Cardio-Oncology Rehabilitation (CORE) Exercise Prescription and Programming

Abstract

Background: Patients with cancer almost universally report diminished health-related quality of life. Many patients experience persistent fatigue and most have below-average exercise capacities. Despite the publication of exercise guidelines for cancer survivors that encourage physical activity, few patients exercise on a regular basis. Cardiovascular disease is a major cause of death in early-stage malignancies. Exercise training has been demonstrated to decrease cardiovascular events in patients with cancer. In addition, regular exercise improves exercise capacity, reduces fatigue, and improves quality of life in cancer survivors. Clinical Considerations: A 2019 American Heart Association scientific statement, endorsed by the American Cancer Society, provided a framework and rationale for partnering with existing multidimensional, interdisciplinary outpatient cardiac rehabilitation programs to provide supervised exercise training and risk factor control services for patients with cancer and cancer survivors: cardio-oncology rehabilitation. In addition, the American College of Sports Medicine has published recommendations for cancer exercise training. Summary: This article provides practical suggestions for incorporating patients with cancer into cardiac rehabilitation and for patient-specific exercise prescription. Illustrative patient case examples are provided.

Cardiac Rehabilitation Improves Fitness in Patients With Subclinical Markers of Cardiotoxicity While Receiving Chemotherapy

“…In addition to the direct effects of cancer-related cardiotoxicity, there is growing interest with respect to the greater downstream heart disease risk in patients with cancer. 27,28 Because exercise training has been shown to improve many CV risk factors, it has been promoted to potentially mitigate heart disease in the cancer population. The barrier, however, that many patients, and referring oncologists, face is that there are not very many cancer-specific exercise programs in the country.…”

A Review on the Role of Exercise Training to Prevent a Decline in Cardiorespiratory Fitness and Cardiac Function in Breast Cancer Survivors

“…In cancer populations there is now growing application of nonlinear periodization models that incorporate multiple types and varying doses of exercise within and across weeks. [60][61][62] This is a principle adapted from athletic training, where multiple physiologic factors contribute to improved V ˙ O 2peak and should be targeted with different forms of ExT. 61 Similarly, there are multiple pathophysiologic processes mediating BC therapy-induced CRF impairment.…”

“…Standard ExT approaches use a linear progression model that starts with an achievable baseline dose and incorporates small, progressive increases in frequency, intensity, and/or duration over the course of the intervention. In cancer populations there is now growing application of nonlinear periodization models that incorporate multiple types and varying doses of exercise within and across weeks 60–62. This is a principle adapted from athletic training, where multiple physiologic factors contribute to improved V˙O 2peak and should be targeted with different forms of ExT 61.…”

Cardio-Oncology Rehabilitation (CORE) for Cancer Patients and Survivors

“…Cancer survivors commonly experience persistent fatigue for months to years after treatment and remission. Exercise capacity is also diminished 1. In addition, cancer and cardiovascular diseases are interrelated and share common risk factors, such as cigarette smoking, diet rich in animal fat, dyslipidemia, obesity, chronic inflammation, sedentary lifestyle, and diabetes mellitus, which increase cardiovascular disease risk 2…”