#099 癌症锻炼的科学 | 凯里·科恩尼娅博士

有一些研究支持这一点。

There's a little bit of research supporting it.

它的效果不如中等至高强度的运动。

It's not as strong as the moderate to vigorous intensity exercise.

所以如果我要排名的话，这肯定优于久坐行为。

So if I had to rank them, that would certainly be above the sedentary behavior.

这些研究中的一个挑战是，很难准确测量人们一整天所做的这些小动作，因为人们更容易回忆起中等和高强度的运动。

Part of the challenge in those studies, it's very much harder to measure all these little things that people do over the course of the day where they're a little bit better at recalling vigorous intensity and moderate intensity exercise.

但无论如何，这些活动是有益的，因为我们知道它们会消耗能量。

But nevertheless, those movements are going to be beneficial because we know they are gonna expend energy.

所以这与其他运动带来的益处类似。

So it's going to be similar to these other exercise benefits.

正如我提到的，我们不再建议将至少十分钟作为运动休息的最低时长。

And as I mentioned, we're no longer recommending this at least ten minute duration as the minimum of exercise break.

因此，如果是中等强度的运动，即使你分几次、每次几分钟地累积完成，这种运动方式也可能带来益处。

So if it's moderate intensity and you're able to accumulate it in a few minutes here and a few minutes there, there could be beneficial, effects of that type of exercise.

我认为也有一些证据支持这一点，尤其是在VILPA研究中，即剧烈间歇性生活方式活动，人们在一天中积累这些短暂的剧烈活动。

I think there's some evidence showing that as well, at least with the, the VILPA studies, the vigorous intermittent lifestyle activity where people are accumulating these short bursts of Yeah.

一天中持续积累几分钟。

A couple of minutes throughout the day all the way.

我认为他们累计达到六到九分钟的这种短暂、更剧烈的运动。

I think they accumulate up to between six and nine minutes of that, you know, those short bursts of intense, actually, exercise, more intense.

是的。

Yeah.

对。

Yeah.

不是。

No.

这项研究非常有趣。

It's very interesting research.

而且，他们当然使用了客观的加速度计，因此不依赖于受试者的回忆，从而获得了更准确的数据。

And there, of course, they're using the objective accelerometer, so they're not relying on the person's recall, and they get a better indication of that.

但如果你参与这种高强度运动，即使每次只有一两分钟，只要全天累计足够，就会带来有益效果。

But, yeah, if you're engaged in this type of vigorous intensity exercise, even if it's only for a minute here, couple minutes there, depending on how much you accumulate during the day, there's going to be beneficial effects to that.

你提到了补充剂。

So you mentioned supplements.

人们服用补充剂，就像买保险一样。

People take supplements sort of as insurance.

有趣的是，我以前也用过这个说法。

And it's funny I've I've even used that term before.

比如，我会吃复合维生素。

Like, I take a multivitamin.

你知道，里面有很多微量元素和矿物质，我可能从饮食中摄取不足，但这样至少能确保我获得一些可能达不到推荐摄入量的矿物质和元素。

You know, there's a lot of trace elements and minerals in there that I may or may not get from my diet, but it's kind of like an insurance that I'm at least gonna get some of these, you know, minerals and and elements that I may not be meeting the the recommended intake for.

我觉得锻炼几乎就像最好的长期保险，能降低我的癌症风险。

And I I think of exercise almost as, like, the best long term insurance for reducing my cancer risk.

你同意这个观点吗，就

Would you agree with that in terms of

是的

Yeah.

在不吸烟且不肥胖的情况下，运动对于降低癌症风险确实非常重要。

In the absence of smoking and obesity, yeah, exercise is really important for lowering the risk of cancer.

没错

Yep.

好的

Okay.

让我们换一个话题，谈谈运动在癌症治疗中的作用。

So let's shift gears and talk about the role of exercise in cancer treatment.

也许我们可以先简单解释一下当前癌症治疗的整体情况。

Maybe maybe we could start just a little bit with explaining this sort of cancer treatment landscape.

当一个人被新诊断出癌症时，针对不同类型的癌症，他们可能面临哪些治疗方式？

Like, when someone's newly diagnosed with cancer, like, what kind of treatments are they potentially looking at for these different types of cancers?

在过去的几十年里，癌症治疗取得了许多令人振奋的进展。

So there's been a lot of exciting progress in cancer treatment over the last couple of decades.

过去癌症治疗的主要手段包括手术（非常重要）、放射治疗、化疗和激素治疗。

The mainstays of cancer treatment in the past were surgery, very important, radiation therapy, chemotherapy, and hormone therapies.

而在过去几十年里，针对所谓靶向治疗和免疫疗法的研究取得了大量进展。

And now over the last couple of decades, there's been a lot of research on so called targeted therapies and immunotherapies.

这些进展彻底改变了患者的治疗方式。

And these have really changed how these patients are treated.

但这也意味着许多患者需要接受长期而繁重的治疗。

What it does mean though, is many of these patients are in for extensive treatments.

我认为，癌症患者可能是我们所知接受治疗最密集的慢性病群体。

I think cancer patients are probably the most heavily treated chronic disease group that we have.

因此，患者通常会接受我们所说的多模式治疗。

So patients get what we call multimodal treatment.

很少有患者只接受其中一种治疗方式。

So it's rare that you would only get one of those treatments.

有些患者会先接受手术，然后是放射治疗，接着是化疗，之后可能还会接受免疫治疗。

And some of these patients get surgery followed by radiation therapy, followed by chemotherapy, and then they may get immunotherapy.

有超过一百种不同的化疗药物，每种都有不同的副作用。

There's over a 100 different types of chemotherapy drugs with all different side effects.

现在已有数十种免疫疗法获得批准。

There's dozens and dozens of immunotherapies that are now approved.

因此，患者会接受这些治疗的各种组合和序列。

So patients get treated with all these combinations and sequences of these treatments.

这并不是一种简单快速的疾病，你进来看病、接受治疗、然后离开就完了。

So it's not a quick and dirty sort of disease where you're in the door, you're treated and you're out.

这些治疗通常持续数月，有些情况下甚至长达数年。

These treatments go on for many months and in some cases many years.

因此，患者不得不经历这一系列治疗的考验，长时间下来会对他们的身体和心理造成巨大影响。

So patients kind of face this treatment gauntlet, and it can take a physical toll and a mental toll on these patients over an extended period of time.

当你进入晚期癌症阶段，可能要与之共存多年，我们有所谓的前线治疗、二线治疗。

And when you get into advanced cancer, which you might have for many, many years, we have what we call first line treatments, second line treatments.

有些癌症甚至有第六线和第七线治疗。

And some of these cancers, have sixth and seventh line treatments.

因此，你面对的是前方可能存在的多种治疗选择。

So you're looking down knowing that ahead of you, you've got all these different treatment options that may be available.

这些疗法有助于对抗癌症，但也会带来很多副作用。

They help with the cancer, but they do have a lot of side effects.

因此，经历这些癌症治疗确实是一个巨大的挑战。

And so it can be a real challenge, you know, to go through these cancer treatments.

这如何影响运动在癌症治疗中的作用呢？

How does that complicate, you know, the role of exercise in cancer treatment?

是的。

Yeah.

因此，我们必须把运动视为一种癌症治疗方法。

So we have to think about exercise as a cancer treatment.

这意味着我们需要考虑将运动与其他治疗结合，并合理安排运动的时机。

So that means we have to think about combining exercise with other treatments and sequencing exercise.

你知道吗？运动在治疗前、治疗中还是治疗后进行，效果会更佳？

You know, is exercise more beneficial before this treatment, during this treatment, after this treatment?

哪些治疗方式？

And what treatments?

运动对哪些治疗有帮助，对哪些治疗没有帮助？

What treatments does exercise add benefit to and which treatments does exercise not add benefit to?

或者运动可能会干扰哪些治疗？

Or what treatments might it interfere with?

所以，这种老式的简单问题——运动是否对癌症有帮助——在过去是独立于任何其他治疗方式来讨论的。

So this sort of old straightforward question, does exercise help with cancer, sort of was in the days of independent of any other treatments.

现在，由于这些其他治疗方式都被提供给患者，我们必须以更复杂的方式思考运动，考虑何时以及如何将运动与患者正在接受的其他治疗相结合。

Now that all these other treatments are being given to these patients, we have to think about exercise in a little more sophisticated way about when and how we combine exercise with these other treatments that patients are receiving.

我听过你说，不要躺下接受癌症。

I've heard you say, don't take cancer lying down.

对于刚被诊断出癌症、感到害怕和困惑的患者，他们如何将恐惧转化为运动的动力？

How you how does a patient who is newly diagnosed with cancer, who is scared, confused, how do they transform that fear into motivation to exercise?

你知道的？

You know?

他们如何将疲劳转化为想要活动和锻炼的动力？

How do they transform their fatigue into that motivation to to to move and and exercise?

是的。

Yeah.

癌症诊断是一个非常艰难的时期。

So cancer diagnosis is a very difficult time.

这些患者在得知自己患有癌症时，可能会感到不知所措和极度压力。

These patients can be overwhelmed and very stressed to find out you have cancer.

接着，他们还要了解自己患的是哪种癌症、癌症处于什么阶段、癌症的分级如何。

And then they're learning what type of cancer, what stage of cancer they have, what's the grade of cancer.

