Exercise to Reduce Anthracycline-Mediated Cardiovascular Complications in Breast Cancer Survivors

Abstract

While developments in cancer therapeutics have greatly reduced morbidity and mortality in females with breast cancer, it comes at a cost of an increased risk of cardiovascular complications. In particular, anthracyclines, like doxorubicin, which are a mainstay of current chemotherapy regimens, are associated with dose-dependent cardiotoxicity. Exercise has been widely accepted as an effective intervention in reducing cardiovascular risk in a variety of different clinical conditions. However, the benefits of exercise in anthracycline-mediated cardiotoxicity are not clearly understood. First, this review discusses the pre-clinical studies which have elucidated the cardioprotective mechanisms of aerobic and resistance exercise in improving cardiovascular function in the setting of anthracycline treatment. Next, it aims to summarize the results of aerobic and resistance exercise clinical trials conducted in females with breast cancer who received anthracycline-based chemotherapy. The review further discusses the current exercise guidelines for women undergoing chemotherapy and contraindications for exercise. Finally, the review addresses gaps in research, specifically the need for further clinical trials to establish a recommended exercise prescription within this patient population.

Mitochondria and Doxorubicin-Induced Cardiomyopathy: A Complex Interplay

“…Lifestyle interventions, such as exercise, were also reported to be a preventive strategy for reducing DCM. Encouraging evidence in clinical studies showed that aerobic and resistance exercises improve systolic function and cardiorespiratory fitness in patients undergoing anthracycline treatment [125]. Innovative approaches targeting mitochondrial derangements may be developed in the near future.…”

Novel Therapeutics for Anthracycline Induced Cardiotoxicity

“…In addition, Alihemmati et al demonstrated that high intensity interval training in rats treated with doxorubicin led to a reduction in pro-apoptotic proteins, such as BAX and caspase 6, and overall fewer apoptotic cells compared to controls (57). Other pre-clinical studies have shown the benefit of exercise in reducing ROS production, increased gene expression of antioxidant molecules, reduced mPTP susceptibility, increased mitochondrial resilience, and lowered lipid peroxidation in rat models of AIC (58). A variety of pre-clinical studies demonstrated that swimming, forced treadmill and wheel running exercise programs reduced fibrosis and necrosis, decreased myocardial inflammatory markers, and protected against loss of cardiomyocytes and myofibrils among rodents exposed to doxorubicin (59).…”

Lifestyle Habit Changes and Mental Health Perceptions Among Women After Cancer Treatment: An Exploratory Qualitative Study in Vietnam

“…Evidence has identi ed that women living with and after cancer are burdened with various adverse physical and psychological consequences from the conditions and associated treatments (Iddrisu et al, 2020;Joshy et al, 2020). In addition to concomitant problems such as osteoporosis (Shapiro, 2020), cardiovascular diseases (Bansal et al, 2022;Dhir & Sawant, 2021;Varghese et al, 2021), or secondary cancers (Demoor-Goldschmidt & de Vathaire, 2019; Roy et al, 2018), they commonly encounter manifestations such as pain (Van Den Beuken- Van et al, 2016), menopausal-like symptoms (Carpenter et al, 2014;Marino et al, 2014), sleeping disorders (Pai et al, 2020), anxiety, sadness, post-traumatic stress disorder (PTSD), and fear of cancer recurrence (Carreira et al, 2018;Niedzwiedz et al, 2019;Tsai et al, 2020).…”