运动干预在结直肠癌患者全程管理中作用的研究进展及展望

doi:10.19401/j.cnki.1007-3639.2025.10.003

摘要/Abstract

摘要：

结直肠癌（colorectal cancer，CRC）是最常见的消化道恶性肿瘤，发病率逐年上升且呈年轻化趋势，给社会及家庭带来了沉重的卫生经济负担。现有证据表明，定期进行中度至高强度的运动锻炼，可显著降低CRC的发病风险，减轻并发症及抗肿瘤治疗相关不良反应，提高患者的生活质量，延长患者的生存期。运动锻炼作为一种简单经济的非药物干预手段，通过调节炎症信号、促进合成代谢等多组学调控网络，在CRC治疗及康复全程中具有重要意义。本文综述临床和实验研究的最新证据，强调运动锻炼在CRC全程管理中的作用不可或缺，并就相关机制进行了汇总分析。未来的研究应进一步分析各种运动类型、强度和频率对CRC的具体影响，并与放化疗等临床治疗手段相结合，探索多模式干预下的精准化方案，以最大化其临床效益。

关键词: 运动, 结直肠癌, 预后, 机制, 防治

Abstract:

Colorectal cancer (CRC) is the most common malignant tumor of the digestive tract, with its incidence rate increasing annually and showing a younger-age trend, imposing heavy health and economic burdens on society and families. Regular moderate-to-vigorous physical exercise has been demonstrated to significantly reduce the risk of developing CRC, alleviate complications and adverse reactions related to anti-tumor treatment, improve patients’ quality of life, and prolong survival. As a simple and economical non-pharmacological intervention, exercise plays a crucial role throughout CRC development and treatment by regulating inflammatory signals and promoting anabolic metabolism through multi-omics regulatory networks. This article reviewed the latest evidence from clinical and experimental studies, emphasizing the indispensability of exercise in the comprehensive management of CRC patients, and provided a summary analysis of relevant mechanisms. Future research should further investigate the specific impacts of various exercise types, intensities, and frequencies on CRC, combine them with clinical treatment methods such as radiotherapy and chemotherapy, and explore precision approaches under multimodal interventions to maximize clinical benefits.

Key words: Physical activity, Colorectal cancer, Outcomes, Molecular mechanism, Prevention and treatment

中图分类号:

R735.3+4

李雅琳, 屠艳, 权明. 运动干预在结直肠癌患者全程管理中作用的研究进展及展望[J]. 中国癌症杂志, 2025, 35(10): 920-928.

LI Yalin, TU Yan, QUAN Ming. Research progress and prospects of exercise intervention in comprehensive management of colorectal cancer[J]. China Oncology, 2025, 35(10): 920-928.

图/表 2

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Category	Research progress	References
Prevention stage of CRC	MVPA can counteract the harms of sedentary behavior and reduce the risk of cancer in high-risk populations such as obesity and type 2 diabetes	[5-6,9]
Prevention stage of CRC	VILPA can reduce the incidence and mortality of CRC, which is significant in populations without exercise habits	[7-8]
Treatment stage of CRC	Preoperative exercise improves physical function and increases muscle mass, providing a buffer for surgery. The positive effects of preoperative exercise continue postoperatively, allowing patients to maintain lean body mass after neoadjuvant chemotherapy and radiation, improving HRQOL scores	[14-17]
	Postoperative structured exercise, especially personalized exercise programs, can significantly extend DFS and OS of CRC patients and reduce adverse reactions during adjuvant chemotherapy and radiation	[11,13,18 -19]
	Exercise and psychological intervention can significantly improve CRF. Aerobic exercise can significantly improve cardiopulmonary function, and RET can significantly alleviate symptoms of depression, and serve as a non-pharmacological method of pain treatment. The combination of the two is more effective than either alone	[20-25]

Mechanism category		Research progress	References
Tumor microenvironment remodeling	Metabolic reprogramming	Exercise modulates the IGF axis via the AMPK/mTOR pathway, improving insulin resistance and hyperinsulinemia, and restoring muscle and adipose cell homeostasis to enhance CRC prognosis	[33-34,43]
Tumor microenvironment remodeling	Inflammation-immune regulation	Exercise-induced myokines release immune-regulatory cytokines, promoting NK and T cell functions and enhancing anti-tumor effects. Acute and chronic exercise modulate IL-6 levels to reduce inflammation and tumor risk	[37-38,41 -42]
Systemic biological effects	Neuroendocrine regulation	Exercise improves serum adipokine levels, reduces treatment toxicity, and regulates bone metabolism to combat osteoporosis and muscle atrophy	[43-44]
	Gut microbiota reconstruction	Exercise enhances gut microbiota diversity and beneficial bacteria, increasing mucus layer thickness and secretion, promoting intestinal motility, and reducing intestinal inflammation and cancer risk	[45]
	Epigenetic modification	Exercise upregulates tumor suppressor gene expression, with DNA methylation and mRNA expression changes primarily occurring in the delayed recovery period post-exercise. Chronic moderate-intensity exercise reduces promoter methylation levels to enhance apoptosis and inflammation regulation	[47-49]