Impact of Aerobic Training on Cardiovascular Function, Fitness, and Patient Reported Outcomes During Anthracycline Chemotherapy: A Case Series in Women With Breast Cancer

James Murray; Hunter Bennett; Sudarsha Selva-Nayagam; Rohit Joshi; Eva Bezak; Rebecca Perry

doi:10.1177/15347354231210874

Impact of Aerobic Training on Cardiovascular Function, Fitness, and Patient Reported Outcomes During Anthracycline Chemotherapy: A Case Series in Women With Breast Cancer

Integr Cancer Ther. 2023 Jan-Dec:22:15347354231210874. doi: 10.1177/15347354231210874.

Authors

James Murray¹, Hunter Bennett¹, Sudarsha Selva-Nayagam², Rohit Joshi³, Eva Bezak^{1

4}, Rebecca Perry¹

Affiliations

¹ Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia.
² Cancer Centre, Royal Adelaide Hospital, Adelaide, SA, Australia.
³ Cancer Centre, Lyell McEwin Hospital, Adelaide, SA, Australia.
⁴ Department of Physics, University of Adelaide, Adelaide, SA, Australia.

Abstract

Background: Chemotherapy for breast cancer can increase the risk of cancer therapy related cardiac dysfunction (CTRCD). Exercise has been proposed to prevent CTRCD, however, research to date has indicated high degrees of individual variability following exercise interventions in this population.

Aim: This study aimed to explore the impact of regular, individualized aerobic exercise on CTRCD incidence (defined by global longitudinal strain [GLS]) during and immediately upon the completion of dose-dense anthracycline (DDAC) chemotherapy in 5 women with breast cancer.

Methods: Five women receiving DDAC with stage I-III breast cancer enrolled. Participants underwent resting echocardiography and exercise testing before, during, upon the completion of, and 3 months after the completion of DDAC treatment to measure GLS and aerobic fitness (VO₂peak). Participants opted-in to an individualized 8-week aerobic exercise intervention (3 sessions per week, 24 sessions total) or standard care for the duration of their DDAC treatment. Data for each participant were presented descriptively.

Results: Four of the 5 participants completed the exercise intervention during DDAC treatment (adherence 79.2%-91.7%). Mild asymptomatic CTRCD occurred in 2 of the 4 exercising participants, of whom both were at an increased risk (one was >65 years of age and diagnosed with hypertension, with the other receiving trastuzumab prior to DDAC treatment). Varied responses in VO₂peak were observed and did not align with changes in GLS. The only participant not to complete the exercise intervention reported poorer health related quality of life and increased cancer related fatigue at all measurement timepoints.

Conclusion: This study details the individual variability in cardiovascular responses to exercise that can occur during DDAC treatment in women with breast cancer, which can inform exercise professionals and researchers when designing individualized exercise programs for this population.

Keywords: echocardiography; global longitudinal strain; physical activity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anthracyclines / adverse effects
Antibiotics, Antineoplastic / adverse effects
Breast Neoplasms* / drug therapy
Exercise
Female
Heart Diseases* / drug therapy
Humans
Patient Reported Outcome Measures
Quality of Life

Substances

Anthracyclines
N,N-dimethyl-N-hexadecyl-1-octadecylammonium
Antibiotics, Antineoplastic