Exercise training improves cardiopulmonary and endothelial function in women with breast cancer: findings from the Diana-5 dietary intervention study

Abstract

To investigate whether exercise training (ET) improves cardiopulmonary and endothelial function in women with breast cancer (BC). Fifty-one female patients (aged between 39 and 72 years) with a history of primary invasive BC within the previous 5 years and enrolled in the Mediterranean diet-based DIANA (diet and androgens)-5 Trial were subdivided into 2 groups: an ET group (n = 25) followed a formal ET program of moderate intensity (3 session/week on a bicycle at 60-70 % VO2peak for 3 months, followed by one session/week until 1-year follow-up), while a control group (n = 26) did not perform any formal ET. At baseline and at 1-year follow-up, all patients underwent cardiopulmonary exercise stress test (CPET) and measurements of vascular endothelial function by peripheral artery tonometry (Reactive Hyperemia Index, RHI). There were no significant differences between the groups in baseline anthropometrical, BC characteristics, and metabolic profile. No differences in baseline CPET and RHI parameters were found. Peak oxygen consumption (VO2peak) significantly increased in ET group (from 12.4 ± 2.9 to 14.3 ± 3.3 mL/kg/min, p < 0.001) compared to the control group (from 12.8 ± 2.5 to 12.6 ± 2.8 mL/kg/min, p = 0.55; p < 0.001 between groups). Compared to the control group (from 2.0 ± 0.4 to 1.9 ± 0.4, p = 0.62), the ET group showed a significant improvement of RHI after 1 year (from 2.1 ± 0.7 to 2.5 ± 0.8, p < 0.001). Changes in VO2peak were correlated with changes in RHI (ΔVO2peak vs. ΔRHI: r = 0.47, p = 0.017). In BC survivors, ET program improves cardiopulmonary functional capacity and vascular endothelial function after 12 months. Whether these changes may favorably modulate some of the pathophysiological mechanisms implied in cancer evolution should be investigated.

Updated systematic review of exercise studies in breast cancer survivors: attention to the principles of exercise training

“…The principle of initial values was correctly reported for 9 aerobic26 30 32 33 35–39 (64% vs 57% overall), all 7 resistance40–46 (100% new and overall), 16 mixed48 50 54–58 60 62 64–69 71 (64% vs 65% overall) and 7 multiarm trials73 75 76 (58% vs 61% overall), and was unclear in 1 aerobic29 (7% vs 18% overall), 2 mixed51 61 (8% vs 6% overall) and 5 multiarm trials72 74 (42% vs 39% overall). Initial values were not reported in 4 aerobic27 28 31 34 (29% vs 25% overall) and 7 mixed studies47 49 52 53 59 63 70 (28% vs 29% overall).…”

“…All seven resistance-only interventions40–46 (100% new and overall) reported all aspects of the exercise prescription. With respect to prescribed frequency in new studies, 1 aerobic29 (7% vs 6% overall) and 2 mixed interventions58 70 (8% vs 9% overall) were assigned an unclear rating, and 1 mixed intervention55(8% vs 3% overall) did not report frequency. Three aerobic29 31 37 (21% vs 11% overall), 12 mixed48 50 55 56 58–60 64 66–68 70 (48% vs 38% overall) and 1 multiarm intervention72 (8% vs 6% overall) were not clear in their reporting of prescribed intensity, and 5 mixed studies53 57 62 65 71 (40% vs. 21% overall) did not report intensity at all.…”

Effect of aerobic exercise intervention on markers of insulin resistance in breast cancer women

“…The study was approved by the Ethical Review Board of the National Cancer Institute of Milan (Italy). All participants belong to the intervention arm of the Diet and Androgen‐5 study (DIANA‐5) (Berrino et al., ; Bruno et al., ; Giallauria et al., , ; Villarini et al., ).…”

“…Physical activity improves body composition (Ligibel et al., ; Schmitz, Ahmed, Hannan, & Yee, ), cardiopulmonary and endothelial function (Berrino et al., ; Bruno et al., ; Giallauria et al., , ; Villarini et al., ), decreases serum levels of insulin over time, IGF‐I and increases IGF‐I‐binding proteins (Ballard‐Barbash et al., ; Ghose, Kundu, Toumeh, Hornbeck, & Mohamed, ; Giallauria et al., ; Irwin et al., ) that are likely to be important prognostic factors for BC (Pasanisi et al., ).…”

Endothelial Function for Cardiovascular Disease Prevention and Management

“…Cardiac rehabilitation with 4-week stretching exercises induced a significant increase in the RH-PAT index and significant decreases in serum levels of von Willebland Factor (vWF), Malondialdehyde-modified Low-Density Lipoprotein cholesterol (MDA-LDL), reactive oxygen species, and fibrinogen concentrations [51]. Cardiac rehabilitation exercise training program of moderate intensity (3 session/ week on a bicycle at 60-70% of Heart Rate Reserve (HRR) for 3 months, followed by one session/week until 1-year follow-up) improved cardiopulmonary function measured by cardiopulmonary exercise stress test and endothelial function measured by RH-PAT in women in breast cancer [52]. In contrast, a 12-week supervised cardiac rehabilitation program with 3 sessions per week at an intensity of 80% of HRR, improved endothelial function assessed by FMD but not by RH-PAT in patients with coronary heart disease [53].…”