Exercise rehabilitation in patients with cancer

Lakoski, Susan G.; Eves, Neil D.; Douglas, Pamela S.; Jones, Lee W.

doi:10.1038/nrclinonc.2012.27

Cited by 138 publications

(114 citation statements)

References 60 publications

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confidence: 77%

“…This model is important as it conceptualizes the importance of maintaining and improving physical fitness levels in persons with MS. Physical fitness might provide a form of "physiological reserve" that is protective of disease consequences and worsening of MS and this is consistent with other literatures such as cancer [9].To that end, this paper provides a comprehensive review of research on physical fitness in persons with MS. We begin by defining physical fitness and its domains as well as differentiating it from physical activity. We then present research on physiological deconditioning (i.e., detraining that manifests as a reduction in domains of physical work capacity or fitness) in persons with MS as well as evidence on the association between markers of physical fitness and consequences of MS. We lastly review research regarding the effects of exercise training on physical fitness and consequences of MS, and conclude with recently developed exercise recommendations for improving physical fitness.…”

supporting

confidence: 59%

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The Importance of Physical Fitness in Multiple Sclerosis

Motl¹

2013

J Nov Physiother

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Multiple Sclerosis (MS) is a common and life-altering neurological disease among adults in the United States and worldwide. This disease has an estimated prevalence of 1 per 1,000 adults in the United States [1] with the majority of cases occurring in women of European descent. The MS pathophysiology initially involves episodic periods of immune-mediated demyelination and transection of axons within the Central Nervous System (CNS). This results in the disruption of saltatory conduction of action potentials along myelinated axonal pathways in the brain, spinal cord, and optic nerves. The MS pathophysiology later transitions into a neurodegenerative disease process, presumably associated with insufficient neurotrophic support, and results in the accumulation of irreversible neurologic disability. The degree and location of axonal and neuronal damage within the CNS result in the heterogeneous expression of symptomatic, functional, and participatory consequences among persons with MS [2]. Such manifestations might be initiated or worsened by physical inactivity and resulting physiological deconditioning.We have previously described a model of physical inactivity, deconditioning, and worsening MS [3,4], and this was based on a similar framework for persons with chronic disease conditions [5] including MS [6]. The model is displayed in figure 1 and indicates that MS onset results in physical inactivity [7,8] that initiates physiological deconditioning (i.e., compromised or reduced physical fitness). This physiological deconditioning, in turn, results in worsening of MS, as indicated by loss of brain structure and function as well as symptomatic (e.g., fatigue) and functional (e.g., walking impairment) manifestations. The worsening of MS results in further physical inactivity and subsequent physiological deconditioning thereby yields a cycle of associations among physical inactivity, deconditioning, and worsening MS that develops over time. This model is important as it conceptualizes the importance of maintaining and improving physical fitness levels in persons with MS. Physical fitness might provide a form of "physiological reserve" that is protective of disease consequences and worsening of MS and this is consistent with other literatures such as cancer [9].To that end, this paper provides a comprehensive review of research on physical fitness in persons with MS. We begin by defining physical fitness and its domains as well as differentiating it from physical activity. We then present research on physiological deconditioning (i.e., detraining that manifests as a reduction in domains of physical work capacity or fitness) in persons with MS as well as evidence on the association between markers of physical fitness and consequences of MS. We lastly review research regarding the effects of exercise training on physical fitness and consequences of MS, and conclude with recently developed exercise recommendations for improving physical fitness. Our goal is the provision of a paper that underscores the (a) importance of p...

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supporting

confidence: 77%

supporting

confidence: 59%

The Importance of Physical Fitness in Multiple Sclerosis

Motl¹

2013

J Nov Physiother

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“…23 A decrease in D LCO is a common finding when performing lung function tests during or after chemotherapy. Lakoski et al 9 reviewed the effects of chemotherapeutic agents on components of oxygen transport and suggested that platinumbased chemotherapy impacts its pulmonary component, presumably by diminishing diffusion capacity. Pulmonary toxicity was also reported for taxanes and gemcitabine.…”

Section: Diffusion Capacitymentioning

confidence: 99%

“…8 The effects of other classes of chemotherapeutic agents and the effects of chemotherapy in general on other components of oxygen delivery and consumption are still poorly explored. 9 Despite such serious adverse effects, survival is improved with preoperative neoadjuvant chemotherapy (NAC) followed by surgery, compared with surgery alone. [10][11][12] By reducing the tumor burden and downgrading the tumor stage, NAC facilitates surgical resection and may improve long-term outcome by eradicating micrometastases.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Peak Oxygen Uptake in Lung Cancer Subjects With Neoadjuvant Chemotherapy: A Cross-Sectional Study

