Exercise program may improve heart function among cancer survivors
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Moderate to vigorous aerobic and resistance exercise may improve vascular function among cancer survivors, according to findings presented at American Association for Cancer Research Annual Meeting.
In a pilot study, Christina Dieli-Conwright, PhD, MPH, and colleagues from the Dieli-Conwright laboratory at Dana-Farber Cancer Institute randomly assigned 90 sedentary survivors of breast, prostate or colorectal cancers to a 4-month exercise intervention (n = 60) or usual care (n = 30).
The exercise intervention included a circuit, interval-based moderate to vigorous aerobic and resistance program conducted three times a week.
Those assigned the intervention demonstrated a significant increase in brachial artery flow-mediated dilation (between-group mean difference, 6.3%; 95% CI, 1.9-9.3) and a significant reduction in carotid intima media thickness (between-group mean difference, 0.039 mm; 95% CI, 0.08 to 0.009).
“This pilot trial demonstrated the efficacy of this circuit, interval-based exercise intervention to support vascular function and cardiometabolic health outcomes among cancer survivors,” Cami N. Christopher, MPH, a research scientist in the Dieli-Conwright laboratory in the department of medical oncology in the division of population sciences at Dana-Farber, told Healio.
Healio spoke with Christopher about the cardiovascular risks cancer survivors face and the potential benefits exercise may offer.
Healio: Can you provide some background about the risk for cardiovascular problems among cancer survivors?
Christopher: Cancer survivors have an elevated risk for cardiovascular disease compared with people without a history of cancer, and it’s one of the leading causes of death among cancer survivors. Several cancer treatments — including radiation therapy and some chemotherapies — can result in cardiac toxicity through vascular and arterial damage and dysfunction, contributing to a higher risk for cardiovascular disease among cancer survivors. Other risks unique to cancer populations include the physiologic effects of cancer, such as increasing levels of inflammation and oxidative stress. Cancer survivors are also at a higher risk for being overweight or obese, being physically inactive, and experiencing poorer cardiometabolic health outcomes, compounding the risk for impaired cardiovascular health outcomes.
Healio: Why did you conduct this study?
Christopher: Cancer survivors who are overweight or obese and engage in sedentary lifestyles have an elevated risk for poor cardiometabolic health. This can lead to poorer survival, as well as increased risk for heart disease, stroke, type 2 diabetes and other chronic conditions. It also can diminish quality of life.
Exercise has shown to be effective in supporting health outcomes in both cancer and noncancer populations. It has been recommended in recent cardio-oncology rehabilitation guidelines as a nonpharmacologic way to support cardiometabolic health in cancer populations. However, the evidence is less conclusive on the effectiveness of exercise on cardiometabolic health outcomes among cancer survivors in clinical settings. This pilot trial tested a novel intervention with circuit, interval-based aerobic and resistance exercise that progressed in intensity over the length of the study.
Healio: What did you find?
Christopher: We assessed two components of vascular function: endothelial function and vascular wall thickening. After 4 months, the exercise group exhibited significantly improved vascular function outcomes, including increased endothelial function and decreased vascular wall thickness. This supports that exercise can be an effective tool to support vascular function among breast, prostate and colorectal cancer survivors.
Healio: What are the potential implications of these findings?
Christopher: As the number of cancer survivors increases, my hope is that there will be meaningful growth in the integration and utilization of exercise in clinical settings to expand the access to exercise programs for [people with cancer] and survivors. This trial has also been a catalyst for many of the ongoing trials that we are conducting to assess a variety of exercise interventions among different cancer populations to support health, function and quality-of-life outcomes. I hope that our work will continue to have a positive impact in the lives of patients and survivors.
Healio: What questions still must be answered?
Christopher: Future research is needed on the long-term implications of exercise interventions on vascular function and cardiometabolic health. Are the effects we observed for vascular function sustained longer term? Is the adherence to exercise maintained after the intervention period? These are just a few important questions to ask to understand what clinicians and researchers should be addressing to better support patients and survivors in maintaining healthy lifestyle behaviors.
Healio: Is there anything else you’d like to mention?
Christopher: Our study is one example of how we can use exercise interventions to support positive survivorship outcomes in cancer populations. We also have many ongoing trials examining different types of exercise, as well as nutritional components, such as protein supplementation, to support a range of cancer-related outcomes. These include cardiometabolic health, physical function, cognitive health and quality of life. These types of programs are so important and hopefully will continue to be incorporated into clinical care.
Reference:
- Christopher CN, et al. Abstract 6290. Presented at: American Association for Cancer Research Annual Meeting; April 5-10, 2024; San Diego.
For more information:
Cami N. Christopher, MPH, can be reached at cameron_christopher@dfci.harvard.edu.
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