然后，肿瘤科医生会向他们介绍各种治疗方案。

And then the oncologist is talking about all these treatments.

我们会给你六个月的化疗，然后让你接受激素治疗。

We're gonna give you six months of chemo and then we're gonna put you on hormone therapy.

所以，这是一个非常令人不堪重负和艰难的时期。

So it's a very overwhelming and difficult time.

因此，我们必须思考，何时是向这些患者提出运动建议并帮助他们介入的合适时机。

And so we have to look at, what's the opportune time to present exercise to these patients and help them intervene.

但我认为许多患者告诉我们，癌症让一切都变得异常。

But I think many patients tell us that cancer makes everything feel abnormal.

他们失去了控制。

They lose control.

癌症似乎已经完全占据了他们的生活。

It's just the cancer has taken over.

许多人觉得运动能帮助他们保持控制感，让他们感觉正常。

And many of them feel that exercise helps them maintain control, helps them feel normal.

因此，一旦他们从最初的震惊中平复下来，意识到自己确实患了癌症，并将面临一系列治疗，许多人就开始寻找：我能做些什么来帮助自己？

So once they kind of settle in the initial shock and realize they have cancer and they're in for these series of treatments, many of them start looking for what can I do to help myself?

是的，我必须按时接受所有这些治疗，但我还能做些什么来可能改善自己的状况？

Yes, I've got to show up and get all these treatments, but what can I do to potentially benefit myself?

当他们开始查阅相关文献时，很快就会发现运动是其中一种可能非常有益的手段——不仅对疾病本身有益，而且对他们在治疗中将面临的诸多副作用、症状和生活质量问题，以及身体和心理健康水平的下降，都有潜在的积极影响。

And when they start looking into the literature exercise exercise is one of these things that they're quickly seeing is potentially very potentially beneficial for them, not just for the disease itself, but yeah, many of these sort of side effects, symptoms, quality of life issues that they're going to face, the declines in physical health and mental health.

我认为一旦他们开始看到这些与癌症相关的益处，对吧？

And I think once they start seeing these cancer specific benefits, right?

癌症患者并不是为了提高最大摄氧量或肌肉力量而运动。

Cancer patients aren't motivated to increase their VO2 max or their muscular strength.

他们想知道什么能帮助他们度过这些治疗？

They want to know what's going to help me get through these treatments?

什么能帮助他们从这些治疗中获益？

What's gonna help me benefit from these treatments?

什么能帮助他们应对副作用？

What's gonna help me manage the side effects?

一旦他们开始看到相关研究，发现运动对癌症患者而言不仅仅是普遍的健康行为，实际上还能帮助他们控制癌症，这会非常激励他们。

And once they start seeing the research there that exercise is not just this general health behavior for cancer patients, but it's actually gonna help them manage their cancer, that can be very motivating for them.

那么，运动能帮助改善哪些方面呢？无论是化疗耐受性、副作用，还是提高生存率？

So what are some of these effects that exercise can help improve, whether we're talking about chemo tolerance, side effects, improved survival?

运动能帮助改善哪些具体效果？

What are some of the effects that exercise helps with?

是的，其中一个主要方面是管理这些治疗带来的副作用。

Yeah, so one of the big ones is managing some of these side effects of the treatments.

你提到了疲劳，这是最重要的副作用之一。

You mentioned fatigue, which is one of the most important ones.

许多癌症患者在治疗期间会经历疲劳以及其他症状。

Many cancer patients experience fatigue from these treatments as well as symptoms.

过去，肿瘤医生通常建议：放松一点，多休息。

And in the past, oncologists used to recommend, take it easy, rest.

这是度过这些治疗的最佳方式。

This is the best way to get through these treatments.

因此，一些早期研究发现，在化疗期间休息的患者，其疲劳感反而比进行锻炼的患者更强烈。

And so some of the early studies started showing the patients that rested during chemotherapy actually reported more fatigue than the patients who exercise.

这对患者来说非常反直觉，对医生来说也是如此。

And this is very counterintuitive for patients, and it's counterintuitive for doctors.

当你感到疲惫、身体不适时，休息似乎是最好的良药。

When you're tired and not feeling well, rest seems like the best medicine.

但这并不是最好的疗法。

But it's not the best medicine.

在运动肿瘤学领域，我们已一再证明，接受治疗期间进行锻炼的患者疲劳感更低。

And we've demonstrated that consistently in the exercise oncology field that patients who exercise going through these treatments have lower fatigue.

因此，这是一个非常重要的因素。

So that's a huge factor.

其他已被明确证实的益处包括睡眠质量的改善。

The other benefits that have been shown definitively are improvements in sleep quality.

你可以想象，接受这些治疗时所承受的压力和焦虑——不确定治疗是否有效，是否会出现复发，这都会严重影响睡眠。

So you can imagine the stress and the anxiety of going through these treatments, not knowing whether the treatments are working, whether or not you're gonna have recurrence, very difficult with sleep.

研究表明，锻炼有助于改善睡眠质量，减轻与癌症相关的焦虑、抑郁水平以及其他一些副作用。

And exercise has been shown to benefit sleep quality, reduce some of the anxiety associated with cancer, depression levels, and some of these other side effects as well.

周围神经病变方面，已有研究显示其可能带来一些益处。

Peripheral neuropathy, there's been some studies showing some potential benefits.

因此，管理副作用是其中一项关键益处。

So that's one of the key benefits is managing the side effects.

你提到了治疗耐受性，也就是你完成这些治疗的能力。

You mentioned treatment tolerance, which is your ability to complete these treatments.

非常重要。

Very, very important.

每个癌症患者都会很快意识到，我必须按时接受所有这些药物治疗。

Every cancer patient learns very quickly that I need to get all of these drugs that I'm supposed to get, and I need to get them on time.

如果肿瘤医生不得不减少这些药物的剂量或推迟治疗，就会增加复发的风险。

If the oncologist has to reduce the dose of those drugs or delay them, that increases the chances of recurrence.

换句话说，这会降低治愈的可能性。

In other words, it reduces the chances of being cured.

因此，肿瘤医生最不想做的就是减少这些药物或推迟治疗。

So the last thing oncologists wanna do is sort of reduce these drugs or delay them.

但如果副作用太严重，他们不得不这么做。

But if the side effects are so bad, they have to do that.

有些患者的副作用太严重，以至于无法完成这些治疗。

Some of these patients, the side effects are so bad, they can't complete these treatments.

因此，早期当我们研究运动时，担心的是运动可能会干扰患者完成这些治疗的能力，让情况变得更困难。

So early on, when we were looking at exercise, the concern was that we might interfere with patients' ability to complete these treatments that are we going to make it harder.

我们在患者已经出现恶心、腹泻、呕吐等副作用的基础上，又增加了运动负担。

We're piling on this exercise on top of all these side effects where they're sick and nauseous and diarrhea and vomiting and so on.

因此，一些研究实际上表明，在化疗期间进行运动的患者能够完成更多的化疗疗程。

And so some of these studies have actually shown that it's the patients who exercise during chemotherapy that end up completing more of their chemotherapy.

他们的化疗药物剂量减少和治疗延迟更少。

They have fewer reductions in the chemotherapeutic drugs and fewer delays.

这意味着更好的治疗效果，更高的治愈几率和更低的复发风险。

And that portends a better outcome, a higher chance at cure and a lower risk of recurrence.

这是一个非常鼓舞人心的重大发现，对患者来说极具激励作用。

So that's been a huge finding that's very motivating for patients.

最终，这种与生存率的关联是否降低了复发风险？

And then ultimately this link to survival, does it reduce the risk of recurrence?

它是否改善了生存率？

Does it improve survival?

我们拥有越来越多的研究数据。

We have a growing amount of research.

在动物模型中的临床前研究探讨了运动与肿瘤生长和扩散的关系，同时这些流行病学研究也表明，报告进行更多运动的癌症患者，其疾病复发风险更低，多年后因癌症死亡的风险也更低。

Preclinical studies in the animal models looking at exercise and tumor growth and spread, but also these epidemiological studies showing that cancer patients who report more exercise seem to have a lower risk of recurrence of the disease and a lower risk of dying from the cancer many years down the road.

所以，是的，运动在生活质量改善方面以及疾病和生存获益方面都有诸多益处。

So, yeah, lots of benefits across the board in terms of quality of life benefits and also disease and survival benefits.

那么在运动类型方面，你认为强度更高的运动在癌症治疗中更有益吗？至少在可能产生这些有益效果的某些机制上是这样吗？

So when it comes to the exercise type, do you think that more intense exercise is more beneficial with respect to cancer treatment and some of some of the, at least, mechanisms that may be occurring to have these beneficial outcomes?

一些研究显示，高强度运动效果更好。

So some of it's been showing that the higher intensity exercise is better.

许多研究采用了高强度间歇训练，但这在很大程度上取决于患者的身体状况以及他们对治疗的反应。

A lot of these studies have done high intensity interval training, but it very much depends on the patient's ability and how they're responding to treatments.

有些患者在第一次接受化疗输注后就会完全虚脱。

Some patients will get a very first chemotherapy infusion and they are completely wiped out.

他们会感到恶心、呕吐，出现腹泻和身体不适，情况非常艰难。

They got nausea and vomiting, they have diarrhea, they have sickness and it's very difficult.

