Feasibility of Aerobic Exercise Training to Mitigate Cardiotoxicity of Breast Cancer Therapy: A Systematic Review and Meta-Analysis

Tsai, Yu Lin; Chuang, Ya-Chi; Chen, Carl Pc; Lee, Yu-Chun; Cheng, Yuan-Yang; Ou-Yang, Liang-Jun

doi:10.1016/j.clbc.2023.04.010

Cited by 4 publications

(3 citation statements)

References 44 publications

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“…34 Furthermore, meta-analysis of RCTs specifically focused on the effect of ExT (typically 2-3 sessions/wk of aerobic ± resistance training [RT]) in BCS undergoing cardiotoxic therapy has shown a 1.8 mL/kg/min net benefit for V ˙O2peak with ExT. 35 The effect differs on the basis of studies focused specifically on BCS undergoing AC, HER2 therapy, or spanning the entire trajectory of (neo)adjuvant therapy. 35 However, the degree to which this is reflective of the type of therapy, exercise prescription, program length, and individual participant characteristics is yet to be determined because of the paucity and heterogeneity of studies (Table 1).…”

Section: Ext and Crfmentioning

confidence: 99%

“…35 The effect differs on the basis of studies focused specifically on BCS undergoing AC, HER2 therapy, or spanning the entire trajectory of (neo)adjuvant therapy. 35 However, the degree to which this is reflective of the type of therapy, exercise prescription, program length, and individual participant characteristics is yet to be determined because of the paucity and heterogeneity of studies (Table 1). In studies focused on BCS undergoing AC, the majority have shown 2-4 sessions/wk of ExT, including moderate continuous training (MCT); MCT + RT or MCT + RT combined with high-intensity interval training (HIIT) typically attenuates declines in V ˙O2peak (or other measures of CRF) associated with AC.…”

Section: Ext and Crfmentioning

confidence: 99%

“…19,20,37,[39][40][41]46 A recent meta-analysis of trials investigating ExT during AC and/or anti-HER2 therapy shows no favorable effect of ExT on resting LVEF. 35 Fewer studies have assessed the impact on resting GLS, but available evidence shows no effect of ExT on GLS-which typically shows a small reduction of negligible clinical significance. 19,20,40,46,47 In addition, no studies have demonstrated that ExT prevents clinical cardiac dysfunction during AC and/or HER2-targeted therapy (based on guideline-based LVEF ± GLS criteria).…”

Section: Ext and Crfmentioning

confidence: 99%

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A Review on the Role of Exercise Training to Prevent a Decline in Cardiorespiratory Fitness and Cardiac Function in Breast Cancer Survivors

Foulkes,

Howden,

Pituskin

et al. 2023

Journal of Cardiopulmonary Rehabilitation and Prevention

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Purpose: Improvements in diagnosis and treatment mean that the long-term health of breast cancer survivors (BCS) is increasingly dictated by cardiovascular comorbidities. This is partly a consequence of exposure to cardiotoxic therapies, which result in cardiac dysfunction and decreased cardiorespiratory fitness (CRF). Exercise training (ExT) is a key therapeutic strategy for secondary prevention and increasing CRF in adults with established cardiovascular disease. Exercise-based cardio-oncology rehabilitation (CORE) has been proposed as an emerging strategy to address CRF and cardiac impairment in BCS. This review aims to (1) provide an overview of the impact of breast cancer therapy on CRF; (2) provide an up-to-date summary of the effects of ExT on CRF and cardiac function in BCS undergoing cardiotoxic therapy; and (3) discuss how traditional ExT approaches can be adapted for BCS undergoing therapy. Review methods: A literature review was performed based on an intensive literature search for systematic reviews and meta-analyses, randomized and non-randomized controlled trials and single-arm trials investigating the impact of exercise training or cardiac rehabilitation on CRF and/or cardiac function in BCS who are undergoing or have completed cardiotoxic cancer therapy. Summary: Overall, current evidence suggests that ExT induces clinically meaningful benefits for CRF in BCS during and after therapy. There is also emerging evidence that ExT can improve peak exercise measures of cardiac function; however, there is a need for further research to understand how to adapt these effective ExT approaches into clinical CORE-based settings.

