Incorporating Exercise Training Into Cardio-Oncology Care: Key Points

Wilson RL, Christopher CN, Yang EH, et al.
Incorporating Exercise Training Into Cardio-Oncology Care: Current Evidence and Opportunities: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2023;5:553-569.

The following are key points to remember from a state-of-the-art review on incorporating exercise training into cardio-oncology care:

  1. Exercise training is an underutilized prevention strategy for cancer treatment-induced cardiotoxicity. It is not widely adopted into cardio-oncology care.
  2. As a primary prevention strategy before and during cancer treatment, exercise may mitigate significant declines in cardiorespiratory fitness, cardiac function, and cardiac injury biomarkers compared to nonexercising controls.
  3. Aerobic exercise training is commonly implemented in cancer patients to improve cardiorespiratory fitness, which is evaluated by peak oxygen consumption. Resistance exercise training is used to increase muscular strength, assessed by one-repetition maximums (1RM) or multi-RM testing.
  4. The specific exercise dose (frequency, intensity, time, type) needed to optimize favorable cardiovascular adaptations during cardiotoxic cancer treatment is currently unclear.
  5. As a secondary prevention strategy after treatment, exercise may lead to clinically meaningful improvements in cardiorespiratory fitness compared to baseline or controls.
  6. Very limited clinical evidence exists for exercise as a tertiary prevention strategy in cancer patients with established, symptomatic cardiovascular disease such as heart failure.
  7. The ability of exercise to improve resting and dynamic measures of cardiac function, as well as biomarkers of cardiac injury when implemented after cancer treatment, requires substantially more research.
  8. High-quality randomized controlled exercise trials are critically needed to evaluate cardiovascular benefits for specific cancer populations and treatments resulting in clinically relevant cardiotoxicities. Future exercise oncology research should focus on determining the optimal manipulation of training variables and sequencing based on an individual's cancer treatment history and time since treatment completion.
  9. Major barriers to implementing exercise rehabilitation into routine cardio-oncology care include lack of reimbursement, infrastructure, and staffing, as well as evidence gaps.
  10. A coordinated effort from medical, research, patient advocacy, and policy groups is urgently required to support the inclusion of exercise testing, prescription, referral, and interventions into standard cardio-oncology care.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Exercise

Keywords: Cardio-oncology, Exercise, Neoplasms

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