所以我们必须为他们个性化制定锻炼方案。

So we have to individualize the exercise for them.

有些患者甚至不知道自己正在接受化疗。

Other patients don't even know they're on chemotherapy.

他们继续工作，继续正常生活。

They continue working and continue going through it.

他们能够进行要求更高的锻炼计划。

And they're able to do a much more demanding exercise program.

但力量训练也被证明非常重要。

But the weight training has also been shown to be very important.

我之前提到过，锻炼有助于提高化疗的完成率。

I mentioned that improvement in chemotherapy completion.

我们的一项研究发现，力量训练组完成化疗的比例高于有氧运动组或常规护理组。

And one of the studies that we did, it was actually the weight training group that completed more of their chemotherapy compared to the aerobic exercise group or the usual care group.

因此，这个力量训练组在接受化疗期间体重增加了超过一公斤的瘦体重。

And so this weight training group was able to put on over a kilogram of lean muscle while they were on chemotherapy.

这可能有助于这些化疗药物的代谢。

And this might help with the metabolism of these chemotherapy drugs.

因此，高强度运动似乎很有益处。

So higher intensity exercise seems to be good.

在治疗期间，力量训练似乎非常有效。

Weight training seems to be very good during these treatments.

我们所说的重量训练方案和有氧运动训练方案具体包括哪些内容？你们试验中的部分患者接受了哪些方案？

What protocols kind are we talking about with respect to the weight training protocol, the aerobic exercise training protocol that some of the patients in your trials have been on?

我们测试的大多数方案是每周进行三天力量训练，大约包含八个针对主要肌群的练习，中等强度，每次做到力竭前做8到12次重复。

Most of the protocols we've tested are three days per week of weight training, maybe eight exercises covering all the major muscle groups, moderate intensity, so eight to 12 repetitions before failure.

所以我将其视为一种标准的全身性力量训练计划。

So I would consider kind of a standard full body type of weight training program.

许多其他试验采用的是每周两天的训练频率。

Many of the other trials have done two days per week.

因此，大量有力的证据表明，即使每周只进行两天的力量训练，也能对这些结果产生显著益处。

So lots of good evidence suggesting that even two days of a week of weight training can be very beneficial for these outcomes.

你有没有把有氧运动和力量训练结合起来，看看是否存在协同或叠加效应？

Have you ever combined the aerobic exercise with weight training and see if there's like a synergy or additive effect?

有的。

Yes.

我们进行过一项名为CARE的研究，即乳腺癌患者联合有氧与抗阻运动。

We did one trial we call the CARE trial, which stands for combined aerobic and resistance exercise in breast cancer patients.

我们确实发现了一些额外的益处。

And we did find some additional benefits.

我们采用了高强度的有氧运动。

We did a high dose of aerobic exercise.

我们采用了中等强度的有氧运动，同时还进行了有氧与抗阻结合的训练。

We did a moderate dose of aerobic exercise, And then we did a combined aerobic and resistance exercise.

当然，联合训练在肌肉力量、瘦体重增加等方面带来了额外益处，甚至在某些症状和副作用上也有轻微改善。

And of course, additional benefits and things like muscular strength, improvements in lean body mass, but even in some of the symptoms side effects, small additional benefits of combining the two.

但最确凿的证据仍然是：运动总比不运动要好。

But the best evidence definitely is exercise compared to nothing at all.

这正是带来益处的关键。

That's that really drives the benefits.

一旦你开始调整运动处方，我们就能看到那些有能力且愿意进行更多运动，或愿意参与综合运动计划的患者获得额外益处。

And once you start manipulating the exercise prescription, we can see some additional benefits for patients who are able and willing to do more exercise or able and willing to do a combined exercise program.

当你提到高强度有氧运动和中等强度有氧运动时，这是指每周的指南标准吗？还是具体的方案是什么？

When you say high aerobic exercise versus moderate, is this guidelines, like, per week, or what what was the kind of protocol?

是的。

Yeah.

中等强度组是每周75分钟的剧烈运动，而高强度有氧组则是每周150分钟的剧烈运动。

So it was seventy five minutes of vigorous in the in the sort of moderate group, and then a hundred fifty minutes per week of vigorous in the high aerobic.

所以这相当于有氧运动的最低推荐量与最佳推荐量之间的区别。

So it was more kind of the minimum guideline versus the optimal guideline for aerobic exercise.

我想聊聊一些关于提高生存率、降低癌症复发的机制。

What so I wanna talk a little bit about some of the the mechanisms for improved survival, for reduced cancer recurrence.

我提到过其中一个，就是坚持治疗。

I mean, you mentioned one, which was continuing the the treatment.

对吧？

Right?

显然，这是一个重要的因素。

So obviously, that's one important.

但也许还有一些其他因素也会影响癌症转移。

But perhaps some other ones that may also affect cancer metastasis.

对吧？

Right?

比如，这些因素也可能影响生存率，并在将来降低复发风险。

Like, that would also affect survival and perhaps recurrence later down the line as well.

你觉得我们可以谈谈这些机制吗？比如与免疫相关、代谢相关的？

What do you find can we talk a little bit about some of these mechanisms, like immune related, metabolic related?

我听过你提到血流增加。

I've heard you talk about increased blood flow as well.

如果其中有一些特别有说服力的，你觉得哪个最突出？

And maybe what's most compelling, if there's any that's most compelling?

如果我们讨论影响原发性肿瘤，我们在临床前模型中已经看到这一点，人类研究中也是如此。有时，当患者已有原发性肿瘤时，第一种治疗方式并不是立即手术切除。

So if we talk about influencing the primary tumor, and we've seen this in preclinical models, but also in the human studies, sometimes when we've got an existing primary tumor, the first treatment is not to surgically remove it.

第一种治疗方式是使用化疗或放疗，试图缩小或消除肿瘤。

The first treatment is to treat it with chemotherapy or radiation therapy and try and shrink or eliminate the tumor that way.

因此，在一些临床前模型中，研究人员发现，如果给小鼠同时使用特定化疗药物和运动，相比单独使用运动或单独使用化疗，联合治疗的效果更好。

And so what they've shown in some of these preclinical models is if you're giving these mice a particular chemotherapy drug and exercise versus neither versus both, exercise combined with chemotherapy is more effective than exercise alone or chemotherapy alone.

这些研究还表明，这些原发性肿瘤的血管状况非常差。

And what they've shown in these studies is that these primary tumors have a very poor vasculature.

它们的血管质量低下，渗漏且结构紊乱。

It's poor quality blood vessels, they're leaky and they're chaotic in there.

但所有这些肿瘤要想生长，都必须诱导血管生成。

But all these tumors in order to grow, they need to draw blood vessels.

它们只能长到很小的尺寸，除非内部形成血管，否则无法继续增大。

They only grow to a very small size and unless they get blood vessels within them, they can't grow any larger.

因此，它们都会开始形成新的血管。

So they all start developing these blood vessels.

这些运动研究显示，运动能够改善这些血管的质量和密度。

What they were able to show in these exercise studies that exercise improves the quality of these blood vessels and the density of these blood vessels.

在改善血管质量的同时，这也提高了化疗药物向肿瘤的输送效率。

And while you're improving the quality of these blood vessels, what that improved was chemotherapy delivery to the tumor.

因此，它改善了药物向肿瘤的输送。

So it improved the delivery of the drugs to the tumor.

它还能改善肿瘤的血液灌注。

What it also does is improve perfusion to the tumor.

这些肿瘤的供氧情况也得到了改善。

And these tumors become better oxygenated.

这一点至关重要，因为放射治疗对氧合良好的肿瘤更有效。

That's critical because radiation therapy is effective with well oxygenated tumors.

如果肿瘤处于缺氧状态，它们对放射线就不敏感。

If they are hypoxic tumors, they're not radio sensitive.

因此，我们现在开始思考：如果在接受放射治疗或化疗的同时进行运动，或许能提高药物向肿瘤的输送效率，并增强肿瘤对放射线的敏感性。

So now we start thinking if you're exercising while getting radiation therapy or while getting chemotherapy, we might improve delivery of the drugs to the tumor and improvements in making them more radio sensitive.

我们在实际的人体研究中也观察到了这一点。

And we've seen this in actual human studies.

因此，在对患者进行的实际研究中，我们对直肠癌患者开展了一项研究。

So, in actual studies with patients, we did a study in rectal cancer patients.

他们的治疗方案是在手术切除肿瘤前十二周接受化疗和放疗的联合治疗。

And the treatment for them is a combination of chemo radiation therapy prior to having the tumor surgically removed twelve weeks later.

因此，他们的目标是缩小并尽可能消除肿瘤。

So, they want to shrink and try and eliminate that tumor.

我们发现，在接受化疗放疗期间进行锻炼的患者更有可能实现完全缓解，即在手术前肿瘤完全消失。

And what we found is the patients who exercise while getting this chemoradiation therapy were more likely to have a complete response, meaning the tumors were completely gone prior to having the surgery.

因此，对于接受所谓新辅助治疗——即手术前的化疗和放疗的患者来说，锻炼可能带来非常显著且重要的益处。

So this is a very profound and important benefit of exercise potentially in these patients who are getting treated with what we call neoadjuvant therapy, this kind of chemo and radiation therapy prior to surgery.

这是其中一种非常重要的机制，或许也是最具说服力的。

So that's one very important mechanism and perhaps the most compelling.

