Exercise testing and cardiac rehabilitation in patients treated for cancer
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Exercise testing and cardiac rehabilitation in patients treated for cancer Samuel G. Wittekind1,2 · Susan C. Gilchrist3
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Cardiovascular disease (CVD) is a major competing cause of morbidity and mortality in patients with cancer. Cancer treatment can have detrimental short- and long-term cardiovascular effects. Moreover, cancer patients may have a significant loss in cardiorespiratory fitness, a key CVD risk factor, during and after cancer treatment. Exercise training has emerged as a potential intervention to improve fitness and reduce the risk of CVD in cancer. In this review, we discuss the role of cardiorespiratory fitness to predict cancer and CVD outcomes, as well as explore the impact of exercise training to improve fitness and other key outcomes in patients with cancer. The role of cardio-oncology rehabilitation will also be highlighted. Keywords Cancer · Cardio-oncology · Exercise testing · Exercise training · Cardiac rehabilitation
Highlights • Cancer is a major risk factor for the development of car-
diovascular disease.
• Cardiorespiratory fitness is a risk modifier for both can-
cer and cardiovascular disease.
• Similar to the long-standing tradition of cardiac reha-
bilitation for survivors of heart disease, evidence-based exercise therapy can improve cardiorespiratory fitness and other outcomes important to cancer survivors.
risk factors including tobacco and alcohol use, obesity, and a sedentary lifestyle. Furthermore, cancer therapy can have detrimental short- and long-term cardiovascular effects in cancer survivors. In this interplay, exercise has emerged as a protective behavior to decrease the risk of both cancer and CVD by improving cardiorespiratory fitness in addition to other benefits (Fig. 1). In this review, we discuss the role of cardiorespiratory fitness to predict cancer and CVD outcomes in patients with cancer, as well as explore the impact of exercise training to improve fitness and other key outcomes in this population. The role of cardio-oncology rehabilitation will also be highlighted.
Introduction
The burden of CVD in cancer survivors
There is a bidirectional relationship between cancer and acquired cardiovascular disease (CVD). One is a risk factor for the other, and both disease processes may share common
CVD and cancer remain the first and second leading causes of death, respectively, in the United States [1]. With advancements in cancer care, mortality has improved to the point that there are > 16.7 million adult cancer survivors in the United States today [2]. Adult cancer survivors have a 1.7 to 18.5-fold increased incidence of CVD risk factors and are significantly more likely to develop CVD [3, 4]. Childhood cancer survivors also are at increased risk for acquiring CVD risk factors. Indeed, CVD is the most common noncancer cause of death among long-term childhood cancer survivors [5].
* Samuel G. Wittekind [email protected] 1
Department of Pediatrics, University of Ci
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