Exercise Training and Cardiovascular Health in Cancer Patients

Abstract

A wealth of clinical studies have documented the safety and benefits of exercise after and during cancer therapy, and pilot and larger-scale studies are currently ongoing to integrate exercise into the treatment program for cancer patients undergoing active therapy (EXACT pilot, OptiTrain, and TITAN study). More recently, efforts have emerged to commence exercise programs before the start of cancer therapy, so-called pre-habilitation. The concept of increasing the cardiovascular reserve beforehand is intuitively attractive. In agreement, preclinical studies support exercise as an effective preventive means before and during cardiotoxic drug exposure. Assuming that a pronounced drop in exercise tolerance will occur during cancer therapy, pre-habilitation can potentially curtail or raise the nadir level of exercise tolerance. Furthermore, such efforts might serve as pre-conditioning efforts in reducing not only the nadir, but even the magnitude of drop in cardiovascular reserve. Initiated beforehand, cancer patients are also more likely to continue these efforts during cancer therapy. Finally, an active exercise routine (≥ 150 min/week moderate intensity or ≥ 75 min/week vigorous intensity or combination) in conjunction with the other six American Heart Association's cardiovascular health metrics (BMI < 25 kg/m, blood pressure < 120/80 mmHg, fasting plasma glucose < 100 mg/dL, total cholesterol < 200 mg/dL, 4-5 component healthy diet, no smoking) reduces not only the cardiovascular but also the cancer disease risk. Exercise can reduce the risks of developing cancer, the detrimental effects of its treatment on the cardiovascular system, and overall morbidity and mortality. Exercise should become an integral part of the care for every cancer patient.

Preventive Cardio-Oncology: The Time Has Come

“…For 2019, almost 2 million new cancer diagnoses and just over 600,000 new cancer deaths are estimated; as cancer incidence continues to increase for most cancers, cancer mortality continues to decrease, leading to millions of cancer survivors each year (29). CVD remains a leading cause of death in cancer survivors (second only to cancer recurrence) (4,20,30,31), and shares some risk factors with various cancers. For example, CVD and breast cancer have several risk factors in common, such as unhealthy Western diet, red or processed meat, physical inactivity or sedentary lifestyle, smoking, early menarche, and hormone replacement therapy (20) ( Figures 1C,D, underlined).…”

“…Incorporation of various methodologies in typical cardiac rehabilitation could also have utility for secondary prevention (76), and possibly also primary prevention, of cardiovascular toxicity from a variety of cancer therapies. Some have suggested a multidimensional system consisting of cardiovascular oncology prehabilitation (30,77,78), habilitation (30,79,80), and rehabilitation (30,78,81), to optimize cardiovascular health before, during, and after cancer therapies, respectively. Prehabilitation focuses on optimizing baseline cardiovascular health and cardiopulmonary fitness prior to initiation of cancer therapies (30,77,78).…”

“…Some have suggested a multidimensional system consisting of cardiovascular oncology prehabilitation (30,77,78), habilitation (30,79,80), and rehabilitation (30,78,81), to optimize cardiovascular health before, during, and after cancer therapies, respectively. Prehabilitation focuses on optimizing baseline cardiovascular health and cardiopulmonary fitness prior to initiation of cancer therapies (30,77,78). Habilitation refers to ongoing optimization of cardiovascular health and cardiopulmonary fitness while patients are undergoing cancer therapies (30,79,80).…”

Physical Education: Adaptations and Benefits for Deaf Students

“…Even in case of patients with specific disorders (e.g. cancer or diabetes) physical activity may bring beneficial effects such as reducing fatigue, improving physical condition, mood and quality of life, helping with cardiovascular integrity, insulin sensitivity, and others (Beuchat-Mamie et al, 2018;Melmer, et al, 2018;Squires, et al, 2018). Thus these activities may bring psychological and physiological benefits (e.g.…”

Acute Effect of Different Types of Exercise on Natriuretic Peptides of Wistar Rats

“…Among all, physical exercise, whether aerobic, resisted or combined, is known as a health-trigger stress type. [15][16][17][18] Studies have shown that during these different types of physical exercise, the ANP and BNP levels increase significantly in the plasma. 9,19 However, it is not known how much of these NPs are released during the practice of a physical training session.…”