一旦肿瘤被手术切除，你就不再担心原发肿瘤了。

Once the tumor is surgically removed, you're no longer concerned about the primary tumor.

你担心的是，少量癌细胞已从原发肿瘤脱落，并可能在全身扩散。

You're concerned that a small number of cancer cells have been shed from the primary tumor and might spread throughout the body.

因此，这些细胞必须经历一段艰难的旅程，穿过血管系统。

So these cells have to go on an arduous journey through the vasculature.

它们可以通过淋巴系统扩散，也可以通过血管扩散。

So they can spread through the lymph system, but also through blood vessels.

有一些非常有趣的研究表明，如果在肿瘤释放这些循环肿瘤细胞时进行锻炼，由于血流剪切应力增加，这些循环肿瘤细胞更难存活。

There's some really interesting research suggesting that if you exercise while the tumors are shedding these circulating tumor cells, those circulating tumor cells are less likely to survive because of the increased sheer stress.

当血液在血管中流动时，会承受一定的压力，但当你锻炼时，这种压力会显著增加。

So when blood's flowing through the vasculature, it's under a certain amount of pressure, but of course, that's dramatically increased when you exercise.

如果你在锻炼，这些循环肿瘤细胞在旅途中死亡的可能性会大大增加，难以存活。

And these circulating tumor cells are far more likely to die and not survive that journey if you're exercising.

因此，这是锻炼可能阻止原发肿瘤扩散的另一个非常有趣的作用机制。

So this is another really interesting mechanisms for how exercise might be able to prevent the spread of a primary tumor.

一旦这些细胞开始循环或已扩散到身体其他部位，其他一些机制就可能变得重要。

And once those cells are circulating or they've kind of disseminated elsewhere in the body, this is where some of these other mechanisms can be important.

运动的代谢效应，比如降低胰岛素和IGF，这些都会促进癌细胞更快地生长和分裂。

The metabolic effects of exercise, such as reducing insulin and IGF, these are all things that help cancer cells grow and divide more rapidly.

运动的抗炎作用可能非常重要。

The anti inflammatory effects of exercise can be very important.

而其中最关键的一点可能是免疫系统，它能追踪并杀死这些癌细胞，对吧？

And probably one of the key ones is the immune system, tracking down and killing these cancer cells, right?

这就是为什么我们现在有了全新的治疗方法——免疫疗法。

This is why we have the whole new treatment now, immunotherapy.

我们已经意识到，调动免疫系统来追踪并杀死这些癌细胞有多么重要。

We've realized how important it is to call on the immune system to be able to track down and kill these cancer cells.

因此，从某种意义上说，运动是最初的免疫疗法。

So exercise in some ways was the original immunotherapy.

它通过刺激免疫系统，提高自然杀伤细胞的细胞毒性，增加自然杀伤细胞、T细胞和B细胞的数量，从而对这些癌细胞进行免疫监视。

This was stimulating the immune system and improving natural killer cells, cytotoxicity, the number of natural killer cells, the number of T cells and B cells that were all doing immuno surveillance of these cancer cells.

因此，运动改善癌症预后的生物学机制非常多。

So lots of good biological mechanisms for how exercise might improve these cancer outcomes.

这太棒了。

That was phenomenal.

谢谢你的解释。

Thank you for that explanation.

我有几个后续问题。

A couple of follow-up questions.

你刚才谈到的免疫监视，是这样的。

So one, what you're just talking about, you know, the the immune surveillance.

我读过一些关于运动的研究，这些研究的对象是健康人群。

And I'm wondering so I I've read some studies about exercise, and these are normal healthy people.

长期以来，人们一直认为，如果你生病了，比如有呼吸道疾病，就不应该运动。

And I you know, for a long time, it was thought like, oh, if you're if you're sick, if you have a respiratory illness, you should you should not not exercise.

因为一些研究发现，运动会暂时降低血液中循环T细胞的数量。

Because some studies that were done found that exercise acutely lowered the number of circulating T cells in in the bloodstream, the vascular system.

但后来的进一步研究发现，这些循环T细胞其实是去了别的地方。

But then subsequent studies were done and found that actually those circulating T cells were going somewhere.

它们实际上进入了肺部。

They're actually going to the lungs.

所以它们被动员到肺部，帮助对抗病原体。

So they're immobilizing, going to the lungs to help fight off, you know, pathogens.

对吧？

Right?

导致呼吸道疾病的病原体。

The respiratory the causing respiratory illness.

运动是否会影响免疫细胞，比如细胞毒性T淋巴细胞或自然杀伤T细胞，使它们迁移到肿瘤部位，并在血管系统中进行监视？

Does exercise affect the immune cells, like the cytotoxic T lymphocytes or the natural killer T cells, immobilization to go to the site of the tumor as well as, you know, surveilling in the vascular system?

是的。

Yeah.

这一点已在那些临床前小鼠模型中得到证实。

So that's been demonstrated in those preclinical mouse models.

研究表明，进行运动的小鼠肿瘤内部的T细胞和自然杀伤细胞数量更多。

So they've shown that the mice that exercise will have higher numbers of T cells, natural killer cells within the tumor itself.

因此，改善的血流使得所有物质都能进入肿瘤，从而杀死它。

So that improved blood flow allows everything to get into the tumor in order to be able to kill it.

所以，是的，增强的免疫力会将所有免疫细胞推向全身，以潜在地追踪这些循环或扩散的肿瘤细胞，同时也会增加免疫物质对原发肿瘤的输送。

So yeah, the improved immunity, it will push all the immune cells out into the system to potentially track down some of these circulating or disseminating tumor cells, but it also increases immuno delivery to the actual primary tumor as well.

现在，正如你提到的，运动也可能具有免疫抑制作用，对吧？

Now, exercise to your point can be immunosuppressive as well, right?

我们知道，那些极高强度的运动，比如铁人三项运动员和马拉松跑者，对吧？

We know these very high levels of exercise, the kind of triathletes and the marathon runners, right?

它可能导致免疫抑制。

It can cause immunosuppression.

这正是早期一些肿瘤学家对运动感到担忧的原因之一，对吧？

And this was one of the reasons some oncologists early on were concerned about exercise, right?

这些患者在接受化疗和其他治疗后可能会出现免疫抑制。

These patients can become immunosuppressive from the chemotherapy treatments and other treatments.

因此，他们对这些患者进行极高强度的运动有些担忧。

So they were a bit concerned with the very high intensity exercise in these patients.

但我们研究和关注的大多数是中等强度或较高强度的运动，而且是适度的运动量，而不是像马拉松运动员或铁人三项选手那样可能让患者过度劳累的情况。

But most of what we're studying and looking at is more the moderate intensity or higher intensity exercise, but for reasonable amounts of exercise, not sort of these marathon runners or these triathletes where you might overwhelm the patient.

而且大多数人并不会去跑马拉松。

And most people aren't out there running marathons.

所以，当只有极少数人存在这种过度训练时，却如此担心免疫抑制，似乎有点荒谬。

So it seems kind of silly to be so concerned about immunosuppression when a very small percentage of people are overtraining in that in that regard.

对吧？

Right?

是的。

Yes.

对。

Yeah.

我们并不担心太多人运动过量会成为公共卫生问题。

We don't have a public health concern about too many people exercising too much.

这种情况确实会发生。

It does happen.

确实存在运动成瘾和过度锻炼的问题，但这只占人口中非常小的一部分。

There is such a thing as exercise addiction and overdoing it and overtraining so on, but that is a very small slice of the population.

我的第二个问题是，您之前提到剪切力——也就是血流增加时产生的力量，可以杀死循环中的肿瘤细胞。

My second question is you were talking about the shearing forces of, you know, increasing blood flow, and that can kill these circulating tumor cells.

通过各种形式的锻炼，有多种方式可以增加血流量。

There's a variety of ways you can increase blood flow through various forms of exercise.

例如，有氧运动是一个连续的过程。

So for example, aerobic exercise, it's on a continuum.

对吧？

Right?

强度越高，血流的冲击力就越强，有助于清理体内系统。

With the higher the intensity you go, the stronger the sort of push of blood flow, you know, cleaning out the system.

力量训练。

Resistance training.

所以，举重也会引起血压变化和血流改变。

So so lifting lifting weights can also cause blood blood pressure changes and changes in blood flow.

你认为这两种运动都会影响这一通路吗，还是主要是更高强度的有氧运动？

Do you do you think both of those types of exercise could affect that that pathway, or is it mostly the more higher intensity sort of aerobic exercise?

是的。

Yeah.

根据这个机制，任何能增加血流的方式都应该有效。

Based on the mechanism, then anything that increases that blood flow should work.

因此，一些已有的研究更多是基于临床前的体外模型。

So some of the research that's been done has been more of a preclinical in vitro model.

所以有些研究人员开发了这些塑料管、橡胶管，可以通过快慢不同的速度让血液流过这些管道。

So there's researchers who develop these plastic tubes, rubber kind of tubes, and they can spin blood through these tubes faster or slower.

然后他们可以把这些循环肿瘤细胞放入他们开发的这种微流体系统中，通过更快或更慢的速度旋转它们。

And then they can put these circulating tumor cells in this sort of microfluidic system that they've developed and they can spin them around faster and slower.