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Section: Ext and Crfmentioning

confidence: 99%

Section: Ext and Crfmentioning

confidence: 99%

Section: Ext and Crfmentioning

confidence: 99%

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A Review on the Role of Exercise Training to Prevent a Decline in Cardiorespiratory Fitness and Cardiac Function in Breast Cancer Survivors

Foulkes,

Howden,

Pituskin

et al. 2023

Journal of Cardiopulmonary Rehabilitation and Prevention

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Guarding the heart: How SGLT-2 inhibitors protect against chemotherapy-induced cardiotoxicity

Vafa,

Sabahizadeh,

Mofarrah

2024

Current Problems in Cardiology

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Effectiveness of aerobic exercise intervention on cardiovascular disease risk in female breast cancer: a systematic review with meta-analyses

Jiao,

Xu,

Meng

et al. 2024

BMC Public Health

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Background Cardiovascular disease (CVD) has become the leading cause of competitive mortality in female breast cancer (BC). Regular aerobic exercise (AE) has been widely accepted as an effective intervention to reduce cardiovascular risk in a variety of different clinical conditions. This study is aimed at evaluating the efficacy and safety of AE on cardiovascular risk factors in female BC and assessing the quality of the synthesized evidence. Methods We searched five English databases (Cochrane Library, PubMed, Embase, Scopus, and Web of Science) from inception to January 2023. Randomized controlled trials (RCTs) and cohort trials studying the effects of AE intervention on cardiovascular disease risk in female breast cancer were included. We used Stata 16 for data synthesis, Risk of Bias 2, and the Newcastle–Ottawa Scale for methodological quality evaluation and assessed the certainty of the synthesized evidence in the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results Forty RCTs and 6 cohort trials involving 44,877 BC patients showed AE reduced the incidence of CVD events by 29.4% [risk ratio (RR) = 0.706, 95% confidence interval (CI) (0.659, 0.757), low certainty] and coronary artery disease events by 36% [RR = 0.640, 95% CI (0.561, 0.729), low certainty]. AE improved LVEF, and reduced weight and hip circumference. The subgroup analysis results showed that nonlinear AE increased VO 2 max by 5.354 ml·kg·min −1 [mean difference (MD) = 5.354, 95% CI (2.645, 8.062), very low certainty] and reduced fat mass by 4.256 kg [MD = 4.256, 95% CI (-3.839, -0.094), very low certainty]. While linear AE reduced low-density lipoprotein cholesterol (LDL-C) by 8.534 mg/dL [MD = -8.534, 95% CI (-15.511, -1.557), low certainty]. The sensitivity analysis results showed that each trial did not affect the impact index of the highly heterogeneous outcomes. Conclusions Our study indicates that AE has a positive effect in reducing cardiovascular risk factors. The individualization principle of AE deserves more attention in the future. This will provide new ideas to reduce CVD events and improve the quality of life in female BC patients. However, further research on AE in female BC should take into account long-term and well-designed administration to draw definitive conclusions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-024-20592-9.

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Feasibility of Aerobic Exercise Training to Mitigate Cardiotoxicity of Breast Cancer Therapy: A Systematic Review and Meta-Analysis

Cited by 4 publications

References 44 publications

A Review on the Role of Exercise Training to Prevent a Decline in Cardiorespiratory Fitness and Cardiac Function in Breast Cancer Survivors

A Review on the Role of Exercise Training to Prevent a Decline in Cardiorespiratory Fitness and Cardiac Function in Breast Cancer Survivors

Guarding the heart: How SGLT-2 inhibitors protect against chemotherapy-induced cardiotoxicity

Effectiveness of aerobic exercise intervention on cardiovascular disease risk in female breast cancer: a systematic review with meta-analyses

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