Meta-analysis of Exercise Training on Vascular Endothelial Function in Cancer Survivors

Abstract

Cancer and cardiovascular disease (CVD) are leading causes of morbidity and mortality in the United States. Vascular endothelial dysfunction, an important contributor in the development of CVD, improves with exercise training in patients with CVD. However, the role of regular exercise to improve vascular function in cancer survivors remains equivocal. We performed a meta-analysis to determine the effect of exercise training on vascular endothelial function in cancer survivors. We searched PubMed (1975 to 2016), EMBASE CINAHL (1937 to 2016), OVID MEDLINE (1948 to 2016), and Cochrane Central Registry of Controlled Trials (1991 to 2016) using search terms: vascular function, endothelial function, flow-mediated dilation [FMD], reactive hyperemia, exercise, and cancer. Studies selected were randomized controlled trials of exercise training on vascular endothelial function in cancer survivors. We calculated pooled effect sizes and performed a meta-analysis. We identified 4 randomized controlled trials (breast cancer, n=2; prostate cancer, n=2) measuring vascular endothelial function by FMD (n=3) or reactive hyperemia index (n=1), including 163 cancer survivors (exercise training, n=82; control, n=81). Aerobic exercise training improved vascular function (n=4 studies; standardized mean difference [95% CI]=0.65 [0.33, 0.96], I2=0%; FMD, weighted mean difference [WMD]=1.28 [0.22, 2.34], I2=23.2%) and peak exercise oxygen uptake (3 trials; WMD [95% CI]=2.22 [0.83, 3.61] mL/kg/min; I2=0%). Our findings indicate that exercise training improves vascular endothelial function and exercise capacity in breast and prostate cancer survivors.

Interventions for prostate cancer survivorship: A systematic review of reviews

“…Five reviews suggested that a combination of aerobic and resistance training delivered during or after treatment for prostate cancer survivors could be effective in improving cardiorespiratory fitness and peak oxygen capacity, with resistance training demonstrating improvements to muscular strength . Exercise interventions were less effective in improving other markers of cardiovascular health such as lipid profile, blood pressure, glucose, and cardiometabolic risk among men undergoing ADT .…”

Exercise and cancer: a position statement from the Spanish Society of Medical Oncology

“…However, interventions in these studies were heterogeneous and did not often describe the intensity or type of exercise used. A recent meta-analysis suggested that a workload of 600 MET (intensity-minutes) was associated with a clinically significant improvement in fitness capacity, suggesting that a 10-week program of 90 min/week of supervised training at 70% of VO 2peak may be sufficient [ 139 – 141 ]. Another meta-analysis found that cancer survivors who completed 15 MET-h/week presented a 27% lower risk of cancer mortality with respect to controls, and this effect was greater in patients who were sedentary at pre-diagnosis (35% lower risk) [ 142 ].…”

Endothelial dysfunction in patients with lymphoproliferative disorders and its changes in the course of polychemotherapy

“…Thus, ED may contribute to limiting blood flow and perfusion of organs and systems. In addition, this complication is of great clinical importance, since it is an initial reversible stage in the development of atherosclerosis [15]. It is proved that ED is the result of endothelium damage, leading to inflammation, activation of endothelial cells, transcription and synthesis of de novo proteins, including adhesion molecules, cytokines, chemokines and procoagulants [16].…”