结果表明，旋转速度越快——这与运动时可能发生的情况一致——死亡的肿瘤细胞就越多。

And they show that the faster you spin these around consistent with what might happen during exercise, the more of these cells that die.

因此，他们尚未研究是什么导致了这种血流动力学剪切应力的增加。

So they've not looked at what's causing that increase in blood hemodynamic sheer stress.

所以，理论上，力量训练和有氧运动都应该能够做到这一点。

So yeah, in theory, both strength training and aerobic exercise should be able to do it.

目前唯一一项在人类身上进行的研究表明，运动可以改善或减少循环肿瘤细胞，那是一项有氧运动计划。

The one study that's been done in humans showing that exercise improves or reduces circulating tumor cells was an aerobic exercise program.

但理论上，两者都应该有效。

But in theory, both should work.

如果你能减少血管系统中的循环肿瘤细胞数量，这是否与更低的癌症复发率或更低的癌症死亡率相关？有数据支持这一点吗？

And if you do reduce the number of circulating tumor cells in your vascular system, is that associated with is there data showing that is associated with lower you know, cancer recurrence, lower cancer mortality, for example?

没错。

That's right.

癌症转移的方式是：癌细胞必须从原发肿瘤脱落，然后在血管中循环，最终到达其他部位。

So the way that cancer spread is the these it has to shed cells from the primary tumor, and they have to circulate throughout the blood vessels, and they have to get somewhere else.

因此，如果你能阻止或减少这一过程，就应该能降低转移的数量。

And so if you're preventing that or reducing that, you should be able to reduce the number of metastases.

这至关重要，因为这正是最终导致癌症患者死亡的原因。

That's absolutely critical because that's what ultimately kills cancer patients.

对吧？

Right?

所以乳腺癌、前列腺癌，你想到这些癌症时，乳腺并不是一个关键器官。

So breast cancer, prostate cancer, you think of these cancers, the breast is not a vital organ.

女性没有乳腺也可以生存。

Women can live without a breast.

那你怎么会死于乳腺癌呢？

So how do you die from breast cancer?

前列腺癌，男性没有前列腺也可以生存。

Prostate cancer, men can live without a prostate.

那你怎么会死于前列腺癌呢？

How do you die from prostate cancer?

这是因为这些肿瘤会释放细胞，并在整个体内扩散。

It's because these tumors shed these cells and they disseminate throughout the system.

然后它们会到达大脑、肺部、肝脏和骨骼等部位。

And then they arrive at places like the brain, the lungs, the liver and the bone.

它们在这些部位形成所谓的肿瘤集落，并开始生长和侵袭这些器官。

And they set up what we call sort of colony tumors there, and they begin to grow and invade those organs.

这就是你最终死于乳腺癌的原因。

And that's how you ultimately die from breast cancer.

如果癌症局限于原发部位，你不会死于乳腺癌。

If it's localized, you're not gonna die from breast cancer.

因此，防止这种扩散是关键所在。

And so preventing that spread is really the critical aspect.

因此，减少循环肿瘤细胞的数量至关重要。

And so reducing the number of circulating tumor cells is critical.

癌症转移需要多长时间？

How long does cancer metastasis take?

这会因肿瘤类型而异吗？

Does that vary by tumor type?

如果有人被诊断出患有，或者说有人患有I期乳腺癌、前列腺癌或结直肠癌，但自己根本不知道，通常需要多长时间才会进展到下一阶段？

So if someone's diagnosed with or let's say someone has stage one, they don't even know they have stage one breast cancer, prostate cancer, colorectal cancer, what's the timeline typically like to get to the next stages?

是的

Yeah.

而且这确实因癌症类型而有很大差异。

And it varies dramatically by the types of cancer, for sure.

所以有时我们看到非常小的肿瘤也会释放癌细胞。

So sometimes we see very small tumors might shed cancer cells.

因此，即使我们发现的是一个我们认为很小的肿瘤，它可能已经释放了这些癌细胞，并且它们可能已经扩散了。

So even though we find what we think is a small tumor, it may have already shed these cancer cells and they may have already spread.

有时肿瘤可能相当大，但尚未扩散任何癌细胞。

Sometimes the tumor can be fairly large and not have disseminated any tumor cells yet.

而真正的挑战在于，这些肿瘤可以释放癌细胞，但转移可能不会立即发生。

And the real challenge there is these tumors can disseminate these tumor cells and metastasis may not happen right away.

有时它们会休眠多年。

Sometimes they sit dormant for years.

所以这就是为什么乳腺癌患者可能会来就诊，我们发现那里有一个原发肿瘤。

So this is where someone with breast cancer may go in, We've got a primary tumor there.

我们把它切除了。

We cut it out.

我们不知道是否有细胞已经扩散，但五年、八年、十年后，我们发现了脑转移或肺转移。

We don't know if any cells have disseminated, but five years later, eight years later, ten years later, we detect a brain metastasis or a lung metastasis.

因此，这些细胞可以在很长一段时间内处于休眠状态，然后才开始重新生长。

So these cells can sit dormant for an extended period of time before they sort of start to regrow.

因此，转移可能是一个非常漫长的过程，也可能是一个相对短暂的过程。

And so metastasis can be a very, very long process or it can be a fairly short process.

其他类型的癌症，这些细胞会迅速扩散，并在其他转移部位快速生长。

Other cancers, these cells spread quickly and they grow quite rapidly at these other metastatic sites.

有没有办法追踪这类细胞？比如，能否通过血液检测来测量循环肿瘤细胞？

Is there any type of tracking that can be done for tracking these types of I mean, is it can you get a blood test and measure circulating tumor cells?

这种检测的灵敏度足够高吗？

Is that something that is that that a test is sensitive enough to do?

这正是当前研究的热点领域。

So that's the new area of hot research.

过去，我们基本上只能通过影像学来检测这些癌症。

So in the past, we could essentially only detect these cancers based on imaging.

因此，这些转移灶必须长到一定大小，比如一毫米、两毫米，才能在扫描中显现出来。

So these metastases would have to grow to a certain size, like one millimeter, two millimeters before they would show up on these scans.

所以我们无法检测到少量的癌细胞。

So small numbers of cancer cells we couldn't detect.

于是你得等待很多年，五年后做一次随访扫描，突然发现肺部或肝脏上有个斑点，心想：好吧，这可能是癌症。

And so you're waiting many, many years doing a follow-up scan five years later, and all of a sudden you see a spot on the lungs or a spot on the liver and say, okay, that could be cancer.

因此，我们是否能通过血液检测更早地发现它们，也就是他们所说的液体活检。

So this whole idea of can we find them earlier through blood tests, what they're calling liquid biopsies.

现在这是一个研究热点，科学家们正试图开发血液检测方法，以检测少量的循环肿瘤细胞或循环肿瘤DNA。

And this is an area of a lot of research now where they're trying to develop these blood tests to detect small numbers of circulating tumor cells or small numbers of circulating tumor DNA.

因为这些癌细胞会生长、分裂，也会发生细胞死亡，并向体内释放一些物质。

Because these cancer cells will grow, divide, undergo cell death as well, and they'll shed some elements into the system.

但这项技术仍处于实验阶段。

But this is very experimental.

目前这些血液检测和液体活检尚未用于临床实践，但相关研究非常多。

It's not being used in clinical practice right now, but there's a ton of research on these blood tests and liquid biopsies.

如果我们能在手术时立即进行检测，切除肿瘤后几周再测试，看看是否仍有循环肿瘤细胞残留，从而判断是否需要进一步的化疗或免疫治疗，这将彻底改变癌症治疗方式。

So that would revolutionize cancer care if we can actually go in at the time, do a surgery, remove the tumor and then test a few weeks later to say, are there any elements of circulating tumor cells still around giving us an indication, okay, well maybe we need further treatments with chemotherapy or immunotherapy.

这将彻底改变这个领域，但目前还

It would revolutionize the field, but it's not

没有进入临床应用。

in clinical practice yet.

那么，像GRAIL这样的消费者可获得的液体活检检测是否已经投入使用？

Well, are consumer available tests like GRAIL that are available with these liquid biopsy tests that are done.

对于健康人群，无论是没有家族史，还是有癌症家族史的人，您如何看待他们做GRAIL这类液体活检？相比之下，您提到的情况可能更适用——即患者曾确诊癌症，经过治疗后原发肿瘤似乎已消失，此时进行GRAIL检测。

Do you think what are your thoughts on on like someone that's healthy without, like, a family history or perhaps with a family history of cancer doing a liquid biopsy like the GRAIL test versus maybe, like, your the situation that you're saying, which may be may be a little more applicable where someone has had a cancer diagnosis, has successfully, quote, quote, unquote, successfully undergone treatment in that the primary tumor seems to have gone away, by all means.

他们去做GRAIL检测，可能发现一些异常，也可能没发现，或者只是用于监测。

And they go and do a grail test and perhaps maybe find something or don't find something or maybe monitor.

也许有人会每年定期做一次。

Maybe someone does it yearly, annually.

你知道吗？

You know?

我不知道。

I don't know.

你对那些测试有什么看法？

What what are your thoughts on on those

那些检测？

those tests?

从科学角度来说，现在可能还为时过早，你谈的是将其用于预防或早期筛查，而不是治疗或复发监测。

It's probably too early for the science, so you're talking about using it on sort of the prevention side of thing or the early detection side of things as opposed to the the treatment recurrent side of things.

