2021. gadā aizstāvētie promocijas darbi un kopsavilkumi

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Browsing 2021. gadā aizstāvētie promocijas darbi un kopsavilkumi by Author "Cešeiko, Rūdolfs"

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    Maksimālais spēka treniņš krūts vēža pacientēm adjuvantas terapijas laikā. Promocijas darba kopsavilkums
    (Rīgas Stradiņa universitāte, 2021) Cešeiko, Rūdolfs; Tomsone, Signe; Wang, Eivind
    Ievads. Krūts vēzis (KV) ir visbiežāk diagnosticētais audzēja tips sievietēm – vairāk nekā 2 miljonu jaunu saslimšanas gadījumu un vairāk nekā 600 000 nāves gadījumu gadā (Bray et al., 2018), un tā sastopamība pasaulē nepārtraukti pieaug. KV pacientes piedzīvo sarežģītas veselības un psihosociālas problēmas. Fizisko aktivitāšu apjoma krituma dēļ KV un pretvēža ārstēšanās process var samazināt muskuļu masu un pasliktināt muskuļu spēka attīstības rādītājus. Agrāk pacientiem, kuriem tika diagnosticēts vēzis, rekomendēja taupīt enerģiju un izvairīties no aktīvas slodzes pēc diagnozes noteikšanas, bet šīs pieņēmums pēdējo 20 gadu laikā ir ievērojami mainījies, jo fizisko aktivitāšu intervences onkoloģijā ir ieguvušas respektējamu atzinību. Spēka treniņa mērķis ir regulāru epizožu veidā stimulēt neiromuskulāro sistēmu, savukārt palielināts muskuļu spēks var veicināt personas iesaisti ikdienas aktivitātēs, tādējādi uzlabojot dzīves kvalitāti, kas saistīta ar veselību (DzK). Tomēr vēl nav zināma optimāla spēka treniņa metodika (intensitāte, biežums, apjoms) onkoloģisko pacientu ārstēšanās procesā, kas pretvēža ārstēšanas laikā kombinācijā ar noteiktu ārstēšanās plānu paaugstinātu maksimālo muskuļu spēku. Christensen et al. (Christensen et al., 2014) pētīja pirmreizēji apstiprinātus (krūts, kuņģa, kolorektāla, plaušu un aizkuņģa dziedzera) vēža pacientus un secināja, ka šiem pacientiem ir par 0,9 kg mazāka muskuļu masa, salīdzinot ar veseliem kontroles grupas indivīdiem pat pirms pretvēža terapijas uzsākšanas. Turklāt adjuvantas ķīmijterapijas laikā KV pacientes zaudēja 1,3 kg muskuļu masas un turpināja zaudēt muskuļu masu pēc terapijas pabeigšanas. Tika konstatēts, ka KV pacientēm muskuļu spēks pēc primārās terapijas pabeigšanas bija samazinājies par 20–30 %, salīdzinot ar veseliem cilvēkiem populācijā. Svarīgi uzsvērt, ka vairākums fizisko aktivitāšu pētījumu KV pacientēm kombinē aerobās izturības treniņu programmas un spēka treniņus, kā arī dažādas relaksācijas terapijas, tādējādi sarežģījot specifisko treniņu veidu ietekmes novērtēšanu. Onkoloģijā trūkst skaidri definētu klīnisko pētījumu KV pacientēm, kas ietvertu augstākas intensitātes spēka treniņus, turklāt apstākļos, kad intervence notiek adjuvantas ķīmijterapijas laikā. Klīniskajos spēka treniņa pētījumos onkoloģijā ievērojami atšķiras treniņos izmantotā intensitāte, sākot no 25 līdz 80 % no viena atkārtojuma maksimuma (1AM), lai gan ir dokumentēts, ka augstāka treniņu intensitāte rezultējas ar lielāku spēka pieaugumu gados jauniem un veseliem cilvēkiem (Campos et al., 2002). Turklāt lielāks muskuļu spēka pieaugums ir dokumentēts, izmantojot pakāpeniski progresējošu treniņu intensitāti onkoloģiskajiem pacientiem, tomēr iespējams, ka pacientiem ir novērojami fizisko spēju uzlabojumi, izmantojot zemu treniņu intensitāti (Fairman et al., 2017). Klīniskajos pētījumos, kuru ietvaros onkoloģiskajiem pacientiem tika veikta spēka treniņu intervence, secināts, ka treniņu programmas ir labi panesamas, tās ir drošas, izpildāmas un to rezultātā uzlabojas pacientu muskuļu spēks, kas paaugstina fiziskās spējas un uzlabo DzK (Segal et al., 2003), (De Backer et al., 2007), (Battaglini et al., 2014). Konstatēts, ka treniņu intensitāte spēka treniņos ir galvenais faktors, kas palielina maksimālo muskuļu spēku un ar spēku saistītos rādītājus. Līdz ar to ir būtiski veidot labi strukturētas treniņu programmas, nošķirot aerobo treniņu no spēka treniņa, kur skaidri ir aprakstīta treniņa metodoloģija (intensitāte, apjoms, biežums), lai rezultāti būtu vieglāk salīdzināmi ar citiem pētījumiem par fiziskajām aktivitātēm KV pacientēm. Līdz ar to ir nepieciešamas precīzi definētas un aprakstītas augstākas intensitātes spēka treniņu metodes, lai veicinātu fizioloģisko procesu lielāku adaptāciju, potenciāli veiksmīgāk izturētu ieplānoto ārstēšanas kursu, ātrāk atgūtu fiziskās spējas un atjaunotu sev vēlamās sociālās lomas.
