Physical exercise improves cardiorespiratory fitness and reduces side effects of cancer treatment

Physical exercise improves cardiorespiratory fitness and reduces side effects of cancer treatment

According to a study published in JACC: CardioOncology, physical exercise interventions during chemotherapy are safe, improve long-term cardiorespiratory fitness, and alleviate some of the side effects of cancer treatment. If exercise is not possible during chemotherapy, the person may then participate in an exercise program to restore the same level of function.

Cardiorespiratory fitness, measured by maximum oxygen uptake (VO2peak), is considered one of the most important independent predictors of cardiovascular health. During cancer treatment, VO2peak drops by up to 25%. Cancer treatment often results in side effects that affect the patient's health-related quality of life (HRQoL), including decreased cardiorespiratory fitness, increased fatigue, and cardiovascular morbidity. Physical activity has been proven to reduce these risks. Exercise therapy is associated with increased cardiorespiratory fitness, improved VO2peak, and reductions in cardiovascular morbidity, cancer mortality, and all-cause mortality.

The benefits of exercise for cancer patients are widely recognized. However, there is insufficient evidence regarding the optimal timing of exercise interventions to improve long-term cardiorespiratory fitness in cancer patients.”

Annemiek ME Walenkamp, ​​MD, PhD, senior author of the study and medical oncologist, Department of Medical Oncology, Groningen University Hospital in Groningen, The Netherlands

In the ACT study, researchers examined the effectiveness of exercise interventions during chemotherapy compared to post-treatment in improving long-term cardiorespiratory fitness. The study was open to adult patients who had recently been diagnosed with breast cancer, colon cancer, testicular cancer or B-cell non-Hodgkin lymphoma and were scheduled to receive curative chemotherapy. Between February 2013 and November 2018, study participants were randomly assigned to a 24-week exercise intervention that began either during or after chemotherapy. Types of exercise included moderate to vigorous exertion on a stationary bicycle, resistance training with weight machines and free weights, and badminton. The primary endpoint was the difference in VO2peak one year after the intervention. The secondary endpoints were VO2peak after completion of chemotherapy and intervention, muscle strength, HRQoL, fatigue, physical activity and self-efficacy at all time points.

The researchers found that the group that started exercise therapy during treatment reported less fatigue and more physical activity immediately after chemotherapy, and experienced smaller declines in VO2peak, HRQoL and muscle strength. Three months after chemotherapy, the group that started exercising after treatment showed similar levels to the group that exercised during treatment. Regardless of timing, both groups returned to their original cardiorespiratory fitness one year after completing the training intervention.

"These results suggest that the optimal time for exercise is during chemotherapy. However, implementing an exercise program after chemotherapy is a viable alternative if exercise is not possible during chemotherapy," said Walenkamp. “We hope our findings motivate healthcare providers to guide patients to engage in physical exercise during cancer treatment.”

Source:

American College of Cardiology

Reference:

van der Schoot, GGF, et al. (2022) Optimal timing of a physical training intervention to improve cardiorespiratory fitness: during or after chemotherapy. JACC CardioOncology. doi.org/10.1016/j.jaccao.2022.07.006.

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