今天我刚读到一篇关于结直肠癌的研究，现在已经有血液检测可用于结直肠癌了。

Just reading a study today in colon cancer, they've got a blood test now out for colon cancer.

他们正在将其与结肠镜检查进行比较，因为结肠镜是目前的金标准检测方法。

They're comparing it to colonoscopy because that's the gold standard way we detect.

而且它的效果相当不错。

And it is fairly effective.

它的敏感度大约是80%，特异性是90%，但他们仍然不建议将其用于普通人群。

It was like 80% sensitivity and 90% specificity, but they still were not recommending that for the general population.

但我认为这项技术正在逐步成熟。

But I think it's coming down the pipeline.

我的意思是，如果这项检测可以私下获得，而你希望做这项检查，最好咨询你的医生，了解如何解读结果，确保你正确地看待这些问题。

I mean, if it is available privately and you want to get that test done, you want to check with your doctor in terms of how to interpret it and make sure you're looking at things properly.

但我认为这项技术正在发展中，再过不了几年，普通人可能就会在早期筛查方面接受血液检测了。

But I think that technology is coming down the road, and it may not be too many more years when the average person is getting a blood test on on the early detection side of things.

在癌症复发方面，假设有人愿意自费去做检测，我会提到Grail，因为这是目前面向消费者最广泛、研究最多的检测之一。

On the on the cancer recurrence side of it, let's say someone wants to pay out of pocket, and they're gonna go do I I say grail because that's, like, the biggest probably most studied one that's out there for consumers.

假设他们发现结果呈阳性。

And let's say they find, oh, I have a positive test.

他们检测到了一些肿瘤细胞DNA，而且这种癌症和他们之前确诊的癌症类型相同。

I've got, you know, some some tumor cell DNA that was detected, and it's the same kind of cancer that I was previously diagnosed with.

那么对于这样的人，接下来该怎么做呢？

What would be the next steps with for someone?

他们要去找肿瘤科医生，然后进一步确认吗？

Do they go to the oncologist and then somehow verify?

我的意思是，有没有办法验证这个测试结果是否准确？

I mean, is there any way to verify if that's you know, if the if the test, you know, is accurate?

或者

Or

在诊断后、复发监测方面，这种检测在临床实践中已有一定程度的应用。

So on the post diagnosis, the recurrent side of things, it is being used in clinical practice to some extent.

因此，他们的肿瘤科医生可能已经建议使用了。

So their oncologists may already be recommending that.

所以我建议你咨询你的肿瘤科医生，看看是否推荐这样做。

So I would check with your oncologist to see if that is something that's recommended.

这种检测的整个优势在于，我们必须谨慎，既不要过度治疗癌症，也不要治疗不足。

The whole advantage, the idea of this is we have to be careful that we're not over treating cancer and of course we're not under treating cancer.

目前，由于我们不确定患者体内是否仍有残留病灶，却希望确保万无一失，因此很多患者都接受了过度治疗。

So right now we over treat a lot of patients because we're not sure if they have any remaining disease, but we just want to be sure.

因此，他们接受了所有这些最终并不需要的治疗。

And so they get all these treatments that they ultimately didn't end up needing.

因此，这种治疗后检测的一个优势是，如果没有发现任何循环肿瘤细胞或循环肿瘤DNA的证据，我们就可以考虑减少治疗，告诉患者目前不需要进一步的治疗。

So one of the advantages of this testing on the post treatment side of things is if there is no evidence of any circulating tumor cells, circulating tumor DNA, we can potentially deescalate the treatments and say, you don't need any further treatments right now.

对于检测结果为阳性的患者，如果存在少量残留癌细胞的证据，我们通常仍希望进行额外的治疗。

For the patient that test is positive, we probably do want additional treatments if there's evidence that there's still small number of cancer cells around.

因此，我们通常会根据医生的判断推荐额外的化疗或免疫治疗。

So usually we'll recommend additional chemotherapy or immunotherapy depending on what the doctors find.

所以，是的，请咨询你的肿瘤科医生，看看这是否已纳入临床护理，或者是否会被推荐。

So yeah, check with your oncologist if that's already built into the clinical care or whether that's something that would be recommended.

回到运动与保险这个话题，事实上，特别是有氧运动，任何能显著增加血流的活动，似乎都能对这些循环肿瘤细胞产生显著影响。因此，对于已经确诊并接受过治疗的癌症患者来说，如果不像生命依赖运动那样积极活动，反而显得很荒谬，对吧？尽可能多地运动，因为这似乎是降低癌症转移风险、确保循环肿瘤细胞不会在其他器官安家落户的最佳方式。

Well, back to this exercise as insurance and the fact that, you know, aerobic exercise in particular, anything that's really increasing blood flow does seem to really have an effect on these circulating, you know, tumor cells, then it would seem silly for someone who is has been diagnosed, has been treated for cancer to not be just moving like they're life dependent on it, right, exercising as much as possible because it seems like that would be your best bet for reducing the cancer metastasis and and ensuring that these circulating tumor cells do not go and take camp into another organ.

是的。

Yeah.

因此，我们有很多研究支持这一观点。

So again, we have a lot of research suggesting that.

这仍然是实验性的，但我仍然认为这是患者自己可以做的为数不多的事情之一，对吧？

It's still experimental, but I still think it is one of the few things that patients can do themselves, right?

其他所有治疗都是施加在他们身上的，比如化疗、手术等等。

Everything else is done to them, done for them in terms of the chemotherapy, the surgery and so on.

所以患者们都在寻找：我自身能做些什么？

So patients are looking for what sorts of things can I do myself?

而运动可能是目前证据最充分的、能为现有治疗带来额外潜在益处的方式。

And exercise probably has the strongest evidence of additional potential benefit beyond sort of their current treatments.

所以，是的，我认为在某些癌症中，我们最终将能证明运动对这些患者的预后有明确的改善作用。

So, yeah, and I think in some of these cancers, are gonna be able to show that there's absolutely benefits to improved outcomes for these patients.

你已经对多种癌症类型结合运动和标准治疗进行了大量研究，比如前列腺癌、乳腺癌、结直肠癌等等，对吧？

Are there so you've done a lot of research on a variety of different types of cancer in conjunction with exercise and and, you know, standard of care treatment, prostate, breast, colorectal, on and on.

那么，你有没有发现不同类型的运动对不同癌症在联合治疗中的效果有所不同？

So have you noticed that the different types of exercise affect these different types of cancers differently in terms of combined treatment?

是的。

Yeah.

不同癌症之间存在一些差异。

There are some differences among the cancers.

尽管我们使用‘癌症’这个词时仿佛它是一种单一疾病，但实际上它是一百多种不同疾病的集合。

So even though we use the term cancer like it's a singular disease, it's a collection of over a 100 different diseases.

驱动这些癌症的所有突变都可能不同。

And all the mutations that drive these cancers can be different.

因此，并非所有癌症都会对运动干预产生敏感或积极响应。

So, not everything is gonna be sensitive or receptive to an exercise intervention.

但我们在所有治疗中都看到这种情况，对吧？

But we see this with all treatments, right?

有些癌症对化疗敏感，有些则对化疗耐药。

Some cancers are chemo sensitive, some are chemo resistant.

有些对放疗敏感，有些则对放疗耐药。

Some are radio sensitive, some are radio resistant.

甚至在免疫疗法中，我们也发现对某些类型的癌症取得了巨大进展。

We've even seen in immunotherapy that we make incredible gains with certain types of cancers.

但在其他类型的癌症中，免疫疗法似乎完全无效。

But in other cancers, immunotherapy doesn't seem to be effective at all.

所以我们需要以这种方式看待运动。

So we need to think this way about exercise.

你知道，运动不会对所有这些癌症都起到神奇的效果。

You know, exercise is not going to be a magic bullet for all these cancers.

因此，它似乎对某些癌症的帮助比其他癌症更大。

So it seems to help with certain cancers more so than others.

当你从预防的角度来看时，运动与结肠癌的关联最为显著。

And when you think on the prevention side of things, their strongest association seems to be with colon cancer.

因此，这些细胞可能特别敏感。

So those cells might be particularly sensitive.

乳腺癌也有很强的关联，而其他一些癌症，如直肠癌、前列腺癌等，则看不出明显的关联。

Breast cancer has a strong association, where some other cancers, we don't see much of an association like rectal cancer, prostate cancer, and stuff as well.

因此，不同类型的癌症中，我们可能会发现一些对运动有反应的癌症，也可能会发现一些对运动无反应的癌症，这取决于驱动这些癌症的突变类型。

So the different types of cancer, we might find cancers that are exercise resistant and cancers that are exercise sensitive, depending on the types of mutations that are driving those cancers.

但除了癌症类型影响运动的种类和益处外，治疗方式也同样重要。

But in addition to the types of cancers affecting the type and benefits of exercise, it's also really the treatments.

患者所接受的治疗可能会决定哪种运动最合适，以及运动量应如何安排。

What treatments the patient's on might determine what type of exercise is best, what amount of exercise is best.

举个例子，我们发现力量训练与前列腺癌的一种治疗方法——雄激素剥夺疗法——非常契合。

And to give you one example, we've really found a really good fit between weight training and a treatment for prostate cancer called androgen deprivation therapy.

