Exercise during chemotherapy improves cardiorespiratory fitness at 1 year
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A physical exercise intervention delivered during chemotherapy was associated with a return to similar levels of baseline cardiorespiratory fitness at 1 year compared with exercise after chemotherapy, researchers reported.
Among patients with breast, testicular and colon cancer, participation in a combination of supervised and home-based exercise intervention during chemotherapy was associated with similar improvements in 1-year peak oxygen consumption (VO2) and other parameters of cardiorespiratory fitness compared with the same intervention initiated after chemotherapy.
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The results of the optimal timing of a tailored physical activity program during the ACT trial were published in JACC: CardioOncology.
“Evidence on the optimal timing and dose of a physical exercise intervention to prevent treatment-induced toxicity such as VO2 peak is sparse,” Gabriela G.F. van der Schoot, MD, medical oncologist in the department of medical oncology at University Medical Center Groningen in the Netherlands, and colleagues wrote. “We hypothesized that the optimal timing for an exercise intervention to mitigate chemotherapy-induced adverse effects is during, not after, chemotherapy.”
The ACT trial
For the prospective, randomized ACT trial, van der Schoot and colleagues randomly assigned 266 patients scheduled to undergo chemotherapy to a 24-week exercise intervention, initiated either during chemotherapy or immediately after.
The intervention consisted of 12 weeks of supervised exercise followed by 12 weeks of home-based unsupervised exercise using a stationary bicycle, resistance training and badminton.
The primary outcome was peak VO2 at 1 year. Secondary endpoints included postintervention peak VO2, muscle strength, health-related quality of life, fatigue, physical activity and self-efficacy.
Within the cohort, 139 patients had breast cancer, 95 had testicular cancer, 30 had colon cancer and two had lymphoma.
Outcomes of an exercise intervention during chemotherapy
Patients in both exercise intervention groups experienced declines in peak VO2 from baseline to completion of chemotherapy; however, the decline was less among participants assigned to exercise during chemotherapy (adjusted between-group difference, 3.1 mL/kg/min; 95% CI, 2.2-4; P < .001).
At both the conclusion of the 24-week exercise intervention and 1 year later, muscle strength had returned to baseline values with no between-group differences, according to the study.
Measures of health-related quality of life in both groups were greater at 1 year compared with baseline, and there were no between-group differences; however, physical functioning declined less in those who exercised during chemotherapy compared with those who exercised after their chemotherapy regimen was over.
Findings were similar for the secondary outcomes of fatigue and physical fatigue, favoring exercise during chemotherapy, but the 1-year results were not different between the two groups.
Moreover, researchers observed no between-group differences in self-efficacy between either group at 1-year after the exercise intervention, immediately after the intervention and immediately after chemotherapy.
“These findings suggest that the most optimal timing of physical exercise is during chemotherapy,” Annemiek M.E. Walenkamp, MD, PhD, medical oncologist in the department of medical oncology at University Medical Center Groningen, said in a press release. “However, initiating a physical exercise program after chemotherapy is a viable alternative when exercising during chemotherapy is not possible. We hope our findings motivate health care providers to guide patients to engage in exercise interventions during anti-cancer treatment.”
Reference:
- Exercise improves cardiorespiratory fitness during and after chemotherapy. https://www.acc.org/Latest-in-Cardiology/Articles/2022/10/18/12/52/Exercise-Improves-Cardiorespiratory-Fitness-During-and-After-Chemotherapy. Published Oct. 18, 2022. Accessed Oct. 18, 2022.
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