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    Maximal Strength Training for Breast Cancer Patients Undergoing Adjuvant Treatment. Doctoral Thesis
    (Rīga Stradiņš University, 2021) Cešeiko, Rūdolfs; Tomsone, Signe; Wang, Eivind
    Objective. Breast cancer (BC) is the most frequently diagnosed type of cancer among women, with more than 2 million new cases and over 600 000 deaths annually (Bray et al., 2018), and its global incidence is steadily rising. BC patients through the cancer continuum experience complex health and psychosocial challenges. BC and anti-cancer treatment accompanied by an inactive lifestyle may further impair muscle strength and muscle force development characteristics. Historically, patients diagnosed with cancer were advises to rest and avoid vigorous activity following their diagnosis, but this dogma has changed markedly over the last 20 years as exercise oncology intervention studies have gained broad acceptance and acknowledgment. Strength training can optimally affect muscles and increased muscle strength may contribute to participation in daily activities, thus potentially improving the health-related quality of life (HRQoL). However, the optimal type, intensity and frequency of strength training, as a part of cancer care, that will most enhance muscle strength during anti-cancer treatment is yet unknown. Christensen et al. (Christensen et al., 2014) investigated newly confirmed (breast, gastric, colorectal, lung and pancreas) cancer patients and concluded that these patients had 0.9 kg lower muscle mass compared with healthy controls even before the initiation of anti-cancer treatment. Furthermore, during adjuvant chemotherapy, BC patients lost 1.3 kg lean body mass (LBM), and continued to lose LBM after therapy was completed. Ultimately, BC survivors evaluated after completion of primary therapy displayed 20–30% lower muscle strength compared with healthy counterparts. Most physical activity interventions for BC patients combine aerobic endurance training with strength training and diverse relaxation therapies, hence making it more complicated to evaluate the impact of training type. There has been a limited number of well-defined clinical trials on BC patients that include higher intensity strength training, moreover when intervention is administered during adjuvant treatment. Training intensities vary substantially across cancer studies ranging from 25–80% of one-repetition maximum (1RM), although, it has been documented that higher training intensities yield greater strength gains in young healthy individuals (Campos et al., 2002). Similarly, greater gains in muscle strength are documented with increasing intensity for cancer patients, however, these patients are likely to have some improvement even at low training intensities (Fairman et al., 2017). The common consent from clinical trials when strength training interventions were applied for cancer patients states that training programs were well tolerated, they are safe, feasible and showed strength improvements that led to improved physical functioning and improved HRQoL (Segal et al., 2003), (De Backer et al., 2007), (Battaglini et al., 2014). Recognizing that training intensity during strength training is a key factor to improve maximal muscular strength and strength related characteristics. Therefore, well-defined training methods with high intensity could also be preferable to induce greater physiological adaptations, thus contribute to faster recovery from specific cancer treatment and enhancing the completion of prescribed anti-cancer treatment.
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    Maximal Strength Training for Breast Cancer Patients Undergoing Adjuvant Treatment. Summary of the Doctoral Thesis
    (Rīga Stradiņš University, 2021) Cešeiko, Rūdolfs; Tomsone, Signe; Wang, Eivind
    Objective. Breast cancer (BC) is the most frequently diagnosed type of cancer among women, with more than 2 million new cases and over 600 000 deaths annually (Bray et al., 2018), and its global incidence is steadily rising. BC patients through the cancer continuum experience complex health and psychosocial challenges. BC and anti-cancer treatment accompanied by an inactive lifestyle may further impair muscle strength and muscle force development characteristics. Historically, patients diagnosed with cancer were advises to rest and avoid vigorous activity following their diagnosis, but this dogma has changed markedly over the last 20 years as exercise oncology intervention studies have gained broad acceptance and acknowledgment. Strength training can optimally affect muscles and increased muscle strength may contribute to participation in daily activities, thus potentially improving the health-related quality of life (HRQoL). However, the optimal type, intensity and frequency of strength training, as a part of cancer care, that will most enhance muscle strength during anti-cancer treatment is yet unknown. Christensen et al. (Christensen et al., 2014) investigated newly confirmed (breast, gastric, colorectal, lung and pancreas) cancer patients and concluded that these patients had 0.9 kg lower muscle mass compared with healthy controls even before the initiation of anti-cancer treatment. Furthermore, during adjuvant chemotherapy, BC patients lost 1.3 kg lean body mass (LBM), and continued to lose LBM after therapy was completed. Ultimately, BC survivors evaluated after completion of primary therapy displayed 20–30% lower muscle strength compared with healthy counterparts. Most physical activity interventions for BC patients combine aerobic endurance training with strength training and diverse relaxation therapies, hence making it more complicated to evaluate the impact of training type. There has been a limited number of well-defined clinical trials on BC patients that include higher intensity strength training, moreover when intervention is administered during adjuvant treatment. Training intensities vary substantially across cancer studies ranging from 25–80% of one-repetition maximum (1RM), although, it has been documented that higher training intensities yield greater strength gains in young healthy individuals (Campos et al., 2002). Similarly, greater gains in muscle strength are documented with increasing intensity for cancer patients, however, these patients are likely to have some improvement even at low training intensities (Fairman et al., 2017). The common consent from clinical trials when strength training interventions were applied for cancer patients states that training programs were well tolerated, they are safe, feasible and showed strength improvements that led to improved physical functioning and improved HRQoL (Segal et al., 2003), (De Backer et al., 2007), (Battaglini et al., 2014). Recognizing that training intensity during strength training is a key factor to improve maximal muscular strength and strength related characteristics. Therefore, well-defined training methods with high intensity could also be preferable to induce greater physiological adaptations, thus contribute to faster recovery from specific cancer treatment and enhancing the completion of prescribed anti-cancer treatment.