Exercise Therapy and Cardiovascular Toxicity in Cancer

Abstract

Cardio-oncology is an emerging discipline focused predominantly on the detection and management of cancer treatment-induced cardiac dysfunction (cardiotoxicity), which predisposes to development of overt heart failure or coronary artery disease. The direct adverse consequences, as well as those secondary to anticancer therapeutics, extend beyond the heart, however, to affect the entire cardiovascular-skeletal muscle axis (ie, whole-organism cardiovascular toxicity). The global nature of impairment creates a strong rationale for treatment strategies that augment or preserve global cardiovascular reserve capacity. In noncancer clinical populations, exercise training is an established therapy to improve cardiovascular reserve capacity, leading to concomitant reductions in cardiovascular morbidity and its attendant symptoms. Here, we overview the tolerability and efficacy of exercise on cardiovascular toxicity in adult patients with cancer. We also propose a conceptual research framework to facilitate personalized risk assessment and the development of targeted exercise prescriptions to optimally prevent or manage cardiovascular toxicity after a cancer diagnosis.

Inhospital exercise benefits in childhood cancer: A prospective cohort study

“…To the best of our knowledge, this is the first study to evaluate the effects of exercise on cardiac function during childhood cancer treatment, with the evidence for a direct cardioprotective role of exercise in patients with adult cancer in general being also limited. 25 However, data in juvenile rat models have demonstrated several cardioprotective effects of exercise against anthracycline-induced cardiotoxicity. 12,13 These included improvements in cardiotoxicity-impaired functional parameters, such as systolic/diastolic function or intrinsic depolarization rate of the heart, 13 and up-regulation of the antioxidant defense capacity of cardiac cells, thereby protecting them from oxidative stress-which is one of the main underpinning mechanisms of anthracycline-induced damage.…”

Exercise as A Potential Therapeutic Target for Diabetic Cardiomyopathy: Insight into the Underlying Mechanisms

“…Similar studies have shown that long-term exercise could be an effective adjuvant treatment strategy against doxorubicin-related cardiac toxicity [92,110]. Recently, despite the limitations of a clinical human trial, the American Heart Association has suggested that personalized exercise therapy could be considered as a part of precision medicine for cancer patients to improve cardiovascular mortality [138,139]. Based on these recommendations, exercise may be presumed to influence an improved outcome in patients with DCM.…”

Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care

“…In conjunction with the improvement of detection methods, increasing awareness and integrating works between oncologists and cardiologists are essential (179). Managing comorbidities adequately [e.g., hypertension, hypercholesterolemia, and diabetes control (180)], exercise therapy (181), and smoking cessation (58,131) are all useful to decrease the risk of anticancer-treatment-related CVD (182), including RACVD. For multidisciplinary management, standard recommendation and structure/infra-structure requirements for patient care are ongoing established (183)(184)(185)(186)(187)(188).…”