Aerobic Exercise-Induced Changes in Cardiorespiratory Fitness in Breast Cancer Patients Receiving Chemotherapy: A Systematic Review and Meta-Analysis

Abstract

While performing aerobic exercise during chemotherapy has been proven feasible and safe, the efficacy of aerobic training on cardiorespiratory fitness (CRF) in women with breast cancer undergoing chemotherapy has not yet been systematically assessed. Therefore, the objective of this work was to determine (a) the efficacy of aerobic training to improve CRF; (b) the role of aerobic training intensity (moderate or vigorous) on CRF response; (c) the effect of the aerobic training mode (continuous or interval) on changes in CRF in women with breast cancer (BC) receiving chemotherapy. A systematic review and meta-analysis were conducted as per PRISMA guidelines, and randomized controlled trials comparing usual care (UC) and aerobic training in women with BC undergoing chemotherapy were eligible. The results suggest that increases in CRF are favored by (a) aerobic training when compared to usual care; (b) vigorous-intensity aerobic exercise (64–90% of maximal oxygen uptake, VO2max) when compared to moderate-intensity aerobic exercise (46–63% of VO2max); and (c) both continuous and interval aerobic training are effective at increasing the VO2max. Aerobic training improves CRF in women with BC undergoing chemotherapy. Notably, training intensity significantly impacts the VO2max response. Where appropriate, vigorous intensity aerobic training should be considered for women with BC receiving chemotherapy.

Home-Based Aerobic and Resistance Exercise Interventions in Cancer Patients and Survivors: A Systematic Review

“…Evidence shows that CRF efficiency can be significantly improved through interval and intensive exercise training [ 39 ]. This prescription demonstrated a superior CRF effect over moderate-intensity continuous training exercise and a further reduction in the severity of adverse events such as nausea, vomiting, pain, and physical fatigue [ 24 , 40 ].…”

Effects of Exercise on Cardiac Function Outcomes in Women Receiving Anthracycline or Trastuzumab Treatment for Breast Cancer: A Systematic Review and Meta-Analysis

“…Exercise training has been suggested as a potential approach to mitigate cancer treatment-related cardiotoxicity [41,42]. There are several reviews that describe the potential protective mechanisms of exercise against cardiotoxicity, but most of these only provide narrative synthesis [43,44], data from animal studies [45,46] or are limited to cardiorespiratory fitness outcomes [47,48]. The present systematic review adds to existing literature by providing the first report of pooled data from RCTs that analyzed the impact of exercise on cardiac function outcomes and circulating biomarkers among women with BC receiving AC-T or TC-T, and a systematic compilation of ongoing trials which are researching this subject.…”

“…These novel findings suggest that the development of cardiotoxicity during trastuzumab may lead to a persistent long-term impairment on cardiac function, which extends beyond the heart, affecting the cardiorespiratory capacity, emphasizing the need to implement holistic strategies for support cardiovascular health. Previous meta-analysis [15,47,48] have highlighted the effectiveness of exercise training to prevent or mitigate the decline of cardiorespiratory capacity.…”

Maintenance of Muscle Mass and Cardiorespiratory Fitness to Cancer Patients During COVID-19 Era and After SARS-CoV-2 Vaccine

“…Exercise intensity should be between 60 and 80% VO 2max , 40 and 85% maxHR, or 12-14 RPE (6-20 scale), for 15-60 min per training session, and with a frequency of 2-7 sessions per week (Haskell et al, 2007;Acsm, 2011). Although low-intensity exercise performed for only 20 min and twice a week increases CRF, greater gains can be obtained by manipulating the training-related variables (Singh et al, 2018;Hayes et al, 2019;Maginador et al, 2020). For instance, recent studies have shown that exercise can be safely performed at even greater intensities during chemotherapy.…”

“…A recent meta-analysis (Wallen et al, 2020) showed that despite the short session duration, interval training protocols with short bouts (≤5 min) of highintensity (80-100% maxHR), interspersed with passive or lower intensity active recovery periods, promote CRF gains comparable to continuous protocols (e.g., ≥20 min) of moderate-intensity (50-70% of maxHR) for patients with cancer or cancer survivors. However, we recently showed that this appears to occur in patients undergoing chemotherapy only when either continuous or interval exercise is performed at high intensities (Maginador et al, 2020). Although the use of %maxHR is a practical method to determine intensity when performing continuous or interval exercise, the physical status of patients with cancer can vary daily due to treatment side effects, which can greatly affect exercise-induced heart rate response.…”