During chemotherapy, exercise intervention is safe, improves long-term cardiorespiratory fitness, and alleviates some of the adverse effects of cancer treatment, according to a study published in JACC: CardioOncology. If exercise is not feasible during chemotherapy, the individual can participate in an exercise program afterward to regain the same level of function.
Cardiorespiratory fitness, as measured by maximal oxygen consumption (VO2peak), is considered one of the most significant independent predictors of cardiovascular health. During cancer treatment, VO2peak decreases by up to 25%. Cancer treatment often leads to adverse effects that impair health-related quality of life (HRQoL), including reduced cardiorespiratory fitness, increased fatigue, and cardiovascular morbidity. Physical activity has been shown to mitigate these risks. Exercise therapy is associated with increased cardiorespiratory fitness, improved VO2 peak, and decreased cardiovascular morbidity, cancer mortality, and overall mortality.
The benefit of exercise for cancer patients is widely recognized. However, there is insufficient evidence regarding the optimal timing of exercise intervention to improve long-term cardiorespiratory fitness in cancer patients.”
Annemiek ME Walenkamp, MD, PhD, lead study author and medical oncologist, Department of Medical Oncology, University Medical Center Groningen in Groningen, The Netherlands
In the ACT trial, researchers examined the effectiveness of exercise intervention during chemotherapy compared with post-treatment in improving long-term cardiorespiratory fitness. Adult patients newly diagnosed with breast cancer, colon cancer, testicular cancer, or B-cell non-Hodgkin’s lymphoma who were scheduled to receive curative chemotherapy were eligible for the study. Between February 2013 and November 2018, trial participants were randomized to a 24-week exercise intervention started during or after chemotherapy. Types of exercise include moderate to vigorous exertion on an exercise bike, resistance training with weight machines and free weights, and badminton. The primary objective was the difference in VO2peak one year after the intervention. Secondary endpoints were VO2peak after completion of chemotherapy and intervention, muscle strength, HRQoL, fatigue, physical activity, and self-efficacy at all time points.
The researchers found that directly after chemotherapy, the group that started exercise therapy during treatment reported less fatigue and more physical activity and had less decline in VO2peak, HRQoL, and muscle strength. Three months after chemotherapy, the group that started exercising after treatment showed similar values to the group that exercised during. Both groups returned to their baseline cardiorespiratory fitness one year after completing the exercise intervention, regardless of timing.
“These findings suggest that the most optimal time to exercise is during chemotherapy. However, starting an exercise program after chemotherapy is a viable alternative when exercise is not possible during chemotherapy,” said Walenkamp. “We hope that our findings will motivate health care providers to guide patients to participate in exercise interventions during cancer treatment.”
Source:
American College of Cardiology
Journal reference:
van der Schoot, GGF, et al. (2022) Optimal timing of an exercise intervention to improve cardiorespiratory fitness: during or after chemotherapy. JACC CardioOncology. doi.org/10.1016/j.jaccao.2022.07.006.