Exercise for Patients With Cancer to Minimize Treatment Cardiotoxicity

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Tailored exercise may help to minimize cardiotoxicity in patients with cancer, according to a report published by D’Ascenzi et al in the European Journal of Preventive Cardiology.

Cardiovascular diseases are common side effects in patients with cancer. This is the result of cardiotoxicity, whereby cancer treatment impairs heart function and structure, or accelerated development of cardiovascular disease, especially when risk factors such as high blood pressure are present. Furthermore, cardiovascular diseases and cancer often share the same risk factors.

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The report highlights the importance of an individual exercise plan for each patient, taking into account personal history, cancer treatment, response to exercise, and personal preferences. Exercise should start as soon as possible, write the authors—even before starting treatment such as chemotherapy.

A multidisciplinary team should be involved in formulating an exercise prescription, including oncologists, cardiologists, physical therapists, nurses, nutritionists, and psychologists. The team is recommended to begin with cardiac evaluation with exercise testing (and particularly cardiopulmonary exercise testing or lactate testing) to determine response to exercise. The appropriate ‘dose’ of exercise can then be prescribed, including the intensity, type of training, and training volume (hours/minutes of training per week).

“Patients with cancer are often less active than adults without cancer,” said first study author Flavio D’Ascenzi, MD, PhD, FESC, of the University of Siena, Italy. “However, exercise is essential for patients diagnosed with cancer who are under treatment, irrespective of the type of treatment. Endurance training is more effective for improving cardiovascular performance and reducing inflammation, but resistance training may be a better starting point for frail patients. Other types of exercise such as inspiratory muscle training are safe and effective, particularly in those with thoracic cancer; therefore, the specific exercise should be chosen based on individual characteristics.”

“Defining the intensity and volume of exercise is important for maximizing the benefits of physical activity while avoiding muscular soreness, fatigue, and sleep disorders,” he said.

Ongoing treatment is not a contraindication to exercise, said the authors, but patients are urged to consult their doctor before starting a new activity. Specific guidance is provided: for example, patients with low hemoglobin levels should avoid high intensity activities; those with low platelet levels should not participate in contact sports. Activities that could increase the risk of fracture should be avoided in frail patients. Breathlessness or fatigue must be investigated but, after excluding associated health problems, exercise can help cope with fatigue, which is relatively common in patients with cancer.

Dr. D’Ascenzi concluded. “Physical activity before, during, and after cancer treatment can counteract the negative effects of therapies on the cardiovascular system. In addition, it can relieve symptoms such as nausea and fatigue and help prevent unwanted changes in body weight.”

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The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.