Physical Activity During Breast Cancer Therapy Associates With Preserved Exercise Capacity and Cardiac Function (WF97415)

Moriah P Bellissimo; Justin M Canada; Jennifer H Jordan; Amy C Ladd; Kerryn W Reding; Tonya L Moore; William O Ntim; Emily M Heiston; Peter Brubaker; Shannon L Mihalko; Ralph D'Agostino Jr; Nate O'Connell; Bonnie Ky; Lynne I Wagner; Mary Helen Hackney; Kathryn E Weaver; Glenn J Lesser; Nancy E Avis; Arnethea L Sutton; Alexander R Lucas; R Lee Franco; Bernard F Fuemmeler; Fadi N Salloum; W Gregory Hundley; UPBEAT Study Group

doi:10.1016/j.jaccao.2022.12.011

Physical Activity During Breast Cancer Therapy Associates With Preserved Exercise Capacity and Cardiac Function (WF97415)

JACC CardioOncol. 2023 Mar 21;5(5):641-652. doi: 10.1016/j.jaccao.2022.12.011. eCollection 2023 Oct.

Authors

Moriah P Bellissimo¹, Justin M Canada¹, Jennifer H Jordan^{1

2}, Amy C Ladd¹, Kerryn W Reding³, Tonya L Moore⁴, William O Ntim⁵, Emily M Heiston¹, Peter Brubaker⁶, Shannon L Mihalko^{6

7}, Ralph D'Agostino Jr⁸, Nate O'Connell⁸, Bonnie Ky⁹, Lynne I Wagner⁷, Mary Helen Hackney¹, Kathryn E Weaver⁷, Glenn J Lesser¹⁰, Nancy E Avis⁷, Arnethea L Sutton¹¹, Alexander R Lucas^{1

11}, R Lee Franco¹², Bernard F Fuemmeler¹¹, Fadi N Salloum¹, W Gregory Hundley¹; UPBEAT Study Group

Affiliations

¹ Department of Internal Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
² Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia, USA.
³ Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, Washington, USA.
⁴ Department of Cardiovascular Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA.
⁵ UNC School of Medicine, Novant Health Campus, Novant Health Heart & Vascular Institute, Charlotte, North Carolina, USA.
⁶ Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA.
⁷ Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
⁸ Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
⁹ Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁰ Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
¹¹ Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
¹² Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, USA.

Abstract

Background: Cancer treatment increases cardiovascular disease risk, but physical activity (PA) may prevent cardiovascular disease.

Objectives: This study examined whether greater PA was associated with better submaximal exercise capacity and cardiac function during cancer therapy.

Methods: Participants included 223 women with stage I to III breast cancer (BC) before and 3 months after undergoing treatment and 126 control participants. Leisure-time PA (LTPA) was reported using the Godin-Shephard LTPA questionnaire. Cardiac function was assessed by cardiac magnetic resonance. Submaximal exercise capacity was determined by 6-minute walk distance.

Results: BC participants reported similar baseline LTPA scores (24.7; 95% CI: 21.7-28.0) as control participants (29.4; 95% CI: 25.0-34.2). The BC group declined to 16.9 (95% CI: 14.4-19.6) at 3 months relative to 30.8 (95% CI: 26.2-35.8) in control participants. Among BC participants, more LTPA was related to better exercise capacity (β ± SE: 7.1 ± 1.6; 95% CI: 4.0-10.1) and left ventricular (LV) circumferential strain (-0.16 ± 0.07; 95% CI: -0.29 to -0.02). Increased LTPA over the 3 months was associated with decreased likelihood of treatment-induced cardiac dysfunction according to LV circumferential strain classifications (OR: 0.98; 95% CI: 0.97-0.998). BC participants reporting insufficient LTPA according to PA guidelines exhibited deteriorations in exercise capacity (adjusted mean difference ± SE: -29 ± 10 m; P = 0.029), LV end-systolic volume (5.8 ± 1.3 mL; P < 0.001), LV ejection fraction (-3.2% ± 0.8%; P = 0.002), and LV circumferential strain (2.5% ± 0.5%; P < 0.001), but BC participants meeting LTPA guidelines did not exhibit these adverse changes.

Conclusions: PA declined during BC therapy; however, PA participation was associated with attenuated declines in exercise capacity and cardiac function that are often observed in this population. (Understanding and Predicting Breast Cancer Events After Treatment [WF97415 UPBEAT]; NCT02791581).

Keywords: breast neoplasm; cardiotoxicity; heart function; lifestyle.

Associated data

ClinicalTrials.gov/NCT02791581