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Year : 2020  |  Volume : 3  |  Issue : 3  |  Page : 636-638

Role of aerobic exercise in mitigating cancer treatment-induced cardiovascular toxicity

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro, Rome, Italy

Date of Submission04-Jul-2020
Date of Decision30-Jul-2020
Date of Acceptance07-Aug-2020
Date of Web Publication19-Sep-2020

Correspondence Address:
Chidiebere Emmanuel Okechukwu
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CRST.CRST_233_20

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How to cite this article:
Okechukwu CE. Role of aerobic exercise in mitigating cancer treatment-induced cardiovascular toxicity. Cancer Res Stat Treat 2020;3:636-8

How to cite this URL:
Okechukwu CE. Role of aerobic exercise in mitigating cancer treatment-induced cardiovascular toxicity. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Oct 28];3:636-8. Available from: https://www.crstonline.com/text.asp?2020/3/3/636/295561

Treatment-induced cardiovascular toxicity is a significant consequence of several cancer therapies. Aerobic exercise plays an important role in preventing myocardial damage induced by cancer treatment. Chemotherapy-induced cardiovascular toxicity is principally facilitated by injury to the endothelium, which in turn could damage the myocardium and cause cardiovascular disease in patients with cancer. Aerobic exercise improves the antioxidant capacity and reduces the oxidative stress, which is beneficial for endothelial function. Moderate- and high-intensity aerobic exercises can exert significant cardioprotective benefits by improving the level and action of cardiac antioxidants. Thus, the rise in the antioxidant function brought about by aerobic exercise plays an important role in protecting the cardiomyocytes against the damaging effects of oxidative stress.[1]

Cardiotoxicity leads to a reduction in the peak oxygen uptake (VO2peak). Studies have shown that participation in aerobic exercises can cause considerable improvements in VO2peak among patients with breast cancer.[2],[3] Therefore, in these patients, aerobic exercise therapy could be an efficient approach to reduce the treatment-induced cardiovascular toxicity. The dose of aerobic exercise training that can considerably mitigate the effects of treatment-induced cardiotoxicity in patients with cancer has not yet been established. Therefore, the frequency, intensity, and duration of exercise should be personalized according to the patients' clinical status, exercise tolerance, and functional capacity. However, the dose of the prescribed aerobic exercise should be sufficient to exert positive changes in the maximal oxygen uptake (VO2max).[4]

Prescribed high-intensity personalized aerobic exercise therapy was able to improve cardiorespiratory fitness and reduce fatigue during treatment in patients with cancer; hence, it appears to be an effective approach for improving the cardiorespiratory fitness during cancer treatment.[4] Aerobic training has several beneficial effects on the endothelial function and can minimize circulatory risk factors. Thus, it could modify the mechanisms leading to blood vessel injury associated with anticancer treatments, thereby decreasing the treatment-induced cardiovascular toxicity in patients with cancer. [5,6]

According to the guidelines on physical activity issued by the American College of Sports Medicine, healthy adults are recommended to participate in moderate-intensity aerobic exercise for 30 min per day for 5 days per week for a total duration of 150 min per week; alternatively, they can participate in high-intensity aerobic exercise for 20 min per day for 3 days per week for a total duration of 75 min per week; another preferable alternative is a blend of moderate- and high-intensity aerobic exercise regimens for 2–3 days per week, to achieve an overall energy expenditure of 500–1000 metabolic equivalents/min per week [Table 1].[7] However, for patients with cancer, these exercise training regimens should be tailored with respect to their level of physical activity, cardiorespiratory fitness/functional capacity, health status, exercise tolerance, and therapeutic target. Furthermore, isotonic exercises that involve shortening and lengthening of several muscle groups, such as cycling, running on the treadmill, and swimming, when performed for a short duration can increase the VO2max. Hence, when performed regularly, these exercises could improve cardiopulmonary fitness and prove to be beneficial to patients with cancer.[8] However, these exercises should be prescribed and supervised by a cardio-oncologist and certified exercise physiologist in order to prevent adverse cardiac events. Moreover, for patients with cancer with limited lower-limb function, performing a combined functional training and balance exercise regimen could improve the gait speed, single-leg stance time, and neuromuscular performance.[9] In patients with borderline compromised left ventricular ejection fraction, a moderate-intensity continuous aerobic training should be tailored and prescribed, because it has been found to decrease left ventricular remodeling and is more advantageous when performed over six months or more.[10]
Table 1: Quantification of physical activity based on the intensity using metabolic equivalents, percentages of heart rate reserve, and rating of perceived exertion

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In conclusion, aerobic exercise appears to be a favorable and useful remedy for treatment-induced cardiovascular toxicity in patients with cancer, because it reduces the adverse effects induced by chemotherapy on the cardiovascular health of these patients. Aerobic exercise prescription should be tailored according to the patients' present health status and history to improve treatment outcomes and prevent adverse cardiac events. An evaluation of the patient's cardiorespiratory fitness/functional capacity is necessary for a suitable aerobic exercise prescription. However, the optimal dose of aerobic exercise required to avert myocardial damage caused by cancer therapy is not yet validated.

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  References Top

Powers SK, Sollanek KJ, Wiggs MP, Demirel HA, Smuder AJ. Exercise-induced improvements in myocardial antioxidant capacity: The antioxidant players and cardioprotection. Free Radic Res 2014;48:43-51.  Back to cited text no. 1
Yu AF, Jones LW. Breast cancer treatment-associated cardiovascular toxicity and effects of exercise countermeasures. Cardiooncology 2016;2:1.  Back to cited text no. 2
Scott JM, Nilsen TS, Gupta D, Jones LW. Exercise therapy and cardiovascular toxicity in cancer. Circulation 2018;137:1176-91.  Back to cited text no. 3
Bjørke AC, Sweegers MG, Buffart LM, Raastad T, Nygren P, Berntsen S. Which exercise prescriptions optimize V-O2 max during cancer treatment? A systematic review and meta-analysis. Scand J Med Sci Sports 2019;29:1274-87.  Back to cited text no. 4
Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R. Exercise training manages cardiopulmonary function and fatigue during and following cancer treatment in male cancer survivors. Integr Cancer Ther 2007;6:235-41.  Back to cited text no. 5
Campia U, Barac A. Exercise and aerobic fitness to reduce cancer-related cardiovascular toxicity. Curr Treat Options Cardiovasc Med 2016;18:44.  Back to cited text no. 6
Okechukwu CE, Deb AA, Emara S, Abbas SA. Physical activity as preventive therapy for older adults: A narrative review. Niger J Exp Clin Biosci 2019;7:82-92.  Back to cited text no. 7
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Menz V, Marterer N, Amin SB, Faulhaber M, Hansen AB, Lawley JS. Functional versus running low.volume high.intensity interval training: Effects on VO2 max and muscular endurance. J Sports Sci Med 2019;18:497-504.  Back to cited text no. 8
Piva SR, Gil AB, Almeida GJ, DiGioia AM 3rd, Levison TJ, Fitzgerald GK. A balance exercise program appears to improve function for patients with total knee arthroplasty: A randomized clinical trial. Phys Ther 2010;90:880-94.  Back to cited text no. 9
Tucker WJ, Beaudry RI, Liang Y, Clark AM, Tomczak CR, Nelson MD, et al. Meta-analysis of Exercise Training on Left Ventricular Ejection Fraction in Heart Failure with Reduced Ejection Fraction: A 10-year Update. Prog Cardiovasc Dis 2019;62:163-71.  Back to cited text no. 10


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