et al. 2016

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BACKGROUND:In non-small-cell lung cancer patients, high peak oxygen uptake (peak V O 2 ) predicts lower rates of postoperative complications and better long-term survival. Neoadjuvant chemotherapy (NAC) may negatively impact peak V O 2 . METHODS: Cardiopulmonary exercise testing (CPET) was performed in 34 consecutive stage IIIA/IIIB non-small-cell lung cancer subjects scheduled for elective lung surgery. Using multivariate linear regression adjusted for potential confounders, we compared CPET results in subjects receiving or not receiving NAC (NAC؉, n ‫؍‬ 19; NAC؊, n ‫؍‬ 15). RESULTS: Adjusted peak V O 2 was lower in NAC ؉ compared with NAC؊ subjects (؊5.3 mL/min/kg [95% CI ؊8.3 to ؊2.2], P ‫؍‬ .01). Likewise, oxygen pulse, maximal work load, and ventilatory threshold were also lower in NAC؉ subjects, whereas peak heart rate and breathing reserve were similar. NAC؉ subjects presented lower values of diffusion capacity for carbon monoxide (D LCO ) (P ‫؍‬ .035) and hemoglobin concentrations (P < .001). D LCO was strongly correlated with peak V O 2 (r 2 ‫؍‬ 0.56). Adjustment for D LCO reduced the effect of NAC on peak V O 2 without suppressing it. CONCLUSIONS: NAC was associated with lower preoperative peak V O 2 in subjects with non-small-cell lung cancer. This lower aerobic fitness may result from NAC-induced reduction in pulmonary gas exchange or heart toxicity. Since lower fitness is linked to poorer outcome, the decision for NAC may have to be balanced with its possible toxicity.

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“…Many anticancer therapies cause unique and varying degrees of injury to the cardiovascular system (i.e., pulmonary-vascular/blood-skeletal muscle axis) [50]. For example, radiation and certain forms of systemic therapy (e.g., chemotherapy, molecularly targeted therapies) can cause pulmonary dysfunction, anemia, endothelial dysfunction and pulmonary/systemic arterial stiffness as well as skeletal muscle dysfunction [11,12,[51][52][53]. These direct insults occur in conjunction with 'indirect' lifestyle perturbations (e.g., physical inactivity) that synergistically cause marked impairments in cardiovascular reserve capacity [54].…”

Section: Current State Of Detection Of Cardiotoxicitymentioning

confidence: 99%

Current and Emerging Modalities for Detection of Cardiotoxicity in cardio-oncology

et al. 2015

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Advancements in diagnostic tools and curative-intent therapies have improved cancerspecific survival. With prolonged survival, patients are now subject to increased aging and development of cardiovascular risk factors such that further improvements in cancerspecific mortality are at risk of being offset by increased cardiovascular mortality. Moreover, established and novel adjuvant therapies used in cancer treatment are associated with unique and varying degrees of direct as well as indirect myocardial and cardiovascular injury (i.e., cardiotoxicity). Current approaches for evaluating anticancer therapy-induced injury have limitations, particularly lack of sensitivity for early detection of subclinical cardiac and cardiovascular dysfunction. With emerging evidence suggesting early prevention and treatment can mitigate the degree of cardiotoxicity and limit interruption of life-saving cancer therapy, the importance of early detection is increasingly paramount. Newer imaging modalities, functional capacity testing and blood biomarkers have the potential to improve early detection of cardiotoxicity and reduce cardiovascular morbidity and mortality. KeywordsMortality rates from cancer have declined over the past 30 years as more effective methods of early detection, pharmacologic treatments and surgical approaches have resulted in significant cancerrelated survival gains [1][2][3]. Long-term survivors with cancer are expected to increase by approximately 30% in the next decade to an estimated 18 million by 2022 in the USA alone [4]. With prolonged survival, cancer patients are now subject to the effects of aging and to the development of other risk factors that determine the long-term risk of cardiovascular disease (CVD) [5][6][7]. In this setting, CVD may limit the survival gains of oncology and is already the predominant cause of mortality in breast cancer patients over 50 years of age [5,6,8] and a more common contributor than cancer to mortality among older survivors [9,10].The cardiovascular effects of a prolonged survival are also compounded by those of standard modern cancer therapy. Current anticancer therapies are associated with unique and varying degrees of direct (e.g., myocardial toxicity, ischemia, hypertension, arrhythmias) [11][12][13][14] as well as indirect (e.g., unfavorable lifestyle changes) sequential and progressive cardiovascular insults [11]. The most well known direct cardiotoxic effects of cancer therapy historically occur with anthracyclinecontaining regimens (i.e., doxorubicin, epirubicin). Anthracyclines are still widely used in solid tumors (i.e., breast cancer, osteosarcoma etc.) and hematologic malignancies (Hodgkin's/nonHodgkin's lymphoma, acute lymphoblastic leukemia etc.) and are well recognized to trigger dosedependent, cumulative, progressive cardiac dysfunction [15,16] manifest as decreased left ventricular ejection fraction (LVEF) [17][18][19], and ultimately, symptomatic heart failure (HF) in up to 5% of patients [20]. Newer, targeted agents have dramatically improved the a...

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Exercise rehabilitation in patients with cancer

Cited by 138 publications

References 60 publications

The Importance of Physical Fitness in Multiple Sclerosis

The Importance of Physical Fitness in Multiple Sclerosis

Preoperative Peak Oxygen Uptake in Lung Cancer Subjects With Neoadjuvant Chemotherapy: A Cross-Sectional Study

Current and Emerging Modalities for Detection of Cardiotoxicity in cardio-oncology

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