男性被诊断出前列腺癌后，主要的治疗方法之一是降低睾酮水平，因为睾酮会促进前列腺癌的生长。

So men get diagnosed with prostate cancer, one of the main treatments is to eliminate their testosterone because testosterone fuels the growth of prostate cancer.

因此，他们会接受药物治疗，将体内的睾酮水平降至去势水平。

So they're given these drugs, which take them down to castrate levels of testosterone.

这对前列腺癌来说效果很好，但对男性的整体健康、力量和肌肉状况却非常不利。

That's fantastic for the prostate cancer, but it's not very good for the man in terms of health, strength, muscle weakness, and these types of things.

因此，对于接受雄激素剥夺疗法的患者，我们已开展了多项关于力量训练的研究。

So these guys who are on these androgen deprivation therapies, we've done multiple studies with weight training.

研究显示，这种训练对这些患者恢复力量、重建肌肉，以及改善疲劳和精力水平非常有效。

And that seems to be a really effective intervention for these guys to regain their strength, regain their muscle and improvements in things like fatigue and energy.

因此，根据不同的治疗方法，某些类型的运动和运动量可能更有益。

So again, depending on the types of treatments, certain types and amounts of exercise may be more beneficial.

我想这很有趣，因为复合动作和重训可能是最能提升睾酮水平的生活方式因素之一。

I wonder if it's interesting because compound lifts and lifting heavy is probably one of the strongest lifestyle factors that can increase testosterone, actually.

我在想，这是否主要对肌肉有局部影响，而不是作用于前列腺，或者说，不像其他会提升睾酮水平的方式那样。

I'm wondering if it's it's having more of a local effect on muscle and not, you know, going to the prostate versus, you know, I guess, other things that would increase testosterone.

是的。

Yeah.

所以当我们最初向临床医生提出这个建议时，他们曾有这方面的担忧。

So that was one of the concerns of the clinicians when we first approached them about the patients.

哦，也许运动会让睾酮水平升高，从而促进前列腺癌生长。

Oh, maybe exercise is gonna increase the testosterone and help this prostate cancer grow.

所以有几点需要说明。

So a couple of things.

第一，这些药物的效果非常强大。

One, these drugs are so powerful.

它们将睾酮水平降低到去势水平。

They take testosterone down to castrate levels.

运动带来的微小影响，医生们并不担心会超越这种效果。

The small impact of excise, the doctors are not worried that it's gonna override that.

但你提到的这些影响通常是急性效应。

But also those effects you're talking about tend to be just acute effects.

长期效应可能会略微降低睾酮水平，但这正是运动可能增加前列腺癌风险的解释之一。

The chronic effect can be a little bit of a reduction in testosterone, but it is one of the explanations for why exercise might increase say prostate cancer risk.

关于这一点，一些研究结果并不一致，尤其是它是否推动了睾酮水平的变化。

Some of the studies are mixed on that, well, if it's driving testosterone levels.

但在癌症治疗的背景下，这种影响与这些强效药物的作用相比微乎其微。

But in the context of cancer treatment, it would be very, very small compared to what these powerful drugs do.

另一方面，我很想谈谈运动作为单一疗法的情况。

Well, I'd love to kind of, on the flip side of that, talk about exercise as a monotherapy.

有一些最近的大规模试验，你参与了ERASE和PREVENT试验，这些试验可能正在研究运动作为低级别、早期癌症的单一疗法。

So there's been some pretty recent large scale trials that you're involved in, ERASE, the PREVENT trial that are potentially gonna be looking at exercise you know, exercise as a monotherapy in, you know, low grade, early stage cancer.

这个领域真的让我非常兴奋，我很想多了解一下。

This is an area that really excites me, so I'd love to hear a little bit more about that.

正如我提到的，大多数癌症都采用多种治疗手段的组合，这些治疗以不同的组合和顺序进行，因此这些患者接受的治疗非常密集。

So as I mentioned, most cancers get treated with a combination of treatments that we give in different combinations and different sequences, so these patients are very heavily treated.

当我们把运动作为单一疗法时，我们指的是仅靠运动本身。

When we think about exercise as a monotherapy, we think about exercise by itself.

仅靠运动对癌症有什么影响？

What's the effects of exercise by itself on cancer?

我们已经在小鼠身上做了临床前研究。

So we've done the preclinical studies in mice.

我们可以把这些小鼠拿来。

We can take these mice.

我们可以向它们注射少量癌细胞或植入小型肿瘤，然后随机分配它们进行运动或不运动，就像药物研究者做药物与非药物的对比一样。

We can inject small number of cancer cells or implant small cancer tumors, and we can randomly assign them to exercise versus no exercise, just like the drug researchers would do, drug versus not.

在这些研究中，我们可以证明，仅靠运动本身，不依赖任何其他治疗，就能减缓这些癌症的生长和扩散。

And we can show in those studies that exercise by itself, independent of any other treatments, tends to slow the growth and spread of these cancers.

大多数研究都表明，虽然不是全部，但大多数研究都显示。

Most of the studies are showing that, not all, but most of the studies.

那么你就需要考虑临床场景。

So then you think of clinical scenarios.

如果所有这些患者都在接受治疗，那么这种临床场景的意义何在？

Well, if all these patients are getting treated, what's the relevance of that clinical scenario?

但癌症领域出现了一种新的临床场景。

But there's a new clinical scenario in cancer.

正如我之前提到的，人们担心一些小型低级别癌症可能被过度治疗了。

And as I mentioned before, there's concern that some of these small low grade cancers, maybe we're over treating them.

我们可能过早介入并治疗这些患者，导致各种副作用，更不用说医疗费用等问题了，也许他们根本不需要治疗。

Maybe we're jumping in and treating these patients causing all sorts of side effects, not to mention the medical costs and so on, maybe they don't need to be treated.

这种管理癌症的全新方法现在被称为积极监测。

And this whole approach to managing cancer is now called active surveillance.

这些癌症非常小，级别很低，生长缓慢，因此我们不会轻易介入并用任何手段治疗它们。

So these cancers are so small and so low grade, slow growing that we're not going to jump in and treat these cancers with anything.

目前这主要应用于前列腺癌。

It's being used mostly right now in prostate cancer.

正是在那里，他们率先采用了主动监测。

That's where they've pioneered this active surveillance.

但这种做法也开始引起其他癌症领域的关注，或许有些癌症我们并不需要立即干预治疗。

But it's starting to get attention even in other cancers about maybe maybe some of these cancers we don't need to jump in and treat right away.

现在，这些被诊断出前列腺癌的人根本不会接受任何治疗。

So now you've got these guys diagnosed with prostate cancer and they're not giving any treatments whatsoever.

这使得生活方式研究者得以介入，探讨生活方式在这里扮演什么角色。

So this has allowed lifestyle researchers to kind of jump in and say, what's the role of lifestyle here?

我们能对这些人有所帮助吗？

Can we help these guys out at all?

我们最近进行了一项研究，观察高强度间歇训练对接受主动监测且未接受其他治疗的前列腺癌患者的影响。

So we've done a recent study looking at high intensity interval training in these men with prostate cancer who are on active surveillance, no other treatments.

除了预期的体能和功能改善外，我们还发现这种高强度运动降低了前列腺特异性抗原（PSA）水平。

In addition to improvements in fitness and function and the types of things you might expect, we also showed that this high intensity exercise lowered prostate specific antigen levels, PSA levels.

这就是男性有时被筛查前列腺癌的方式。

So this is how men are sometimes screened for prostate cancer.

检测PSA水平可以反映前列腺内癌症的多少。

Looking at PSA levels can be an indication of how much cancer there is in the prostate.

我们发现，这种高强度运动降低了PSA水平。

We showed that this high intensity exercise lowered PSA levels.

然后，我们还在培养皿中研究了这些前列腺癌细胞——这是一种体外模型，我们将前列腺癌细胞暴露于运动者和非运动者的血清中。

And then we also looked at these prostate cancer cells in a petri dish, just an in vitro model, where we exposed those prostate cancer cells to the serum of the men who exercised or the serum of the men who didn't exercise.

我们发现，用运动者血清处理这些细胞会抑制前列腺癌细胞的生长，这表明运动产生了一些作用。

And we showed that exposing them to the serum in the men who exercise reduced the growth of those prostate cancer cells, suggesting that there's something that exercise is doing.

我们认为，这是由于运动的抗炎作用以及对胰岛素、IGF和免疫系统的影响，减缓了这些前列腺癌细胞的生长。

And we think it's the anti inflammatory, the insulin IGF immune system effects that are slowing the growth of these prostate cancer cells.

这是一个非常令人兴奋的领域，因为许多接受主动监测的男性最终仍需要接受治疗。

So this is a very exciting area because many of these guys who are on active surveillance ultimately will require treatments.

因此，如果你能推迟或避免治疗需求，就能显著提升他们的生活质量。

So if you can delay the need for treatments or prevent treatments, you can substantially improve their quality of life.

因此，在这种临床环境中，运动干预非常有前景。

So very promising exercise in intervention in that clinical setting.

你们为什么选择高强度间歇训练作为运动干预方式，而不是像慢跑这样强度较低的运动呢？

Why did you choose high intensity interval training as your exercise intervention type versus something perhaps more moderate intensity, like jogging?

是HIIT和剧烈运动对前列腺癌更有益，还是这种运动方式更容易让患者坚持？

Is there something about HIIT and vigorous exercise that you felt was maybe more beneficial for prostate cancer, or is it just easier to adopt that type of routine for people?

