行い，示唆を得ることである．

方法：医学中央雑誌とPubMedを用い過去5年間の原著論文で，末梢神経障害に対する運動療法に限定し検索を行った．

結果：対象文献は20件であり，糖尿病性末梢神経障害の文献が多くそれ以外は少数であった．運動は有酸素運動，レジスタンス運動，感覚運動が主であり，専門家による管理にて安全面への配慮がされていた．運動療法前後での比較では，全ての研究においてバランス力や歩行力に有意な改善を認めたが，群間比較による有意な改善は必ずしも明確ではなかった．

結論：運動療法前後の比較から，がん化学療法誘因性末梢神経障害への運動療法の試験的導入は，神経症状やバランス力の改善に期待できるものと考える．運動内容は単独より複合的な運動プログラムにて，医療者の管理のもと軽度から始め中等度の負荷で維持することが適切と考える．

Aim: A study was conducted to clarify the effects of exercise therapy for patients with chemotherapy-induced peripheral neuropathy (CIPN) based on a review of the English literature.

Method: A literature search was conducted using the Japan Medical Abstracts Society and PubMed. To be included in the study, a paper had to meet all of the following conditions: Publication within the past five years, the original articles, and the search terms “peripheral neuropathy” and “exercise therapy.”

Results: Following the search, most of the search conditions were many studies on diabetic peripheral neuropathy, and others were few. The exercise contents were mainly aerobic exercise, muscular strength exercise, sensory exercise, and expert management that took safety into consideration. Nerve conduction velocity, muscular strength, balancing power, and walking speed were used, and in all the literature, a significant improvement was seen in the comparison between before and after the intervention. However, the significant improvement by comparison between groups was not necessarily clear.

Conclusion: This review provides evidence that neurological symptoms and balance ability can be improved by exercise therapy for CIPN through a comparison between before and after the intervention. Regarding the exercise content, it is a complex exercise program rather than alone. It is appropriate to conduct exercise intervention starting with a mild load under the management of medical staff and maintain a moderate load.