High intensity exercise during breast cancer chemotherapy - effects on long-term myocardial damage and physical capacity - data from the OptiTrain RCT

Abstract

Background Adjuvant systemic breast cancer treatment improves disease specific outcomes, but also presents with cardiac toxicity. In this post-hoc exploratory analysis of the OptiTrain trial, the effects of exercise on cardiotoxicity were monitored by assessing fitness and biomarkers over the intervention and into survivorship. Methods; Women starting chemotherapy were randomized to 16-weeks of resistance and high-intensity interval training (RT-HIIT), moderate-intensity aerobic and high-intensity interval training (AT–HIIT), or usual care (UC). Outcome measures included plasma troponin-T (cTnT), Nt-pro-BNP and peak oxygen uptake (VO2peak), assessed at baseline, post-intervention, and at 1- and 2-years. Results For this per-protocol analysis, 88 women met criteria for inclusion. Plasma cTnT increased in all groups post-intervention. At the 1-year follow-up, Nt-pro-BNP was lower in the exercise groups compared to UC. At 2-years there was a drop in VO2peak for patients with high cTnT and Nt-pro-BNP. Fewer patients in the RT-HIIT group fulfilled biomarker risk criteria compared to UC (OR 0.200; 95% CI = 0.055–0.734). Conclusions In this cohort, high-intensity exercise was associated with lower levels of NT-proBNP 1-year post-baseline, but not with cTnT directly after treatment completion. This may, together with the preserved VO2peak in patients with low levels of biomarkers, indicate a long-term cardioprotective effect of exercise. Trial registration Clinicaltrials.govNCT02522260, Registered 13th of august 2015 – Retrospectively Registered Graphical abstract

Exercise Cardio-Oncology: Exercise as a Potential Therapeutic Modality in the Management of Anthracycline-Induced Cardiotoxicity

“…During the 16-week exercise intervention, where survivors were concurrently receiving chemotherapy, cardiac troponin T significantly increased in all groups, suggesting this was treatment-induced, and values returned to baseline concentration at one-year follow-up. Nt-pro-BNP levels showed no significant difference between groups at baseline or 16 weeks, however, at the one-year follow-up, the usual care group was significantly higher than both exercise groups (91). Survivors who met the biomarker criteria for risk of decreased cardiac function (cardiac troponin T > 10 ng/ml at post-intervention and Nt-pro-BNP >100 ng/ml at 1 year follow up), most likely in the usual care control group, had significant declines in VO 2peak 2-years post-follow up compared to those who did not meet the criteria, suggesting an early change in these biomarkers may indicate compromised cardiovascular function.…”

“…Ansund, Mijwel (91) conducted a one-year follow-up of the OptiTrain trial. This study primarily assessed acute and chronic chemotherapy-induced cardiotoxicities monitored by cardiorespiratory fitness, cardiac troponin T, a biomarker used in detecting acute cardiac damage, and NT-pro-BNP, a protein secreted by cardiomyocytes in response to cardiac wall stress a marker of long-term cardiac remodeling (91). This follow-up study examined 88 survivors, of which more than 93% of each group received anthracycline treatment.…”

Physical Activity and Cardiac Function in Long-Term Breast Cancer Survivors

“… 40 , 41 The limited evidence from studies in cancer patients also points toward the hypothesis of exercise-mediated cardioprotection, although no clear, consistent benefit has been demonstrated thus far on LVEF or GLS. 42 , 43 , 44 , 45 Finally, analyses were adjusted for relevant confounders, including cardiovascular risk factors.…”

Descifrando el papel del entrenamiento interválico de alta intensidad en el cáncer de mama: revisión sistemática (Deciphering the role of high-intensity interval training in breast cancer: systematic review)

“…En personas con cáncer de mama existe un aumento significativo de la cantidad máxima de oxígeno que el organismo puede absorber (V0 2 máx.) (A. M. Ansund et al, 2021), manteniendo o evitando la aptitud cardiorrespiratoria en pacientes con un tratamiento de antraciclina Lee et al, 2020;Mijwel, Backman, Bolam, Olofsson, et al, 2018), en pacientes obesos con esta enfermedad (Schulz et al, 2018).…”