Supervisors info:
Αναστάσιος Φιλίππου, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μιχαήλ Κουτσιλιέρης, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Γεώργιος Βαϊόπουλος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Breast cancer patients are at high risk of developing cardiovascular disease due to the cardiotoxicity, which is associated with the use of anticancer drugs. Cardiotoxicity is related to chemotherapeutic drugs, such as anthracycline, in monotherapy or in combination with monoclonal antibodies, like trastuzumab. These agents act either indirectly, accelerating cardiovascular aging and worsening the course of underlying comorbidities, or directly disrupting cardiac function. Given the increased mortality of breast cancer patients, even in the early stages of the disease, due to cardiovascular complications associated with their treatment, the purpose of this study is to examine the possible role of various forms of exercise in alleviating the cardiotoxicity of anticancer drugs, focusing mainly on aerobic exercise and resistance exercise training. A thorough systematic review was carried out using various keywords and different algorithms. Reviews and clinical studies published in journals with high impact factor and particularly related to the effect of exercise on the quality of life and the clinical outcome of the disease in breast cancer patients were selected. Therapeutic exercise has been studied before, during or after the systemic treatment and patients received doxorubicin in combination with trastuzumab or not and in rare cases only trastuzumab, while they performed aerobic exercise at various frequencies per week, with or without the combination with resistance exercises and flexibility exercises. Exercise prevents the negative impact of anticancer treatment on cardiovascular system, as it improves cardiopulmonary function. In addition, it reduces all cause-mortality by 41%. The beneficial effect of exercise is observed independently of the time that is performed in relation to the systemic therapy. Aerobic exercise in combination with resistance exercise is more beneficial in increasing VO2max, In addition, exercise reduces systolic blood pressure and heart rate at rest. High intensity aerobic exercise reduces the risk of acute cardiac failure by 46% and hemodynamic disturbances are prevented, though there are no changes in subclinical cardiotoxicity. Exercise of at least >3 MET-h/week is suggested and particularly when exercise reaches >24.6 MET-h/week the risk of cardiovascular disease is reduced by 35%. At least 8 weeks of regular exercise is recommended and the beneficial effects are even better after 16 or 24 weeks, while patients should attend more than 55% of the total number of sessions to get benefits. In terms of compliance, exercising in the day before chemotherapy helps patients adhere to the exercise program. In general, cancer patients can cope with certain intensity aerobic exercise depending on their overall state of health. This in combination with the contraindications that these patients may have depending on the stage of the disease are factors that suggest the use of individualized exercise programs, while future studies should focus on the optimum combinations of aerobic and resistance exercise training and the development of strategies that promote a better compliance of the patients to the exercise programs.
Keywords:
Τherapeutic exercise, Prevention, Cardiovascular function, Breast cancer, Cardio-oncology, Cardiotoxicity, Chemotherapy
