Exercise, cancer, and the cardiovascular system: clinical effects and mechanistic insights

Abstract

Cardiovascular diseases and cancer are the leading causes of death in the Western world and share common risk factors. Reduced cardiorespiratory fitness (CRF) is a major determinant of cardiovascular morbidity and cancer survival. In this review we discuss cancer- induced disturbances of parenchymal, cellular, and mitochondrial function, which limit CRF and may be antagonized and attenuated through exercise training. We show the impact of CRF on cancer survival and its attenuating effects on cardiotoxicity of cancer-related treatment. Tailored exercise programs are not yet available for each tumor entity as several trials were performed in heterogeneous populations without adequate cardiopulmonary exercise testing (CPET) prior to exercise prescription and with a wide variation of exercise modalities. There is emerging evidence that exercise may be a crucial pillar in cancer treatment and a tool to mitigate cardiotoxic treatment effects. We discuss modalities of aerobic exercise and resistance training and their potential to improve CRF in cancer patients and provide an example of a periodization model for exercise training in cancer.

Cardiovascular mortality in people with cancer compared to the general population: A systematic review and meta‐analysis

“…This finding underscores the importance of assessment and management of pre‐existing CVD risk factors including through lifestyle modifications such as increased physical activity, exercise, weight management, healthy diet and smoking cessation in order to reduce CVD risk. 44 , 45 , 46 …”

Relevance of Cardiovascular Exercise in Cancer and Cancer Therapy-Related Cardiac Dysfunction

“…Professional support in cancer rehabilitation is of pivotal importance as structured and personalized exercise rehabilitation training in breast cancer survivors reduces fatigue and fatigue-related biomarkers [ 87 ], and can also improve social and physical function [ 88 ]. Taken together, evidence for the beneficial effects of exercise on patients’ well-being and CRF have been demonstrated across the whole temporal continuum of cancer treatment and should induce integration of exercise as a main pillar of standard-cancer therapy [ 89 ]. Future trials will also provide more insights on the effects of structured, individualized exercise to improve quality of life and fatigue in more advanced cancer stages, such as metastatic breast cancer [ 90 ].…”

“…Resistance training (RT), as a measure to reduce or even reverse muscle wasting, is recommended in addition to endurance training to improve CRF by current guidelines of sports cardiology and cardio-oncology [ 8 , 94 ] as it improves skeletal muscle and mitochondrial respiration [ 95 ]. Assessment of muscle strength in cancer patients is usually performed by measuring handgrip strength [ 96 ], and RT intensity to establish training prescriptions should be identified by the one repetition maximum (1 RPM) [ 89 , 94 ]. A meta-analysis of randomized trials of RT during and after chemotherapy in cancer survivors demonstrated the most effective increase of muscle strength at intensities below 75% of 1 RPM [ 97 ] and provides evidence for a safe integration of RT into training of cancer patients.…”

“…Following principles of exercise sciences, variations of exercise intensity, duration, and frequency should be applied in cancer patients. Repetitive re-assessments of training corridors throughout the treatment periods should be implemented for both AET and RT (a prospective design for exercise intervention has been suggested by our group, [ 89 ]). As exercise interventions in trials of sports cardio-oncology are heterogeneous, exercise prescriptions should be based on objective measures gained by repetitive cardiopulmonary exercise testing and handgrip strength assessment.…”

“…However, in less compromised patients, the advent of telemonitoring and app-based solutions may bear the potential to improve home-based training with maintenance of adequate exercise monitoring. Future trials of sports cardio-oncology should make use of this digital progress [ 89 ].…”