The Impact of Exercise on Cardiotoxicity in Pediatric and Adolescent Cancer Survivors: A Scoping Review

Abstract

Childhood and adolescent cancer survivors are disproportionately more likely to develop cardiovascular diseases from the late effects of cardiotoxic therapies (e.g., anthracycline-based chemotherapy and chest-directed radiotherapy). Currently, dexrazoxane is the only approved drug for preventing cancer treatment-related cardiac damage. While animal models highlight the beneficial effects of exercise cancer treatment-related cardiac dysfunction, few clinical studies have been conducted. Thus, the objective of this scoping review was to explore the designs and impact of exercise-based interventions for managing cancer treatment-related cardiac dysfunction in childhood and adolescent cancer survivors. Reviewers used Joanna Briggs Institute’s methodology to identify relevant literature. Then, 4616 studies were screened, and three reviewers extracted relevant data from six reports. Reviewers found that exercise interventions to prevent cancer treatment-related cardiac dysfunction in childhood and adolescent cancer survivors vary regarding frequency, intensity, time, and type of exercise intervention. Further, the review suggests that exercise promotes positive effects on managing cancer treatment-related cardiac dysfunction across numerous indices of heart health. However, the few clinical studies employing exercise interventions for childhood and adolescent cancer survivors highlight the necessity for more research in this area.

Physical Activity Among Adolescent Cancer Survivors: The PACCS Study

“…If we assume a directional association between iso-BMI and MVPA to ST, helping overweight CCS to do more MVPA may also counterbalance ST and yield synergic improvements to their health, which is important in this population at high long-term risk of cardiovascular disease. 41,42 Methodologically robust descriptions of MVPA and ST in adolescent survivors of CNS tumor are sparse, which emphasizes the significance of our findings. We found lower levels of MVPA and higher ST in this vulnerable diagnostic group compared with the other diagnostic groups.…”

Association of European Paediatric and Congenital Cardiology practical recommendations for surveillance and prevention of cardiac disease in childhood cancer survivors: the importance of physical activity and lifestyle changes From the Association of European Paediatric and Congenital Cardiology Working Group Sports Cardiology, Physical Activity and Prevention, Working Group Adult Congenital Heart Disease, Working Group Imaging and Working Group Heart Failure

“…67,68 Although knowledge of chemotherapy-related cardiotoxicity and exercise interventions is at an early stage, 69 the importance of engagement in exercise for childhood cancer survivors to mitigate and manage treatmentrelated cardiovascular dysfunction is obvious. 70…”

The pediatric oncology exercise field speeds up to address important issues regarding chemotherapy-related cardiotoxicity

“…Through the recently published international pediatric oncology exercise guidelines, clinical and research experts in pediatric oncology have highlighted that "cardiotoxicity" is a specific condition that needs to be considered in the field of pediatric oncology exercise (11). Hence, in a recent scoping review discussing the benefits of exercise at different intensities to prevent and manage cancer treatment-related cardiac dysfunction in childhood and adolescent cancer survivors, authors pointed out the necessity to do clinical research to consolidate current findings (12). This opinion paper discusses the potential of exercise for childhood cancer survivors to prevent chemotherapy-related cardiotoxicity and associated cardiovascular risk factors.…”