我认为这是有证据表明，高强度运动能激活更多这些生物学变化。

I think it's the evidence suggesting that high intensity activate activates more of these biological changes.

所以我把它看作是搅动生物汤，对吧？

So I think of it kind of as stirring the biological soup, right?

人体内有各种各样的生物过程。

The body's got all these biological processes.

运动强度越高，这些生物学变化就被激发得越多。

And the more intense the exercise, more these biological changes get stirred up.

因此，你会向外周血输送更多的免疫细胞，产生更多胰岛素和IGF的变化，以及更多的抗炎标志物。

So you're gonna send more immune cells into the peripheral blood, more of the changes in insulin and IGF, more of the anti inflammatory markers.

因此，这些生物变化似乎存在剂量强度效应。

So there seems to be a dose intensity effect on some of these biological changes.

由于我们针对的是生物变化而非功能变化，我们希望采用我们认为最能驱动可能与癌症生长相关的生物变化的最优运动方案。

And because we're targeting biological changes as opposed to functional changes, we wanna go with what we think is the optimal exercise prescription for really driving biological changes that might be relevant for cancer growth.

那么，你们是如何——无论是在这个试验中还是普遍而言——帮助那些处于主动监测状态、久坐不动、从未规律进行结构化锻炼的人呢？我肯定，即使被诊断为早期或低级别前列腺癌，这个过程依然令人恐惧。

So how do you guys, and maybe in this trial or generally speaking, take someone who's under active surveillance, maybe they have been sedentary, they're not someone that's really done structured exercise as a routine, and help transform their fear because I'm sure it's scary to be diagnosed with prostate cancer as early or as, you know, I would say, you know, low grade as it is.

这仍然是一个非常令人害怕和恐惧的过程。

It's still probably a very scary, fearful process.

有没有一些结构化的项目，比如配备教练或团体课程，能帮助这类人群？什么样的方式会比较有效？

Are there any sorts of programs, structured programs that can help, like having a coach or group classes, things like that that what what would help for someone in that situation?

你们在研究中使用了什么方法？

What did you guys use in the study?

是的，这些男性中的许多人非常有动力为自己做点什么。

Yeah, so many of these guys are quite motivated to do something for themselves.

因此，这是一个非常重要的激励因素，对吧？

So that's one of the big motivating factors, right?

只是等待治疗，或者接受定期监测，比如定期进行PSA筛查和活检之类的检查。

Waiting around just for treatments, or just getting the surveillance, which is regular PSA screenings and biopsies and those types of things.

许多患者在确诊癌症后，这可能成为一种警醒。

So many of these patients, cancer diagnosis can be a bit of a wake up call.

这可能是一个具有教育意义的时刻，让人意识到：我并非永生不死。

It can be a bit of a teachable moment in the sense that, oh, I am not immortal.

也许我真的需要关注自己的健康。

Maybe I do need to take care of my health.

因此，这常常促使患者思考：我能做些什么来改善我的健康？

So oftentimes it prompts patients to say, what can I be doing to try to improve my health?

有些时候，慢性疾病的体验本身就令人恐惧，让人不得不认真对待自己的健康，而过去你可能只关注预防方面。

So some of it is just the experience of a chronic disease can be very scary in thinking about taking your health more seriously than you might've done when you're focused on the prevention side of things.

因此，我们通过谈论癌症特有的益处来激励这些患者。

So we motivate those guys by talking about the cancer specific benefits.

正如我所说，如果只是提高体能、增强力量，是的，这些都是人人都能获得的常规益处。

As I say, if it's just improvements in fitness, just improvements in strength, yeah, these are the standard benefits that everybody gets.

那我呢？

But what about me?

对吧？

Right?

癌症患者非常关心自己的癌症。

And cancer patients are very concerned about their cancer.

一旦被诊断出乳腺癌、肝癌或脑癌，你就会专注于：患有脑癌的人应该吃什么饮食？

Once you're diagnosed with breast cancer or liver cancer or brain cancer, you become focused on what kind of diet should I eat for someone with brain cancer?

我应该做什么样的运动来应对脑癌？

What kind of exercise should I do with brain?

你对一般的健康益处并不感兴趣。

You're not interested in general health benefits.

所以他们想知道这些与癌症相关的具体益处。

So they wanna know about these cancer specific benefits.

因此，我们通常会讨论这些类型的益处来激励他们，比如说：这可能会真正对你的癌症有帮助。

And so we'll usually talk about those types of benefits to try and motivate them, say, hey, this might actually help with your cancer.

它可能有助于你的治疗，帮助你顺利完成治疗并从治疗中恢复。

It might help with your treatments, getting through the treatments, recovering from treatments.

当然，我们总是根据他们的实际情况来开展工作。

And of course, we always work with them where they're at.

我们会告诉他们，我们绝不会要求你做超出你能力范围的运动。

We tell them, you know, we'll never ask you to do more exercise than you can do.

我们会循序渐进地帮助你，逐步达到推荐的运动量。

We'll progress you slowly, we'll build you up to the prescription.

对于癌症患者来说，另一个关键因素是肿瘤科医生的意见。

One of the other key things for cancer patients is, the opinion of the oncologist.

肿瘤科医生至关重要。

The oncologist is absolutely crucial.

如果肿瘤科医生说患者应该锻炼或考虑锻炼，他们会非常认真地对待这个建议。

You know, if they if the oncologist says that that patient should be exercising or think about exercising, they take that very seriously.

因此，我们已经成功让肿瘤科医生或泌尿科医生参与进来，告诉他们：你的泌尿科医生认为，针对你的前列腺癌，你也应该进行锻炼。

So we've been able to get the oncologists on board or the urologists and say, hey, your urologist thinks, with your prostate cancer that you should be exercising as well.

所以，关键是建立一个支持团队，根据患者的具体情况和独特处境，向他们展示运动带来的具体益处，以此激励他们。

So it's really building that team of support and motivating patients with the benefits that are gonna be specific to them and their unique situation.

在与肿瘤科医生合作并让他们支持这一点的过程中，你们是否经常听到，即使肿瘤科医生也会建议患者多休息、放轻松，尤其是当他们即将接受治疗，比如化疗或放疗，而不是处于主动监测阶段时？

With with the oncologists and getting them on board, is that something you know, you often do still hear again, even oncologists will say to take it easy, to rest, especially if they're gonna undergo you know, they're not in active surveillance, but perhaps they're gonna undergo a a treatment, like a chemotherapy treatment or radiation.

那么，你们如何改变这种观念，帮助患者向肿瘤科医生传递正确的信息？比如提供研究证据？有哪些方法可以帮助医生从建议‘多休息、轻松散步’转变为认可‘我们应该进行高强度间歇训练来辅助治疗’？

And so how do you sort of change the, you know, the paradigm here and help perhaps a patient give the right information to their oncologist, like giving them studies, or what what what can help sort of change the oncologist from a you should rest and take it easy or just a light walk around the neighborhood to, okay, we should do some high intensity interval training classes to help with treatment?

简单来说，答案就是证据。

So, the short simple answer is evidence.

肿瘤科医生会推荐那些有科学依据的治疗方式。

So, oncologists will recommend for patients things that are evidence based.

我认为，运动肿瘤学领域真正的优势在于，我们对运动的科学研究，其严谨程度与他们对药物的研究一样。

And one, I think, the real strength of the exercise oncology field is we've subjective exercise to the same rigorous research that they would subject their drugs to.

我们开展随机对照试验，这是被公认为最高标准的研究方法，样本量大，明确证明了这些益处对患者的有效性。

So we do randomized controlled trials, which are sort of the gold standard research methodology with large sample sizes showing these benefits for their patients.

然后，我们将这些研究成果发表在肿瘤科医生常读的顶级癌症期刊上。

And then we publish them in the top cancer journals that the oncologists read.

所以他们需要的是证据，而不是那种‘我叔叔弗雷德做了这个，他的癌症就好了’之类的轶事。

So that's what they're looking for is evidence, not that anecdotal stories about, hey, my uncle Fred did this and his cancer went away.

他们想看到这些高质量的研究成果。

They wanna see these high quality research studies.

过去几十年来，这些证据一直在逐步积累，起初很慢，但现在进展快得多，证据正在广泛传播，大多数肿瘤医生现在都已了解。

And so that's been building over the last couple of decades slowly at first, but now much more quickly where the evidence is getting out there and most oncologists are now aware of it.

事实上，两年前，也就是2022年，美国临床肿瘤学会发布了首份运动指南。

In fact, two years ago, so it's only in 2022, two years ago, the American Society of Clinical Oncology put out its first exercise guidelines.

这些是癌症医生。

So this is cancer doctors.

运动专家说癌症患者应该锻炼，这是一回事。

So it's one thing for exercise specialists to say, hey, cancer patients should exercise.

但现在，癌症医生本人及其专业组织——美国临床肿瘤学会（ASCO）明确表示：所有接受治愈性治疗的癌症患者，都应在治疗期间接受有氧运动和抗阻训练的建议。

But now we have the cancer doctors themselves, their professional organization, ASCO, the American Society of Clinical Oncology says, All cancer patients who are being treated with curative intent should be recommended aerobic and resistance exercise while they go through treatments.

这些指南被肿瘤医生严格遵守。

And those guidelines are adhered to very closely by oncologists.