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

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

doi:10.1016/j.clbc.2023.04.010

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

Clin Breast Cancer. 2023 Aug;23(6):576-590. doi: 10.1016/j.clbc.2023.04.010. Epub 2023 May 3.

Authors

Yu-Lin Tsai¹, Ya-Chi Chuang², Carl Pc Chen³, Yu-Chun Lee⁴, Yuan-Yang Cheng⁵, Liang-Jun Ou-Yang⁶

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan.
² Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan.
³ Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
⁴ Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan; Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan.
⁵ Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁶ Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan. Electronic address: ohyoung18287@gmail.com.

PMID: 37286435
DOI: 10.1016/j.clbc.2023.04.010

Abstract

Background: Current anticancer treatments for breast cancer (BC) may cause cardiotoxicity. This study aimed to investigate the effectiveness of aerobic exercise in mitigating cardiotoxicity caused by BC therapy.

Materials and methods: PubMed, Embase, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database were searched until February 7, 2023. Clinical trials investigating the effectiveness of exercise training, including aerobic exercise, in BC patients receiving treatments that could cause cardiotoxicity were eligible. Outcome measures included cardiorespiratory fitness (CRF) (peak oxygen consumption, VO₂peak), left ventricular ejection fraction, and peak oxygen pulse. Intergroup differences were determined by standard mean differences (SMD) and 95% confidence intervals (CIs). Trial sequential analysis (TSA) was utilized to ensure whether the current evidence was conclusive.

Results: Sixteen trials involving 876 participants were included. Aerobic exercise significantly improved CRF measured by VO₂peak in mL/kg/min (SMD 1.79, 95% CI 0.99-2.59) when compared to usual care. This result was confirmed through TSA. Subgroup analyses revealed that aerobic exercise given during BC therapy significantly improved VO₂peak (SMD 1.84, 95% CI 0.74-2.94). Exercise prescriptions at a frequency of up to 3 times per week, an intensity of moderate to vigorous, and a >30-minute session length also improved VO₂peak.

Conclusion: Aerobic exercise is effective in improving CRF when compared to usual care. Exercise performed up to 3 times per week, at a moderate-to-vigorous intensity, and having a session length >30 minutes is considered effective. Future high-quality research is needed to determine the effectiveness of exercise intervention in preventing cardiotoxicity caused by BC therapy.

Keywords: Aerobic exercise; Breast cancer; Cardiac function; Cardiorespiratory fitness; Cardiotoxicity.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Breast Neoplasms* / therapy
Cardiotoxicity / etiology
Cardiotoxicity / prevention & control
Exercise
Feasibility Studies
Female
Humans
Stroke Volume
Ventricular Function, Left